**3. Examination**

From here, we can move onto the examination. A summary of the steps involved in the examination can be found at the end of the chapter. The examination should be systematically performed and an ideal method is to examine the front of the infant from head to toe and then turn them over and examine them from top to toe again. This chapter has been designed with that in mind and the examination should follow this structure were possible.

#### **3.1 Exposure and positioning**

The correct exposure for the examination is important because signs can be easily missed if they are not obvious to us. The best level of exposure is with the infant fully undressed and their nappy on. The nappy can be removed and replaced at the time of the genital and hip examination which gives the examiner confidence that they will not encounter any unfortunate surprises.

Positioning the newborn for the examination should rely on the principle of ensuring both the examiner and infant are comfortable. It would be appropriate to have the infant resting supine on a firm standard examination bed. Have the infant laying straight in front with their legs towards you and head away. If the infant is larger where it may compromise your ability to visualise distal parts of their body, laying them as you would an older patient perpendicular to you and examining them from their right is also fine. Being able to appreciate subtle asymmetry is the key so if you cannot achieve this, position the patient so you can.

#### **3.2 General inspection**

Look at the infant from a distance and comment on any dysmorphic features, deformities, rashes, skin lesions or skin colour changes [2–4]. Remember to repeat this process when examining the infants back.

Make a note of whether the child is comfortable or distressed. This can influence how we interpret signs throughout the examination.
