ASSESSING NEWBORNS AND INFANTS

 Newborn 0-28 Days

 Infant 28 Days – 1 Year

Vital Statistics of Newborn

PARAMETERS NORMAL RANGE
VALUE
Weight 2.5 g to 4000 g (5 lbs. 8
oz. – 8 lbs 13 oz.)
Length 48 cm to 53 cm ( 19 to
21 inches)
Skin, Hair & Nails
Head circumference 32 cm to 37 cm (12.5 in.
 Skin is smooth and thin
to 14.5 in.)
 Vernix caseosa may be visible on the skin
Chest Circumference 30 cm to 35 cm ( 12 in.
 Sebaceous glands are active because of
to 14 in. )
high levels of maternal androgen
Abdominal 32 cm ( 12.5 in.)
 downy hairs (lanugo)
Circumference
 Scalp hair-follicle growth phases occur
*Mid-arm 9 cm – 11 cm
concurrently at birth but are disrupted
Circumference
during early infancy
 Nails are usually present at birth

Head & Neck

 Head growth predominates during the fetal
period.
 head circumference is greater (by 2 cm)
than that of the chest
 CLAMPS (Coronal, Lamboidal, Anterior
fontanelle, Metopic, Posterior fontanelle,
Sagittal)
 Skull is typically asymmetric
(plagiocephaly) because of molding that
GROWTH & DEVELOPMENT OF THE NEWBORN occurs as the newborn passes throughthe
Physical Development birth canal
֍ Head to Foot  Posterior fontanelle usually measures 1 to 2
- head is first to develop even in the womb cm at birth closes at 2 months.
- babies can first control their head  then  Anterior fontanelle measures 4 to 6 cm at
their arms, hands birth and closes between 12 and18 months.
֍ Near to Far  Neck is usually short during infancy
- Starts close to trunk of body & moves (lengthening at about age 3 or 4 years)
outward
- goes from waving to grasping
֍ Simple to Complex
- Large muscle groups develop first then
more complex movements requiring small
muscle development

Eyes
 Eye structure and function are not fully
developed at birth.
 iris shows little pigment, and the pupils are
small. The macula, which is absent at birth,
develops at 4 months and is mature by 8
months.
 Pupillary reflex is poor at birth and
improves at 5 months of age.
 The sclera is clear.
 Peripheral vision is developed, but central
vision is not.
 The newborn is farsighted and has a visual
acuity of 20/200.
 4 months, an infant can fixate on a singular
object with both eyes simultaneously
(binocularity). Tearing and voluntary
control over eye muscles begin at 2 to 3
months;
 4 months, infants establish binocular vision
and focus on a single image with both eyes
simultaneously & improves at 9 months
 Newborns cannot distinguish between
colors; this ability develops by 8 months.
Ears
 The inner ear develops during the first
trimester of gestation.
 hear loud sounds at 90 decibels and react
with the startle reflex
 respond to low frequency sounds, such as a
heartbeat or a lullaby, by decreasing crying
and motor movement
 the external auditory canal curves upward
and is short and straight
 eustachian tube is wider, shorter, and more
horizontal, increasing the possibility of
infection rising from the pharynx
Mouth, Throat, Nose and Sinus
 Saliva is minimal at birth but drooling is
evident by 3 months because of the
increased secretion of saliva (Drooling)
 The development of both temporary
(deciduous) and permanent teeth begins in
utero.
 Deciduous tooth eruption takes place
between the ages of 6 and 24 months
 tonsils and adenoids are small in relation to
body size and hard to see at birth
 pharynx is best seen when the newborn is
crying
 Newborns are obligatory nose breathers
and, therefore, have significant distress
when their nasal passages are obstructed
 The maxillary and ethmoid sinuses are
present at birth but they are small and
cannot be examined until they develop
Thorax & Lungs
 Fetal lungs should be developed and the
alveoli should be collapsed.
 Immediately after birth, the lungs aerate;
blood flows through them more vigorously,
causing greater expansion and relaxation
of the pulmonary arteries.
 The decrease in pulmonary pressure closes
the foramen ovale, increasing oxygen
tension and closing the ductus arteriosus.
 The lungs continue to develop after birth,
and new alveoli form until about 8 years of
age.
Breasts
 Ventral epidermal ridges (milk lines),
which run from the axilla to the medial
thigh, are present during gestation.
 True breasts develop along the thoracic
ridge; the other breasts along the milk
line atrophy.
 Occasionally a supernumerary nipple
persists along the ridge track.
 At birth, lactiferous ducts are present in
the nipple but there are no alveoli.
 Newborn’s breasts may be temporarily
enlarged from the effects of maternal
estrogen, they are usually flat and
remain so until puberty
Heart
 The foramen ovale closes within the first
hour because of the newly created low
pressure in the right side of the heart, and
 the ductus arteriosus closes about 10 to 15
hours after birth
 murmur generally resolves within 24 to 48
hours after birth
 pulse rate is usually between 120 and 160
beats/minute
 The heart should be auscultated at
approximately the 4th intercostal margin to
the left of the mid -clavicular line.
 The heart lays more horizontal in the chest
and may seem enlarged with percussion.
 Heart sounds are also more audible in the
newborn secondary to the thin
subcutaneous layer of skin on the newborn.
Abdomen
 UMBILICAL CORD is prominent in the
newborn and contains two arteries and one
vein.
 The umbilicus consists of two parts: The
amniotic portion is covered with a gel-like
substance and dries up and falls off within 2
weeks of life.
 The cutaneous portion is covered with skin
and draws back to become flush with the
abdominal wall.
 The abdomen of infants is cylindrical.
 newborn’s liver is palpable at 0.5 to 2.5 cm
below the right costal margin, thereby
occupying proportionately more space than
at any other time after birth
 Kidney development is not complete until 1
year of age.
 Bladder capacity increases with age; the
bladder is considered an abdominal organ
in infants because it is located between the
symphysis pubis and the umbilicus.
Peripheral Vascular System
 The skin should appear pink and well
perfused.
 The hands and feet may appear blue at
times (acrocyanosis), which is normal,
especially when the newborn is cold.
 Pulses should be audible at the 4th
intercostal space. Pulses should be felt in
extremities, assessing the radial, brachial,
and femoral pulses bilaterally
Genitalia
 In male infants the testes develop
prenatally and drop into the scrotum during
month 8 of gestation.
 Each testis measures about 1 cm wide and
1.5 to 2 cm long.
 At birth, female genitalia may be engorged.
Mucoid or bloody discharge may be noted
because of the influence of maternal
hormones.
 The genitalia return to normal size in a few
weeks and remain small until puberty.
Anus, Rectum & Prostate
 Meconium is passed during the first 24
hours of life, signifying anal patency.
 Stools are passed by reflex, and anal
sphincter control is not reached until 1.5 to
 2 years of age after the nerves supplying the
area have become fully myelinated.
 In boys, the prostate gland is
underdeveloped and not palpable.
MUSCOLOSKELETAL SYSTEM
 At birth the newborn should have full
range of motion (ROM) of all extremities.
 The feet should turn to the normal position
with ease by the examiner.
 The hips should also be checked for
dislocation and ease of movement by
performing the Ortolani test and Barlow’s
sign
 The spine has a single C-shaped curve at
birth.
 By 3 to 4 months, the anterior curve in the
cervical region develops from the infant
raising its head when prone.
NEUROLOGIC SYSTEM
 The neurologic system is not fully
developed at birth.
 Motor control is maintained by the spinal
cord and medulla, and most actions in the
newborn are primitive reflexes.
 Newborns have rudimentary sensation.
Any stimulus must be strong to cause a
reaction, and the response is not localized.
 Motor control develops in a head to neck
to trunk-to-extremities sequence
MOTOR DEVELOPMENT (in another page)
SENSORY PERCEPTION DEVELOPMENT
VISUAL: unfocused, ability to distinguish
between colors is not developed until
approximately 8 months of age.
AUDITORY: can distinguish sounds and turn
toward voices and other noises; very familiar with
their mother’s voice, and other sounds gradually
gain significance when associated with pleasure
OLFACTORY: Smell is fully developed at birth, and
2-week-old infants can differentiate the smell of
their mother’s milk and parents’ body odors.
TACTILE: Touch is well developed at birth,
especially the lips and tongue
COGNITIVE AND LANGUAGE DEVELOPMENT
(PIAGET)
 The sensorimotor stage, from birth to around
18 months:
ꬹ development of intellect and knowledge
of the environment gained through the
senses.
ꬹ During this stage, development
progresses from reflexive activity to
purposeful acts.
ꬹ At the completion of this stage, the
infant achieves a sense of object
permanence (retains a mental image of
an absent object; sees self as separate
from others).
ꬹ An emerging sense of body image
parallels sensorimotor development.
ꬹ Crying is the first means of
communication, and parents can
usually differentiate cries.
ꬹ Cooing begins by 1 to 2 months,
ꬹ laughing and babbling by 3 to 4 months,
and consonant sounds by 3 to 4 months.
ꬹ The infant begins to imitate sounds by 6
months.
ꬹ Combined syllables (“mama”) are
vocalized by 8 months, and
ꬹ the infant understands “no-no” by 9
months.
ꬹ “Mama” and “dada” are said with
meaning by 10 months, and the infant
says
ꬹ a total of 2 to 4 words with meaning by
12 months.
MORAL DEVELOPMENT (KOLBERG)
 Child moral development begins with the value
and belief system of the parents and the
infant’s own development of trust.
 Parental discipline patterns may start with the
young infant in the form of interventions for
crying behaviors.
 Stern discipline and withholding love and
affection may affect infant moral development.
 Love and affection are the building blocks of an
infant’s developing sense of trust.
PSYCHOSOCIAL DEVELOPMENT (ERIKSON)
 The crisis faced by an infant (birth to 1 year) is
termed trust versus mistrust.
 In this stage, the infant’s significant other is the
“caretaking” person.
 Developing a sense of trust in caregivers and
the environment is a central focus for an infant.
 This sense of trust forms the foundation for all
future psychosocial tasks.
 The quality of the caregiver–child relationship
is a crucial factor in the infant’s development of
trust.
PSYCHOSEXUAL DEVELOPMENT (FREUD)
 Oral Stage of development, from birth to 18
months, the erogenous zone is the mouth, and
sexual activity takes the form of sucking,
swallowing, chewing, and biting.
 In this stage, the infant meets the world by
crying, tasting, eating, and early vocalization;
biting, to gain a sense of having a hold on and
having greater control of the environment; and
grasping and touching, to explore texture
variations in the environment.
NORMAL INFANT NUTRITIONAL REQUIREMENTS
 Breast milk is the most desirable complete food
for the first 6 months of a child’s life.
 Iron-fortified formula is an acceptable
alternative. Formula intake varies per infant.
 Most infants take 100-cal/kg body weight/day.
This amount of formula should be offered to the
infant every 3 to 4 hours, approximately four to
six times a day.
 Juices may be offered at 6 months of age.
 Finger foods are introduced at 8 or 9 months.
 Weaning from breast or bottle to cup should be
gradual. The desire to imitate at 8 to 9 months
increases the success of weaning.
NORMAL INFANT SLEEP REQUIREMENTS AND
PATTERNS
 Sleep patterns vary among infants.
 During the first month, most infants sleep when
not eating.
 By 3 to 4 months, most infants sleep 9 to 11
hours at night.
 By 12 months, mos infants take morning and
afternoon naps.
 Bedtime rituals should begin in infancy to
prepare the infant for sleep and prevent future
sleep problems.
 Because of the possibility of SIDS (sudden
infant death syndrome), caution parents to
place their young infants to sleep in the supine
or side-lying position.
SUBJECTIVE DATA (NURSING HEALTH HISTORY)
Interviewing Parents
- Get a complete history of the mother
before and during pregnancy
Focus Questions
 Prenatal History: Gravida? Para? EDC?
Gestational Age? Maternal Hx? Risk Factors?
Prenatal exposure to drugs? Complications?
Blood type? Maternal testing?
 Labor and Delivery History: Date, time, type
of delivery? Prolonged labor? Narcotics? Time
of rupture of membranes? Intrapartum
complications?
 Delivery History: APGAR scores? Respiratory
effort? Resuscitation efforts? Medications?
Procedures performed? Evidence of injury?
Void? Stool?
 Social History: Parent interaction? Significant
others? Cultural variations? Type of infant
feeding? Male circumcision requested?
OBJECTIVE DATA (NEWBORN PHYSICAL
EXAMINATION) 3. TEMPERATURE
1. APGAR SCORE
- Assigned at 1-5 minutes after delivery

2. VITAL SIGNS
- Vital signs measurements begin to change
from those present in intrauterine life at
the moment of birth
 4. PULSE
- The heart rate of a newborn often remains
slightly irregular because of immaturity of
the cardiac regulatory center in the
medulla.
- Transient murmurs may result from the
incomplete closure of fetal circulation
shunts.
- A newborn’s heart rate is always
determined by listening for an apical
heartbeat for a full minute, rather than
assessing a pulse in an extremity.

5. RESPIRATION
- Respiratory depth, rate, and rhythm are
likely to be irregular, and short periods of
apnea (without cyanosis) which last less
than 15 seconds, sometimes called
periodic respirations, are normal.
- Respiratory rate can be observed most
easily by watching the movement of a
newborn’s abdomen, because breathing
primarily involves the use of the
diaphragm and abdominal muscles.

6. BLOOD PRESSURE
- The blood pressure of a newborn is
approximately 80/46 mm Hg at birth.
- By the 10th day, it rises to about 100/50
mm Hg.
- Because measurement of blood pressure
in a newborn is somewhat inaccurate, it is
not routinely measured unless A cardiac
anomaly is suspected.

MEASUREMENTS: GENERAL APPEARANCE

ASSESSMENT OF GESTATIONAL AGE (AOG)

 4 hours after birth
 Ballard Scale
NEWBORN REFLEXES
Blink Reflex
How to elicit/How to observe:
It may be elicited by shining a strong light such
as a flashlight or an otoscope light on an eye
Rooting Reflex
Normal Finding:
How to elicit/How to observe:
A sudden movement toward the eye
Brushed or stroked near the corner of the
sometimes can elicit the blink reflex
mouth
Normal Finding:
A newborn infant will turn the head in that
direction
Disappearance of Reflex:
The rooting reflex disappears by 3– 4 months.
Sucking Reflex
How to elicit/How to observe:
Newborn’s lips are touched
Normal Finding:
The baby makes a sucking motion
This reflex disappears at 10–12 months
Swallowing Reflex
How to elicit/How to observe:
Food that reaches the posterior portion of the
tongue is automatically swallowed
Normal Finding:
Normal swallowing does not keep the pharynx
free of obstructing mucus
Palmar Grasp Reflex
How to elicit/How to observe:
Newborns grasp an object placed in their palm
by closing their fingers on it
Normal Finding:
Newborns grasp so strongly
Disappearance of Reflex
This reflex disappears at 3–4 months
Stepping Reflex
How to elicit/How to observe:
Newborns who are held in a vertical position
with their feet touching a hard surface
Normal Finding:
Will take a few quick, alternating steps
Disappearance of Reflex
Within 2 months
Placing Reflex
How to elicit/How to observe:
Elicited by touching the anterior surface of the
lower part of a newborn’s leg against a hard
surface such as the edge of a bassinet or table
Normal Finding:
The newborn makes a few quick lifting
motions, as if to step onto the table
Plantar Grasp Reflex
How to elicit/How to observe:
Object touches the sole of a newborn’s foot at
the base of the toes
Normal Finding:
The toes grasp in the same manner as do the
fingers.
Disappearance of Reflex:
This reflex disappears at 8–10 months
Tonic Neck Reflex
How to elicit/How to observe
Newborns lie on their backs
Normal Finding
Heads usually turn to one side or the other
Disappearance of Reflex
This reflex disappears by 4–6 months.
Magnet Reflex
How to elicit/How to observe
Pressure is applied to the soles of the feet of a
newborn lying in a supine position
Normal Finding
The baby pushes back against the pressure

Trunk Incurvation Reflex (Galant)

How to elicit/How to observe
Moro Reflex (startle)
When newborns lie in a prone position and are
How to elicit/How to observe
touched along the paravertebral area by a
Hold newborns in a supine position and allow
probing finger
their heads to drop backward about 1 inch
Normal Finding
Normal Finding
they flex their trunk and swing their pelvis
Sudden head movement, they abduct and
toward the touch 60
extend their arms and legs. they swing their
Disappearance of Reflex:
arms into an embrace position and pull up their
3-4 months
legs against their abdomen
Disappearance of Reflex
This reflex disappears by 3 months

Landau Reflex
How to elicit/How to observe
A newborn who is held in a prone position with
Babinski Reflex a hand underneath, supporting the trunk
How to elicit/How to observe Normal Finding
When the sole of the foot is stroked in an Should demonstrate some muscle tone
inverted “J” curve from the heel upward
Normal Finding
A newborn fan the toes (positive Babinski sign)
Disappearance of Reflex
This reflex disappears within 2 years

Deep Tendon Reflex

How to elicit/How to observe
elicited in a newborn by tapping the patellar
tendon with the tip of the finger
Normal Finding
The lower leg moves perceptibly if the infant
has an intact reflex
Inspect and palpate the head. Note shape and
symmetry. In newborns, inspect and palpate the
condition of fontanelles and sutures.
NURSING PROCESS OVERVIEW
Health Promotion of a Term Newborn
Assessment
 Assessment of a newborn or neonate (a baby in
the neonatal period) includes a review of the
mother’s pregnancy history; physical
examination of the infant; analysis of
laboratory indicated;
 Parent–child interaction for the beginning of
bonding.
 Assessment begins immediately after birth and
is continued at every contact during a
newborn’s hospital or birthing center stay,
early home visits, and well-baby visits.
 Teaching parents to make assessments
concerning their infant’s temperature,
respiratory rate, and overall health is crucial so
that they can continue to monitor their infant’s
health at home
Nursing Diagnosis
 Ineffective airway clearance related to
mucus in airway
 Ineffective thermoregulation related to heat
loss from exposure in birthing room
 Imbalanced nutrition, less than body
requirements, related to poor sucking reflex
 Readiness for enhanced family coping
related to birth of planned infant
 Health-seeking behaviors related to
newborn needs
Outcome Identification and Planning
 Planning nursing care should take into
account both the newborn’s needs during
this transition period and a mother’s need
for adequate rest during the post-partal
period.
 Try to adapt teaching time to the schedules
of the mother and her newborn.
 Although the woman must learn as much as
possible about newborn care, she also must
go home from the health care setting with
enough energy to practice what she has
learned.
 Important planning measures for
newborns include helping them regulate
their temperature and helping them grow
accustomed to breastfeeding or bottle
feeding.
Implementation
 A major portion of implementation in the
newborn period is role modeling to help
new parents grow confident with their
newborn.
 Be aware how closely parents observe you
for guidance in newborn care.
 Conserving newborn warmth and energy, to
help prevent hypoglycemia and respiratory
distress, should be an important
consideration to accompany all
interventions.
Outcome Evaluation
 Evaluation of expected outcomes should
reveal that parents are able to give
beginning newborn care with confidence.
 Be certain parents make arrangements for
continued health supervision for their
newborn, so that evaluation can be
continued and the family’s long-term health
needs can be met.
 Examples indicating achievement of
outcomes concerning newborns are:
o Infant establishes respirations of 30
to 60 per minute.
o Infant maintains temperature at
97.8°to 98.6°F (36.5° to 37° C).
o Infant bottle feeds or breastfeeds
well with a strong sucking reflex.