Baby's First Checks: Apgar Score, Heel-Prick Test and Hearing Screening

Baby has just been born, laid on your belly, and already the midwife is watching, counting, noting. Then come the weighing, the paediatrician's examination and, over the next days, a prick on the heel for the Guthrie test and a small device slipped into the ear. These checks follow one another fast, often without anyone explaining what they are for.

Yet their aim is simple: to check that baby is adapting well to life outside the womb, and to spot very early a few rare conditions that are easy to treat when caught in time. Here, in order, is what is done at birth and in the first days, what exists in Morocco, and how to keep track of it all in the health record.

The Apgar score, in the first minutes

This is baby's very first "mark", given without disturbing them, often while they lie on you. The team assesses five criteria, each scored from 0 to 2:

The score is calculated at 1 minute and 5 minutes after birth (American Academy of Pediatrics). The Moroccan health record also has a box for 10 minutes. Most newborns score above 7. Between 5 and 7 at one minute, baby may have been a little short of oxygen during the birth and needs a helping hand; a score below 5 is rare.

Above all, the Apgar score measures adaptation to birth, not the future: it cannot predict your child's health or development.

The newborn examination and first care

In the hours that follow, baby is weighed and measured (length, head circumference), then examined from head to toe. The child health record published by the Ministry of Health details what must be checked: skin, head, belly, heart, breathing, reflexes, hips, feet, eyes, genitals, and the search for malformations such as a cleft lip or clubfoot.

Several items of care are listed in the same record: vitamin K, eye care, cord care and the first dose of the hepatitis B vaccine. BCG and the other vaccines follow the schedule presented in our article on the vaccination schedule in Morocco.

Vitamin K prevents a deficiency that can cause bleeding in newborns. At the CHUV in Lausanne, it is given by mouth in three doses: at birth, on day 4 and at 1 month. The form and rhythm vary between countries and maternity units; ask what is planned for your baby, and what remains to be done after discharge.

Pulse oximetry, carried out for example at the CHUV between 6 and 24 hours of life, means placing a sensor on the foot to measure oxygen in the blood. Painless, it complements the heart examination to spot a serious heart malformation.

The paediatrician also watches for jaundice, common in the first days (see our article on newborn jaundice), weight loss, which can reach 10% of birth weight before being regained around 7 to 10 days, and the first stools and urine. The whole stay is described in our article on the first days at the maternity unit.

The Guthrie test: what is the heel prick for?

The Guthrie test, also called newborn blood spot screening, consists of taking a few drops of blood from baby's heel and placing them on blotting paper, which is then sent to the laboratory. It looks for rare conditions, invisible at birth, that can seriously affect development if not treated early (CHUV).

When? Ideally between day 3 and day 5 of life, say the authors of a Moroccan study. It is done on day 4 at the CHUV, and around day 5 in the United Kingdom.

Which conditions? The list varies from country to country. In the United Kingdom, the NHS screens for ten, including:

• congenital hypothyroidism (an underactive thyroid);
• phenylketonuria and several other metabolic diseases;
• cystic fibrosis;
• sickle cell disease.

And the results? In most cases, no condition is suspected. Otherwise, the family is contacted for a check; a repeat sample does not necessarily mean there is a problem (NHS).

In Morocco: what exists for hypothyroidism and hearing

Congenital hypothyroidism. This is the condition that most justifies screening: an affected baby often looks normal at birth, but without treatment their development can be seriously harmed. A pilot study carried out between 2001 and 2003 in Fez and Sefrou, among 15,615 newborns, found one case per 1,301 births, and its authors concluded that a national screening programme was justified (Eastern Mediterranean Health Journal, 2018). The child health record includes a "hypothyroidism screening" box among the examinations of the first two months.

As of October 2026, we have not found an official source confirming that this blood screening is offered to every newborn, in every maternity unit in the country. So ask your maternity unit, public or private, whether it is done on site, on which day, and what to do if you leave early. The paediatrician can arrange it at a laboratory if needed.

Hearing. The Ministry of Health institutionalised a national newborn hearing screening programme in October 2022, officially launched in April 2023 at the Abderrahim Harouchi mother-and-child hospital in Casablanca (Médias24). The first phase planned to equip 21 maternity units in the Casablanca-Settat region with otoacoustic emission devices, with two pilot regions. Ask whether your maternity unit is part of the programme or offers the test.

The newborn hearing test in practice

The most common test measures otoacoustic emissions: a small tip placed in the ear emits a sound, and the device records the echo sent back by the inner ear, proof that baby heard it (CHUV). It lasts a few minutes, does not hurt and is ideally done while baby sleeps.

A first abnormal result is not necessarily accurate: fluid or earwax can interfere with the measurement. The test is then repeated the next day; if the abnormality persists, a check is arranged with a child hearing specialist. The very aim of the Moroccan programme is early diagnosis and suitable care.

The health record: write everything down

The child health record follows baby from the birth room to adolescence. Before discharge, check that the birth page is filled in: weight, length, head circumference, Apgar score, care received, vaccines given, screenings done or still to do. To understand each page, see our article on the child health record in Morocco, and for the follow-up, our guide to choosing a paediatrician.

A cover protects the record from spilt bottles and trips to the health centre; it also lets you keep prescriptions and results together. You will find several models in our health record covers section.

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