Normal Newborn Slide Normal newborn crying

Well-flexed Full Range of Motion Spontaneous Movement

Common Variations Frank Breech Limp Posture Asymmetry of Movement Persistent Tremor or Twitching Limp posture-Erb’s palsy-full function returns in 88-92% by 1 year of life Asymmetry may be from birth trauma or intrauterine pressure

Skin Skin reddish in color, smooth and puffy at birth Edema around eyes, feet and genitals Vernix Caseosa Lanugo

Acrocyanosis

Acrocyanosis

Mongolian Spots .

Mottling

Jaundice

Milia

Erythema Toxicum

Deviations Jaundice within 24 hours of birth Circumoral cyanosis between feedings Rashes other than erythema toxicum Hemangioma Petechiae Skin tags or extra digits Harlequin color changes Harlequin-1/2 deep red, other ½ pale. Caused by immature auto-regulation of blood flow

Forceps Marks

Head Anterior fontanel diamond shaped Posterior fontanel triangular shaped Fontanels soft, firm and flat Sutures palpable with small separation between each

Cephalhematoma-blood in the subperiosteal space on the surface of the skull bone. Does not go across suture lines, resolves in 6-8 weeks. Caput-edematous area over presenting part of scalp-extends across suture lines, resolves in 24-48h.

Caput

Molding of Fontanels and Suture Spaces

Cephalahematoma

Eyes Slate gray or blue No tears Fixation at times Red and blink reflexes Eyebrows No tears until 2 months Red reflexes-normally present and indicates an intact lens-appears as a homogeneous bright red-orange.

Edematous Eyelids

Uncoordinated Movements Erratic and purposeless movements may be observed during the first few weeks of life. Median focal distance for the neonate is about 8 inches.

Deviations Opaque lenses Chemical conjunctivitis Discharges Opaque lenses may indicate cataracts or retinoblastoma.

Subconjunctival Hemorrhage

Ears Loud noise elicits startle reflex Flexible pinna with cartilage present

Pinna top on horizontal line with outer canthus of eye

Common Variation Skin tags on or around ears

Deviations Preauricular sinus Low ear placement Preauricular sinus- increased risk of congenital deafness and renal abnormalities

Nose Nostrils patent Obligate nose breathers No discharge

Deviations Choanal atresia Nasal flaring

CHOANAL ATRESIA Bilateral choanal atresia is easily recognized immediately after birth. Signs may include pink while crying, becoming cyanotic and struggling for air when quiet (even with good respiratory effort). Inability to gently pass a small (3F) catheter through the nares into the pharynx suggests the diagnosis. Problems arise because infants usually breath through their noses.

Mouth and Throat Minimal or absent salivation Tongue moves freely and doesn’t protrude Well developed fat pads bilateral cheeks Sucking, Rooting, and Gag reflexes

Mucosa moist Sucking calluses

High arched palate

Variation - Epstein’s pearls on ridges of gums

Deviations Cleft lip or palate Asymmetrical lip movement Protruding tongue Protruding tongue associated with trisomy 21 and beckwith-wiedemann

Candida Thrush

Teeth

Neck Short and thick Turns easily Tonic neck reflex Some head control

Deviations Webbing Large fat pad on back of neck Palpable crepitus, movement with palpation of clavicle Webbing associated with Turner and Noonan syndromes and trisomy 21 Crepitus-dur to fractured bone ends rubbing together.

Chest Evident xiphoid process Bilateral synchronous chest movement Symmetrical nipples

Common Variations Enlarged breasts “Witch’s milk” Accessory nipples 

Abdomen Dome shape Soft to palpation Well formed umbilical cord Three vessels in cord Bilateral equal femoral pulses Bowel sounds Voiding within 24 hours of birth Meconium within 24 - 48 hours of birth

2 small thick walled arteries at 4 and 8 o’clock positions 2 small thick walled arteries at 4 and 8 o’clock positions. 1 thin walled vein at 12:00 o’clock position

Deviations Umbilical hernia Peristaltic waves visible Redness or drainage at base of cord Distention or scaphoid shaped

Female Genitalia Edematous labia and clitoris Labia majora are larger and surrounding labia minora Vernix between labia

Common Variations Hymenal tag Pseudomenstruation Smegma Increased pigmentation “Brick dust” urine due to uric acid crystals

Deviations Fecal discharge from vaginal opening Imperforate hymen Ambiguous genitalia

Male Genitalia Urinary meatus at tip of glans penis Palpable testes in scrotum Large, edematous, pendulous scrotum with rugae Smegma

Common Variations Erections Prepuce covering urinary meatus Increased pigmentation

Deviations Hypospadius Epispadius Smooth scrotum Ambiguous genitalia

Back and Rectum Intact spine without masses or openings Patent anal opening Wink reflex

Deviations Limitation of movement Spina Bifida Tuft of hair Imperforate anus Anal fissures Pilonidal cysts

Extremities Full range of motion Equal and bilateral movement and tone Legs appear bowed Grasp reflex No hip click

Feet appear flat

Palmar creases present

Sole creases present

Deviations Asymmetrical movement of extremities Unequal tone Unequal leg length

Polydactyly

Asymmetrical skin creases posterior thigh

Marked metatarus varus “clubbed” feet