What to expect at baby's six week check

Mama, general practitioner, and urgent care doctor Isabelle Duck, gives us the down low on what to expect at your baby’s six week check.

The six week check is often the first visit a baby will make to their doctor's surgery. As a general practitioner myself, and having completed many of these checks, I am able to say that it is an absolute pleasure to meet these new small humans and alleviate any parental concerns that may have arisen within the first few weeks. In some instances, the doctor may be looking after these little people for many years. They will watch them grow from babies into children and approach adolescence. For myself, this is a privilege, and is one aspect of the job that gives me the most enjoyment.

The adjustment to being a new parent can sometimes be tough, but it’s important to remember that alongside your midwife, Plunket nurse and your relatives, your GP can be an excellent source of information during these challenging but exciting times. I like to think of the six week check as a 'check-in'. It is a visit that enables parents to introduce their new baby to the practice, and to ask any questions.

The structure of the consult will differ slightly depending upon the doctor you see. It often starts with a discussion about the pregnancy, the labour experience, mum’s mental health, and the baby's feeding and growth. The doctor will then ask to examine the baby. This examination of the baby is extensive and it includes an assessment of the head, eyes, tongue and mouth, and the heart and lungs. The baby's hips will also need to be examined, and the doctor will complete some tests to make sure that the baby's hips have developed normally.

None of these assessments will hurt your baby, but the baby may get a bit upset in the presence of a stranger. Feel free to comfort your baby during this examination.

Developmental hip dysplasia, or DDH, (also known as congenital dislocation of the hips) is an important diagnosis not to be missed. The earlier it is picked up, the easier it is to treat. If the hip examination is abnormal, then your baby will be referred to an outpatient orthopaedic clinic for an assessment by a paediatric orthopaedic specialist. There are certain risk factors for DDH and these include the presence of a family history of DDH, and the baby being of a breech presentation (the baby being the wrong way round when they are in the mother's uterus during the later stages of pregnancy). If a baby has risk factors for DDH, even if the examination is normal, they will be referred for a bilateral hip x-ray. This x-ray will usually happen when a baby is aged four to six months. Treatment of DDH differs depending upon the severity, but may include either a harness or brace, or, in some instances, surgery followed by casting. The great news is that the vast majority of babies who are diagnosed with DDH are cured.

In addition to hip abnormalities, there are other situations when a doctor may wish to refer your baby for a further assessment. Examples include the presence of a heart murmur (an extra heart sound made by blood flowing differently through the heart), or any issues with growth or development. Understandably, some parents may become concerned about these extra checks, but rest assured your baby is in good hands, and is getting the best care. 

Other primary health care professionals may be involved in your baby's care during the six week check. It’s common for the baby to see the practice nurse in addition to seeing the GP, and the nurse may take your baby's measurements and administer immunisations. The standard measurements include head circumference, weight and length. These measurements are taken to make sure that your baby's growth is tracking as expected, and will be written into your baby's Plunket book. There is indeed a lot to address during this visit, so you may wish to come prepared. Below is a list of six tips which will help you to get the most out of your visit…

6 TIPS TO GET THE MOST OUT OF YOUR SIX WEEK CHECK

+  Don’t forget your Plunket book: This little book serves many purposes. Not only is it a good record of your baby's growth and development, but it can be used as a communication tool between health care professionals who will document any treatment given, referrals and immunisations. There’s a page which is dedicated to the six week check that your doctor will need to complete and sign.      

+  Bring a support person if you can: For many people, the first few weeks of parenthood are comparable to a fog of emotion and fatigue, often caused by lack of sleep. Because of this, some people like to bring a support person to the six week check. This may be the other parent, the baby's grandparent, or a friend. Having another person can also be beneficial if there is any information or advice given, as sometimes this information can be forgotten.

+  Be prepared for a wait: Whilst we always try our best to run on time, we are sometimes held up by an emergency with another patient. Don't forget to bring spare nappies and extra bottles of milk if your baby is bottle fed. 

+  Make sure your baby is dressed in clothing that can be easily removed: The baby will have a thorough head to toe check with the doctor and there will often be measurements and vaccines completed by the nurse. It is possible that your baby will need to be dressed and undressed a couple of times. Dressing your baby in easily removable clothing makes the process run a lot more smoothly and keeps your baby comfortable.

+  If you have multiple issues to discuss consider making a double booking or a second booking on another day: If you have any questions, it is best to mention them at the start of the consult. If there is not enough time to address everything, you may be asked to make a second appointment. As doctors, we want to make sure that all your questions are properly answered, and sometimes extra time is needed for this.  

+  Make your GP booking in advance: Most people are aware of how busy doctors' surgeries are these days. Do not leave your booking to the last minute. Unfortunately some practices are having to ask patients to wait for longer than a week in order to see the GP, so my advice would be to book well in advance, so that this visit is not delayed.

Although your baby will be thoroughly examined, do not forget the six week check is also a visit for mum.

If you have had a caesarean section, the doctor may wish to examine your wound. You may need other measurements checking such as your blood pressure. If it is the right time for you, contraceptive options can also be discussed at this stage.

Caring for a new baby can sometimes be very overwhelming, and transitioning to this new stage of life can be demanding. If the baby is waking every few hours throughout the night it can be so very draining and a lot of mothers feel isolated. It can also be hard if there are extra hurdles such as feeding challenges, maternal health issues or if the baby has been unwell. Twins and multiple births pose even more challenges. If you are a single parent it can also be tough. If you feel as though you are struggling with your mental health, it is very important to discuss this as soon as possible with your midwife, Plunket nurse or GP. Even if your mental health is OK, but you are having a hard day, don’t forget to look after yourself. As a GP, I am a real advocate for self-care – this can be in the form of taking some time alone to have a bath whilst the baby sleeps, meeting some other new mums for a coffee, or asking a trusted adult to hold the baby for a couple of hours while you go for a nap. 

Becoming a parent is a pivotal moment in one's life. The six week check enables every parent to check-in with their GP and while there is much to discuss, but we hope you gain a lot of information and support from this visit. And don’t forget, many general practitioners are also parents and have been through this transition too! 

Dr Isabelle Duck is a General Practitioner at Silverdale Medical in Auckland. She lives in Hobsonville with her husband – a lecturer, and their daughter, Lauren.