Newborn Examination of the head and neck

This will expand upon what you have already learnt about the head and neck from your visual observation of the baby at the outset regarding head size, shape, and proportions/symmetry. Now it is time to use your hands: * Head circumference - (OFC - occipitofrontal circumference). If this was not measured at birth it needs to be measured now. Place the tape so that it passes the occiput in the rear and the forehead in front, and adjust it so that you get the highest number. Plot the value on a percentile chart. Anterior fontanelle - trace the edges. Large vs small, bulging vs flat vs depressed? * Sagittal suture - trace forwards and backwards from the fontanelle. Wide vs narrow/overriding, open vs fused? Posterior fontanelle - should be smaller than the anterior, and triangular shaped. * Other sutures - Wide vs narrow/overriding, open vs fused? * Nose - push the tip of the nose in towards the base where the septum and the philtrum join and observe for signs that the nasal septum slips out to either side - it should be seated in a "fork" at the base. If it is dislocated, it can be reduced easily during the first days of life, and thus prevent breathing difficulties and need for plastic surgery later in life. * Mouth - look and feel for patency of palate (inspection + digital exam), inspect the tongue, gums, and mucous membranes, noting any discoloration, enanthema, or malformations. Natal teeth may be present, and should probably be removed if they are lose (risk of aspiration) or cause cuts in the mouth or on the nipple during sucking. A short frenulum ('tongue tie') may need to be cut if it causes problems with latching on during breast feeding, or if the mother experiences the baby's sucking as painful. We do not advise 'prophylactic' cutting just because the frenulum looks short, but recommend clinical observation for the signs just mentioned. The anterior part of the frenulum is essentially avascular, and cutting it causes little or no bleeding. * Neck - torticollis (asymmetric/twisted neck), if present at birth, is most commonly due to intrauterine position, though rarely defective segmentation of the cervical vertebrae may be involved. Torticollis may also appear 2-3 weeks after birth, and is then presumed to be due to trauma of a sternocleidomastoid muscle during delivery, causing hemorrhage followed by fibrotic repair/organization. Although this mechanism is debated, you should palpate both sternocleidomastoids to rule out such phenomena. The presence of torticollis calls for physiotherapy, and the infant should be evaluated by a physiotherapist before discharge. * Clavicles - may fracture during birth, and you should palpate both clavicles for the presence of swelling or the feeling of crepitation. No therapy is necessary, although paracetamol may be indicated if the infant appears to be in pain. Parents need to know, so they can exercise caution during handling for the first 1-2 weeks.

Category:

Education

Tags:

• crepitation
• Newborn Examination
• Clavicles
• sternocleidomastoid
• Torticollis
• baby's sucking
• Head circumference
• occipitofrontal circumference
• Sagittal suture

[adnanaliable]

stop bothering the poor kid, she is pissed off .

[emeraldmorn]

awww poor little girl. hurry up dude, she wants her momma!

[tashantx]

she seems to have a tongue tie

[Spankztah]

aww lil princess

[NycAttentionWhore]

she is not a happy camper.