Infant Exam

  1. Vital Signs:
    Pulse, respirations, temperature.
  2. Measurement:
    Weight, length, head circumference - plot on growth curve.
  3. General Appearance:
    • 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.
  4. 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.
  5. Abdomen:
    • 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.
  6. 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.
  7. Eyes:
    • 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.
  8. Ears:
    • 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.
  9. Nose:
    • Determine patency of nares.
    • Note nasal discharge, sneezing, any flaring with respirations.
  10. 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.
  11. Neck:
    • 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.
  12. Upper extremities:
    • 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.
  13. Lower extremities:
    • 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.
  14. Genitalia:
    • Females:
    • Inspect labia and clitoris (edematous in newborn), vernix caseosa between labia, patent vagina.
    • Males:
    • Inspect posiiton of urethral meatus (do not retract foreskin), strength of urine stream if possible, rugae on scrotum.
    • Palpate testes in scrotum.
  15. Neuromuscular:
    • 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.
  16. 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.
  17. Final procedures:
    • 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.
Card Set
Infant Exam
Objective data