ASSESSING NEWBORNS AND INFANTS

Newborn or Neonate

is the term used to describe a child from birth to 28 days old.

Infant

refers to a child between the ages of 28 days and 1 year.

T

T or F:
At birth, the newborn’s skin is smooth and thin.

ruddy

A newborn’s skin may appear ________ because of visible blood circulation through the newborn’s thin layer of subcutaneous fat.

ineffective temperature regulation

Thin layer of fat, combined with the skin’s inability to contract and shiver, results in ___________________________________________.

T

T or F:

The dermis and epidermis are thin and loosely bound together. This increases the skin’s susceptibility to infection and irritation and creates a poor barrier, resulting in fluid loss.

Acrocyanosis

When the newborn’s body temperature drops, the hands and/or feet may appear blue.

Vernix Caseosa

may be visible on the skin. It appears as a thick, cheesy, white substance on the skin and is especially prevalent in skin folds. This is normal and usually absorbs into the skin.

maternal androgen

After birth, the newborn’s sebaceous glands are active because of high levels of ___________________________.

Milia

develop when these glands become plugged.

Eccrine Glands

function at birth, creating palmar sweating, which is helpful when assessing pain.

Apocrine Glands

stay small and nonfunctional until puberty.

lanugo, 3 months gestation

The fine, downy hairs called _____________, which appear on the newborn’s body, shoulders, and/or back at birth, develop in the fetus at _____________________ and disappear within the first 2 weeks of life.

F, early infancy

T or F:

Scalp hair-follicle growth phases occur concurrently at birth but are disrupted during late infancy.

alopecia

Scalp hair-follicle growth phases occur concurrently at birth but are disrupted during early infancy. This may result in ________________.

T

T or F:

Nails are not usually present at birth.

prematurity, post maturity

Nails are usually present at birth. Missing or short nails usually signify __________________, and long nails usually signify _________________________.

F, convex

T or F:

Nails are usually pink, concave, and smooth throughout childhood and adolescence.

fetal period

Head growth predominates during __________________________.

2 cm

At birth, the head circumference is greater (by ________) than that of the chest.

Cranial Bones

are soft and separated by the coronal, lambdoid, and sagittal sutures, which intersect at the anterior and posterior fontanelle.

coronal lambdoid, sagittal sutures

The cranial bones are soft and separated by the _____________________, and _________________________, which intersect at the anterior and posterior fontanelle

Ossification

begins in infancy and continues into adulthood.

plagiocephaly

The newborn’s skull is typically asymmetric (_________________________) because of molding that occurs as the newborn passes through the birth canal.

Posterior Fontanelle

usually measures 1 to 2 cm at birth and usually closes at 2 months

Anterior Fontanelle

usually measures 4 to 6 cm at birth and closes between 12 and 18 months.

T

T or F:

A full anterior fontanelle may be palpable when the newborn cries.

sutures and fontanelles

allow the skull to expand to accommodate brain growth.

Brain Growth

is reflected by head circumference (occipital—frontal circumference), which increases six times as much during the first year as it does the second.

first year of life

Half of postnatal brain growth is achieved within the _______________________.

short

The neck is usually ________ during infancy.

age 3 or 4 years

Lengthening of the neck occurs about ________________________.

Lymphoid Tissue

is well developed at birth and reaches adult size by age 6 years.

F, little pigment, small

T or F:

Eye structure and function are not fully developed at birth. The iris shows prominent pigment, and the pupils are big.

Macula

which is absent at birth, develops at 4 months and is mature by 8 months.

Pupillary Reflex

poor at birth and improves at 5 months of age.

T

T or F:

Small subconjunctival hemorrhages are normal after birth.

peripheral vision

At birth, ___________________________ is developed, but central vision is not.

20/200

The newborn is farsighted and has a visual acuity of _____________________.

4 months

At _______________, an infant can fixate on a singular object with both eyes simultaneously (binocularity).

2 to 3 months

Tearing and voluntary control over eye muscles begin at ____________________; by 4 months, infants establish binocular vision and focus on a single image with both eyes simultaneously.

F, 8

T or F:

Newborns cannot distinguish between colors; this ability develops by 10 months.

inner ear

The __________________ develops during the first trimester of gestation.

Rubella

a maternal problem that may impair hearing.

startle reflex

Newborns can hear loud sounds at 90 decibels and react with the _________________.

Saliva

is minimal at birth but drooling is evident by 3 months because of the increased secretion of saliva.

Drooling

persists for a few months until the infant learns to swallow the saliva.

utero

The development of both temporary (deciduous) and permanent teeth begins in __________.

6 and 24 months

Deciduous tooth eruption takes place between the ages of _______________________.

nose breathers

Newborns are obligatory ___________________ and, therefore, have significant distress when their nasal passages are obstructed.

Pharynx

is best seen when the newborn is crying.

fetal lungs

At term gestation, the _________________ should be developed, and the alveoli should be collapsed.

Placenta

performs gas exchange.

foramen ovale

The decrease in pulmonary pressure closes the ___________________, increasing oxygen tension and closing the ductus arteriosus.

after birth, 8

The lungs continue to develop _______________, and new alveoli form until about ___ years of age.

Ventral Epidermal Ridges (milk lines)

which run from the axilla to the medial thigh, are present during gestation.

thoracic ridge

True breasts develop along the __________________; the other breasts along the milk line atrophy.

ridge track

Occasionally a supernumerary nipple per sists along the _____________________.

lactiferous ducts

T or F:

At birth, ______________________ are present in the nipple but there are no alveoli.

systolic murmurs

When listening to the heart in the infant, ________________________ may be audible due to the transition from intrauterine to extrauterine life.

24 to 48 hours

When listening to the heart in the infant, systolic murmurs may be audible due to the transition from intrauterine to extrauterine life. This murmur generally resolves within _____________________________ after birth.

120 and 160

The pulse rate is usually between ________________ beats/minute. The rate decreases as the child ages, having a normal heart rate of 120 to 160 at birth and declining to approximately 120s at 6 months of age and down to 110s from 6 months to 1 year old.

4th ICS to the left of the MCL

The heart should be auscultated at approximately the __________________________________.

pink

With warming, skin color should return to ____________.

4th ICS

Pulses should be audible at the ______________. Pulses should be felt in extremities, assessing the radial, brachial, and femoral pulses bilaterally.

coarctation of the aorta, patent ductus arteriosus

Weakness or absence of femoral pulses may indicate _________________________. Bounding pulses can be seen with _______________________________.

Umbilical Cord

is prominent in the newborn and contains two arteries and one vein.

amniotic portion, cutaneous portion

The umbilicus consists of two parts:

Amniotic Portion

is covered with a gel-like substance and dries up and falls off within 2 weeks of life.

Cutaneous Portion

is covered with skin and draws back to become flush with the abdominal wall.

cylindrical

The abdomen of infants is __________________.

Peristaltic Waves

may be visible in infants and may be indicative of a disease or disorder.

liver

The newborn’s __________ 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.

T

T or F:

Kidney development is not complete until 1 year of age.

Bladder

considered an abdominal organ in infants because it is located between the symphysis pubis and the umbilicus.

1 cm wide and 1.5 to 2 cm long

In male infants, the testes develop prenatally and drop into the scrotum during month 8 of gestation. Each testis measures about ____________________________.

Mucoid

At birth, female genitalia may be engorged. _____________ or bloody discharge may be noted because of the influence of maternal hormones.

Meconium

is passed during the first 24 hours of life, signifying anal patency.

Anal Sphincter Control

is not reached until 1.5 to 2 years of age after the nerves supplying the area have become fully myelinated.

prostate gland

In boys, the ____________________ is underdeveloped and not palpable.

T

T or F:

At birth, the newborn should have full range of motion (ROM) of all extremities.

intrauterine position

Many newborns have feet that may appear deformed in position due to the _____________________________ of extremities. The feet should turn to the normal position with ease by the examiner.

Ortolani Test, Barlow’s Sign

The hips should also be checked for dislocation and ease of movement by performing the ___________________________.

Motor Control

is maintained by the spinal cord and medulla, and most actions in the newborn are primitive reflexes.

strong stimulus

causes a vigorous response of crying with whole-body movements.

9 months, 10 months, 12 months

They pull to stand by ____________, cruise by ________________, and walk when hand held by _________________.

Grasp Reflex

is present at birth and strengthens at 1 month. This reflex fades at 3 months, at which time an infant can actively hold a rattle.

Smell

is fully developed at birth, and 2-week-old infants can differentiate the smell of their mother’s milk and parents’ body odors.

Touch

should be used frequently because infants enjoy rocking, warmth, and cuddling.

Crying

is the first means of communication

6 months

The infant begins to imitate sounds by ___________________.

T

T or F:

The infant understands “no-no” by 9 months.

Trust

Child moral development begins with the value and belief system of the parents and the infant’s own development of _________.

oral stage

In the ________________ 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.

Breast Milk

is the most desirable complete food for the first 6 months of a child’s life.

Feeding Patterns

help the nurse to assess nutrition and gastrointestinal function.

bradycardia, fetal demise

Pulse is less than 100 bpm, indicating _________________. Absent heartbeat indicates _________________.

grimace

Delayed neurologic function may be seen in ____________, no response.

sepsis

A temperature of less than 97.5°F (36.4°C) indicates hypothermia, which may suggest _______________.

Positive Ortolani’s Sign

A click heard along with feeling the head of the femur slip in or out of the hip.