Hi everybody! I am that nursing prof and welcome to my channel. In today's video I'm going to be demonstrating a head-to-toe assessment on a newborn. The first thing we want to check when we enter the room is infant safety. So does this baby look safe to you?
No, it doesn't. And the reason why is because there's a stuffed animal in the crib. People don't know what they don't know, right? So it's part of our job to educate the parents about infant safety. If they have dollies and things like that, in the crib in the hospital, that means they're definitely going to have dollies and things in the crib at home.
So you want to come in and educate them right away about how not safe this is for baby. And don't worry about them getting angry or being offended. Nobody ever is because they know that you're there to teach them about their baby and that you have the baby's best interests at heart, and they just want their baby to be safe and protected.
So don't be afraid to, you know, correct them and educate them about infant safety. That's very important. So we're going to take this out of the crib.
The other thing about safety, the only thing I do like being in the crib, is the bulb syringe. It makes me very angry when I go to a clinical site and I don't see the bulb syringe anywhere and it's still wrapped up in the package in the drawer. When you need this, you need this right away. You need this very quickly.
So when you admit your patient, when you admit the baby, I want you to unwrap it and then explain to mom and dad how to use it properly and then keep it at the foot of the bed in the crib. So if you don't know how to use a ball... syringe correctly, let me tell you.
So this is how you use the bulb syringe. Press in, then put it in the mouth, then release. Press in, then put it in the nose, then release.
Okay, that's how you suck the snot out and the mucus. It's very important that you do it in that order. We always do the mouth before we do the nose because baby's at risk for aspiration if you were to do the nose before the mouth.
And parents don't necessarily understand this all the time. So so and we don't use the word aspiration for them anyway right we want to keep it very simple and we don't want to scare them so I just say well you wouldn't stick something in your nose and then put it in your mouth would you and they go oh no that's gross I wouldn't do that so that's how they can remember mouth first nose second so always keep the bulb syringe in the crib so those are our safety things okay our other big safety thing of course is we're going to verify our patient we're going to identify this baby now this is a situation where you can't say, can you please state your name and date of birth, baby? Obviously they can't do that, right?
So you're going to verify their wristband and you're going to match it to mom's wristband. Okay. That's how you're going to know.
And then you're going to let mom know, I'm just going to do a quick head to toe assessment on your baby. Check everything out, make sure everything's okay. Now we're ready to do our assessment on baby. So the first thing before we even touch the baby is noticing how the baby's acting right now. So this is considered baby's level.
of consciousness. So this baby happens to be asleep here in the crib. So sleeping, that's what we would say.
Other options could include quiet alert, active alert, and crying. Quiet alert is when baby's awake, their eyes are open, and they're just kind of looking around. Active alert is when they're doing something, they're wiggling around, maybe they're breastfeeding.
Okay, that's active. And then crying is crying. Okay, so before you walk in, before you touch... the baby how is it acting.
This is also when we're going to do pain assessment on our baby. Okay so once you start touching the baby and messing with the baby to do your head to toe it's gonna start crying. Just because it's crying doesn't mean it's in pain it means it's annoyed with you. Leave me alone I was cozy and comfy.
So before you touch the baby this again when we're gonna monitor for pain and our baby's not having any pain because our baby is asleep and happy. Okay. Now we're going to actually touch the baby. Of course I put on gloves for this.
I know this baby had a bath because I just did it, but you don't always know if the baby's been bathed. They could have, you know, amniotic fluid and vernex and blood and stuff like that on them, so always wear gloves when you're touching a newborn. born.
And the first thing you're going to do is auscultate. Now you don't technically have to do this first, but I highly recommend that you do this first. Why? Because when you start messing with them and they start crying, it's going to be a lot harder to hear them. A lot harder to hear those lung sounds, those bowel sounds, things like that.
So before they get too mad at you, this is one you want to listen. So we're going to use the bell of our stethoscope. If you have an infant stethoscope, obviously that's better.
Most of us just don't have one of those lying around. But if you do, use it. So when we listen, I'm going to pull baby's outfit up a little bit. So we're going to listen to the heart for a full minute. A normal heart rate is between 110 and 160. So it's very important that you listen to baby's heart rate for one full minute.
I'm not going to do that in this video because I know you don't want to just sit here and watch me hold my stethoscope on the baby for one minute, but it's very important that you know you have to listen for one full minute. The next thing you want to do is listen to the lungs, and listening to the lungs on babies is a little complicated. Because the heart is so big, it's so loud.
So if you were to listen to the baby's lungs up here, or even on their back, it's going to hear a lot of heart sounds. It's going to be really overpowering. So what I highly recommend is when you listen to baby's lungs, listen on the sides. So listen to baby's lungs down here, okay?
And while we're here, this is when you want to take a respiratory rate. Okay, so we're doing baby's vitals. We did their heart rate for one minute now We can do the respiratory rate for one minute too while we're listening Yes, you can do a respiratory rate the normal way just like watching the rise and fall of the chest But babies are kind of irregular breathers.
So that's a little bit difficult. So I think it's much much easier So while you're listening to the lung sound just take a respiratory rate and then finally Of course, we want to listen to the bell sounds now just like we would in an adult We're going to go in a clockwise motion. It's just everything is a lot smaller.
Do babies have bowel sounds? Yes, of course they do. The only time they wouldn't have bowel sounds is if they were like brand, brand new babies. So within that first 30 minutes of life, we kind of give them a little bit of flex room to may or may not have bowel sounds. So that's okay.
So the big three vitals we do on a baby are heart rate, temperature, and respirations. So you're probably wondering, why didn't you take this baby's temperature? Because they hate it, okay? All babies hate getting their temperature taken, so I always save that as the very last thing I do, okay? So we'll do that at the very, very, very end of our assessment.
So now we're going to continue on with our assessment. We've done all of our listening. So now we're going to start literally head to toe.
So we'll take off baby's little hat. So some babies will be completely bald, some will have a ton of hair. So when you're checking the suture lines on the baby, just take your hand and kind of like run it over their head.
Okay, so if they have a lot of hair and you can't see what's going on, you'll be able to feel it with your hand. And let me pick up this baby so you can see what I'm talking about when I say the suture lines. So these are the suture lines on the baby. So this one here, that's kind of like where you would wear a headband, this is called your corneal suture. Think of it as like maybe a crown or something.
So your corneal suture. And then this one here going through the the middle, kind of like a mohawk, that's your sagittal suture line. Okay, so babies have these. They may be what we call overriding where maybe their corneal is a little bit higher than the rest.
That's very normal, okay? That's not a reason to worry. That's just, you know, helping facilitate passage through the birth canal.
Same thing if baby has like an elongated head. Sometimes they call it a cone head, which isn't a very nice thing to say. That's called molding on the baby.
And that's also incredibly normal just to help facilitate passage through the birth canal in a vaginal delivery. So we are not worried about either one of those things. Alright, so we've done the head. Now we're going to come down to the eyes.
If you can, take your pin light and shine it in baby's eyes. It is difficult to get baby's eyes open. What I would recommend is to put the light down low in the room, kind of dim the lights, and they're more likely to open their eyes.
What I do not recommend is physically forcing the baby's eyes. open. I've seen people do that. I've seen doctors do that and that's, I don't like that.
Please don't do that. If you want baby to open their eyes, just go ahead and dim the lights and they'll open their eyes on their own. But this assessment can be a little bit challenging to do if they don't want to open their eyes.
So we want to check the ears. So the ears should line up with the eye and they do. That's good. Sometimes they don't, sometimes they're lower, and that's usually a sign of some sort of congenital abnormality or maybe like a fetal alcohol syndrome or something like that.
So you might see that. Another thing you might see is only one ear on your baby. So making sure your baby does have two ears, because sometimes they don't.
Sometimes they're only born with the one ear, okay? And the other ear is malformed or partially formed or something like that. So you want to take note of the baby's ears. ears.
Now we'll check baby's nose. Babies are obligate nose breathers and what that means is they breathe through their nose. So we want to make sure that their nose is functioning well.
So you're going to occlude each nostril and make sure baby's still able to breathe just fine. If this was a c-section baby, it's very common that they have maybe a little bit of fluid in there. They can sound a little stuffy and almost like they have a cold.
It's not a cold. They're not sick. They don't have allergies or anything like that.
It's just a little stuffiness from fluid because of the c-section and it'll go away. That's normal. Now we'll come down and we'll check the mouth. So from the outside we see okay, it looks pretty good. Sometimes the cleft palate doesn't always present this way, so we don't know about it.
So we actually have to take your gloved finger and put it in baby's mouth to check their palate to make sure it's intact. And while you're doing this, most of the time baby will start sucking on your finger, and now you've discovered the sucking reflex. And I'll do a whole other thing about the different types of reflexes, but I'm going to address some of them here in this video as well.
So that's one of them. That's the sucking reflex. Another one is called the rooting reflex, where we brush our finger on baby's cheek, and baby kind of turns their head slightly towards that stimulation.
Is there a time when these things don't happen? Yes. So if baby is born very prematurely And they haven't you know established a good sucking reflex yet They're not going to do this or if baby is full if they just ate and they're not hungry They may or may not show you these signs and that's okay So moving down Checking baby's neck for webbing.
And again, this is where a lot of vernix likes to hide is in their neck folds. So we're gonna be checking baby's chest, any obvious discoloration, checking the skin, checking their arms. Most babies will be like this.
This is the flexed position, right? They're very similar to the position they were in in the womb, the fetal position, right? This is normal. They should be like this. This shows good muscle tone.
We like this. We don't like it when they're like this, with their arms too relaxed, when they're floppy. Okay, so this is not good for baby We like flexed babies and they should be flexed One thing you might notice on baby is like a little bump here in the middle of their chest This is actually called their xiphoid process. It's normal.
Everybody has them You have one too, but you're not five pounds. So we can't see yours. Okay, so it's normal their skin is thin They don't weigh a lot. That's why we can see it but Everybody has one.
It's normal. It's fine. So this is something that the parents tend to worry about tell them not to worry about it Okay, it's just part of their anatomy When we check the fingers, we literally have to count the fingers Okay, so one two three four five on each hand one two three four five on each hand We can check our Palmer grasp. So that's when you give baby your finger and it curls its little hand around Okay, you can check that Working our way down. We can check the legs, we can check the feet, count the little toes.
There should be five on each. The most common abnormality is extra fingers and toes. Okay, so if you're gonna see something abnormal, it's probably going to be polydactyly, so an extra digit.
And sometimes it's just a little bit and they can just tie it off there right then and there and it's done. And then sometimes it requires like actual surgery. So it depends on what's going on if there's bone formed in there and that kind of thing.
But you do want to count the fingers and the toes. When we're at baby's foot, just like we did the palmer grass, we can do the planter grass. So putting your finger here and then they curl their little toes around.
And you can do Babinski's sign. So gently brushing baby's sole. and then their little toes will kind of flare out.
Okay, that's what Binsky's saying. Checking the legs, we want to make sure that one leg isn't shorter than the other leg. And now checking the diaper area.
Now this baby doesn't have any genitals because it's a practice baby, but let's talk about what we would see on a little girl and what we would see on a little boy. So if this was a little girl, it's really going to depend on how far along in gestation she was. So if this is a term baby like a 40 week baby it should be clearly differentiated the labia minora and the labia majora the clitoris should be covered okay you might see a little bit of white stuff in the vaginal folds that's called smegma that's normal it's fine it doesn't hurt the baby we don't need to do anything to like scrub it to get it off it's fine also little baby girls have something called pseudo menstruation which when you change the diaper you might see what looks like a little bit of blood in the diaper that's okay what that is is mom's hormones circulating through baby so it's almost like a little fake period that the baby girl is having that's normal within the first few days of life that's normal if this is happening you know baby's like a week or two old and they're having this then it's probably not that it's probably caused from something else like maybe you know bleeding from the rectum or something like that pseudo-menstruation totally normal If this is a little boy, we're going to be checking the penis. We're going to be checking the meatus where the urine comes out.
Okay, so that should be on the tip of the penis. It could be on the underside, which is called a hypospadias, or if it's on the top, it's called an epispadias. So both of those things are not normal and then we need to get those checked out. If baby is to be circumcised, we're going to give proper instruction on that.
If not, we need to teach mom about how to pull back the foreskin. when taking care of the baby and cleaning the baby. Also in little boys, we want to check the testicles to make sure that they're descended.
You literally do have to like put your fingers and feel to make sure that they're descended. They feel like little marbles, okay? That's how you know that they're descended. And if the baby is term gestation, like a 40-week baby, we would absolutely expect those testicles to be descended. When it comes to the genitals, the gestational weeks is really important.
The more term, the more you are like... you would expect them to be. Pre-term there's going to be lots of variations okay of what's normal. And then just another side note I wanted to put down when talking about the GU when talking about urine on the baby sometimes little boys and little girls you might it might look like a little blood is in their diaper maybe it's like a like a dark amber maybe you might even mistake it for a red. but it's like a dark amber.
That is fine. It's not actually blood. It's just their urine is very concentrated and it's those like uric acid crystals in their urine and it causes like a rusty amber color stain in the diaper.
This is very important to educate the parents on this because they think it's blood, right? And of course that's very scary. So you want to let them know like what's normal, what's not normal, when to expect things, that kind of stuff. When it comes to bowel movements on the baby, at this stage in the hospital we're waiting for that first stool, that meconium stool.
So meconium is like greenish black and tar-like and very, very sticky. Sometimes even the baby wipes aren't enough to clean that meconium off and you want to get like soap and water on a wash rag to clean that off. But then as baby starts eating, baby gets a little bit older, the stools will transition and they're gonna vary depending on whether baby is formula feeding or breastfeeding. There's a lot of variations on what's considered normal baby stool. It can be brown, it can be that tarry black, it can be green, it can even be yellow and look like bird seed.
So all of those are considered normal depending on what's going on with your baby. Diarrhea on a baby is not normal. Diarrhea is when they have two or more watery stools. If they have one watery stool, okay, I'm not going to freak out about that so much, right?
It could be a transitional stool, whatever. If it's more than one, two, three, four, etc., okay, that's not good. That's for sure diarrhea and that's not good for baby.
So educating parents about what to expect when it comes to... urine and bowel movements on their baby. So I'm just gonna wrap this back up here, put the diaper back on baby. I'm making sure to get it below the level of the umbilical cord.
When we look at the umbilical cord, we're just gonna assess the site. We're gonna check for redness, swelling at the area, and any drainage or bleeding. So there shouldn't be any of those things, right?
It should look normal and healthy. Depending on how far along baby is, like how old baby is, the cord is going to look different. So if baby is brand new, baby is an hour old, the cord is going to be thick and shiny. If baby is two days old, the cord is going to be kind of shriveled up and almost like a yellowy color.
It all depends on how many hours old baby is, what the cord is going to look like. So very important that we educate parents, it's normal, make sure you tuck the diaper underneath the umbilical cord and never like pull or tug on the umbilical cord, that's very dangerous. So now we can check out baby's back. we're checking out the curvature of the spine.
We can check their little booty, we can check their little bottom. Right here, this is what we're looking for, Mongolian spots or a sacral dimple. If that occurs, that's going to be right where the lower back meets the bottom. And we don't want to have a sacral dimple on a baby, that's not good. If they have a Mongolian spot, that's totally fine, that's a normal birthmark.
Special thing about Mongolian spots though is that they appear like a bluish purplish color and can sometimes be Mistaken for like a bruise. So of course we don't want to you know, get that mixed up a birthmark versus you know abuse Very important that we check the Mongolian spots on the beak. So the very last thing, I said this at the beginning of the video, is we're going to take baby's temperature because he's not going to like it. He's going to cry.
They all cry. Okay, so where we take baby's temperature, we no longer do rectal temperatures on babies unless we absolutely have to. We take baby's temperature underneath the armpit, so axillary.
And I want to show you there is a right way and wrong way to do this. So do not do it like this. If I can show you on camera here where you do this because look at is it actually in the baby's armpit? No, you're taking the temperature of like the baby's blanket and I've had that happen before in clinical where students will say I've done the baby's temperature and it's 95 degrees I'm like, is it though?
Really? Let's go check that again. And that's because they were taking it incorrectly.
So very important that when you take baby's temperature, you go into the armpit and hold their arm down like this. Let me pick it up so you can see it better. Okay.
So into the armpit like this. They don't like having their arm held down in place. They don't, I'm sure it feels weird to have you know thermometer in their armpit.
They don't like it. So at this point they're usually, if they haven't cried yet, this is when they're gonna start crying and get mad at you. But we're almost done, you know.
So take a quick temperature. We're done. Everything's okay.
We can get rid of it. And then you know get baby all swaddled up, give her back to mom. And now she's happy.