THE IMPORTANT

MEASUREMENTS
HEAD CIRCUMFERENCE
Normal measurement: 33 to 35 cm (13 to 14
inches). In vaginal delivery, molding may
reduce head circumference (HC) immediately
after birth but it will return to normal size after
two to three days. The HC is actually the
occipitofrontal circumference (OFC).
Comparison to other measurements:
It is approximately equal to crown-rump length (CRL)
or sitting height which is about 31 to 35 cm in term
infants. The relationship of HC to CRL is more
reliable in identifying in high risk infants than that of
the head and chest.
The HC is usually greater than chest circumference
(CC) by 2 cm.
The head is one fourth of the total body length; this is
because the head of the newborn is proportionately
larger than the head of the adult
During the first four months, HC increases by
half an inch a month and in the next 8 months,
by one fourth inch a month.

Measure HC at the level of eyebrows to the

most prominent portion of the infant’s head
with the use of a tape measure. Measure it after
birth, then after 48 hours because molding and
caput succedaneum may misshape the head
making the first measurement inaccurate.
Take note of the following changes in the head
circumference:
At birth HC may be equal or greater than CC due
to molding.
After 2 to 3 days, HC is greater than CC by 2 to 3
cm.
After six months, HC is equal to CC.
After 1 year, HC is less than CC.
 . Abnormal findings:
HC less than 32 cm is indicative of
microcephaly in term infants.
HC that is 4 cm and greater than CC or
more than 37 cm is indicative of neurologic
involvement such as hydrocephalus.
 
CHEST CIRCUMFERENCE
Normal CC range from 30.5 to 33 (12 to 13
inches), usually 2 cm less than HC.
The CC is measured at the level of the nipple
using a tape measure.
A CC less than 30 cm indicates prematurity.
An enlarged heart may make the left side of
the chest larger.
ABDOMINAL CIRCUMFERENCE
Abdominal circumference (AC) is
approximately the same as chest circumference.
It is measured just above the level of the
umbilicus. It is no longer recommended to
measure AC below the level of the umbilicus
because a full bladder may interfere with
accurate measurement.
AC is not routinely measured unless there is a
suspicion of abdominal distention due to
obstruction in the gastrointestinal tract. The
neonate’s abdomen usually enlarges after a
feeding due to lax abdominal muscle.
WEIGHT
Birth weight of full term newborn infants range from 6
to 8.5 lbs. or 2700 to 4000 g. Average is 3500 g. Birth
weight should be recorded immediately after birth
because weight loss occurs rapidly in newborns.
The average female infant birth weight is around 7
lbs. while that of male infant is around 7.5 lbs. Boys is
usually heavier than girls by 100 g or 3 ounces. The
average birth weight of Filpino infants is 3000 grams.
Physiological Weight Loss – Newborns loss about 10%
(6 to 10 oz) of their birth weight during the first 3 to 4
days of life due to:
 Excretion of fluids through the lungs, urinary bladder
and bowels
 Passage of meconium
 Withholding of calories and fluids immediately after
birth
 Minimal food intake because sucking is not yet
established and colostrum contains less calories than
mature milk
 Weight Gain
 Generally, breastfeed infants regain their birth
weight within 10 days and formula fed infants
within 7 days.
 Birth weight doubles at 5-6 months and triples at one
year. By 2 years of age, expected weight gain is four
times the birth weight.
 Infants generally gain approximately 20 to 25 grams
per day or 150 to 210 g weekly during the first five
months of life. And about 15 grams (6 to 8 oz
weekly) from 6 months to 1 year.
Keep in mind the following changes in weight of
different ages:
5-6 months --- 2X birth weight
1 year --- 3X birth weight
2 years --- 4X birth weight
3 years --- 5X birth weight
5 years --- 6X birth weight
7 years --- 7X birth weight
10 years --- 10X birth weight
Computation of Expected Weight Gain:

Term infants = (age in days – 10) X 20 + 3000

grams
10 – Term infants takes 10 days to regain birth weight
20 – A weight gain of 20 grams/day is expected during
the first 5 months
Computation of Expected Weight Gain:

Pre-term infants = (age in days – 14) X 15

14 – Pre-term infants takes 14 days to regain their
birth weight
15 – Amount of weight gain each day
Computation of Expected Weight Gain:

 infants below 6 months old:

Weight in grams = age in months X 600 + birth
weight
 6 months to 12 months:
Expected weight in pounds = Age in months + 10
Weight in grams = Age in months X 500 + birth
weight
Computation of Expected Weight Gain:

 1-6 years: weight in kg = age in years X 2 + 8

 6-12 years: weight in kg = age in years X 7 – 5
2
When assessing birth weight, remember that:
a.Birth weight is affected by race, nutrition,
intrauterine conditions and genetic factors.
b.Birth weight increases with each succeeding
child in the family.
c.Plotting birth weight in a neonatal graph helps
to identify newborns at risk because of their
small or too large size.
d. Weight should be compared with height and
head circumference to see any disproportion that
indicates risk conditions. For example, a child’s
head circumference may be too large for his birth
weight and height causing the caregiver to suspect
for possible hydrocephalus.
e. The infant should be weighed not wearing a
diaper. If a diaper is in place, subtract the weight of
the diaper from the total weight.
f. The same weighing scale should be used every time
the infant’s weight is measured to prevent inaccuracies.
g. If the infant is being weighed on a bed that has a
built-in scale:
It is important to remove any extra sheets, toys or
diapers
When weighing the critically ill neonate, lift the
intravenous infusion lines, as well as other pieces of
equipment such as ventilator tubing, so they do not
cause an inaccurately high weight
Abnormal Findings:
Birth weight less than 1000 grams for term
infants is considered extremely low birth
weight
Birth weight less than 1500 grams in term
infants is considered very low birth weight
Birth weight less than 2500 grams for term
infant is called Small for Gestational Age
(SGA) infant in term infants.
Birth weight more than 4000 grams is known
as Large for Gestational Age (LGA) infant.
Infant may be born of a diabetic mother.
Weight loss of more than 10% of birth
weight.
CONVERTING grams to pounds and ounces:

1 lb. = 453.59237 grams

1 oz. = 28.349523 grams
1000 g = 1 kg
LENGTH
1.Newborn average head to heel length is 45 to 55 cm (18
to 22 inches)
2.Average is 50 cm.
3.Female infants generally are 1/2 inch shorter than male
infants. The average length of boys is 20 inches or 50
cm and girls, 19.6 inches or 49 cm.
4.The height or length of the newborn increases by 2.5 cm
or 1 inch a month from 1 to 5 months and 1.25 cm from
6 months to 1 year.
Remember that similar to weight, the rate of
growth diminishes as the infant grows older.
Total average increase in length during the first
year of life is 25 cm distributed as follows:
From birth to 3 months – 9 cm
From 3 to 6 months – 8 cm
From 6 to 9 months – 5 cm
From 9 to 12 months – 3 cm
Formula for expected height:

Height in cm = age in years X 5 + 80

Height in inches = age in years X 2 + 32
OR
Height in inches = age in years X 2 ½ + 30
Remember that:

At 1 year – 30 inches of 1 ½ birth length

2 years – ½ of mature height in boys
3 years – 3 feet tall
4 years – 40 inches or 2X birth length
13 years – 3X birth length
Measure newborn length from top of the head to
heel using a tape measure. Extending the
neonate’s leg to its fullest extension and then
recording the length from crown of head to heel
is the most accurate way to measure length. One
person should hold the infant’s in place while
the other completes the measurements.
An adjunct to crown-heel measurement is the
crown-rump measurement. This particular
assessment is useful in determining anatomical
abnormalities such as dwarfism.

A length of less than 47 cm is a sign of

prematurity.
VITAL SIGNS
It is recommended that the newborn vital signs
are measured:

On admission to the nursery

Every 30 minutes until the condition of the
newborn is stable for at least two hours
Every eight hours until discharged
TEMPERATURE
Characteristics of Newborn Temperature
1.Heat regulation is the second most important task a newborn
must achieve after birth. Heat regulation is achieve by
maintaining a balance between heat loss and heat production.
2.The average newborn temperature at birth is around 37.2ºC.
It is not unusual for the temperature to fluctuate during the
first few hours after birth due to immature temperature
regulating mechanism but it should stabilize within 10 hours.
If chilling is prevented, newborn temperature stabilizes
within 4 hours after birth.
3. The average newborn axillary temperature – average
37ºC. Rectal temperature is 0.2 to 0.8ºC higher.

4. Heat loss in newborns occur in four ways:

Convection – the flow of heat from body surface to the
cooler surrounding air. Air conditioner and drafts cause
heat loss by convection so keep newborn warm by
wrapping her in warm blanket and by maintaining
nursery ambient temperature at 24ºC or 75ºF.
Radiation – transfer of heat to cooler objects or surfaces
not in contact with the body. Cold window surfaces or
examining tables although not in contact with the
newborn but located near the newborn creates heat loss
by radiation. This type of heat loss can be prevented by
moving the newborn away from cold objects.
Evaporation – loss of heat due to conversion of liquid to
vapor. Wet newborns loss a great amount of heat when
the amniotic fluid in their skin evaporates. Wipe newborn
dry immediately to prevent heat loss by evaporation.
Conduction – loss of heat by way of cooler
surfaces in contact with the body. This occurs
when newborn is placed on a cold crib, weight
scale or counter.
Newborns loss heat easily because:
a.They have immature temperature regulating system. In
fact, they are not capable of shivering (employed by
adults to increase metabolic rate to be able to produce
more heat).
b.Of very little amount of subcutaneous fat to provide
heat in their body.
c.They have a larger body surface area that results in
more heat loss. Newborn loss heat four times than the
adult for this reason.
a.They have little ability to conserve heat by changing posture and
no ability to adjust own clothing in response to thermal stress.
b.They tend to take on the temperature of their environment; this
means that newborns can become hypothermic or hyperthermic
easily depending on the temperature of the environment. For
example, exposure to cold environment can cause cold stress
(hypothermia) which can lead to metabolic acidosis, this can be
lethal even to normal newborn infants. The neonate increases
metabolic rate to produce heat when exposed to cold. This requires
oxygen and glucose. Too much cold exposure depletes oxygen and
glucose in the body resulting in acidosis and hypoglycemia.
 Newborns can conserve heat by:

a.Constricting blood vessels

b.Moving blood away from the skin
c.Burning brown fat which is most abundant in
the intrascapsular region, thorax and perineal
area
 Newborn produced heat by:
a.Increasing muscular activity such as by
kicking and crying which also increases
metabolic rate and respiratory rate. Immature
newborn with poor lung development may not
be able to use this mechanism of heat
production.
a.Burning brown fat – present only in newborns,
begins to form at 17 weeks of gestation, the less
mature the infant the less brown fat.
c. Increasing metabolic rate which consequently
increases the need for oxygen. Inability to meet this
increased oxygen requirement could lead to
hypoxemia (decreased amount of oxygen in the
blood) because oxygen is being utilized for heat
production. The shivering mechanism in infant is
underdeveloped
 Baby’s temperature can be assessed with reasonable
precision by touching with dorsum of hand over the
abdomen, hands and feet.
 In newborn, abdominal temperature is representative of
the core temperature.
 When feet are cold and abdomen is warm, it indicates that
baby is in cold stress.
 In hypothermia, both feet and abdomen are cold to touch
(Taken from: Essential Newborn Nursing for Small Hospitals Learner’s Guide, WHO
Collaborating Centre for Training and Research in Newborn Care, All India Institute
of Medical Sciences, New Delhi, 2004)
Method of Temperature Assessment
1.The method of choice when obtaining the
temperature of the children below 6 years old
is the axillary because it is safer, more
accessible and convenient. Place the
thermometer in the axilla for 5 minutes and
hold the hands over the abdomen to keep the
thermometer in place.
2. In the past the initial temperature of the newborn is
taken rectally to assess patency of the anus at the same
time. Nowadays, waiting for the passage of meconium
within the first 24 hours after birth is the preferable
method of assessing anal patency.
3. The glass mercury thermometer is still considered as
the gold standard in taking the newborn temperature. It
should be placed5 minutes when taking axillary
temperature and for 3 minutes when taking rectal
temperature.
4. When taking newborn temperature, it is
important to remember that radiant warmer may
falsely increase axillary temperature and crying
may slightly increase body temperature.
Physiologic Fever 
1.Transient fever on the 2nd to 4th day usually
occur secondary to fluid loss and poor intake
of milk because of inability to suck well.
2.This is characterized by sunken fontanel, dry
skin and decreased urinary output. The infant
recovers from this fever once fluid intake is
increased and feeding is established.
Hypothermia
1.Hypothermia occurs when the body temp. drops
below 36.5 ºC. The newborn infant is most
sensitive to hypothermia during the stabilization
period in the first 6-12 hours after birth.
2.Effects of hypothermia:
 Acidosis – increased metabolic rate results in
increased production of carbon dioxide and
metabolic waste products results in acidosis.
 Hypoxemia – oxygen is utilized for increase
metabolism in order to produce more heat instead of
being used for oxygenation of cells and tissues.
 Hypoglycemia – increased metabolic rate increase
glucose utilization resulting in depletion of glucose
stores and lowering blood glucose levels.
 Water is used to lower body temperature but in an
effort of the body to prevent heat loss, there occurs
renal excretion of water and solute to prevent more
heat loss thus depleting fluid stores in the body and
altering the fluid and electrolyte balance.
3. Important immediate interventions for
hypothermia include:
 Inform the doctor immediately
 Remove the wet cloth
 Place the baby under the heat source
 Encourage breastfeeding
 Start oxygen administration if the baby has
respiratory distress or cyanosis
 Due to risk of burning the neonate, avoid using
hot water bottle for (re)warming the baby.
Hypothermia and hyperthermia (above 37.5ºC)
can be both sign of sepsis. If the newborn has
been in a stable temperature environment with
fairly constant temperature readings but begins
to have fluctuating temperature readings (low,
high or both), inform the doctor for evaluation.
 Hyperthermia
1.The newborn is also at risk of hyperthermia which
is a temperature above 37.5ºC. Although not as
common as hypothermia, hyperthermia can be as
equally dangerous.
2.Common causes of hyperthermia:
 Too hot external environment
 Too many covers or clothes on baby
 Infection
 Signs and Symptoms of hyperthermia:
 Irritability, fussy
 Abdomen and extremities are very warm to
touch
 Red flushed skin
 Hot and dry skin
 Lethargy
 Stupor, coma, convulsion for temp above 41ºC
Interventions for hyperthermia:
 Place the newborn in a cool environment (25 to
28ºC), and keep away from sources of heat such
as direct sunlight
 Undress the newborn partially or fully, if
necessary.
 Give frequent breastfeeds.
 Measure the newborn’s axillary temp every hour
until it is in normal range.
 If the body temp is very high (>39ºC), sponge
the baby with tap water. Do not use cold or ice
water for sponge
 If the newborn has been under the radiant
warmer reduce the temp setting until temp
becomes normal
 Examine the infant for infection
RESPIRATORY RATE
Characteristics of Newborn Respiration:
1.Range from 30 to 60 breaths per minute
2.Respiratory Rate (RR) slows down during the
infancy period
3.The respiratory environment is abdominal or
diaphragmatic in nature, the chest and abdomen
should rise at the same time, and this is carried on
during the infancy period.
1.Periodic respiration – With short periods of
apnea, should not be longer than15 seconds
and not accompanied by cyanosis
2.Loud and clear upon auscultation
3.Respiration is irregular and shallow
4.RR increases with sensory and tactile
stimulation
1.Newborns are obligate nose breathers. Unlike
the adult, the newborn does not open his
mouth to breath through it when the nose is
obstructed. Keep nose clean and patent.
2.Infant is more at risk to develop infection than
the adult because:
 Inability to produce IgA in the mucosal lining
 Short and straight eustachian tube can easily
transmit infection from the pharynx to the
middle ear
 Closeness of the trachea to bronchi and its
branching structures can easily transmit
infection
Signs of Respiratory Distress:
1.Nasal flaring
2.Chest retraction, indrawing of the chest when
breathing
3.See-saw respiration – indrawing of the chest
and rising of the abdomen during inspiration.
1.Cyanosis other than the hands and feet. Cyanosis of
the hands and feet should disappear when the infant
cries. If the infant turns blue while crying, this is
abnormal.
2.Respiratory grunting – noisy respiration
3.More than 50 (tachypnea) and less than 30
(bradypnea) breaths per minute. Anaesthetics and
analgesics given to the mother during labor tend to
slow down respiration of the newborn because of their
depressant effect.
1.Adventitious Chest Sounds in newborns:
 Rhonchi – a coarse snoring sound caused by air passing
through mucus in a major air passage, this is usually
normal during the first 24 to 48 hours in a newborn infant
 Rales – crackling sound caused by air passing through
the fluid filled alveoli. It may be a manifestation of
unabsorbed lung fluid and pneumonia
 Stridor – a high crowing sound (rooster-like) heard on
inspiration caused by narrowing of the air passages. It
may be a sign of beginning obstruction.
 Wheezing – a whistling sound heard on inspiration
caused by air being pushed through narrowed
bronchioles. May be a sign of obstruction.
 Grunting – a grunt heard on inspiration caused by
air pushed through a partially closed glottis. May
be a sign of respiratory distress syndrome.
 Absent/diminished breath sounds occur when air is
not entering a lung or lobe of a lung on one side.
May be a sign of atelectasis.
HEART RATE
1.Full term infants have heart rate that ranges from
120 to 150 bpm approx. the same as FHR. It may go
down as slow as 80 bpm when infant is asleep and
may go up to as high as 160 bpm when he is
vigorously crying. It slows down during infancy
period
2. Rhythm is char. as sinus arrhythmia, rate increasing
with inspiration and decreasing when expiration.
3. Newborn heartbeat is often irregular and heart
murmurs may be heard until 6 months of age.
4. Take apical pulse and respiratory rate first
while he is asleep to obtain accurate results.
Take temp last as the infant may struggle with
the placement of thermometer in the axilla.
BLOOD PRESSURE
1.BP at birth is approx. 80/40 mmHg rising to 100/50
mmHg by the 10th day of life. In the 1st week of life, BP
may be slightly higher in lower extremities than the
upper.
2.Pulse pressure is obtained by subtracting the diastolic
pressure to the systolic pressure. For the term infant a
wide PP is 25-30 mmHg and in pre-term, is 15-25 mmHg
3.BP is not routinely measured in newborns unless a
cardiac anomaly is suspected or present.
4. Systolic pressure increases during the first 2
months and diastolic pressure during the first 3
months before gradually rising again.
5.Abnormal finding: Calf systolic pressure 6-9
mmHg than systolic pressure in upper
extremities may be indicative of coarctation of
the aorta.
HEAD
The newborn’s head is disproportionately larger
than the body because it is about one fourth of
the total body length compared to being one
eight only in adult.
FONTANELS
1. Fontanels, also known as soft spots, are spaces located at the
areas where skull bones meet. The most prominent fontanels
that are important to assess are the:
 Anterior Fontanel (Bregma) – located at the junction of the
two parietal bones and fused frontal bones. It is diamond
shaped, about 3 cm long and 2 to 3 cm wide. The anterior
fontanel closes at 12 to 18 months of age.
 Posterior Fontanel (Lambda) – located at the junction of
parietal and occipital bones. Begins to close at 2 months of
age. Measures at about 0.5 to 1 cm in length. It may be so
small in some newborns that it cannot be felt.
Fontanels are usually flat, soft and firm and may
pulsate. They tend to bulge when the infant
strains when passing stool, crying vigorously or
coughs.
 Abnormal Findings:
Very large fontanels may indicate
hypothyroidism
Bulging fontanel may indicate increased
intracranial pressure
Sunken fontanel is a sign of dehydration
Abnormally small fontanels or suture lines
that do not override or have spaces
SUTURE LINES
Sutures or suture lines are membrane covered spaces
between skull bones. The four suture lines that can be
palpated are:
1.Frontal Suture – can be palpated midline above the
eyes running up the forehead and ending at the
anterior fontanel.
2.Coronal Suture – can be palpated from the anterior
fontanel running down the side of the head along the
forehead line towards the ears.
3.Sagittal Suture – can be palpated running
midline between the anterior and posterior
fontanel.
4.Lambdoid Suture – can be felt from the
posterior fontanel running down the head above
the occiput towards the area behind the ears.
MOLDING
1.In vaginal delivery, the cranial bones in the part of the head
that enters the cervix molds to decrease the diameter (size) of
the head and be able to fit in the birth canal. This is achieved
by the sliding and overlapping of cranial bones to each other.
This overlapping is called molding and it cause the newborn to
become cone-head in appearance, the head flattened over the
forehead and rises to a point of the posterior of the skull over
the occiput. Molding is generally symmetrical in nature. This
change in the contour of the head of the newborn is expected
during the first two days of life. The head regains its normal
shape within one week.
There is lack of molding in premature infants
because their small skull can easily pass through
the birth canal and those infants born by
caesarian section and breech delivery.
Molding of Newborn Head
PRESENTATIO SITES OF MOLDING
N
Occipitoanterior Biparietal and
suboccipitobregmatic are
decreased
Occipitoposterior Occipitobregmatic increased,
occipitofrontal decreased
Face presentation Submentobregmatic is
decreased and occipitofrontal
is lengthened
CAPUT SUCCEDANEUM
1.Pressure of the presenting part against the cervix
delays venous return resulting in accumulation of
fluid within the scalp, a condition called caput
succedaneum.
2.This edema of the scalp is seen on the presenting
part and has a generally symmetrical appearance
and crosses the suture lines.
3.Caput succedaneum is present at birth, absorbs and
disappears without treatment in 3 to 4 days.
CAPUT SUCCEDANEUM
CEPHALHEMATOMA
1.Forceps delivery and too much pressure against the
pelvis may lead to rupture of several capillaries of
the periosteum of the fetal skull resulting in
bleeding and accumulation of blood between the
skull bone and periosteum. This condition is known
as cephalhematoma.
2.It is a swelling that never crosses suture lines, has a
generally asymmetrical appearance and appears
several hours after birth.
3.It resolves within 3 to 6 weeks after birth without
treatment.
4.Hemolysis of blood when the hematoma begins to
resolve can lead to release of large amounts of
bilirubin in the newborn’s bloodstream which may
cause jaundice.
CEPHALHEMATOMA
PHYSIOLOGIC CRANIOTABES
1.Craniotabes are soft areas in the cranial bones
that corrects without treatment within a few
months after birth as the bones harden with the
aid of calcium in milk. The bones can be
indented by pressure applied by a finger at the
margin of the parietal and occipital bones
along the lambdoid suture. It returns to normal
contour once pressure is removed.
2.It is caused by prolonged pressure of the fetal
skull against the mother’s pelvis after the
lightening that is why it is more common in
firstborns. It is also found in infants born in breech
presentation.
3.May also indicate hydrocephalus, congenital
syphilis or rickets.
PHYSIOLOGIC CRANIOTABES
HEAD CONTROL
1.Although head lag is normal in newborn because of
the immaturity of the muscles and nervous system,
the newborn exhibits some degree of head control in
certain positions.
a. When the newborn is placed in sitting position, it will
attempt to control the head in upright position.
b.If the newborn is placed in prone position, it will
attempt to lift its head and move it fom side to side.
2.Excessive head lag is a sign of down syndrome,
prematurity, brain damage and hypoxia.
EYES
1.The vision of term infants is characterized as:
Visual acuity at birth is 20/150 to 20/190
Myopic
2.Eye reflexes:
Blink reflex – shine a bright light of touch
newborn lightly, the infant should demonstrate
an immediate blink.
 Corneal reflex – apply light pressure on the cornea
using a piece of cotton, the infant should
demonstrate an immediate blink. This should occur
symmetrically. This reflex is not generally examined
unless brain or eye damage is suspected.
 Pupillary reflex – shine light directly into the eye,
the pupil should constrict instantly. They should
have equal size constriction in the same amount of
time.
3. Tears usually appear fter 3 to 4 months when
lacrimal glands are mature.
4. Subconjunctival hemorrhage – a flame-shaped
hemorrhage on the white of the eye (sclera) is not
uncommon. It’s harmless and due to birth trauma. The
blood is reabsorbed in 2 to 3 weeks.
5. When attempting to open the newborn’s eyes
spontaneously for examination, the newborn is placed
supine and the head is gently lifted.
 Assess Normal Findings Abnormal Findings

Pupils Equal in size, round briskly Coloboma – irregularly

to light and clear, should shaped pupil
react Sluggish or asymmetrical
action to light is a sign of
intracranial pressure

Iris Almost all light skinned Pink iris – sign of albinism

newborns have blue or grey Opacities – congenital
eyes while dark skinned cataract especially if
newborns will have brown mother has history of
eyes rubella during pregnancy
 Assess Normal Findings Abnormal Findings

True eye color does not Setting sun sign – iris

show until the infant is 3 to beneath lower lid, sign of
6 months old. Upper and intracranial pressure, also
lower margins of eyelids seen in premature
should visible when infant
is quiet
Sclerae Completely white and clear Yellowish/Jaundice sclera
is a sign of
hyperbilirubinemia
Blue sclera – sign of
ostogenesis imperfecta
 Assess Normal Findings Abnormal Findings

Discharge None newborns cry Purulent discharge is a sign

tearlessly because of of infection
immature lacrimal glands

Conjunctiva Clear Conjunctivitis – redness,

swelling, discharge
Stimson’s line – small red
line that runs across
conjunctiva
 Assess Normal Findings Abnormal Findings

Cornea Clear Opacity, redness,

Corneal reflex is present at inflammation
birth

Eyeball Random movements Strabismus persisting past

Strabismus and nystagmus
until four months
Doll’s eye until 10 days old
(eyes do not follow in
response to head
movement)
four months indicates
muscle paralysis
Persisting Doll’s eye
increased intracranial
pressure
 Assess Normal Findings Abnormal Findings

Can focus on objects 7 to 8

inches away,
Can follow up to midline

Eyelids Should follow cover eye Absence of blink reflex

when close and should fully indicate deafness
raise when open Tyoptosis – early sign of
Blink reflex present neurologic problem
Eye edema is normal
during the first two days of
life
 Assess Normal Findings Abnormal Findings

Placement in Normally placed Exopthalmus – protrusion

eye socket of eyeball
Enopthalmus – deeply
placed eyeballs
EARS
POSITION
1.The top part of the pinna should be in line with
the outer canthus of the eye.
2.Ears below this line are considered to be low
set and are found in children with Down’s
syndrome.
STRUCTURE
1.In term newborns, the ears should be firm with
cartilage and recoil rapidly after bending. Lack
of cartilage in the ears indicates prematurity.
2.It is normal to find the ears folded over or
flattened against the side of head at birth. This
is due to pressure inside the uterus.
3.There should be no pinpoint openings in front
of the ear.
4. Otoscopic examination is not advisable in
newborns because the ear canal is usually filled
with amniotic fluid that interferes with
visualization of the tympanic membrane.
5. Ears are considered small if less than 2.5 cm
[5] in the term neonate.
FUNCTION
1. The newborn can hear as soon as mucus is
removed.
2. They should turn to sound. Loud noise should
elicit the startle reflex. If the newborn is not
affected by a loud noise, it could be a sign of
hearing impairment.
3. Minor abnormalities may be signs of various
syndromes, especially renal problems.
NOSE
1.The newborn’s nose should be assessed for
 Placement – located midline on the face
 Shape – symmetrical in placement and size
 Patency
 Close infant’s mouth and assess the quality of
respiratory effort.
 Obstruct one nare at a time to determine choanal
atresia which is a blockage in the posterior nasal
passage.
 Assess the movement of air in and out of the nares
by placing a finger under the nares to feel air
movement.
 Presence of drainage – may have small amount of
clear or white discharge.
2. Excessive or discolored nasal discharge may be a
sign of congenital syphilis or other respiratory
problems.
MOUTH AND THROAT
STRUCTURE
1. Lip color is normally pinkish and should open evenly when
the infant cries.
2. The mouth and jaw should move equally when the baby cries.
3. The soft and hard palate should be intact and the uvula
located at midline.
4. The tongue should be symmetric in shape and movement,
free movable and should not protrude.
5. Lingual frenulum attaches the underside of the tongue to the
lower palate. It should not be too tight to allow freedom of
movement.
6. Small white cyst may be seen at the palate which
are accumulation of epithelial cells and are called
Epstein pearls. They disappear within two weeks.
7. The patency of the esophagus should be checked by
passing a stiff rubber catheter into the stomach in the
following situations:
 Small-for-dates baby
 Single umbilical artery
 Polyhydramnios
 Excessive drooling of saliva
o If there is no esophageal atresia and the catheter has
reached the stomach, gastric content should be
aspirated. If gastric aspirate exceeds 20 ml in
volume, it indicates high intestinal obstruction due
to pyloric or duodenal atresia.
FACIAL PALSY
FUNCTION
1. Rooting, sucking, gagging and extrusion reflex should be present at
birth.
 Assess sucking reflex by placing a gloved finger in the infant’s mouth
or by monitoring feeding. The newborn exhibits a strong suck when
she is able to form a tight seal around the finger, nipple or bottle. A
weak suck occurs if the infant is either unable to form a seal or unable
to suck because of fatigue or deformity.
 Assess for gag reflex by gently stimulating the posterior oral cavity.
The infant should have a strong coughing response to the stimulation.
Absence of gag reflex should be considered an emergency situation
because the neonate cannot protect his airway without this reflex.
 Assess for the rooting reflex by gently stroking the
neonate’s cheek. The infant should respond by turning his
head to the side that was stimulated. This is an important
feeding reflex. Its absence indicates possible neurologic
abnormality.
The extrusion reflex occurs when the infant responds to
foreign objects in the mouth by pushing them outward with
the tongue. ( Keehn Nicole F., Lieben Katrina, Newborn
Assessment, Available at NetCE Website
http://www.netce.com/courseoverview.php?courseid=257,
Accessed 7/26/08)
2. It is normal for a newborn to have scanty saliva due
to immature salivary glands.
3. Some newborns have teeth at birth called
precocious teeth or natal teeth. These teeth are usually
located at the position of the lower incisors. If the
teeth are loosely attached, they should be pulled to
prevent aspiration. If not they can be left in place until
they are shed off spontaneously.
ABNORMAL FINDINGS
1.Cleft lip and palate.
2.Asymmetry in lip movement indicate 7 th cranial
nerve damage.
3.Assymetric crying is a useful marker of associated
cardiovascular anomalies and congenital dislocation
of lips.
4.Lip cyanosis indicates respiratory distress or
hypothermia.
5.Macroglossia indicate prematurity.
6. Protruding tongue may indicate chromosomal disorder
such as Down’s syndrome.
7. Excessive saliva may indicate esophageal atresia or
tracheoesophageal fistula.
8. Presence of oral thrush that bleeds when touched in
moniliasis transferred from the mother during delivery.
9. A tight frenulum often referred to as tongue-tie, can
prevent proper sucking. In this case frenuloplasty may be
required to correct the defect.
NECK
STRUCTURE
1. The neck of the newborn appears short and chubby with many skin
folds. It should be symmetric without webbing, flexible enough to
allow free movement of the head equally to both sides.
2. The neck lengthens at 2 to 3 years of age.
3. Although it is not strong enough to support the head, the infant should
exhibit temporary head control when placed in sitting position.
4. When in prone, newborns can lift their head slightly and move from
side to side
5. The thymus gland is usually enlarged due to rapid growth of
glandular tissue and triples in size by 3 years. After 10 years, the
thymus gland decrease in size.
ABNORMAL FINDINGS
1. Enlarged thyroid gland may be sign of goiter or hyperactive
thyroid.
2. Limited neck movement accompanied by pain is a sign of
meningeal irritation (opisthothorus).
3. A distended vein is a sign of cardiopulmonary disorder.
4. Rigidity of the neck or torticollis may be due to injury to
sternocleidomastoid muscle.
5. Webbing of the neck, generally noticed from the back of the
neck, may be indicative of chromosomal abnormalities.
CHEST
STRUCTURE
1.The chest usually looks small in relation to head. The
chest has a barrel shaped appearance almost circular
should be symmetric with clavicles straight.
2.The shoulders are sloping with width greater than length.
3.Heart rate is heard to the left of midclavicular space at
third or fourth interspace; may have functional murmurs.
4.The heart should be examined for its position and any
murmurs.
ABNORMAL FINDINGS
1.Chest retraction – respiratory distress
2.Bulging of the chest – pneumothorax,
pneumomediastenum
3.Displacement of the heart towards the right side
accompanied by respiratory difficulty and
resuscitation problems is suggestive of either
diaphragmatic hernia or pneumothorax on the left
side.
4.Malformation – funnel shaped, pectus excavatum
BREAST
STRUCTURE
1. The newborn’s breast nodule is approximately 6 mm (5 to
10mm)
2. The nipples are prominent, well formed and symmetrically
placed.
3. Engorgement of the breast in both male and female infants is
due to the influence of maternal hormones in the utero, it
subside within 2 weeks.
4. Sometimes a thin watery fluid called witch’s milk is secreted
by the newborn’s nipple. It disappears within the first week of
life. It is caused by the influenced of maternal hormones.
ABNORMAL FINDINGS
1.Malpositioned or widely spaced nipple
2.Presence of supernumerary nipples
3.Lack of breast tissue, less than 5cm, indicates
prematurity
THANK YOU !!!
Angeline s. zafe
Rlp-bsn 2a
REFERENCES
Infant Care and Feeding 2nd edition. Maria Loreto
Evangelista-Sia. RMSIA Publishing. pp. 38-57.