| ASSESSING NEWBORNS AND INFANTS
APGAR
NORMAL
SPONTANEOUS VAGINAL DELIVERY (NSVD)
● Infant Weight: 2500-4000 g
The Apgar Score Rates:
● Respiration, crying
● Reflexes, irritability
● Pulse, heart rate
● The skin color of the body and extremities
● Muscle tone
VITAL SIGNS
Temperature:
● 97.5 - 99 F (36.4 - 37.2 C)
● Breathing is easy and Nonlabored
● Respiratory Rate: 30-60 Bmp
Functional Assessment of Newborns,
Infants & Children, Adults/Elderly
● Newborn (APGAR Scoring & Anthropometric
Measurements)
● Infants & Children (MIMDST & some major
developmental milestones)
● Adults/Elderly (PADC, Lawton Scale for IADL,
KATZ index of independence on ADL, Barthel
● Index)
Initial Newborn Assessment
APGAR Scoring
● Provides a numeric indicator of the newborn's
physiologic capacity to adapt to extra-uterine
life
● Assessed at 1 and at 5 minutes after delivery
● each of the five aspects is assigned a
Maximum score of 2
● The maximum achievable total score is 10
● A score under 7 suggests that the baby is
having difficulty
● A score under 4 indicates that the baby's
condition is critical
● Those with very low scores require special
resuscitative measures and care
Anthropometric Measurements
● Weight
● Length
● Head and Chest Circumference
1 | Jearah C. Simbajon N-13
Newborn's Anthropometric Measurement
Weight
● At birth, most babies weigh 2.7-3.8 kg (Kozier
et al) or 2500 to 4000 g (Weber & Kelly)
● After birth, newborns lose 5%-10% of their
birth weight because of fluid loss (normal)
● Regains birth weight in about 1 week
● 5 to 6 months, infants usually reach twice
their birth weight
● By 12 months, an infant's weight is usually 3
times their birth weight
● Weigh the newborn unclothed using a
newborn scale
Length
● Average length varies
● Female babies are usually smaller in length
than male babies
● The rate of increase in height/length is largely
influenced by the baby's size at birth & by
nutrition
● Measure the newborn from head to heel (from
the top of the head to the base of the heels)
Head & Chest Circumference
● Normal head circumference (Normocephaly)
should be assessed in relation to chest
circumference
● The chest circumference of the newborn is
usually less than the head circumference by
about 2.5 cm (1 inch)
● As the infant grows, the chest circumference
becomes larger than the head circumference
● At about 9 or 10 months, head and chest
circumferences are almost the same after 1
year of age, chest circumference is larger.
● A newborn's head circumference is measured
around the skull above the eyebrows
● Measure chest circumference by placing the
tape measure at the nipple line and wrapping
it around the newborn
NEWBORN REFLEXES
● Rooting Reflex
● Sucking reflex
● palmar grasp reflex
● plantar grasp reflex
● Tonic Neck Reflex
● Moro Reflex
● Babinski Reflex
● Stepping Reflex
| ASSESSING NEWBORNS AND INFANTS
2. Passive Immunity
SUBSEQUENT PHYSICAL ASSESSMENTS - resistance of the body to an infection in which
the host receives natural (from mother to her
Developmental Screening Test unborn child through placental transfer) or
artificial antibodies produced by another
Developmental Assessment of source/host.
Infants & Children (MMDST)
● Adopted from Denver Developmental
Screening Test (DDST)
● A screening tool to identify developmental
delays among children from birth to 6 y.o.
● Intended to estimate the abilities of a child
compared to those of an average group of
children of the same age
● not a test of intelligence

4 Main Areas of Development are Screened:

1. Personal- Social
- tasks that indicate the child's ability to get
along with people and take care of himself
2. Fine-motor Adaptive
- tasks which indicate the child's ability to see
and use his hands to pick up objects and to
draw A child's immunization status can be categorized:
3. Language ● Incompletely Immunized
- tasks that indicate the child's ability to hear, ● Completely Immunized
follow directions and speak
● Fully Immunized
4. Gross Motor
*Based on the child’s age*
- tasks that indicate the child's ability to sit,
walk and jump
Assessment of a Pregnant Woman
Assessment of Infants & Children ● Estimating Delivery Date (EDC/EDD)
Immunization Status ● Estimating Gestational Age (AOG/Age of
Gestation
Immunization
● Maternal Assessment (History)
- the process by which resistance to an
infectious disease is produced or augmented
SUBSEQUENT PHYSICAL ASSESSMENTS
Types of Immunity Head Circumference
Abnormal
1. Active Immunity ● Microcephaly
- acquired when a person produces an ● Macrocephaly
antibody in response to an antigen Skin, Hair & Nails
Can either be: Normal
● Physiologic Jaundice
● Natural
● Birthmarks
- exposure and/or recovery from an infection
● Milia
● Artificial ● Harlequin Sign
● acquired through the injection of a small ● Mongolian Spot
amount of attenuated (weakened) or dead ● Vernix Caseosa
organisms (vaccines) or modified toxins from ● Acrocyanosis - blue hand, blue foot
the organism (toxoids) into the body. ● Desquamation
● Cutis Mamorata
● Lanugo
2 | Jearah C. Simbajon N-13
| ASSESSING NEWBORNS AND INFANTS
Abnormal
Abnormal ● Low set ears
● Jaundice ● Abnormal shape
● Cyanosis ● Presence of foreign body or cerumen
● Pallor ● Purulent discharge
● Redness ● Purulent, serous discharge
● Ecchymoses ● Bloody discharge
● Petechiae ● Clear discharge
● Dirty, Matted hair
● Tufts of hair over spine Mouth, throat, nose, sinuses
Normal
Head, neck and Cervical Lymph Nodes ● Epstein’s Pearls
Normal ● Gums appear pink and moist
● Frontanelle ● Teeth may begin erupting at 4-6 months
● Full range of motion ● Tonsils are not visible
● Face normally proportionate & symmetric ● The nose is midline in the face, the septum is
● Neck is usually short with skin folds between straight, and the nares are patent
the head & shoulder during infancy Abnormal
● Cleft Lip Palate
Abnormal
● Very large head Heart
● Oddly shaped head Normal
● One-sided flattening of the head ● PMI 4th left intercostal space, midcostal line
● Third fontanelle Abnormal
● Caput succedaneum ● Cardiomegaly
● Cephalohematoma
● Hyperextension of the head Gastrointestinal
● Limited ROM Normal
● Unusual proportions ● The abdomen is prominent in a supine
● Short, webbed neck position
● Distended neck ● The umbilicus is pink, with no discharge, odor,
● Enlarged or thyroid or palpable mass redness, or herniation
● The cord should have 3 vessels
Eyes ● Normal bowel sounds (10-30)
Normal ● The abdomen is soft to palpation and without
● Inner canthus distance approximately 2.5cm masses and tenderness
● Horizontal slant, no epicanthal folds Abnormal
● Outer canthus aligns with tips of the pinnas ● Inflammation, discharge, and redness of
● umbilicus
Abnormal ● Diastasis recti
● Hypertelorism ● A bulge at the umbilicus
● Sun Setting ● Abnormal insertion of cord, discolored cord, or
● Brushfield Spots two-vessel cord
● A rigid abdomen
Ears
Normal Male Genetalia
● The top of pinna should cross the eye-occiput Normal
line & be within a 10-degree ● Penis normal size for its age, no lesions seen
● No unusual structure or markings should ● Foreskin is retractable in uncircumcised child
appear on the pinna ● Urinary meatus is at the tip of the glans penis
● No excessive cerumen, discharge, lesions, and has no discharge or redness
● excoriations, or foreign body in the external ● Scrotum is free of lesions
canal ● Testes are palpable in the scrotum with the
left testicle usually lower than the right
3 | Jearah C. Simbajon N-13
| ASSESSING NEWBORNS AND INFANTS

Terminology
Abnormal
● Phimosis ● Functional Assessment Activities of Daily
● Paraphimosis Living (ADLs)
● Hypospadias ● Instrumental Activities of Daily Living (IADLs)
● Epispadias ● Psychological function
● Cryptorchidism ● Social functioning
● Hydrocele
● Inguinal Hernia Characteristics of Functional Decline

Female Genetalia ● Chronic conditions increase with age

Normal
● Labia majora and minora are pink and moist
● Newborn's genitalia may appear prominent
because of the influence of maternal
hormones
● Bruises and swelling may be caused by
breech vaginal delivery
- arthritis, HT, heart disease, hearing
impairment, cataract
● Older persons use 1/3 of physician resources,
14 of total medications prescribed, and 2/5 of
hospital admissions
Functional Decline

Abnormal ● 35.6 million over 65 (2002)

● Enlarged clitoris in newborns combined with Who are limited by the chronic condition? (2000 data)
the fusion of the posterior labia ● 26.1% of those 65 - 74 (young-old)
● 45.1% of those 75+ (old-old)
Anus and Rectum ● 73.6% of those 80+ (oldest old)
Normal
● The anal opening should be visible, moist Comorbid Conditions
● Perianal skin should be smooth & free of
lesions ● Acute illness
● Meconium passed within 24-48 hours ● Alteration in nutrition and/or hydration
● Meconium ● Chronic illness
● Delirium
Abnormal ● Dementia
● Imperforate Anus ● Economics
● Environment
Muscuskeletal ● Medications
Normal ● Psychiatric comorbidities- depression
● Feet and legs are symmetric in size, shape & ● Psychological/social stressors
movement
● Extremities should be warm & mobile with Functional Assessment Tools
adequate capillary refill
● All pulses should be strong & equal bilateral Katz Activities of Daily Living (ADL)
Older American Resources & Services Assessment
Abnormal (OARS)
● Palmar Simian Crease
● Polydactyly ● Bathing
● Syndactyly ● Dressing
● Phocomelia ● Toileting
● Hemimelia ● Transferring
● Talipes ● Continence
● Feeding

4 | Jearah C. Simbajon N-13

| ASSESSING NEWBORNS AND INFANTS

APGAR

0 1 2

Activity Flaccid Some Well

Flexion Flexed

Pulse Absent Less More

Than Than
100 100

Grimace No Grimace Cough/

Response Sneeze

Apperance Pale/ Blue Completely

Blue Extremities Pink

Respiration Absent Weak Good

Cry

5 | Jearah C. Simbajon N-13