Child Health
Eight week check
Elaine Burfitt
July 2010
Child Health

Eight week check
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Check list
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Referral information
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DVD

Pitfalls
Schedule
Screen
 Newborn
 6-8 weeks
-
Non screen status
 2 year check -
SHO or midwife
GP or HV
nursery nurse
Eight week check

Newborn & Infant Physical Examination
Standards and Competencies
March 2008
UK National Screening committee

Local referral information

Awaiting Public Health oversight
Eight week checklist
 Examine in appropriate
surroundings, preferably with calm,
fed baby
 Take opportunities to discuss
health promotion messages along
the way e.g. smoking, back to
sleep, careful handling, etc.
 Brief review of birth history,
general health and feeding.
Sets context of examination and growth
assessment.
 Review red book information to
date including hearing screening
data
May have missed hearing screen or not
had a clear response.
 Ask carer if they think baby can
see and hear
 Ask carer if any concerns about
baby
Eight week checklist
 Head to toe examination
All areas of skin must be seen at some
point during the examination.
May carry out some parts of examination
when babe is dressed or partially
dressed in order not to disturb ie when
auscultating the heart but still need to
carry out examination appropriately.
Including general handling, demeanour,
skin, head shape and size, fontanelles,
dysmorphism, eyes including red reflex
and visual fixation and behaviour, palate,
neck, heart, abdomen, genitalia, spine,
anus, hips, limbs including hands and
feet.
Eight week check
Eight week check
Eight week checklist
 Plot and assess growth
 Complete red book
Send in return slip
 Discuss outcomes with
parent/carer
Make any referrals needed
 Immunisation as appropriate
With appropriate consent
Eight week check
Eight week check
Eight week check

Sacral dimple is simple if:

< 5mm diameter
Lying in midline
<25 mm from anus
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Heart defects
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Screen all by 72 hours
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Refer all screen positive within 24 hours of
examination for pulse oximetry and expert
consultation
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Review by 10 days if considered at risk of clinical
deterioration

1st appointment within 4 weeks if no significant
clinical risk
Heart defects
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6-8 week check
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Refer by phone if symptomatic at that time
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No other timescales recommended at present
Hearing
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Universal neonatal screening
Oto acoustic emissions
Normal
Abnormal - further diagnostics
Normal but in high risk group – 8 month FU
Incomplete test or not done
Hearing
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Check parental concerns
Check neonatal screening page
Encourage attendance at further screen or
diagnostic appointments
If unclear ring neonatal screeners for
information on child on pathway
Fill in slip appropriately
Hearing

Several missed in recent years
Presented May 2008 by Hilary Smith

Jan 2008 – Dec 2009
78 babies recorded on 8 week slip as normal
hearing when had NCR in one or both ears
on neonatal screen
Hearing

Pre screening average age of aiding 22
months

i.e. huge loss of developmental window for
learning language

Recent good examples of successes
Vision

Neonatal check no concerns
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8 weeks parental concerned about visual
behaviour
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Reported to HV/ GP at time of 8 w check
Vision
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Referred to paediatrician by letter
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Seen by paediatrician at 12 weeks
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Concern regarding red reflex
Congenital cataract
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Tel ref to ophthalmologist
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Operation at 13 weeks (despite anaesthetic
risk re URTI at the time)
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17 m no detectable VI problem over and
above lens limitation
Congenital cataract survey
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1995-1996
12 months
Data on 235 children
35% detected at newborn
12% detected at 6-8 week check
By 3 months 47% had been detected by
screening and 57% of these had seen an
ophthalmologist
Vision
Neonatal
Inspect external eye structures and red reflex
Referral to ophthalmologist see below
National recommendation to be seen within 2 weeks of birth
Retinopathy of prematurity, < 31 weeks and/ or < 1500g then
should be in ophthalmology screening pathway at neonatal
unit.
6-8 week
check
 Establish if any concerns of parents and check relevant
family history
 Observe visual behaviour
 Observe visual fixing and following
 Inspect external eye structures
 Check red reflexes
Abnormal red reflexes are to be referred urgently to
ophthalmology at Manchester Eye Hospital.
Urgent means including phone contact ASAP with paediatric
ophthalmology, via switch 0161 2761234
Retinoblastoma can be life threatening
Congenital cataracts need to be operated upon by 12 weeks
of age to prevent loss of vision development.
Other vision concerns include possible severe vision impairment or parental concern of such.
Refer to Mr Simon Wallis, Bolton Royal, does weekly Thursday Pendleton Gateway clinic and will see with
low threshold urgently.
Urgent fax referrals 01204 390051,
Confirm by Tel 01204 390390 ext 3935
Squint, family history of squint or any vision concerns/reduced vision will be seen by orthoptists via
chose and book and liase with Mr Wallis accordingly
Vision
4-5 years
Universal screen by orthoptist.
Orthoptists available for discussion of concerns. Work closely
with ophthalmology, based in Sandringham 0161 2124128 or
Orthoptics.Salford@nhs.net
8 week vision

Fixing and following
Hips
Neonatal
examination
Universal Ortolani and Barlow screen in hospital
Dislocated or dislocatable hips for urgent referral to
orthopaedics and hip ultrasound
Ultrasound arranged for high risk babies, screen positive
as above or clinical concern, particularly marked limited
abduction.
Referrals are made directly to orthopaedics from
neonatology and Dr Jill Carling, paediatric radiologist at
SRFT
Hips
8 week check
Universal Ortolani and Barlow screen
(Not if already seeing orthopaedics for such/ in harness!)
Confirm US appointment has been attended if high risk
National Screening Committee March 2008 definition of high risk:
 Clinical diagnosis of breech presentation at any time, even if
cephalic birth
 Family history of DDH (Developmental Dysplasia of the Hip)
Locally Talipes or other lower limb abnormality is also considered to
indicate a high risk baby
Screen positive, clinical concern or high risk baby not already in the system
at SRFT or elsewhere then referral for urgent hip ultrasound at SRFT.
Urgent fax number at SRFT is 0161 2065494
Note that asymmetrical thigh creases with no other positive findings or
history are not an indication for referral.
Hips
Older ages
Refer if needed because of clinical concern at any later date direct to Mr Henry
orthopaedic surgeon at RMCH
Refer via fax to 0161 7015421
Tel confirmation of receipt is requested on 0161 7015352
Referral will be triaged clinically
Weekly hips clinic is at RMCH
Hips

Video / DVD
Testes Neonatal check
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Bilateral undescended – 100% to see
paediatrician within 24 hours
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Unilateral – make parent aware and review at
6-8 weeks
Testes 8 weeks
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Bilateral undescended
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Refer to surgeons
C&B
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Appointment by 1 year old
Operation by 2 years old
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Testes 8 weeks
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Unilateral
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All reviewed by GP at 22-26 weeks
Child Health computer can notify
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Refer to surgeon at review if needed
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All seen by 1 year and all operated on by 2 years of
age
Eight week check
Be thorough
Check slips and send in returns
Thank you very much
DVD