1. Normal Newborn
Slide Normal newborn crying

3. Well-flexed
Full Range of Motion
Spontaneous Movement

4. 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

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

7. Acrocyanosis

8. Acrocyanosis

9. Mongolian Spots .

10. Mottling

11. Jaundice

12. Milia

13. Erythema Toxicum

17. 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

18. Forceps Marks

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

20. 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.

21. Caput

22. Molding of Fontanels and Suture Spaces

23. Cephalahematoma

25. 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.

26. Edematous Eyelids

27. 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.

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

30. Subconjunctival Hemorrhage

31. Ears Loud noise elicits startle reflex
Flexible pinna with cartilage present

32. Pinna top on horizontal line with outer canthus of eye

33. Common Variation
Skin tags on or around ears

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

35. Nose
Nostrils patent
Obligate nose breathers
No discharge

36. Deviations
Choanal atresia
Nasal flaring

37. 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.

38. 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

39. Mucosa moist Sucking calluses

40. High arched palate

41. Variation - Epstein’s pearls on ridges of gums

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

43. Candida Thrush

44. Teeth

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

46. 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.

47. Chest Evident xiphoid process Bilateral synchronous chest movement
Symmetrical nipples

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

50. 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 hours of birth

51. 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

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

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

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

56. Deviations Fecal discharge from vaginal opening Imperforate hymen
Ambiguous genitalia

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

59. Common Variations Erections Prepuce covering urinary meatus
Increased pigmentation

60. Deviations
Hypospadius
Epispadius
Smooth scrotum
Ambiguous genitalia

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

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

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

64. Feet appear flat

65. Palmar creases present

66. Sole creases present

67. Deviations Asymmetrical movement of extremities Unequal tone
Unequal leg length

68. Polydactyly

69. Asymmetrical skin creases posterior thigh

70. Marked metatarus varus “clubbed” feet