Pulse, respirations, temperature.
Weight, length, head circumference - plot on growth curve.
- Body symmetry, spontaneous position, flexion of head and extremeties, spontaneous movement.
- Skin color and characteristics, any obvious deformities.
- Symmetry and positioning of facial features.
- Alert, responsive affect.
- Strong, lusty cry.
Chest and Heart:
- Skin condition over chest & abdomen, chest configuration, nipples, and breast tissue.
- Note movement of abdomen with respirations, any chest retraction.
- Palpate apical impulse and note location; chest wall for thrills, tactile fremitus if infant is crying.
- Ausculatate breath sounds, heart sounds in all locations, bowel sounds in abdomen and in chest.
- Inspect shape and skin condition.
- Inspect umbilicus; count vessels (2 arteries, 1 vein), note condition of cord or stump, any hernia.
- Palpate skin turgor.
- Palpate lightly for muscle tone, liver, spleen tip, bladder.
- Palpate deeply for kidneys, any mass.
- Palpate femoral pulses, inguinal lymph nodes.
- Percuss all quadrants.
Head and Face:
- Note molding after delivery, any swelling on cranium, bulging of fontanel with crying or at rest.
- Palpate fontanels, suture lines, any swellings.
- Inspect positioning and symmetry of facial features at rest and while the infant is crying.
- Note: To open eyes, support head and shoulders and gently lower the baby backward, OR ask parent to hold baby over his or her shoulder while you stand behind parent.
- Inspect the lides (edematous in neonate), palpebral slant, conjunctivae, any nystagmus, any discharge.
- Using penlight, elicit pupillary reflex, blink reflex, corneal light reflex, assess tracking of moving light.
- Using an opthalmascope, elicit red reflex.
- Inspect size, shape, alignment of auricle, patency of auditory canals, any extra skin tags or pits.
- Note the startle reflex in response to loud noise.
- Palpate flexible auricles.
- Note: Defer otoscopic exam until end of complete exam.
- Determine patency of nares.
- Note nasal discharge, sneezing, any flaring with respirations.
Mouth and Throat:
- Inspect lips and gums, high-arched intact palate, buccal mucosa, tongue size, frenulum, note absent or minimal salivation in neonate.
- Note rooting reflex.
- Insert a gloved little finger, note sucking reflex, and palpate palate.
- Lift shoulders and let head lag to inspect neck; note midline trachea, any skinfolds, any lumps.
- Palpate lymph nodes, thyroid, and any masses.
- While infant is supine, elicit tonic neck reflex; not a supple neck with movement.
- Inspect and manipulate, noting ROM, muscle tone, absence of scarf sign (elbow should not reach midline).
- Count fingers, count palmer creases, note color of hands and nail beds.
- Place your thumbs in the infant's palms to note grasp reflex, then wrap your hands around infant's hands to pull up and note head lag.
- Inspect and manipulate the legs and feet, noting RM, muscle tone, and skin condition.
- Note alignment of feet and toes, look for flat soles, count toes, note any syndactyly.
- Test Ortanlani's sign for hip stability.
- Inspect labia and clitoris (edematous in newborn), vernix caseosa between labia, patent vagina.
- Inspect posiiton of urethral meatus (do not retract foreskin), strength of urine stream if possible, rugae on scrotum.
- Palpate testes in scrotum.
- Lift infant under axillae, hold infant facing you at eye level.
- Note shoulder muscle tone, infant's ability to stay in your hands without slipping.
- Rotate the neonate slowly side to side, note the doll's eye reflex.
- Turn infant around so his/her back is to you; elicit the stepping reflex and the placing reflex against the edge of the exam table.
Spine and rectum:
- Turn the infant over and hold him/her prone in your hands, or place prone on exam table.
- Inspect length of spine, trunk incurvation reflex, symmetry of gluteal folds.
- Inspect intact skin, any sinus openings, protrusions, or tufts of hair.
- Note patent anal opening. Check for passage of meconium stool during 1st 24-48 hrs.
- With an otoscope, inspect the auditory canal and tympanic membrane.
- Elicit the Moro reflex by letting the infant's head and trunk drop back a short way, by jarring crib sides, or by making a loud noise.