The document provides guidance on taking a perinatal history and performing a physical examination of a newborn infant. It discusses the importance of the history, outlines the key components of a perinatal history, and describes the process and order of performing a physical examination. The physical examination includes measurements, general inspection, regional examination, and neurological assessment. Findings should be recorded on an examination form and an overall assessment made.

1. Skills workshop:
Clinical history
and examination
infant record. Discussion with the staff who
Objectives have cared for the mother and infant is also
important. The history will often identify
clinical problems and suggest what clinical
When you have completed this skills signs to look for during the examination.
workshop you should be able to: A general examination is not complete if a
• Take a perinatal history. history is not taken.
• Perform a physical examination on a
newborn infant. 3-b The sections of a perinatal history
• Complete an examination chart. 1. The maternal background:
• Issue a preschool health card. • The mother’s age, gravidity and parity.
• The number of infants that are alive
The complete examination of a newborn infant and the number that are dead. The
consists of: cause of death and age at death.
• The birth weight of the previous
1. The perinatal history infants.
2. The physical examination • Any problems with previous infants,
3. The assessment of the findings e.g. neonatal jaundice, preterm delivery,
congenital abnormalities.
TAKING A PERINATAL • The home and socioeconomic status.
• Family history of congenital
HISTORY abnormalities.
2. The present pregnancy:
3-a The importance of a perinatal history • Gestational age based on menstrual
Before examining a newborn infant, it is dates, early obstetric examination and
important to first take a careful perinatal ultrasound examination.
history. The history should be taken from • Problems during the pregnancy,
the mother, together with the maternal and e.g. vaginal bleeding.

2. SK ILLS WORKSHOP : CLINICAL HISTOR Y AND EXAMINATION 73
• Illnesses during the pregnancy, THE PHYSICAL
e.g. rubella.
• Smoking, alcohol or medicines taken. EXAMINATION OF A
• VDRL (or RPR) and TPHA (or FTA) NEWBORN INFANT
results. Treatment if syphilis diagnosed.
• HIV status and CD4 count if HIV
positive. 3-d Requirements for the examination
• Antiretroviral prophylaxis or treatment.
• Blood groups. 1. Whenever possible the infant’s mother
• Assessment of fetal growth and should be present. This gives her the chance
condition. to ask questions. She can also be reassured
by the examination. The examiner should
3. Labour and delivery: use the opportunity to teach the mother
• Spontaneous or induced onset of about caring for her infant.
labour. 2. A warm environment is essential to
• Duration of labour. prevent the infant becoming cold. The
• Method of delivery. room should be warm or a source of heat
• Signs of fetal distress. must be used, e.g. an overhead radiant
• Problems during labour and delivery. heater. Prevent draughts of cold air by
• Medicines given to the mother, e.g. closing doors and windows. Do not place
pethidine, antiretroviral therapy. the infant on a cold table top. Use a towel
or blanket if necessary.
4. Infant at delivery: 3. A good light is important so that the
• Apgar score and any resuscitation examiner can see the infant well.
needed. 4. Wash your hands before examining the
• Any abnormalities detected. infant to prevent the spread of infection.
• Birth weight and head circumference. 5. The infant should be completely undressed.
• Estimated gestational age. A full examination is impossible with the
• Vitamin K given. infant partially dressed.
• Placental weight. A basic general examination should be
5. Infant since delivery: done on all infants. A more detailed general
examination is needed in ill infants.
• Time since delivery.
• Feeds given.
3-e The order of examination
• Urine and meconium passed.
• Any clinical problems, e.g. hypothermia, The physical examination should always be
respiratory distress, hypoglycaemia. performed in a fixed order so that nothing
• Contact between infant and mother. is forgotten. Usually the following steps are
followed:
3-c Assessment of history
1. Measurements:
It is a valuable exercise to make an assessment
of the potential and actual problems after • The infant’s weight and head circumference
taking the history and before examining the are measured and recorded.
infant. This helps you to look for important • An assessment of the infant’s gestational
clinical signs that may confirm or exclude age should be made. If necessary,
problems suggested by the history. the weight and head circumference
measurements can now be plotted against
the gestational age on weight and head
circumference for gestational age charts.

3. 74 NEWBORN CARE
• Often the infant’s skin or axillary on a completed examination form as it will be
temperature is measured at this stage of the recorded to the right of the solid line.
examination.
2. General inspection: 3-g Assessment of the complete
examination
A general inspection is made of the infant,
paying special attention to the infant’s When the history has been taken and the
appearance, nutritional state and skin colour. physical examination completed, an overall
assessment of the infant must be made. The
3. Regional examination: examiner must decide whether the infant is
normal or abnormal. In addition, a list of the
The infant is examined in regions starting problems identified must be drawn up. The
at the head and ending with the feet. The management of each problem can then be
examination of the hips is usually left until last addressed in turn. A perinatal history and
as this often makes the infant cry. physical examination are of little value if an
assessment is not made.
4. Neurological status.
5. Examination of the hips. Figure 3.A: On the next page, see a form used to
record the results of the physical examination. It can
6. Examination of the placenta (if available). also be used as a guideline for a basic general
examination.
7. An assessment:
An assessment is made using all the
information from the history and the physical
examination.
The physical examination of the newborn
infant is not easy and requires a lot of practice.
The correct method of examination should
be taught at the bedside by an experienced
doctor or nurse. It is not possible to learn how
to examine an infant simply by reading an
explanation of the method of examination.
3-f Recording the findings of the physical
examination
Usually a form is used to remind the nurse
or doctor which clinical signs to look for
and also to record the results of the physical
examination. The important observations
needed are listed together with the possible
normal and abnormal results. The normal
results are given on the left hand side of the
form while the abnormal results are given on
the right hand side. The normal and abnormal
results are separated by a bold vertical line. A
tick should be placed in the appropriate blocks
to indicate which physical signs are present.
At a glance any abnormality will be noticed

4. SK ILLS WORKSHOP : CLINICAL HISTOR Y AND EXAMINATION 75
General Well Sick
Appearance Well nourished Obese Wasted Dysmorphic
Behaviour Responsive Lethargic Irritable Jittery
Colour Pink Pale Plethoric Cyanosed
Skin Normal Rash Jaundice Purpura Bruises
Odour Normal Offensive
Head shape Normal Asymmetrical Caput Cephal-
haematoma
Fontanelles Normal Bulging Large
Sutures Mobile Overriding Fused
Face Symmetrical Asymmetrical Abnormal
Eyes Normal Small Large Slanting Discharge
Nose Patent Blocked
Mouth Normal Smooth philtrum Cleft lip
Palate Normal Cleft
Tongue Normal Large Protruding
Chin Normal Receding
Ears Normal Abnormal Low slung
Neck Normal Swellings Webbed
Clavicles Intact Swellings Crepitus
Nipples Normal Accessory
Respiratory rate 40 – 60/minute Fast Slow
Chest movements Symmetrical Asymmetrical Shallow
Recession Absent Costal Sternal
Breath sounds Quiet Grunting Noisy
Heart rate 120 – 160/minute Tachycardia Bradycardia
Pulses Present No femoral
Arms Normal Not moving Fracture
Palmar creases Normal Single crease
Fingers Normal Polydactyly Syndactyly Extra fingers
Abdomen Normal Distended Scaphoid
Umbilicus Normal Moist Flare Bleeding Meconium
stained
Hips Normal Dislocated Dislocatable
Legs Normal Not moving
Feet position Normal Positional Clubbed
deformity
Toes Normal Polydactyly Syndactyly
Back Normal Scoliosis Meningocoele Sacral dimple Tuft of hair
Genitalia male Testes descended Undescended Fluid hernia Inguinal hernia Hypospadias
Genitalia female Normal Ambiguous
Anus Patent Imperforate
Moro reflex Present and equal Asymmetrical Absent
Sucking reflex Present Weak Absent
Grasp reflex Present Weak Absent
Muscle tone Normal Hypotonic Hypertonic
Cry Normal High pitched Hoarse
Assessment: Examined by:
Date and time:

5. 76 NEWBORN CARE
3-h Guidelines for a detailed examination
Measurements Normal Abnormal
Birthweight 2500 g to 4000 g. Between 10th Low birthweight (below 2500 g).
and 90th centile for gestational Underweight (below 10th centile)
age. or overweight (above 90th centile)
for gestational age.
Head circumference Between 10th and 90th centile Small head (below 10th centile) or
for gestational age. large head (above 90th centile for
gestational age).
Gestational age Physical and neurological Immature features in preterm
features of term infants (37– infant (below 37 weeks). Postterm
42 weeks). infants (42 weeks and above) have
long nails.
Skin temperature Abdominal wall (36–36.5 °C) or Hypothermia (below 36 °C).
axilla (36.5–37 °C).
GENERAL INSPECTION
Wellbeing Active, alert. Lethargic, appears ill.
Appearance No abnormalities. Gross abnormalities. Abnormal
face.
Wasting Well nourished. Soft tissue wasting.
Colour Pink tongue. Cyanosis, pallor, jaundice, plethora.
Skin Smooth or mildly dry. Vernix Dry, marked peeling. Meconium
and lanugo. Stork bite, staining. Petechiae, bruising.
mongolian spots, milia, Large or many pigmented
erythema toxicum, salmon naevi. Capillary or cavernous
patches. haemangioma. Infection. Oedema.
Regional examination
HEAD
Shape Caput, moulding. Cephalhaematoma,
subaponeurotic bleed. Asymmetry,
anencephaly, hydrocephaly,
encephalocoele.
Fontanelle Open, soft fontanelle with Full or sunken anterior fontanelle.
palpable sutures. Large or closed fontanelles. Wide
or fused sutures.
EYES
Position Wide or closely spaced.
Size Small or abnormal eyes.
Lids Mild oedema common after Marked oedema, ptosis, bruising.
delivery.
Conjunctivae May have small subconjunctival Pale or plethoric. Conjunctivitis.
haemorrhages. Excessive tearing when
nasolacrimal duct obstructed.

6. SK ILLS WORKSHOP : CLINICAL HISTOR Y AND EXAMINATION 77
Cornea, iris and lens Cornea clear, regular pupil, red Opaque cornea, irregular pupil,
reflex. cataracts, no red reflex, squint,
abnormal eye movements.
NOSE
Shape Small and upturned. Flattened in oligohydramnios.
Nostrils Both patent. Easy passage of Choanal atresia. Blocked with dry
feeding catheter. secretions.
Discharge Mucoid, purulent or bloody
secretions.
MOUTH
Lips Sucking blisters. Cleft lip. Long smooth upper lip in
fetal alcohol syndrome.
Palate Epstein’s pearls. High arched or cleft palate.
Tongue Pink. Cyanosed, pale, or large.
Teeth None at birth. Extra or primary teeth.
Gums Small cysts. Tumours.
Mucous membranes Pink, shiny. Thrush, ulcers.
Saliva Excessive if poor swallowing or
oesophageal atresia.
Jaw Smaller than in older child. Very small.
EARS
Site Ears vertical. Low-set ears.
Appearance Familial variation. Skin tag or sinus. Malformed ears.
Hairy ears.
NECK
Shape Usually short. Webbing, torticollis.
Masses No palpable lymph nodes or Cystic hygroma. Goitre.
thyroid. Sternomastoid tumour.
Clavicle Swelling or fracture.
BREASTS
Appearance Breast bud at term 5 to 10 mm. Extra or wide spaced nipples.
Enlarged, lactating breasts. Mastitis.
HEART
Pulses Brachial and femoral pulses Pulses weak, collapsing, absent,
easily palpable. 120–160 beats fast or slow or irregular.
per minute.
Capillary filling time Less than 4 seconds over chest Prolonged filling time if infant cold
and peripheries. or shocked.
Blood pressure Systolic 50 to 70 mm at term. Hypertensive or hypotensive.
Precordium Mild pulsation felt over heart Hyperactive precordium.
and epigastrium.
Apex beat Heard maximally to left of Heard best in right chest in
sternum. dextrocardia.

7. 78 NEWBORN CARE
Murmurs Soft, short systolic murmur Systolic or diastolic murmurs.
common on day 1.
Heart failure Oedema, hepatomegaly, tachy-
pnoea or excessive weight gain.
LUNGS
Respiration rate 40-60 breaths per minute. Tachypnoea above 60 breaths
Irregular in REM sleep. Periodic per minute. Gasping. Apnoea
breathing with no change in with drop in heart rate, pallor or
heart rate or colour. cyanosis.
Chest shape Symmetrical. Hyperinflated or small chest.
Chest movement Symmetrical. Asymmetrical in pneumothorax
and diaphragmatic hernia.
Recession Mild recession in preterm infant. Severe recession in respiratory
distress.
Grunting Expiratory grunt in respiratory
distress.
Stridor Inspiratory stridor a sign of upper
airway obstruction.
Percussion Resonant bilaterally. Dull with effusion or
haemothorax. Hyperresonant with
pneumothorax.
Air entry Equal air entry over both lungs. Unequal or decreased.
Bronchovesicular.
Adventitious sounds Transmitted sounds. Crackles, wheeze or rhonchi.
ABDOMEN
Umbilicus 2 arteries and 1 vein. 1 artery, 1 vein. Infection. Bleeding
or discharge. Hernia. Exomphalos.
Skin Periumbilical redness or oedema.
Shape Distended or hollow.
Liver Palpable 1 cm below coastal Enlarged, firm, tender.
margin, soft.
Spleen Not easily felt. Enlarged, firm.
Kidneys Often felt but normal size. Enlarged, firm.
Masses No other masses palpable. Full Palpable mass.
bladder can be percussed.
Bowel sounds Heard immediately on Few or absent.
auscultation.
Anus Patent. Absent or covered.
Stools Meconium passed within Blood in stool. White stools in
48 hours of birth. Yellow stools obstructive jaundice. Offensive
by day 5. Breastfed stool may be watery stools.
green and mucoid.
SPINE
Appearance Coccygeal dimple or sinus. Sacral dimple or sinus. Scoliosis.
Straight spine. Meningomyelocoele.

8. SK ILLS WORKSHOP : CLINICAL HISTOR Y AND EXAMINATION 79
GENITALIA
Penis Urethral dimple at centre of Hypospadias.
glans.
Testes Descended by 37 weeks. Undescended.
Scrotum Well formed at term. Inguinal hernia. Fluid hernia.
Vulva Skin tags, mucoid or bloody Fusion of labia.
discharge.
Clitoris Uncovered in preterm or wasted Enlarged in adrenal hyperplasia.
infants.
Urine Passed in first 12 hours. Poor stream suggests posterior
urethral valve.
ARMS
Position Flexed position in term infant. Brachial palsy.
HANDS
Appearance Extra, fused or missing fingers.
Skin tags. Single palmar crease.
Hypoplastic nails.
LEGS
Appearance Mild bowing of lower legs Dislocatable knees in breach.
common.
FEET
Appearance Positional deformation. Clubbed feet. Abnormal toes.
NEUROLOGICAL STATUS
Behaviour Alert, responsive. Drowsy, irritable.
Position Flexion of all limbs at term. Extended limbs or frog position in
preterm and ill infants.
Movement Active. Moves all limbs equally Absent, decreased or asymmetrical
when awake. Stretches, yawns movement. Jittery or convulsions.
and twists.
Tone Decreased or increased.
Hands Intermittently clenched. Permanently clenched.
Cry Good cry when awake. Weak, high pitch or hoarse cry.
Vision Follows a face, bright light or Absent or poor following.
red object.
Hearing Responds to loud noise. No response.
Sucking Good suck and rooting reflexes Weak suck at term.
after 36 weeks gestation.
Moro reflex Full extension then flexion of Absent, incomplete or
arms and hands. Symmetrical. asymmetrical response.
HIPS
Movement Click common. Fully abducted. Dislocated or dislocatable. Limited
abduction.
NOTE The Moro reflex was described by Ernst Moro in 1918. He was professor of paediatrics in Heidelberg,
Germany.

9. 80 NEWBORN CARE
3-i Examination of the hips have suffered a chronic intrauterine infection
(e.g. syphilis) or fetal hydrops have placentas
The hips must be examined in all newborn
that weigh more than expected.
infants to exclude congenital dislocation or an
unstable hip. There are three layers to the placental
membranes. The amnion on the inside
The infant is examined lying supine (back on
(prevents the fetus sticking to the membranes),
the bed) with the hips flexed to a right angle
the chorion in the middle (to provide
and knees flexed.
strength), and the decidua on the outside.
Barlows test demonstrates both a dislocated The amnion is usually smooth and shiny. If
and a dislocatable (unstable) hip: One hand the healthy amnion is peeled away from the
immobilises the pelvis (thumb over pubic rest of the membranes, it is completely clear
ramus, fingers over sacrum) while the other and transparent. A cloudy or opaque amnion
hand moves the opposite thigh into mid- suggests infection (chorioamnionitis) while a
abduction. If the hip is dislocatable, backward granular surface (amnion nodosum) suggests
pressure on the inner side of the thigh with too little amniotic fluid (oligohydramnios).
the thumb causes the femoral head to slip The membranes should not smell offensive.
backwards out of the acetabulum. Conversely
The umbilical cord normally has one large
forward pressure on the outer side of the thigh
vein and two thick walled arteries. The more
with the fingers would tend to cause the head
the pull (e.g. when a cord is relatively short
to spring forwards, back into the acetabulum.
due to it being wrapped around the fetal neck)
The same procedure is then carried out for the
the longer the cord will grow. A short cord
opposite side.
suggests very poor fetal movement. The cord
Ortolani test for a dislocated hip: Both thighs becomes stained green once the amniontic
are held so that the examiner’s fingers are fluid has been contaminated with meconium
over the outer side of each thigh (greater for a few hours. A single umbilical artery is
trochanter) and his thumbs rest on the inner associated with congenital malformations.
side of each thigh (lesser trochanter). Both The umbilical vein has one-way valves (‘false’
thighs are then abducted. If a hip is dislocated, knots). A true knot may kill the fetus.
a ‘clunk’ can be felt and heard as the femoral
The shape of the placenta is not important.
head slips forward into its normal position in
Most are oval. Usually the umbilical cord
the acetabulum.
is inserted into the centre of the placenta
with arteries and veins radiating out in
3-j Examination of the placenta all directions over the chorionic plate.
Every placenta should be carefully examined A peripheral insertion is of no clinical
after birth as this can provide valuable importance. However, insertion into the
information about the infant. Usually the membranes in a low-lying placenta can result
gross placental weight is measured and is severe haemorrhage from a fetal vessel
recorded (placenta, membranes and umbilical when the membranes rupture (vasa praevia).
cord). As gestation progresses the weight of Arteries always cross over veins. Fetal vessels
the placenta increases. An infant of 3000 g torn off at the placental edge indicate that
usually has a placenta weighing about 600 g an extra piece of placenta has been retained
(between 450 and 750 g). Therefore, at term (accessory lobe). Pale patches on the fetal
the gross placental weight is about a fifth that surface are due to fibrin deposits and are not
of the fetus. Infants who are underweight for clinically important.
gestational age have both an absolutely and The maternal surface of the placenta is dark
relatively small placenta. In contrast, infants of maroon in preterm infants but becomes
poorly controlled diabetics, and infants who grey towards term. A pale placenta suggests

10. SK ILLS WORKSHOP : CLINICAL HISTOR Y AND EXAMINATION 81
anaemia. Calcification is not important and developing country. The card is widely used
reflects a good maternal calcium intake. throughout southern Africa.
The maternal surface is divided into lobes
After delivery each newborn infant is issued
(cotyledons). Make sure that the placenta
with a road-to-health card which forms the
is complete as a retained lobe can result in
primary health-care record until the infant
postpartum haemorrhage or infection. Firmly
starts school by the age of 6 years. The infant’s
attached blood clot, especially if it lies over
mother keeps the card in a plastic cover and
an area of compressed placenta, suggest
should present the card whenever the infant
placental abruption. Fresh infarcts are best
is taken to a clinic or hospital. The infant’s
identified on palpation as they form a hard
perinatal history, growth, immunisations
lump. Old infarcts are yellow or grey and
and childhood illnesses are recorded on the
easily seen, especially if the placenta is sliced.
card. Usually the infant’s HIV status and
It is of no help to simple describe a placenta
management are also recorded on the card.
as ‘unhealthy’.
It is particularly important to examine the 3-k Completing the road-to-health card
placentas of twins. Unlike-sexed (boy and girl) after delivery
twins are always non-identical (dizygous).
Liked-sex twins are definitely identical After delivery the clinic or hospital staff must
(monozygous) if they share a single placenta enter the perinatal details onto the road-to-
(monochorionic twins). Monochorionic health card. The details which are usually
placentas always have fetal blood vessels on entered onto the card are:
the chorioninic place which run from one 1. Maternal information:
umbilical cord to the other. Monochorionic
placentas have one chorion and usually two • The mother’s name
amniotic sacs. Two placentas fused together • The mother’s hospital number
(dichorionic placentas) may be mistaken for • The mother’s home address
a single placenta. However, there are never 2. Pregnancy and delivery information:
fetal blood vessels linking the two umbilical
• The duration of pregnancy
cords. Dichorionic placentas can be seen in
• The result of the VDRL or other
both identical and non-identical twins. The
creening test for syphilis and HIV
separating membranes of dichorionic twins
• The maternal blood group
always include both amnion and chorion.
• Any pregnancy complications
Pathological examination with histology should • The method of delivery
be requested if an abnormality of the placenta • The date and place of birth
is identified. Placental ischaemia, chronic
3. Neonatal data:
intrauterine infection and chorioamnionitis are
easily identified on histology. • The Apgar scores
• The birth weight (mass), head
circumference (and sometimes length)
THE ROAD-TO-HEALTH • The name and sex of the infant
• The date, infant weight and method of
CARD feeding at discharge
Use of the road-to-health card (preschool Details of the information recorded on the
health card) is advocated by the World Health preschool health card vary slightly from one
Organisation as one of the main methods region to another. Sometimes additional
of improving child health, especially in a information is also recorded after delivery.

11. VITAMIN A SUPPLEMENTATION
Supplementation:
age in months Schedule Date given Signature
Road to Health Chart
IMPORTANT: always bring this chart when you visit
IMMUNISATIONS
Date given
day month year any health clinic, doctor or hospital and Batch no: Vaccine Site day month year
Signature
PROPHYLAXIS present the chart on school entry
GW 8/123 Department of Health
BCG Right arm
Mother at delivery boy
(not later than 6-8 weeks) 1 x 200 000 IU Child's Polio 0 Oral
name girl
Infant not breastfed Polio 1 Oral
(at 6 weeks) 1 x 50 000 IU
Child's ID DTP 1 Left thigh
At 6 months*
number
(up to 11mths) 1 x 100 000 IU Hib 1 Left thigh
Date of Place of DTP 1 / Hip 1
Left thigh
12mths 18mths 24mths birth day month year
birth (combined)
Hep B 1 Right thigh
PRIMARY SCHEDULE
Birth Birth Birth head
weight length circumference Polio 2 Oral
At 12 - 60 months 1 x 200 000 IU 30mths 36mths 42mths DTP 2 Left thigh
(mark with X) every 6 months Problems during pregnancy / birth / neonatally
Hib 2 Left thigh
DTP 2 / Hip 2
48mths 54mths 60mths (combined) Left thigh
APGAR 1 min. Gestational :
age (wks)
Mother's :
Serology
Hep B 2 Right thigh
5 min.
Polio 3 Oral
TREATMENT OF : Antenatal:
Mother's
(NOT if prophylactic dose was given within previous month)
file numbers : DTP 3 Left thigh
Dosage according to following age group: 2-5mths: 50 000IU Delivery: Hib 3 Left thigh
(See IMCI classification) 6-11mths: 100 000IU DTP 3 / Hip 3
12-60mths: 200 000IU RtHC information given by: (combined) Left thigh
Persistent diarrhoea/
Mother's name: Hep B 3 Right thigh
Diarrhoea with Immediate 1 x ............IU
severe dehydration Father's name: Measles 1 Right thigh
Immediate 1 x ............IU Who does the child live with? Polio 4 Oral
Measles
DTP 4 Left arm
BOOSTERS
24h repeat 1 x ............IU
How many children has the mother had?
Immediate 1 x ............IU Date Measles 2 Right arm
Xerophthalmia Number Number information
24h repeat 1 x ............IU born alive now given: dd mm yy Polio 5 Oral
Reason(s) for death(s): DT 1 Left arm
Severe Immediate 1 x ............IU
malnutrition
In need of special care (mark with X)
* Allow a period of at least one month between doses Was the baby less yes no Are any brothers or yes no
Visual screening than 2,5kg at birth sisters underweight?
A PASSPORT FOR HEALTHY CHILDREN Pencil test (>6 weeks) Is the baby a twin? yes no Is the baby bottle fed? yes no
Show mothers you value the use of the Road to Health Chart Date
and they will take care of it Result: L: yes no R: yes no tested: dd mm yy Does the mother need
Household TB contact? yes no more family support? yes no
Snellen Chart test: conduct with E-chart (5> years)
Date Are there any reasons yes (for example:
no single parent etc.)
Result: L: / R: / tested: dd mm yy for taking extra care?
Hearing screening
Does baby appear to listen when someone is talking or singing? (at 3 months)
yes no Date
Result: tested: dd mm yy
Address of clinic(s) visited
Does baby turn to a loud noise? (at 6 months)
Date Clinic 1: Clinic 2:
Result: L: yes no R: yes no tested: dd mm yy
Voice test: Hearing impairment (>12 months)
Normal Moderate Severe Date
Result: hearing impairment impairment tested: dd mm yy
19 kg
Child's Date for next visit
name: 18,5
nr. day month year
18 18 centile
4 97th 1
17,5 BCG IMMUNISATIONS 17,5 DTP 17,5
2
17 17 17
0 1 2 3 4 3
16,5 Polio 16,5 Polio 16,5
4
16 16 16
1 2 3 1 2 5
15,5 Hib, DTP & Hep B Measles 15,5 Measles 15,5
6
15 15kg 15kg
birth 6wks 10wks 14wks 9mths 18mths tile 7
14,5 14,5 14,5 50th cen
8
14 14 14
Discuss: 9
13,5 13,5 13,5
Breastfeeding 10
13 Child spacing 13 13
Food intake 11
12,5 Oral rehydration solution 12,5 12,5
12
12 12 12
13
11,5 11,5 11,5
14
11 11 11 3rd centile
15
10,5 10,5 10,5
16
10kg 10kg 10kg
17
9,5 9,5 9,5
18
9 9 9
19
8,5 th centile
60% of 50
8,5 8,5
20
8 8 8
21
7,5 7,5 7,5
22
7
I can talk
7 7
23
6,5 6,5 6,5
24
6 6 6
5,5 5,5 5,5 Write on the chart
- Any illness e.g.
5kg 5kg 5kg ~ diarrhoea,
~ ARI, etc.
4,5 4,5 4,5 - Admission to hospital,
2
years - Solids introduced,
- Breastfeeding stopped,
4 4 - Birth of next child, etc.
24 25 26 27 28 29 30 31 32 33 34 35
3,5 3,5 1
age in months
year like this:
3 3
Diarrhoea
Extra meals
12 13 14 15 16 17 18 19 20 21 22 23
2,5kg 2,5kg age in months
given
2
ARI
Birth 1 2 3 4 5 6 7 8 9 10 11
Worm medicine
weight age in months
1,5 write
2 to 3 Years
Admitted to hospital
birth month
(2-7 September)
1
Watch the direction of the curve showing the child's growth
0,5 write
birth month 1 to 2 Years GOOD VERY DANGEROUS
0 Means the child is Child may be ill,
growing well. DANGER SIGN needs extra care.
write birth month
and year
Birth to 1 Year Growth Monitoring Chart Not gaining weight.
Find out why.
Chart revised: August 2003 jjb
Figure 3.B: The front and back of a road-to-health card