PERFORMING

A
NEWBORN
HEAD-TO-TOE
PHYSICAL ASSESSMENT
ASSESS FOR: HEENT
Posture Chest
Head Circumference Respiratory
Chest Circumference Cardiac
Abdominal Circumference Abdomen
Length Rectum
Weight Female Genitalia
Temperature Male Genitalia
Pulse Musculoskeletal
Respirations Neurological
Blood Pressure
Integumentary
POSTURE:
•Head and extremities normally flexed
HEAD CIRCUMFERENCE:
•From occiput to forehead
•Normal circumference : 33-35 cm
• Circum <10% of normal : Microcephaly
• Circum >90% of normal: Macrocephaly
Microcephaly
Hydrocephaly
CHEST CIRCUMFERENCE:
•chest at nipple line
•30.5-33 cm (2-3 less than head)

ABDOMINAL CIRCUMFERENCE:
•Abdomen above umbilicus
•Similar to chest circum , with no distension
 LENGTH:
•Crown to rump: 31-35 cm
•Head to heel: 45-55 cm (18-22 in) at birth

WEIGHT:
•Between 2500 and 4000 g (5lb, 8 oz, and 8 lb, 13 oz)
• LBW: prematurity
• Macrosomic: gestational diabetes of mother

LBW Macrosomic
TEMPERATURE:
•Axillary: 36.5-37.2 degree Celsius
•Hypothermia vs. Hyperthermia

PULSE:
•Apical rate 120-160 BPM
•Bradycardia (<100 BPM) vs. Tachycardia (>160 BPM)
•Most murmurs nonpathological & disappear by mos. Old

RESPIRATIONS:
•30-60 breaths/min; irregular
•Bradypnea (<30) vs. Tachypnea (>60)
•Apnea of >15 sec

BLOOD PRESSURE:
•Systolic: 50-75 mm Hg
•Diastolic: 30-45 mm Hg
•Low BP: hypovolemia
•Increased BP: placental transfusion
 INTEGUMENTARY:
SKIN
• Note skin color & lesions
• Acrocyanosis, physiological jaundice
• Harlequin sign – color changes with position
• Milia, miliaria or audamina, mongolian spots, telangiectatic nevi, flat
hemangiomas (“stork bites”)
HAIR
• Note distribution
• Presence of lanugo
NAILS
• Inspect neonate’s nails

Acrocyanosis Mongolian Spots

HEENT:
HEAD/FACE
• Inspect facial movements, features, head and fontanels;
palpation of fontanels
• Anterior fontanel: diamond-shaped, 2.5-4 cm
• Posterior fontanel: triangular-shaped 0.5-1 cm
• Fontanels soft and flat
• Facial movements & features symmetrical
NECK
• Inspection & palpation
• Short neck
EYES
• Blue-gray or brown iris; white or bluish-white sclera
• Positive red light , blink, & corneal reflexes
• No tears (tear production begins at 2 mos.)
• Positive fixation
• Positive pupillary reaction to light
• Strabismus & nystagmus (immature oculo-muscular control)
EARS
• Pinna flexible, no deformities, aligns with external canthus of
eye
• Positive startle reflex
NOSE
• Nares patent
• Presence of thin white mucus in small amount
• Flattened & bruised nose due to birth
MOUTH/THROAT
• Minimal saliva
• Natal teeth may be benign or associated with congenital defects
• Cleft palate and lip
Strabismus

Brushfield Spots
Natal teeth
CHEST:
•Anteroposterior:lateral (1:1)
•Breast engotgement – due to hormonal influences
•“witch’s milk”
•Supernumerary nipples – benign finding
• Funnel chest: congenital anomaly
• Pigeon chest: obstructed respiration

Pectus Excavatum
RESPIRATORY:
•Lungs clear, bronchial, bronchovesicular sounds audible
•Cough reflex absent at birth; present 1-2 days later
•Scattered crackles a few hours after birth.
CARDIAC:
•S1, S2, normal rhythm with respiratory variations
•PMI fourth intercostal space midcostal line
ABDOMEN:
•Abdomen round and protrudes
•Positive bowel sounds
•liver, tip of spleen & kidneys palpable
•Cord bluish white with 2 arteries & 1 vein
•Positive femoral pulses
•Umbilical hernias & diastasis recti more common in Afro-
Americans and resolves within a year
Umbilical Hernia
RECTUM:
•anus patent
•Passage of meconium stool within 48 hours
•Positive anal reflex (“anal wink”)
• Anal fissures or fistulas
• Imperforate anus
FEMALE GENITALIA:
•Urination within 24 hours
•Labia minora & majora may be edematous
•Occurrence of pseudomenstruation
MALE GENITALIA:
•Urination within 24 hours
•Foreskin retracts
•Urethral opening at tip of penis
•Scrotum edematous
•Smegma
•Palpable testes
• Hypospadias vs. Epispadias
• hydrocele
Anal fistulas Imperforate Anus
MUSCULOSKELETAL:
•10 fingers & 10 toes
•Full ROM
•No clicks in joints
•Equal gluteal folds
•C curve of spine, no dimpling
•Hands held as fists until after 1 month
•When arms & legs extended:
• Muscles symmetrical with equal muscle tone
• Arms & legs symmetrical in size & movement
• Polydactyly, synactyly
• Phocomelia
• Hemimelia
• Talipes
• Simian creases: Down syndrome
NEUROLOGICAL:
•Positive newborn reflexes (discussed in later part)
• Hypotonia vs. Hypertonia
• Paralysis
• Spina bifida, pilodinal cyst
Polydactyly Syndactyly
Talipes Phocomelia
 Pilodinal Cyst
Flaccid Paralysis of legs
NEWBORN/INFANT
REFLEXES
 REFLEX DURATION NORMAL ABNORMAL-
RESPONSE ITIES

Moro Present at birth & lasts 1-4 •Quickly abducts & •Premature/ill infants
months extends arms & legs •Injury to clavicle,
symmetrically humerus or brachial
•Makes “C” with index plexus
finger & thumb. Legs flex
up against trunk

Startle Present at birth & lasts 4

months
Hands clenched, arms
abducted, flexion at elbow
(same as Moro)

Tonic Neck Present between birth & 6 Infant assumes “fencing Response after 6 months
weeks; disappears at 4-6 position”, with arm & leg indicate CEREBRAL
months extended in direction to PALSY
which head was turned

Palmar Grasp Present at birth; disappears Infant’s grasps object Negative grasp indicates
at 3-4 months tightly. hypotonia or prenatal
asphyxia
 REFLEX DURATION NORMAL ABNORMAL-
RESPONSE ITIES

Plantar Grasp Present at birth; disappears Toes flex tightly Negative grasp seen with
at 3-4 months downward in a grasping hypotonia or spinal cord
motion injury

Babinski Present at birth; disappears

at 1 year
Toes should fan Neurological problem

Stepping or Present at birth; disappears Infant steps up & down in Hypotonia

at 3-4 weeks place
Dancing

Rooting Present at birth; disappears Infant turns head in Prematurity or

at 3-6 months direction of stimulus & neurological problem
opens mouth
 REFLEX DURATION NORMAL ABNORMAL-
RESPONSE ITIES

Sucking Present at birth; disappears Toes flex tightly Sucking motion occurs
at 10-12 months downward in a grasping
motion

Swallowing Present at birth & lasts

throughout life
Should occur without
coughing, gagging or
Prematurity or
neurological problem
vomiting

Extrusion Present at birth & lasts 3-4 Tongue protrudes outward Neurological problem;
months Down syndrome

Glabellar Present at birth Newborn blinks for first Extrapyramidal problem

few taps
 REFLEX DURATION NORMAL ABNORMAL-
RESPONSE ITIES

Crawling Present at birth; disappears

at 6 weeks
Newborn attempts to
crawl

Crossed Present at birth; disappears Flexion, adduction, then •Weak response:

at 2 months extension of opposite leg peripheral nerve damage
Extension •Absent response: spinal
cord lesion

Pull-to-Sit Present at birth Head lags as infant is Prematurity or hypotonia

pulled to sitting position,
then infant is able to hold
up head temporarily

Trunk Present at birth; disappears Flexion of trunk with hip Neurological or spinal
in a few days to 4 weeks moving toward stimulated cord problem
Incurvation side

Magnet Present at birth Extends legs against •Breech birth may

pressure diminish reflex
•Spinal cord problem
Thank You
And
God Bless!!!