Head-to-Toe Assessment of a Newborn

Infant Safety

• Remove Unsafe Items: Ensure no stuffed animals or toys are in the crib.
• Bulb Syringe:
  • Always unwrap and keep at the foot of the crib.
  • Usage: Press in, insert (mouth first, then nose), and release to clear mucus.
  • Important to educate parents on its use and order to prevent aspiration.
• Patient Identification: Match baby's wristband with mother's for verification.

Initial Observations

• Level of Consciousness: Identify if the baby is sleeping, quiet alert, active alert, or crying.
• Pain Assessment: Conduct before touching the baby as crying post-touch isn't necessarily indicative of pain.

Physical Examination

Auscultation (Listening)

• Heart Rate:
  • Use stethoscope, listen for a full minute.
  • Normal rate: 110-160 bpm.
• Lung Sounds:
  • Listen to lungs on the sides to avoid heart sound interference.
  • Conduct respiratory rate assessment while listening.
• Bowel Sounds:
  • Listen in a clockwise motion; new babies might not initially have bowel sounds.
• Temperature: Save for last due to baby discomfort.

Head

• Suture Lines:
  • Check coronal (crown position) and sagittal (mohawk position) sutures.
  • Overriding sutures and molding (cone head) are normal.

Eyes, Ears, and Nose

• Eyes:
  • Use dim lights to encourage opening, avoid forcing.
• Ears:
  • Check alignment with eyes.
  • Presence of two ears and check for abnormalities like fetal alcohol syndrome indicators.
• Nose:
  • Verify unobstructed breathing by occluding nostrils.
  • Fluid in c-section babies' noses is common and normal.

Mouth and Reflexes

• Mouth:
  • Check palate for intactness.
  • Sucking reflex and rooting reflex should be observed.

Neck and Chest

• Neck: Check for webbing and hidden vernix.
• Chest:
  • Position: Flexed position is normal, indicates good muscle tone.
  • Xiphoid process visibility is normal.

Limbs and Genitals

• Arms and Legs:
  • Count fingers and toes; check for extra digits (polydactyly).
  • Palmer and plantar grasps, Babinski’s reflex.
• Genital Examination:
  • Girls: Check labia differentiation, presence of pseudo menstruation.
  • Boys: Check penis for proper meatus, circumcision care, and descended testicles.

Urinary and Bowel Movements

• Urine: Dark amber due to uric acid, normal but educate parents.
• Stool: Meconium initial stool; variety in stool colors is normal.
• Diarrhea: Defined as two or more watery stools.

Umbilical Cord and Back

• Umbilical Cord:
  • Check for redness, swelling, drainage.
  • Appearance changes with age (thick and shiny at birth to shriveled).
• Back:
  • Observe for Mongolian spots (birthmarks) and sacral dimples.

Final Steps

• Temperature Measurement:
  • Conduct axillary temperature measurement correctly.
  • Ensure thermometer is in the armpit to avoid inaccurate readings.
• Swaddling: Return baby to mother after assessment.