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Position • Top of pinna must be in line with the outer canthus of the eye. • Ears below this line are considered to be low set and are found in children with Down Syndrome
• There should be no pinpoint openings in front of the ear • Ototscopic examination is not visible in newborns • Ears are considered small if less than 2.Structure • Term: ears should be firm with cartilage and recoil rapidly after bending • Premature: Lack of cartilage in the ears. .5cm in term neonates.
it could be a sign of hearing impairment.Function • The newborn can hear as soon as mucus is removed • They should turn to sound. especially renal problems. • Minor abnormalities may be signs of various syndromes. Loud noise elicits the startle reflex. If the newborn is affected by a loud noise. .
.Nose Structure • Midline on the face • Symmetrical in placement and size • Close infant’s mouth and assess the quality of respiratory effort.
• May have a small amount of clear or white discharge .• Obstruct one are at a time to determine choanal atresia which blockage in the posterior nasal passage. • Assess the movement of the air in and out of the nares by placing finger under the nares to feel air movement.
• Vulva is located at midine.Mouth and Throat Structures • Lip must be pinkish and should open evenly when infant cries. • Mouth and jaw should equally move when baby cries. • Soft and hard palate should be intact. .
• Small white cyst may be seen in hard palate. It should not be too tight to allow freedom of movement. • Lingual frenulum attaches the underside of the tongue to the lower palate. .• Tongue should be symmetric in shape and movement and should not protrude. It disappear within two weeks.
• Patency of the stomach should be checked by passing a stiff rubber catheter into the stomach in the following situations: a.Small-for-dates baby b. Single umbilical artery • .
*If there is no esophageal atresia and the catheter has reached the stomach. . Polyhydramnios d. Excessive drooling of saliva.c. it indicates high intestinal obstruction due to pyloric or duodenal atresia. If gastric aspirate exceeds 20 ml in volume. gastric contents should be aspirated.
Assess sucking reflex by placing a gloved finger in the infant’s mouth or by monitoring feeding. nipple and bottle. A weak suck occurs if the infant is either unable to form a seal or unable to suck because of fatigue or deformity. gagging and extrusion reflex should be present at birth. a. sucking. The newborn exhibits a strong suck when she is able to form a tight seal around the finger.Function • Rooting. .
a) . The infant should have 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 gag reflex by gently stimulating the posterior oral cavity.b.
. It’s absence indicates possible neurologic abnormalities. d. This is an important feeding reflex. The extrusion reflex occurs when the infant responds to foreign objects in the mouth by pushing them outward with the tongue. Assess for rooting reflex by gently stroking the neonate’s cheek. The infant should respond by turning his head to the side that was stimulated.c.
. • Some newborns have teeth after birth called precocious teeth or natal teeth.• It is normal for a newborn to have scanty saliva due to immature salivary glands.
Abnormal Findings • Cleft lip and palate • Asymmetry in lip movement indicate 7th cranial nerve damage. . • Asymmetric crying is a useful marker of associated cardiovascular anomalies and congenital dislocation of hips.
• Macroglossia indicate prematurity • Protruding tongue may indicate chromosomal disorder such as Down’s Syndrome • Excessive saliva may indicate esophageal atresia or .• Lip cyanosis indicates respiratory distress or hypothermia.
frenuloplasty may be required to correct the defect.• Presence of oral thrush that bleeds when touched is moniliasis transferred from mother during delivery/ • A tight frenulum often reffered to as tongue-tie. In this case. can prevent proper sucking. .
Neck Structure • Neck of newborn appears short and chubby with many skin folds. flexible enough to allow free movement of the head equally to both sides. • Lengthens at 2 to 3 years of age . It should be symmetric without webbing.
the infant should exhibit temporary head control when placed in sitting position. . newborns can lift their head slightly and move from side to side. After 10 years.• Although it is not strong enough to support the head. • The thymus gland is usually enlarged due to rapid growth of glandular tissue and triples in size by 3 years. • When in prone.
Abnormal Findings • Enlarged thyroid gland may be a sign of goiter or hyperactive thyroid. • Limited neck movement accompanied by pain is a sign of meningeal irritation (opisthothonus). • Absence of head control is a sign of prematurity and .
• Rigidity of the neck or torticollis may be due to injury to sternocleidomastoid muscle. . • Webbing of the neck. may be indicative of chromosomal abnormalities. generally noticed from the back of the neck.• A distended vein is a sign of cardiopulmonary disorder.
• Shoulders are sloping with width greater than length. • Barrel shape in appearance • Symmetric with clavicles straight. .Chest Structure • Chest looks small in relation to the head.
• Heart rate is heard to the left midclavicular space at third or fourth interspace. . • Heart should be examined for its position and any murmurs. may have functional murmurs.
• Malformation • Fractured clavicle is manifested by a lump or bony prominence .Abnormal Findings • Chest retraction • Bulging of chest • 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.
Breast Structure • Newborn’s breast nodule is approximately 6mm (510mm) • The nipples are prominent. . well formed and symmetrically placed.