• 8-week check: CVS (murmurs e.g. PDA)

Question

Which of the following necessitates an URGENT referral? 

1. Unilateral red reflex

2. Unilateral tearing

3. Umbilical hernia

4. Preauricular skin tag

5. Stridor that changes with position and activity

Any red reflex asymmetry needs immediate referral. Unilateral tearing can be due to nasolacrimal duct obstruction and can be treated by inner canthic massage; if it persists beyond 12 months then referral is required. Preauricular skin tags can be removed for cosmetic reasons but this would not warrant an urgent referral.

Stridor that changes with position and activity is likely to be laryngomalacia and, as long as the baby is feeding and growing adequately, the parents should receive reassurance. Umbilical hernias often spontaneously regress and do not need referral unless they remain to the preschool years.

Resources

• Newborn and infant physical examination programme handbook (PHE)

• Newborn and infant physical examination screening: programme overview (gov.uk); Newborn physical examination (NHS Choices); Newborn hearing screen (NHS Choices)​

• Your baby's health and development reviews (NHS Choices)

• UK-WHO growth charts - 2-18 years (RCPCH)