Normal Newborn

Well-flexed

Full Range of Motion

Spontaneous Movement

Common Variations

Frank BreechLimp PostureAsymmetry of MovementPersistent Tremor or Twitching

Skin

Skin reddish in color, smooth and puffy at birth

Edema around eyes, feet and genitals

Vernix CaseosaLanugo

Acrocyanosis

Acrocyanosis

Mongolian Spots

.

Mottling

Jaundice

Milia

Erythema Toxicum

http://www.calvin.edu/~rbobeldy/brandy/images/Nevus_jpg.jpg

Deviations

Jaundice within 24 hours of birthCircumoral cyanosis between feedingsRashes other than erythema toxicumHemangiomaPetechiaeSkin tags or extra digitsHarlequin color changes

Forceps Marks

Head

Anterior fontanel diamond shapedPosterior fontanel triangular shapedFontanels soft, firm and flatSutures palpable with small separation

between each

Caput

Molding of Fontanels and Suture Spaces

Cephalahematoma

Eyes

Slate gray or blueNo tearsFixation at timesRed and blink reflexesEyebrows

Edematous Eyelids

Uncoordinated Movements

Deviations

Opaque lensesChemical conjunctivitisDischarges

Subconjunctival Hemorrhage

Ears

Loud noise elicits startle reflexFlexible pinna with cartilage present

Pinna top on horizontal line with outer canthus of eye

Common Variation

Skin tags on or around ears

Deviations

Preauricular sinusLow ear placement

Nose

Nostrils patentObligate nose breathers No discharge

Deviations

Choanal atresiaNasal flaring

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.

Mouth and Throat

Minimal or absent salivationTongue moves freely and doesn’t protrudeWell developed fat pads bilateral cheeksSucking, Rooting, and Gag reflexes

Mucosa moistSucking calluses

High arched palate

Variation - Epstein’s pearls on ridges of gums

Deviations

Cleft lip or palateAsymmetrical lip movementProtruding tongue

Candida Thrush

Teeth

Neck

Short and thickTurns easilyTonic neck reflexSome head control

Deviations

WebbingLarge fat pad on back of neckPalpable crepitus, movement with palpation

of clavicle

Chest

Evident xiphoid processBilateral synchronous chest movementSymmetrical nipples

Common Variations

Enlarged breasts“Witch’s milk” Accessory nipples

Abdomen

Dome shapeSoft to palpationWell formed umbilical cordThree vessels in cordBilateral equal femoral pulsesBowel soundsVoiding within 24 hours of birthMeconium within 24 - 48 hours of birth

Deviations

Umbilical herniaPeristaltic waves visibleRedness or drainage at base of cordDistention or scaphoid shaped

Female Genitalia

Edematous labia and clitorisLabia majora are larger and surrounding

labia minoraVernix between labia

Common Variations

Hymenal tagPseudomenstruationSmegmaIncreased pigmentation“Brick dust” urine due to uric acid crystals

Deviations

Fecal discharge from vaginal openingImperforate hymenAmbiguous genitalia

Male Genitalia

Urinary meatus at tip of glans penisPalpable testes in scrotumLarge, edematous, pendulous scrotum with

rugaeSmegma

Common Variations

ErectionsPrepuce covering urinary meatusIncreased pigmentation

Deviations

HypospadiusEpispadiusSmooth scrotumAmbiguous genitalia

Back and Rectum

Intact spine without masses or openingsPatent anal openingWink reflex

Deviations

Limitation of movementSpina BifidaTuft of hairImperforate anusAnal fissuresPilonidal cysts

Extremities

Full range of motionEqual and bilateral movement and toneLegs appear bowedGrasp reflexNo hip click

Feet appear flat

Palmar creases present

Sole creases present

Deviations

Asymmetrical movement of extremitiesUnequal toneUnequal leg length

Polydactyly

Asymmetrical skin creases posterior thigh

Marked metatarus varus “clubbed” feet