Initial newborn assessment walkthrough
1. If baby is wrapped and settled, start with vital signs!
a. Respirations: 30-60/min, can be slightly irregular with periodic breathing, unlabored,
breath sounds clear and equal
b. Heart rate: 110-160 bpm, can be down to 90-110 bpm with sleep, S1 and S2? Murmurs?
c. Temperature: 36.5-37.5 degrees
2. Keep baby wrapped and begin assessing the head: any caput, moulding or cephalohematoma
present? Sutures may be visible and slightly overlapping
a. Anterior fontanel: diamond shaped, closes by 18-24 months, should be flat, not bulging
or depressed
b. Posterior fontanel: triangle shaped, closes by 2-3 months, should be flat, not bulging or
depressed
c. Eyes: symmetrical
d. Nose: symmetrical, nasal stuffiness can be normal, patent nares; tip and trick: occlude
each nare separately ensuring the infants mouth is closed
e. Mouth: symmetrical and midline, moist mucous membranes, palate intact, suck and
rooting reflexes should be present; tip and trick: while you’re checking palate, test suck
reflex at the same time ☺
f.
Ears: cartilage should be stiff for term infant, inline with eyes
3. Unwrap baby and assess chest: round and symmetrical, no use of accessory muscles, clavicles
intact, breast tissue present for gestational age assessment
4. Assess abdomen: rounded but soft and symmetrical, cord should be clamped with no signs of
infection, bowel sounds present
5. Open diaper and assess genitalia:
a. Female: labia majora should nearly cover labia minora in term infant
b. Male: testes should be descended (palpate), scrotum should be darker in pigmentation
c. Anus: present and patent?
6. Extremities: good tone, spontaneous flexion and extension, spontaneous movement
a. Feet: creases on majority of foot in term infant, plantar reflex, 10 toes?, normal to be
slightly bluish
b. Hands: 10 fingers? Grasp reflex, startle reflex (tip and trick: to perform startle reflex
safely, lift infants shoulder blades off the bed by pulling gently on their hands, but keep
head on bed, then let go 😊), normal to be slightly bluish
7. Skin: appropriate for race, smooth and soft, warm to touch, vernix? Lanugo? Bruising?
Birthmarks?
8. Flip baby over to assess spine, look for dimple at bottom of spine; tip and trick: to flip baby,
place one hand cupping under babies chin, other hand under babies shoulders/neck, lift gently
and rotate baby onto the arm supporting the head
9. Measurements!
a. Head circumference: always in centimeters, place measuring tape underneath infants
head and wrap around largest circumference (typically at the eyebrows)
b. Length: slide infant to top of bassinette so head is against the top, stretch out one foot
and use your pen to mark the length, easiest way ☺
10. Encourage skin to skin with Mom as soon as you’re done!! Assist with breastfeeding ☺
11. Document! Must be cosigned ☺