NEW BORN ASSESSMENT &

CARE OF NEONATE

Rupinder Deol
Assistant Professor
College of Nursing
AIIMS, RISHIKESH
 INTRODUCTION
• Monitoring of neonates is the keynote to
their successful outcome.
• Accurate nursing observation is a vital
factor in the survival and future
development of newborn.
• The initial physical examination should be
performed as soon as after the birth.
• All newborns should be thoroughly
examined in the first 24-48 hrs of age.
 INTRODUCTION
• The basic tools of assessment are the human senses of
vision, hearing, touch and smell.

• Examination of newborn entails investigation into the history

using different techniques namely inspection, palpation,
percussion and auscultation.

• The newborn assessment database includes information

gathered from the history, reviewing mother’s record, head to
toe examination for physical and neurological characteristics
and is used to establish nursing priorities, which guide nursing
diagnosis and nursing interventions.
 PURPOSE OF EXAMINATION
The overall purposes of new born
examination are to:
Identify the physical and neurological
characteristics of new born.
Identify and record evidence of common
neonatal problems and congenital
anomalies.
Provide a basis for identification of needs
and plan nursing care of new born.
 SPECIFIC INSTRUCTIONS
To perform thorough skilled examination of newborn, the
following specific instructions should be kept in mind:

1. Observation should be made when newborn is quiet

and awake.

2. Ensure adequate light in examination room.

3. The temperature of the examination room is maintained

at 28 +/- 2 degree C. avoid draft and chills in the
examination room.

4. Wash your hands till elbow for 3 minutes before and

after handling the newborn.
 SYSTEMATIC ASSESSMENT OF
NEWBORN

Neonatal assessment is done systematically from birth till

discharge of neonate.

Examination of newborn soon after birth is done very

quickly. Examination at birth includes assessment of

certain important parameters, to evaluate the adjustment

of newborn to these life processes.

On the basis of time of performing, assessment is of three
types:

1. Immediate assessment of newborn

2. Transitional assessment during period of reactivity

3. Periodic assessment.
 PURPOSES
The purposes of first examination at birth are:

1. To ensure the patency of orifices and

spontaneous breathing.

2. To identify life threatening congenital

malformations and birth injuries.

3. To classify the new born according to weight

and gestational age.
Immediate response of newborn to extra uterine
life can be determined by:
- Apgar score at one, five and ten minutes.
- Birth weight
- Length
- Axillary temperature
- Patency of orifices – anal patency, esophageal
atresia.
A detailed examination of newborn is performed
after 24 hrs of birth.
 FIRST DAY
• New born can tolerate much handling after first
day, as they recover from labour stress.
• Examination of newborn within first 24 hrs
include information about physiological
establishment and future physiological changes
that the newborn might undergo.
• Therefore, a thorough assessment that identifies
normal and abnormal findings , facilitates
planning of care by nurses.
 PUPROSES
The purposes of first day examination are to:
1. Identify any congenital anomaly missed out at
birth.

2. Assess feeding behavior.

3. Ensure passage of urine and stool.

4. Perform thorough head to toe examination.

5. Record measurements.
 IMMEDIATE ASSESSMENT OF NEW BORN
• For assessment of baby immediately after birth, APGAR
scoring is done.
• APGAR scoring is a quantitative method of assessing
infant’s respiratory , circulatory and neurological status.
• APGAR scoring is done at 1 min & 5 minutes after birth.
• Maximum APGAR score is 10 & the score of more than
7 is considered satisfactory & indicates absence of
difficulty in adjusting to extra uterine life.
• Score 4-6 : Moderate distress
• 0-3 : Severe distress
PARAMETER 0 1 2

Heart Rate Absent <100 >100

Respiratory Absent Irregular, Good, strong

Effort slow cry
Muscle Tone Limp Some flexion Well flexed
of extremities

Reflex No Grimace Cry, Sneezes

Irritability response
Color Blue, Pale Body pink, Completely
extremities pink.
blue
Immediate newborn assessment includes:
 APGAR scoring
 Recording of birth weight
 Umbilical cord is examined for presence of 2 umbilical
arteries and 1 vein.
 Orifice counting & checking their patency.
• Mouth is checked for cleft palate and lip.
• Ears and nose
• Anus is checked for imperforation or malformation.
• Urethra is checked for hypospadias or epispadias.
• Any visible lesions on back or front.
Examination at 24 hrs: Assess

Ask
o Breastfeeding
o Activity of the baby
o Any other problems*

Check
o Weigh the baby
o Temperature

Record
•Passage of meconium up to 24 hrs and urine up to 48 hrs of life
is usually normal

EN- 16
 ROUTINE EXAMINATION
• Detailed examination on routine basis is not
required.
• But till the time, the new born remains in the
hospital the new born should be observed for
feeding behavior and maintenance of
temperature, jaundice, seizures and any
superficial infections.
• The mother should be enquired about the
behaviour of the new born eg; feeding problems,
passage of urine and stool, vomiting.
 PURPOSE OF ROUTINE EXAMINATION

• To assess the feeding behavior.

• To detect any superficial infection.

• To assess the temperature maintenance.

• To identify any feeding problem.

 ON DISCHARGE

Before the new born is sent home, a detailed examination

is necessary. The purposes are:
- To identify any anomaly and birth injury which might
have got missed out at earlier examination.

- To assess any other problem.

- To educate the mother about care of new born at home.

- To record baseline data for future comparison.

- To refer the newborn, if needed.

 STEPS OF EXAMINING THE NEW BORN
• Place the newborn on a flat surface at a
comfortable height to yourself.
• The examiner’s hands must be dry and warm, as
cold hands startle the new born. Warm up your
hands by drying and rubbing.
• The examiner’s nail should be short and free of
nail polish.
• Handle newborn gently.
• Don’t expose the newborn unnecessarily.
Redress after completion of examination.
 STEPS OF EXAMINING THE NEW BORN
• Proceed systematically.
• The sequence in which the various features of
the examination are assessed is a matter of
personal preference.
• Generally, the nurse begins by performing
examination of those areas that require newborn
to be in quiet state. Eg, counting respiratory rate.
• Measure head and chest circumference and
length at same time to compare the results.
• Involve parents during newborn examination, by
swaddling, holding, keeping the baby clean.
 STEPS OF EXAMINING THE NEW BORN
• Avoid performing a detailed assessment just before or

after feeding.

• The findings should be recorded promptly, accurately

and systematically.

• Collect required articles, ensure proper functioning and

that they are accessible.

 ARTICLES & PURPOSES
ARTICLE PURPOSE
WEIGHING MACHINE TO MEASURE WEIGHT.

MEASURING TAPE TO MEASURE HC,CC & ABDOMINAL

GIRTH.

INFANTOMETER TO MEASURE CROWN TO HEEL

LENGTH.

T.P.R. TRAY TO CHECK TEMPERATURE

STETHOSCOPE TO AUSCULTATE H.R.

TORCH TO CHECK PUPILLARY REFLEX &

TO OBSERVE ORAL CAVITY.

RECORD SHEET TO RECORD THE FINDINGS.

 Assess:
Listen for

Grunting, Cry, Heart sounds

EN- 27
 Assess:
Feel for
• Any abnormal swelling:
Caput, cephalhematoma
• Palpable femoral pulses
• Dislocation of hip
• Capillary refill time ( CRT)
• Confirm the findings of inspection
• Palpate the abdomen
• Feel for testes in male baby

EN- 28
 GUIDELINES FOR ASSESSMENT
• Examination of new born includes reviewing
history, measurements, general appearance,
vital signs & head to toe assessment for
identification of physical characteristics,
neurological characteristics and deviations, if
any.

• Nurse review’s history from the mother’s records

related to previous and present pregnancy and
labour.
1. INFORMATION RELATED TO PREVIOUS
PREGNANCY:

- Gravida, para, abortions, number of alive

children, still born.

- Nature of previous pregnancy/ies, nature of

puerperium.
2. Information related to present pregnancy:
- LMP & EDD/ period of gestation.
- Parity
- Registered/ unregistered or booked/unbooked case
- Mother’s immunization – tetanus toxoid.
- Nutrition during pregnancy
- Folic acid, calcium and iron supplementation.
- Any history of illness and infections during 1st, 2nd
and 3rd trimester, medications taken or treatment
required viz; PIH, eclampsia, anemia, fever, and
diabetes.
- Blood group, Hb, urine for albumin, sugar.
3. History of Labour:

- Presentation

- Duration of labour (during 1st stage, duration of

2nd stage)

- ROM

- Medication during labour

- Method of delivery
WHAT TO ASSESS? TECHNIQUE FOR CHARACTERISTICS OF
ASSESSMENT NORMAL NEW BORN

2. SKIN
i) Skin color Observe color of skin Pink color; peripheral
especially of hands, feet cyanosis/acrocyanosis
and nails. within 1st 24 hrs of birth
involves the hands, feet
and circumoral area
(around the lips) in a
normal variation.

ii) Texture Examine by inspection and Soft, smooth, possible

pinching the skin . peeling, dryness and
cracking over hands and
feet.
iii) Skin turgor Check by inspection and
pinching. Good turgor

iv) Vernix Caseosa Observe for presence Greasy, grey white

substance with cheese like
consistency
 Color of the baby

 Normal vs. Abnormal

EN-
Teaching Aids: ENC 34
Erythema Toxicum
 Erythema Toxicum
• Erythematous macules and firm 1-3 mm
yellow or white papules or pustules
• Etiology obscure
• Pustules contain eosinophils and are
sterile
• Appear in the first 3-4 days of life
– Range: Birth to 14 days
• Benign and self limited
Erythema Toxicum
 DD: Impetigo Neonatorum
• Vesicular, pustular, or bullous lesions
developing as early as day of life 2-3 up to
2 weeks of life
• Lesions occur in moist or opposing
surfaces of skin
• Unroofed lesions do not form crusts
• Treat with antibiotics
Impetigo Neonatorum
 MONGOLIAN SPOTS
• 90% of African infants, 81% of Asian, and
9.6% of Caucasian infants
• Slate-gray to blue-black lesions
• Usually over lumbosacral area and
buttocks
• Accumulation of melanocytes within the
dermis
• Generally fade by age 7 years
Mongolian Spots
BENIGN PUSTULAR MELANOSIS OF THE
NEWBORN
PUSTULAR MELANOSIS
 GENERAL INSPECTION
• Vigorous cry is assuring
• Weak cry
– sepsis, asphyxia, metabolic, narcotic use
• Hoarseness
– Hypocalcemia, airway injury
• High pitch cry
– CNS causes, kernicterus
WHAT TO ASSESS? TECHNIQUE FOR CHARACTERISTICS OF
ASSESSMENT NORMAL NEW BORN
v) Lanugo Examine on back, shoulders, Lanugo (fine hair) seen on
forehead and cheeks. back, shoulders, forehead
and cheeks.
vi) Normal Variation Check by blanching skin Yellowish discoloration of
Physiological Jaundice over bridge of nose. skin.

Erythema Toxicum Observe back, shoulders Small isolated areas of

and trunk of new born. redness with a yellowish
white wheal in the center
commonly seen on back,
shoulders and trunk.

Milia Observe chin, nasal bridge Whitish pin head sized spots
and nasolabial folds. on around the nose or the
chin may be present.

Mongolian spot Observe sacral region for Smooth, bluish green naevus
mongolian spot. measuring 2-10 cm in
diameter may be present in
the sacral region.
WHAT TO ASSESS? TECHNIQUE FOR CHARACTERISTICS
ASSESSMENT OF NORMAL NEW
BORN
3) VITAL SIGNS
i) Respiration Observe by watching Norma RR = 40-60
Determine rate, rhythm abdominal movement breaths/min
and count for 1 min.

ii) Heart rate Check by placing the Normal H.R =120-160

Determine rate stethoscope apically i.e. beats/min. crying
5th intercostal space in increases & deep sleep
the mid clavicular line for decreases HR.
1 min.

iii) Temperature Axillary temperature is Normal axillary temp=

preferable and should be 36.5- 37.5 0 C (95.5-
taken for atleast 3 mins. 99.3o F)

You should also gain Trunk feels warm,

experience in assessing extremities are
the temperature of reasonably warm and
newborn using hand. pink.
 Temperature
• At birth-warmth, keep the baby in skin to
skin contact with the mother

EN- 47
 Temperature recording

• Hands and feet should be checked for

warmth with the back of the hand to see if
the baby is in cold stress
• Temperature measurement
 Use clean thermometer
 Hold vertically in the axilla for 3 minute
 Read and record
 Normal 36.5ºC-37.5ºC

EN- 48
WHAT TO TECHNIQUE FOR ASSESSMENT CHARACTERISTICS
ASSESS? OF NORMAL NEW
BORN
4)
MEASUREMENTS Place the tape measure firmly over the Normal HC = 33-35.5
i) Head supra orbital ridges anteriorly and cm
circumfrence posteriorly over the occipital
protuberence that gives maximum Moulding after birth
circumference. may decrease the HC.
Bring the two ends of the tape in front .

ii)Length Record weight immediately after birth &

iii) Body weight daily while in hospital.
Place a paper lining on the scale.
Balance weighing scale beam balance.
Place nude newborn on weighing scale.
While weighing, place hand an inch
above newborn’s body to quickly grasp
the newborn, if neccesary.

iv)Chest Place & position the measuring tape Between 31-35 cm or

circumference under the rib cage at the nipple line. 12-13 inches (1 inch or
2-3 cm less than HC)
 Weighing the baby
• Prepare the scale: cover the pan with a
clean cloth/autoclaved paper; ensure the
scale reads zero
• Preparing and weighing the baby
 Remove all clothing
 Wait till the baby stops moving
 Weigh naked
 Read and record
 Return the baby to the mother
• Scale maintenance
 Calibrate daily
 Clean the scale pan between each
weighing
EN- 50
WHAT TO TECHNIQUE FOR CHARACTERISTICS OF
ASSESS? ASSESSMENT NORMAL NEW BORN

5) HEAD
i) Fontannels Palpate anterior and AF is diamond shaped, flat,
posterior fontanelles when soft, firm.
newborn is quiet. Measures 2.4*4.0 cm
PF is triangular in shape, 1.2
cm wide.
Fontanel may bulge when
newborn cries.

ii) Sutures Palpate sutures Sutures may override during

vaginal delivery.

iii) Hair Observe texture Silky separate strands.

iv) Head lag Holding at the hands lift Able to maintain head in line
the supine baby gently. with the body and bring head
Observe the position of the anterior to the body.
head in relation to trunk.
WHAT TO ASSESS? TECHNIQUE FOR CHARACTERISTICS
ASSESSMENT OF NORMAL NEW
BORN
vi) NORMAL VARIATION
MOULDING Observe for appearance, May have elongated
shape of head. appearance in vaginal
birth newborns.
Bruising, abrasion Inspect head for No bruising or abrasions
bruising, abrasion or
swelling.
Caput succedaneum Observe for Localised edema on the
subcutaneous edema newborn scalp crossing
(soft tissue swelling) and the suture lines may
locate the extent. present at birth.
Cephal hematoma Observe for swelling on A localised effusion
the scalp. (serum blood) firmer to
touch than edematous
area, feels like a water
filled balloon usually
appears on 2nd or 3rd day
after birth. Does not
cross suture line.
CEPHALHEMATOMA
CAPUT SUCCADANEUM
NEWBORN SCALP HEMATOMATA
 Caput succedaneum vs.
cephalohematoma

 Normal vs. Abnormal

EN-
Teaching Aids: ENC 56
Infant skull
 CRANIOSYNOSTOSIS
• Definition: premature closure of one or
more cranial suture.
• Growth of the skull occurs parallel to the
suture(s) involved
• Early correction optimizes cosmetic
appearance
• Can be part of syndromes:Crouzon's ,
Apert's syndrome
 CRANIOSYNOSTOSIS

• Types:
– Sagittal synostosis results in
scaphocephaly
– coronal synostosis results in
brachycephaly
– coronal, sagittal, and
lambdoid synostosis results
in acrocephaly
– single suture on one side of
head can result in
plagiocephaly

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WHAT TO ASSESS? TECHNIQUE FOR CHARACTERISTICS OF
ASSESSMENT NORMAL NEW BORN
6) EYES Observe eyes, color of Eyes usually closed, lids
sclera & iris, discharge usually edematous.
etc. Sclera-white to bluish
white.
Iris- dark gray & brown.
No discharge, eyes clean
& healthy.
Glabellar Tap Tap sharply at galbella &
look for closure of eyes. Brisk closure of eyes.
7)EARS Draw a horizontal line Top of pinna of ear is in a
i) Location from outer canthus of horizontal plane to the
eye. outer canthus.

ii) Ear cartilage Assess ear firmness by Pinna firm, cartilage felt
palpation. along with edge.

iii) Ear recoil Check ear recoil by Instant recoil.

folding pinna forward and
releasing it.
WHAT TO TECHNIQUE FOR CHARACTERISTICS OF
ASSESS? ASSESSMENT NORMAL NEW BORN
8) NOSE Observe patency of nasal
Nasal passage passage. Nasal passage is patent.
9) ORAL CAVITY Observe oral cavity (lips, Clean oral cavity. Intact high
i) Cleanliness gums, teeth, palate, tongue) arched palate. Uvula in
by stimulating newborn to midline. No precocious teeth.
cry. No epstein pearls & no oral
thrush.

Touching/stroking the cheek

ii) Rooting reflex Touch/ stroke the cheek along the side of the mouth
along the side of mouth. stimulates the newborn to turn
head towards the side.

Sucking & swallowing reflex is

iii) Sucking reflex well developed & coordinated.
Observe while mother is
breast feeding the new born When tongue is touched or
depressed, newborn responds
iv) Extrusion reflex Touch or depress tongue of by forcing it outwards.
newborn.
WHAT TO TECHNIQUE FOR ASSESSMENT CHARACTERISTICS OF
ASSESS? NORMAL NEW BORN
10)NECK Inspect & palpate lymph nodes in Neck is short, symmetrical, no
neck & also check for range of glands palpable, full ROM.
motion.

Place the newborn in supine The arm & leg on the side to
Tonic Neck position, turn the head to one side. which head is turned extend
Reflex while the opposite arm and leg
flex. (a symmetric response).

11) CHEST Observe size, shape of chest, Breast tissue >10 mm diameter.
Breast Nodule retractions. Areola raised.

Hold the breast tissue between May have gynaecomastia, may

thumb & finger. have milky white discharge
(white milk)
Observe for breast engorgement &
discharge. Round, symmetrical,
slightly smaller than head.
Retraction may be present
immediately after birth.
 CHEST
• Distress signs(Grunting,Tachypnea,Nasal
flaring,asymetric chest rise,supra-sternal,
intercostal, sub costal retraction).
• Deformities(Pectus excavatum, carinatum)
• Auscultate
– Air entry, symmetry
– Early crepitation sound is transmitted upper
sound
– Late inspiratory crepitation
 SUPERNUMERARY NIPPLES
• Found in males and females
• Pink or brown papules along the milk line,
most commonly on the chest or abdomen
• May contain breast tissue and in women
carry the same relative neoplasia risks
• Not considered a marker for other
anomalies
SUPERNUMERARY NIPPLES
 GENITALIA
• Penile size
• Hypospadias, epispadias
• Testes
– 2% crypoorchid
• Female:
– Prominent clitoris and minora
– Vaginal skin tag
– Vaginal discharge /blood
– Labial fusion
• Anus : Patency and location
INGUINAL HERNIAS
 HIP AND EXTREMITIES
• Erb’s palsy: extended arm and internal
rotation with limited movement
• Humerous fracture
• Digital abnormality
– Syndactaly, brachdactaly, polydactaly
• Single palmar crease
• Hip dislocation
– Female, breach
SUBLUXATION OF THE HIP
SUBLUXATION OF THE HIP
LUMBAR HAIR TUFT &
HAEMANGIOMA
WHAT TO ASSESS? TECHNIQUE FOR CHARACTERISTICS OF
ASSESSMENT NORMAL NEW BORN
12) ABDOMEN
i) Bowel Sound Auscultate bowel sound. Bowel sounds are present.

ii) Umbilical Cord Initially umbilical cord is

Observe & count number of white & gelatinous, later it
blood vessels, observe for dries & shrivels. Two
any discharge or bleeding. arteries & one vein (clean,
no discharge or bleeding)

13) GENITALIA
i) Female Observe development of Labia majora well
Labia majora, urethral developed. Labia majora
meatus & vaginal opening & completely covers the labia
any discharge. minora. Urethral meatus is
located above the vaginal
opening. Whitish mucoid or
bloody discharge
(Pseudomensturation may
be present)
 The umbilicus: Which one is
normal?

 Normal vs. Abnormal

Teaching Aids: ENC EN- 73
 Umbilicus
The NORMAL umbilicus is:
Bluish-white in colour on day 1.
It then begins to dry and shrink and

If falls off after 7 to 10 days

No discharge

LOCAL UMBILICAL INFECTION

RED umbilicus or
RED skin around the umbilicus

POSSIBLE SERIOUS INFECTION

Umbilicus draining pus or

Umbilical redness, swelling extending to skin

Teaching Aids: ENC EN- 74

 ABDOMEN
• Inspection
– Scaphoid
– Distention
– Abdominal wall defect (gastroschisis)
• Palpation; baby sucking and use warm hands
– Kidneys are normaly palpable
– Liver 2-3 cm
– Spleen palpable
– Umbilical vessels
• 2 artery, one vein
– Hernias ; umbilical and inguinal
WHAT TO ASSESS? TECHNIQUE FOR CHARACTERISTICS
ASSESSMENT OF NORMAL NEW
BORN

ii) Male Observe the scrotal Testes descended in

rugae and palpate testes scrotum.
in the scrotum. Scrotum pendulous and
deeply pigmented
Observe location of Urethra opening located
urethral opening. at tip of glans.

14) BACK
i) Spinal curve Observe spinal curve Spinal curve round.
while newborn is in
prone position.

Observe for location & Patent & opening.

anal opening. H/O
passage of meconium
during the 1st 24-48 hrs.
 NEUROLOGIC ASSESSMENT

The neurologic assessment is based on 4 four fundamental

observations:
1. Muscle tone
2. Joint mobility
3. reflexes
4. Body movements
1. Muscle tone: This is assessed by three parameters: a)
Posture ; b) Passive tone c) Active tone.
2. Joint mobility: In preterm babies, the joints are relatively
stiff so the degree of flexion at ankle and wrist is limited.
In term babies, joints are more flexible and relaxed.
3. Certain reflexes: The presence of certain reflexes such
as moro’s reflex, pupillary reflex, blinking, grasp, rooting
and sucking reflex help in establishing neurological
health of neonate. These reflexes disappear after
maturity of nervous system.
4. Body movements: The neonate if not sleeping, is active
and alert. The baby moves extremities actively.
WHAT TO ASSESS? TECHNIQUE FOR CHARACTERISTICS OF
ASSESSMENT NORMAL NEW BORN
15) EXTREMITIES
i) No. of fingers & toes. Count the fingers of toes & 10 fingers of hands & toes
hands & types. each.

ii) Sole creases Observe for sole creases Deep creases over anterior
after stretching the skin. 1/3rd to ½ of sole.

Newborn offer resistance

iii) Resistance to passive Move elbow across the to passive movement.
movement/ scarf sign. chest. Elbow does not cross the
mid line of chest.

iv) Joint mobility Joints are flexible i.e.

Check for joint mobility by makes 0o angle between
observing degree of flexion foot & leg.
at ankle joint.

v) Grasp reflex Place a finger across the

palm at the base of the
fingers.
WHAT TO ASSESS? TECHNIQUE FOR CHARACTERISTICS
ASSESSMENT OF NORMAL NEW
BORN
vi) Moro’s Reflex Elicit by sudden change Sudden extension &
in equilibrium. abduction of extremities
& fanning of fingers
followed by flexion &
adduction of extremities.

vi) Babinski’s reflex Stroke plantar surface of The toes flare open.
newborn’s foot.

vii) Step or dance reflex Hold newborn in upright New born make stepping
position so that sole of movement.
foot touches examination
table.
REFLEXES EXPECTED AGE OF AGE OF
OF EYE BEHAVIORAL APPEARA DISAPPEAR
RESPONSE NCE ANCE

1. BLINKING Infant blinks at sudden Birth Does not

appearance of bright light disappear.
or approach of any object
towards light.

2. Pupil constricts when bright Birth Does not

PUPILLA light falls on it. disappear
RY
REACTIO
N
3. DOLL’S As head is moved to right Birth 3-4 months.
EYE or left, eyes lag behind &
do not immediately adjust
to new position.
REFLEXES EXPECTED AGE OF AGE OF
OF NOSE BEHAVIORAL APPEAR DISAPPEA
RESPONSE ANCE RANCE
4. SNEEZE Spontaneous Birth Does not
response of nasal disappear
passage to any
irritant.
5. Tapping briskly on Birth Does not
GLABELLAR bridge of nose disappear
(Gabella) causes
eyes to close
tightly.
REFLEXES EXPECTED AGE OF AGE OF
OF MOUTH BEHAVIORAL APPEARAN DISAPPEAR
RESPONSE CE ANCE
6. ROOTING The infant turns his head Birth 3-4 months
towards any object that
touches his cheek and
actively seeks the nipple
and begins to suck.
7. SUCKING Baby begins to suck in Birth Persists
response to stimulation of during infancy
circumoral area.
8. GAG Stimulation of posterior Birth Persists
pharynx by food or suction throughout
causes infant to gag. life.
9.EXTRUSION When tongue is touched or Birth 4 months
depressed, infant responds
by forcing it outward.
10. COUGH Irritation of mucus Birth Persists life
membranes of larynx long.
causes cough
REFLEXES OF EXPECTED AGE OF AGE OF
EXTREMITIES BEHAVIORAL APPEARANCE DISAPPEARAN
RESPONSE CE
11. GRASP Touching palms of Birth Palmar grasp – 3
hands or soles of months
foot near base of Palmar grasp – 8
digits causes months.
flexion of hands
(Palmar grasp)
and soles (Plantar
grasp)
12. BABINSKI Stroking outer Birth 1 year
sole of foot
upward from heel
across ball of foot
causes toes to
hyperextend.
MASS EXPECTED AGE OF AGE OF
REFLEXES BEHAVIORAL APPEARANCE DISAPPEA
RESPONSE RANCE
13. MORO’S When loud voice is made or Birth 3-4 months
there is sudden change in
equilibrium, it causes
sudden extension and
abduction of extremities and
fanning of fingers.
14. Perez When infant is prone on a Birth 4-6 months
firm surface, thumb is
pressed along the spine
from sacrum to neck, infant
responds by crying, flexing
extremities and elevating
pelvis and head and
lordosis of spine.
15. Tonic When infant’s head is 2nd month 3-4 months
neck turned to one side, arm and
leg extend on that side and
opposite arm and leg flex.
MASS EXPECTED AGE OF AGE OF
REFLEXES BEHAVIORAL APPEARANCE DISAPPEARAN
RESPONSE CE
16. Galant reflex Stroking infant At birth 4 weeks
back alongside
spine causes hip
to move towards
stimulated side.
17. Dance or If infant is held At birth 3-4 weeks
stepping such that side of
foot touches a
hard surface,
there is reciprocal
flexion and
extension of legs.
18. Crawl When placed on Birth 5 weeks
abdomen, infant
makes crawling
movements.
 It is NORMAL for a baby

 To pass urine six or more times a day after day 2

 To pass six to eight watery stools (small volume) in
24 hrs
 Female baby may have some vaginal bleeding for
a few days during the first week after birth. It is not
a sign of a problem.
 Loses weight and regains by 7-10 days
EN-
Teaching Aids: ENC 87
OBSERVATIONS OF DEVIATIONS FROM
NORMAL
While examining the new born, it is important to
observe for deviations.
i) CONGENITAL MALFORMATIONS
Hydrocephalous, microcephaly, cleft lip & palate,
TEF, imperforate anus, hypospadias,
epispadias, polydactyly, syndactyly.
ii) NEONATAL INFECTION, LETHARGY, POOR WEIGHT GAIN.
Restlessness, lowered temperature, visible
lesions, discharge from eyes & umbilical cord,
weak reflexes, refusal of feed intolerance,
hypotonia.
 Danger signs

 Not feeding well • Floppy or stiff

 Less active than before • Temperature >37.50C
 Fast breathing (>60/ or <35.50C
min) • Umbilicus draining pus
 Moderate or severe or umbilical redness
chest in-drawing extending to skin.
 Grunting • >10 skin pustules
 Convulsions • Bleeding from umbil.
Stump

EN-
Teaching Aids: ENC 89
 Conclusion
• All newborn babies must be examined at
– Birth
– 24 hrs
– Before discharge and
– Follow-up
• A systematic approach consisting of ‘Ask,
Check, Look, Listen, Feel’ should be followed at
each assessment
Thank You!