College of Our Lady of Mt.

Carmel

Care of a Family
With a Newborn
MA. JYRELL BONITO, RN
The family’s new apple of the eye is
already out, and everybody can’t
wait to cuddle and hold the little
angel. Everyone is anxious about
the health of the little one, so it is
best to know the normal profile
and activities of the newborn.
Profile of the
Newborn
NEWBORNS MAY LOOK ALIKE, BUT EACH HAS

THEIR OWN PHYSICAL ATTRIBUTES AND

PERSONALITIES. SOME NEWBORNS ARE FAT

AND SHORT WHILE SOME ARE LONG AND

THIN. THERE ARE NEWBORNS WHO NEVER

GIVE A FUSS WHENEVER THEY ARE CHANGED

OR CUDDLED, BUT SOME CAN CRY IN HIGH

DECIBELS WHENEVER YOU LIFT THEM FROM

THEIR CRADLES.
Profile of the
Newborn
NEWBORNS MAY LOOK ALIKE, BUT EACH HAS

THEIR OWN PHYSICAL ATTRIBUTES AND

PERSONALITIES. SOME NEWBORNS ARE FAT

AND SHORT WHILE SOME ARE LONG AND

THIN. THERE ARE NEWBORNS WHO NEVER

GIVE A FUSS WHENEVER THEY ARE CHANGED

OR CUDDLED, BUT SOME CAN CRY IN HIGH

DECIBELS WHENEVER YOU LIFT THEM FROM

THEIR CRADLES.
The weight of newborns varies according

to their race, genetics, and nutritional

factors.

To determine if the newborn’s weight is

appropriate for its gestational age, a

neonatal graph should be used in plotting

the newborn’s weight.

Plotting the height and head

circumference of the newborn also helps

determine any disproportions.

The median birth weight was about 3,000

grams. In other words, half of the

newborn babies weighed at least 3,000

grams. (PSA)

The average birth weight for a mature

female newborn in the United States is

3.4kg or 7.5 lbs, and for a mature male,

the newborn is 3.5 kg or 7.7 lbs.

For all races, the normal weight is 2.5 kg

or 5.5 lbs.

The newborn loses 5% to 10% of its birth

weight during the first few days of life,

then has 1 day of stable weight, and

gains weight rapidly afterward.

The newborn must gain 2 lbs per month

for the first six months of life.

The average birth length of mature

female newborns is 53 cm or 20.9 inches.

The mature male newborn has an average

birth length of 54 cm or 21.3 inches.

A mature newborn has a head

circumference of 34 to 35 cm.
Head circumference is measured with a

tape measure drawn across the center of

the forehead and around the most

prominent part of the posterior head.

The chest circumference in a mature

newborn is 2 cm less than the head

circumference.

Chest circumference is measured at the

level of the nipple using a tape measure.

Vital Statistics
Vital Signs
Adjustment to
Extrauterine Life
The newborn’s color on the first 15 to 30 minutes of life is still

acrocyanotic, and after 2 to 6 hours, there are quick color

changes that may occur with movement or crying.

The temperature within the first 15 to 30 minutes after birth falls

⁰ ⁰
from the intrauterine temperature of 100.6 F or 38.1 C then

⁰
stabilizes at 37.6 C after 2 to 6 hours.

The rapid heart rate of as much as 180 BPM on the first 15 to 30

minutes of life will have wide swings in rate with activity as it

slows to 120-140 BPM.

Adjustment to
Extrauterine Life
The newborn’s respirations are irregular in the first few minutes of life,

then slows to 30-60 breaths per minute after 30 minutes and will

become irregular again only during activity.

The newborn would be alert in the first 15 to 30 minutes of life, and

later on, will alternate between the sleeping and awakening phases.

Just a few minutes after birth, the newborn would respond to

stimulation vigorously but would be difficult to arouse while it is still

on a resting period until it becomes responsive again 2 to 6 hours

after birth.

The bowel sounds can be heard after the first 15 minutes of life and

becomes present afterward.

Appearance of the
Newborn
Increased concentration of red blood cells in newborns,

and decreased amount of subcutaneous fat gives them a

ruddy complexion.

In the first month, this ruddy complexion slightly fades.

A pale and cyanotic newborn signifies that she may have

poor central nervous system control.

A gray color in newborns may indicate infection.

Appearance of the
Newborn
Acrocyanosis is normal in a newborn, wherein the hands, feet, and

lips are bluish in color.

Central cyanosis, however, is a cause for concern as this may indicate

a decrease in oxygenation.

Jaundice appears on the second or third day of life as a result of the

breakdown of fetal red blood cells.

Early feeding to speed the passage of feces through the intestine

and prevent reabsorption of bilirubin from the bowel may diminish

physiologic jaundice.

Pallor in newborns is a sign of anemia, and the newborn must be

watched closely for signs of blood in the stool or vomitus.

Appearance of the
Newborn
Harlequin sign or when a newborn who is lying on his or her side

appears red on the dependent side and pale on the upper side does

not have a clinical significance.

Vernix caseosa or the white cream cheese-like substance is washed

away in the first bath, but never rub harshly as it will only come off

gradually.

Lanugo or the fine, downy hair that covers the shoulders, arms and

back of the newborn would be rubbed away by the friction of the

bedding and clothes of the newborn.

A white, pinpoint papule called milia can be found in some

newborns, mainly on the cheek or the bridge of the nose, and they

disappear by 2 to 4 weeks of age.

Appearance of the
Newborn
The fontanelles or the spaces or openings where

the skull bones join are soft spots on the newborn’s

head.

The anterior fontanelle is located between the

two parietal bones and the two frontal bones

which gives it a diamond shape, and normally

closes at 12 to 18 months of age.

The posterior fontanelle is located at the

junction of the parietal bones and the

occipital bone and is triangular in shape, and

closes at the end of the second month.

Appearance of the
Newborn
Newborns cry tearlessly until three months of age when the lacrimal ducts mature.

Birthmarks

Hemangiomas are vascular tumors of the skin.

Nevus flammeus are muscular purple or dark red lesion. Generally appear on the face and thighs.
Strawberry hemangiomas—elevated areas formed by immature capillaries and endothelial cells.
Cavernous hemangiomas—these are dilated vascular spaces.
Mongolian spots—slate gray patches across the sacrum or buttocks and consist of a collection of

pigment cells.

Forceps marks—these are circular or linear contusion matching the rim of the blade forceps on the

infant’s cheeks.
Appearance of the
Newborn
Permanent eye color appears on the 3rd to 12th month of age.

The newborn’s external ear is not yet fully formed, and the top part of the external ear should be on

a line drawn from the inner canthus to the outer canthus of the eye and back across the side of the

head.

The newborn’s nose tends to look large for the face but the rest of the face will grow more than the

nose does.

The newborn’s mouth must open evenly when he or she cries.

Newborn
Reflexes
Watching newborns with their odd-

timed kicking is a wonderful sight of

life inside the hospital. They are like

bundles of nerves waiting for nurses

and doctors to touch them so they can

begin their little spontaneous dance

with occasional twitching and flailing.

These involuntary movements that

newborns exhibit when stimulated are

called newborn reflexes.

These reflexes aid newborns to survive

while they have limited control over

their body. These also provide health

clues, which is why assessment of the

neuromuscular function is part of the

general newborn examination. Specific

focus should be given to newborns’

alertness, muscle tone and strength,

head control, and response to

manipulation and handling.

Simple
Maneuvers
for 11
Newborn
Reflexes
Blink Reflex
Blink reflex is the rapid eye closure exhibited by

newborns upon coming of objects near it.

Similar with adults, this reflex serves a

protective function against hurting the eye. It

can be elicited by shining a strong light (e.g.

flashlight, otoscope light, etc.) on the eyes. Blink

reflex can also be elicited by a sudden

movement of an object towards the eye. This is

important in assessing newborns’ visual

attentiveness.
Rooting Reflex
Brushing the cheek or stroking near the mouth of the

newborn will cause the head of the newborn to turn

to that direction. This reflex is called rooting reflex,

which helps the baby find the source of food. For an

instance, during breastfeeding, when the mother

allows her breast to brush the cheek of the newborn,

this allows the newborn to turn to its direction and

begin sucking. However, this reflex disappears on

the sixth week because by that time, the baby is

able to steadily focus on a food source.

Sucking Reflex
Touching the newborn’s lips causes the baby to

make sucking motions. Like rooting reflex, sucking

reflex helps the baby find food. For an instance,

when the lips of the baby touch the mother’s breast

or a bottle, the baby would begin sucking and so

food is taken in. Sucking reflex disappears at six

months of age
Extrusion
Reflex
Until four months of age, any food placed on the

anterior portion of the tongue of babies will be

expelled by them. This serves a protective function

by preventing the baby from swallowing substances

that are toxic or poisonous. This is also the reason

why complementary feeding or introduction of solid

food is done at about six months of age.

Palmar Grasp
Reflex
Objects placed on newborns’ palms will be grasped

by newborns. They tend to close their fingers on

these objects and sometimes their grasps are so

strong that they can be momentarily raised from

supine position through this reflex. Palmar grasp

reflex disappears between six weeks to three

months.
Walk-in-Place
Reflex
If newborns are held in a vertical position with their feet

touching a hard solid surface, newborns will take few,

alternating steps. This can last until three months of age, the

time where they start to bear a good portion of their weight

without being hindered by this reflex.

An almost similar reflex to this is called placing reflex. However,

the major difference lies in the manner of eliciting it. The

anterior surface of the newborn’s lower leg is made to touch the

edge of a bassinet or a table. Then, the newborn makes few

lifting motions as if to step onto the table.

Tonic Neck Reflex

Turning a newborn’s head to one side will cause the extremities

to on that side extends while the opposite extremities contracts

or flexes. This is also called boxer of fencing reflex because of

the position of the newborn. Of all reflexes, this is the one which

appears to have no function. However, it is being linked to eye

stimulation and handedness. This disappears between 8-12

weeks.
Moro Reflex
There are many ways to elicit Moro reflex. However, the most common method used is the “drop

method” wherein the nurse lifts the baby completely off the bed while supporting the head and the

neck, and then the nurse lowers the baby rapidly till there is only 4-8 inches between the baby and the

bed. It is important to note that while doing this, the baby is kept in supine position. Complete Moro

reflex involves bilateral abduction of arms, extension of forearms, and full opening of hands. This is

then followed by slow return of hands towards the midline and then followed by curling of the fingers.

Startle reflex is different from Moro reflex in the sense that it lacks full extension and hand opening

and can be elicited spontaneously by sudden noise or movement.

Babinski Reflex
When the nurse strokes the sole of the foot in an inverted “J”

curve from the heel upward, the newborn’s toes fan. It is only in

newborns that positive Babinski reflex is considered normal. It

normally disappears after the 3rd month.

Reflexes of spinal
cord integrity
There are three reflexes to test spinal cord integrity of

newborns. First on the list is magnet reflex, which can be

elicited by applying pressure on the soles of the foot of

newborns lying in supine position. As a response, the newborns

would push back against the pressure.

Reflexes of spinal
cord integrity
The second reflex to test spinal cord integrity is called crossed
extension reflex. This is exhibited by the newborn in supine
position by raising his other leg and extending it when the other

leg is extended and, the sole of that foot is irritated or rubbed

by a sharp object (e.g. thumbnail). This is like the act of the

newborn trying to push the hand away that irritates the other

leg.
Reflexes of spinal
cord integrity
Lastly, newborns lying in prone position would flex their trunk

and swing their pelvis towards the direction of the touch when

their paravertebral area is touched by a probing finger. This

reflex is called trunk incurvation reflex.

Landau Reflex
Babies will exhibit some degree of muscle tone if they were

made to lie in a prone position with the nurse’s hand supporting

the trunk. While they are not expected to raise their head or

arch their back in this position, babies who will sag into an

inverted “U” position show extremely poor muscle tone. In such

cases, further assessment and management is needed.

It is essential for nurses to
master these simple maneuvers to
promote health and safety of
newborns. Neuromuscular
dysfunctions can signal a lot of
serious health problems like spinal
cord injury, neonatal sepsis, and
even inborn errors of metabolism.
Through these simple maneuvers,
health problems can be detected
early and medical interventions
will be instituted right away.
ANY QUESTIONS?