FULL SCRIPT - OSCE

Introduction

Hi my name is Kiara

I am a second-year student midwife

Procedure Overview

So today I'll be doing baby's first week check
This is checking baby from head to toe, to make sure baby is healthy and developing normally
I'll explain what I am doing as I go
Did you have any questions or concerns before we start?
And do I have your consent to do the first week check on baby?
If you have questions throughout this check, feel free to ask

History/Neonatal Behaviour

Before examining your baby, I'd like to ask a few questions.
How old is your baby today?
You were (gestation) when you gave birth is that correct?
Was the pregnancy and birth uncomplicating?
Was your baby born vaginally or by caesarean section?
How has feeding been going? Can you hear baby swallowing during feeds, and how often is baby feeding? And does baby wake itself up for feeds?
That's great. We generally recommend feeding at least every 3 to 4 hours. If baby sleeps longer than this, it's important to wake them for a feed, as newborns need regular feeds to support growth and hydration.
Is your baby having regular wet nappies and bowel motions? What colour are the dirty nappies?
Do you have any concerns about your baby today?
Ok thank you for that, is it ok if I start on baby's check now
Perform Hand Hygiene

General observations

The room is nice and warm so is it ok if I undress baby, to examine the heart and lungs
Remove baby's clothes
I'll auscultate baby's heart rate and sounds in the four cardiac areas; the aortic, pulmonic, tricuspid, and mitral regions, and note the heart rate, rhythm and for any abnormalities like murmurs
Baby's heart rate is normal, 140 beats per minute, the normal range is between 110-160 beats per minute
Next, I'll auscultate the lungs, baby has clear, equal breath sounds bilaterally with good air entry. There are no abnormal sounds such as crackles or wheezes, which can sometimes indicate there is an obstruction or fluid in the lungs
Since baby is asleep, I'll now assessing baby's breathing (RR)
The normal range is 40-60 breaths per minute, and baby's respiratory rate is 50 breaths per minute
There are also no signs of respiratory distress like abnormal chest movement
Baby is also warm to touch and pink, which is a good signs baby is warm, if you ever do check baby's temperature the normal temperature range is between 36.5 - 37.5 degrees
If baby is ever cold, skin to skin, breastfeeding or wool clothing can help them to warm up, usually the rule of thumb is that baby's need one more layer than we wear

Head

• I'll assess the size and shape of baby's head. The head appears proportionate to the body and symmetrical. Significant asymmetry, swelling, or an unusually large or small head size may require consultation with paediatrics; however, baby's head appears normal for age with no concerns noted.

• I'm now going to check baby's scalp for any bruising, swelling, or signs of trauma that can occasionally occur during birth

• Baby's scalp looks healthy, with no bruising, swelling, or other concerns noted

• I'll have a feel of baby's anterior fontanelle, this takes anywhere between 7 to 18 months of age to close… and now the posterior fontanelles, this takes anywhere between 2 to 3 months of age to close

• Both are soft and flat with no signs of bulging or sunkeness

• A bulging fontanelle may indicate increased intracranial pressure, while a sunken fontanelle can be a sign of dehydration

• I'll now feel the suture lines, which should be open as this facilitates brain growth

• Premature closure may affect skull and brain development, but suture lines usually close around 2 years of age or later

• I'll measure baby's head circumference; this is to check baby has normal head and brain growth and to rule any underlying developmental or neurological issues

• In the first week the normal range is around 33-35 cm and your baby's head circumference is 34 cm

 

• Did you have any questions, or want me to re-explain anything?

Eyes/Ears

• Ok, I'll check baby’s eyes now

• I'm ensuring baby's eyes are clear, and there's no abnormalities. I'll inspect the sclera, which is the white part of the eye for any yellowness that can indicate jaundice, as well as erythema (redness), oedema (swelling), or discharge that could suggest infection or inflammation.

• The sclera is white and clear, with no jaundice, redness, swelling, discharge, or other abnormalities noted.

• If baby does get discharge in the eyes putting a little bit of breastmilk in the eye can help, if it doesn't go away after some time, we can do a swab to check and rule out infection

 

• I can also see that baby's eyes are level with the ears and symmetrical to the face, this is to check unusual facial features, for example low set ears, which can sometimes be associated with congenital or genetic conditions.

 

• I will also assess the baby's red reflex by shining a light into each eye

(check one eye, then the other, then both at the same time)

• This checks that light is passing clearly through the structures of the eye to the retina

• An absent, diminished, or unequal red reflex may indicate conditions such as congenital cataracts or retinoblastoma, a rare retinal tumour.

• Baby's red reflex is present and equal bilaterally, which is a normal finding.

 

• I will assess the ears for normal shape, position, and cartilage development, ensuring the pinnae are well formed and not fused to the scalp.

• I will also check for any preauricular puts or skin tags, as these may occasionally be associated with congenital anomalies.

• The ears are well formed and symmetrical, with normal positioning and cartilage development. No preauricular pits, tags, or other abnormalities are present.

 

• Did you have any questions, or want me to re-explain anything?

Nose

• I'll also check baby's nose. Baby's nose appears normally formed, there is no nasal obstruction, flaring or discharge and both nostrils are patent, and baby is breathing comfortably without signs of respiratory distress

• One sign of respiratory distress can be nasal flaring

 

• Did you have any questions, or want me to re-explain anything?

Mouth

• I’ll baby's mouth for cleanliness and moisture, and check the tongue’s size, position and range of movement, including the frenulum for signs of tongue-tie.

• I’ll inspect the hard and soft palate, gums, inner cheeks and lips for any abnormalities, lesions, or signs of oral thrush, and check that the mucous membranes are intact.

• The baby’s mouth appears normal, moist, intact mucous membranes, a normal palate, and full tongue movement, with no visible abnormalities or signs of oral thrush or tongue-tie.

• And when I stroke baby's check, baby turns towards my finger indicating normal rooting reflex

• Sometimes baby can get blisters on there lip from breastfeeding due to the friction from the breast, this is normal, and should resolve on its own

 

• Did you have any questions, or want me to re-explain anything?

Neck/Shoulders

• I'll assess length and range of motion for baby's neck now, as well as checking for any abnormalities like masses, webbing, clefts, or swelling

• Baby's neck has normal range of motion and length; there is also no visible abnormalities

• Looking at the jaw, I can also see it is a nice normal size and nicely symmetrical as well

• Now I'll palpate the clavicles aka collarbone, this is to check for any factures that might have occurred during birth which can cause pain, or reduced arm movement.

• Baby's clavicles feel intact on palpation, and also have normal appearance with no visible deformities

 

• Did you have any questions, or want me to re-explain anything?

Chest

• The chest is symmetrical with normal thoracic shape, and equal bilateral chest movement

• Nipples are appropriately positioned and breast tissue is present bilaterally

• It is normal for newborns to get small breast buds due to maternal hormones, this usually resolves spontaneously within 2-4 weeks

 

• Did you have any questions, or want me to re-explain anything?

Abdomen

• Your baby’s tummy looks just as we’d expect — it’s soft, round, non-distended and moving gently with their breathing, with no unusual swelling or colour changes

• A hard, or distended abdomen can sometimes indicate constipation

• I'll now auscultate baby's bowel sounds. Bowel sounds are present in all four quadrants

• I'm now going to gently palpate baby's tummy

• On palpation, the abdomen is soft with no masses or organomegaly (enlarged organs) detected

 

• Babys umbilical area also looks clean and dry. It usually falls off on its own around 5-15 days after birth, so avoid pulling it off yourself

• With the umbilicus signs of infection include redness, discharge, or a foul odour

 

• Did you have any questions, or want me to re-explain anything?

Hips

• I'll do baby's hip check now using the Ortolani and Barlow manoeuvres

• Your baby’s hips feel nice and stables — everything sits in the right place, and there’s no looseness or clicking, which tells me their hip joints are developing normally.

• If the hips were unstable a referral would be required for a specialist consultation

Arms/legs

• Baby's skin integrity is intact, with no evidence of skin breakdown, lesions, bruising, or infection.

• Limb movements are symmetrical with a full range of spontaneous movement in all four limbs

• Leg creases are all symmetrical, meaning no sign of developmental dysplasia of the hip

• All of baby’s fingers and toes are present, and well‑formed, with no evidence of polydactyly or syndactyly

• And looking at the creases of baby's hands, there's normal no palmar creases

• Sometimes an abnormal crease can occasionally be associated with chromosomal or genetic conditions

• Baby has good palmar grasp reflex by grasping my finger when it is placed in their palm, and good muscle tone when gently pulled upwards, this shows nerves and muscles are functioning normally

 

• I'll now assess the Babinski reflex. When gently stroking the bottom of baby’s foot, the toes spread out and the big toe moves upwards. This is a normal newborn reflex and is reassuring of normal neurological development.

• And the feet are in a normal position with no evidence of talipes aka club foot, which is when the foot is twisted out of their normal shape position, which would've required a referral would be required for a specialist consultation

 

• Ok I'll measure baby's length now, baby is 50 cm, which is a normal length, the normal length range is between 45 to 56 cm

 

• Did you have any questions, or want me to re-explain anything?

Genitalia/Anus

• Next is checking baby's genitalia, so are you ok if I remove baby's nappy?

• Femoral pulses are present and equal bilaterally. Femoral pulses indicate there's adequate blood flow to the lower extremities, a weak or absent femoral pulse may indicate an underlying cardiovascular abnormality

 

• I'll now observe baby's genital area

• Hand hygiene, place on gloves before touching genital area

• Your baby girl’s external genitalia appear normal and appropriately formed. The labia are separated, if labial fusion were present a referral for further assessment would be recommended.

• No abnormalities like hymenal tag, or abnormal vaginal discharge noted.

• You may notice a small amount of blood in her nappy; this is sometimes called a 'mini period' which happens due to maternal hormones leaving her body. This is normal and settle on its own within a few days.

 

• Your baby external genitalia appear normal and appropriately formed. Penile size appears appropriate

• No abnormalities like hydrocele, or hypospadias noted.

• Both testes are palpable within the scrotum, if they weren't palpable, it could have indicated undescended testes which requires monitoring or referral for further assessment.

 

• The anus is normally positioned and appears clean and patent

• Remove gloves, perform hand hygiene

 

• Did you have any questions, or want me to re-explain anything?

Spine/back

• I'm now going to check baby's back is it ok if I flip baby over?

• Gently flip baby onto back

• Back of baby's head and neck appears healthy and normally formed, with no obvious abnormalities noted

• And on palpation and inspection the spine feels straight, aligned, and well-formed, no spinal abnormalities are noted.

• This sacral dimple is also normal as I can see the end. If I couldn't see the end or I could see tuft of hair that could indicate spina bifida or another spinal abnormality

 

• I'll now assess the Moro reflex by gently dropping the head slightly while supporting it, baby responds symmetrically by throwing both arms out and then bringing them back in. The response is equal on both sides, which is expected and reassuring of normal neurological function.

• Did you have any questions, or want me to re-explain anything?

Weight

• Ok, shall we check baby's weight now?

• Calibrate weight to zero w/ nappy on, if baby is wearing nappy

• Look or ask about baby's birth weight/ or weight last time checked

• Ok, baby's weight is ___kg

Conclusion

• I'm all done with baby's check, are you ok with me dressing baby, or did you want to?

• Dress baby

• Baby appears to be healthy and developing well

• Did you have any questions or concerns?

• Thank you for your time and allowing me to check baby