1. Physical assessment of the newborn can be divided into 3 phases: initial assessment using Apgar score, transitional assessment of periods of reactivity, and a period of stabilization. 2. Key assessments include vital signs like temperature, pulse, respiration; physical exams of general appearance, head/neck, chest, heart, abdomen, back, limbs; and neurological assessment of primitive reflexes. 3. Primitive reflexes present at birth like sucking, rooting, and moro reflexes are important for survival and typically disappear by 3-4 months as the baby develops higher brain functions.

1. PhysicalAssessment of TheNormal
Newborn
Prepared By :Maha Nahal
1

2. Assessment after delivery can be
divided into 3 phases
1.Initial assessment using Apgar
score.
2.Transitional assessment periods of
reactivity.
3.Period of stabilization.

3. APGAR SCORING YSTEM
A
P
G
A
R
3
for Appearance
for Pulse Rate
for Grimace
for Activity
for Respiration

4. Test 0 1 2
Activity (Muscle
Tone)
Absent Arms & legs
extended
Active movement
with flexed arms
& legs
Pulse (heart rate) Absent <100 <100
Grimace
(Response
Stimulation or
Reflex Irritability
No response Facial grimaces Sneeze, cough
Appearance (skin
color
Blue or pale Body pink,
extremities blue
Completely pink
Respiration Absent Slow irregulars,
weak cry
Good strong cry

5. 1)Heart rate
5
 A heart rate of 100-140 was considered good
and given a score of two, a rate of under 100
received a score of one, and if no heart beat
could be seen, felt or heard the score was zero.
 If one attends the baby alone, it is easy to learn
to look briefly at the epigastrium or precordium
for visible heart beat.
 Palpation of the cord about two inches from the
umbilicus is the most satisfactory method for
determining the heart rate quickly and avoids the
area of clamping or tying of the cord.

6. 2) Respiratory Effort –
6
 An infant who has apnea at 60 seconds after
birth received a score of zero, while one who
breathed and cried lustily received a two rating.
All other types of respiratory effort, such as
irregular, shallow ventilation were scored one.
 An infant who had gasped once at thirty or
forty-five seconds after birth, and who then
became apnea, received a zero score, since he
was apnea at the time decided upon for
evaluation.

7. 3) Reflex Irritability
7
 This term refers to response to some
form of stimulation. The usual testing
method was suctioning the oro pharynx
and nares with a soft rubber catheter
which called forth a response of facial
grimaces, sneezing or coughing.
Although spontaneous micturition and
defecation are not a response to an
applied stimulus, they were considered to
be favorable signs if they occurred.

8. 4) Muscle Tone
8
A completely flaccid infant received
a zero score, and one with good
tone, and spontaneously flexed
arms and legs which resisted
extension were rated two points.

9. 5) Color
9
 All infants are obviously cyanotic at birth
because of their high capacity for carrying
oxygen and their relatively low oxygen content
and saturation.
 The disappearance of cyanosis depends
directly on two signs previously considered --
respiratory effort and heart rate. Comparatively
few infants were given a full score of two for
this sign, and many received zero in spite of
their excellent score for other signs

10. A. Physical Assessment of General measurements:
1 Weight ranges from 2700gm to 4000gm.average
3500gm.
2 Length = head to heal 48-53cm.average 50cm
3 Head circumference 33- 35cm it compromise one
quarter of his size.
4 Chest circumference 30.5 - 33cm.
*Usually HC is more than chest circumference in 2-3
cm, but it may show equal measures due to molding
of skull bone on delivery butafter 2-3 days it differs.
10

11. 11

12. 12

13. 13

14. Physiological measurement
14
Temperature 36.5 – 37.5.
- Rectal temp from moment of delivery is
taken to exclude imperforated rectum.
Pulse: 120-140 beats/mApical pulse.
Respiration = 30-60 breath/m _ shallow
and irregular
.
BP = 65/41 average at1-3 days of age.

15. Temperature
15

16. 16

17. B. GeneralAppearance
Posture: in flexion position = due to in uterus
position.
The normal baby appears plump, and has a prominent
abdomen
Skin: 1- Skin is smooth and puffy especially eyes
and genetalia. Skin of neonate is thin, easily
traumatized by: friction, pressure or substances with
different PH that can cause blisters, excoriation, or
infection.
Sweet glands: are present but not active in the first
few days.
17

18. Vernix caseosa 
_a white yellowish sticky substance that
covers the Skin, and is absorbed within hours,
it protects the skin of the fetus.
18

19. Lanugos hair is afine hair found on skin,
especially over the forehead, shoulders
and thigh.Skin color becomes white – if
was pink to red since delivery. Becomes
Black – ifwas pinkish brown since
delivery.
Milia: whitish spots ofdistended
sebaceous glands over nose and cheeks.
19

20. 20

21. Hemangiomas: Are collections
of capillaries under the skin
Acrocyanosis: the peripheral
cyanosis,
common in the newborn
21

22. Mongolian spots:bluish discoloration of 
lower back.
22

23. Erythema: is normally present on the
skin, mainly on the face.
- Mature baby has plentiful skin creases
on the palms of his hands and soles of his
feet.
23

24. 24

25. Observe head neck and Face for
Head: the nurse should be able to palpate the fontanel.
Posterior fontanel (triangle shape) =closed by 6-8
weeks.
Anterior fontanel diamond shape) ==closed at 18
months of age.
Lack of ossification in the skull bones is essential for
growth of the brain and facilitates molding during
labour, which is resolved within few days. (Head
shape is oval at the first few days then it becomes
round)
Wide anterior fontanel and splayed sutures may
indicate hydrocephalus or immaturity.
25

27. Observe
caput succedaneum that results from pressure of
the cervical os, and will disappear spontaneously
within 24 hours,or
cephal hematoma that can result from vaccum or
prolonged delivery where hematoma occurs because
of bleeding between the periostum and the skull
bone. It disappears in weeks or months.
Assessing the level of hydration and intracranial
pressure is possible by palpating the fontanel.(If
sunken =dehydration), and (pluging =high intracranial
pressure).
27

28. 28

29. 29

30. CAPUT SUCCEDANUM CEPHALHEMATOMA
Normal @ birth _ Not normal @ birth
Appears @ birth _Appears hours to a
dayafter birth
(largest on Day 2-3)
_ Crosses suture
lines
_ Does not crosssuture
lines
Resolves within afew days _ Resolves within 3 to 6
weeks
_ Observe forjaundice
30

31. Neck.
Short and covered with folds of tissues that
must be clean.
Neck must be examined to exclude the
presence of swelling and to ensure well
rotation and flexion of the head.
Short and thick neck considers a syndrome.
31

32. Eyes: are symmetrical, normal space is up to
3 cm .slight edema or bruising may be
observed. Closed most of the time, Tears may
present.
Pupils react to light. Nystagmus is present
(improper movement because of weak orbital
muscle)
Eyes become easily infected – purulent
discharge must be reported.
 Most babies have dark blue – grey eyes.
Permanent color is difficult to be manifested
early.
32

33. Both nostrils are flattened after birth. 
Babies breathe through the nose – difficult to
convert automatically to mouth breathing
when nasal obstruction occurs.
Sneesing is frequent and normal reflex to clear

nasal canal. Nasal flaring is common due to air
hunger.
33

34. Inspect for position symmetry, the pinna of the
ear should be at the eyes level (Horizontal to
the outer acanthus of the eye).
Observe for patency, accessory auricles, or
small tags of tissues.
Otoscopy examination is not done due
to vernix and amniotic fluid in the ear.
 Hearing test done by observing the baby
reaction when making noise.
34

35. Mouth:
Inspect for cleft lip, Midwife use the fingers to feel
the palate for any cleft palate.
 Precocious teeth may protrude through the central
part of the lower gum reflects a syndrome.
Observe for excessive salivation (tracheoesophageal
fistula).
Check for moniliasis, a tongue thrush from the
mother's milk that needs antifungal therapy.
Observe the sucking reflex, rooting and gaging reflex.
35

36. Chest
The chest is circular and remains until the
infant becomes atpreschool age(at 7 years)
Respirations are rapid, shallow and irregular –
R.R= 30-60b/m
Also breathing is diaphragmatic.Abdominal
movement is clear
.
Newborn demonstrates periods of apnea of
10-15 seconds
36

37. Heart:
The heart rate is rapid – and is fluctuating
according to the respiratory function – sleep
or cry states. H.R is 120-160beats/M.
By Auscultation Heart murmur maybe
present for some days after birth.
Blood pressure fluctuates according to
activity and ranges from 50/25 to 70/40
mm/hgin the first 10 days of life.This B.Pwill
in crease gradually by the ageuntil 12 years,
when it reaches the adults B.P
37

38. Abdomen
Is cylindrical and prominent shape with
visible veins.
Bowel sounds and peristalsis present
Abdomen should be observed for any
enlargement or any protrusions at the base of
the umbilical cord.
Umbilical vein contains two arteries and one
dilated vein. After clamping cord begins to dry
and disappear by 7-10 days.
38

39. Back
porne position-inspects and palpates
the baby's back.
Observe for any swelling, dimples, or
openings.
Hairy patch maysignify an occult spinal defect.
39

40. Rectum
Evaluate the rectal patency by using the thermometer.
40
Meconium-Present in large intestine from 16 weeks of
gestation, is passed within the first 24 hrs and lasts 2-3
days. (It is a thick dark green odorless fecal substance
contains amniotic fluid, hair bile and epithelial cells.
the transitional stool brownish yellow.
Consistency and frequency of stools depends on type of
feeding given,
Breast milk==loose bright yellow (golden yellow,
sweet smelling).
8-10 times a day, or every 2-3 days.
Artificial milk-=Pale, semisolid with strong odor4-6
times a day, but with high tendency to get constipation
Gastric emptying time is 2.5_3hr.

41. Genitalia and breast:
Female: Enlarged vulva + vernix present at the
41
labia majora covers the labia minora.
- Pseudo menstruation: due to maternal hormones.
Male: Urethral meatus at the tip – covered by fore
skin.
 90% of males' testes are descended in the
Scrotum that is edematous with dark pigmented
skin.
Smegma a white cheesy substance on glans penis
If the sex is uncertain Report it to pediatrician.
In both sexes withdrawal of maternal estrogens
results in breast enlargement, sometimes
accompanied with milk called (witch milk).

42. Bladder
- empties when stretched by 15ml results in
frequent voiding 20/days.
- First urine is passed atbirth, or within the first
24hrs.
- Bladder can be easily palpated when it is full
small pelvis.
42

43. Hips Barlow's and Ortolanis test to detect
congenital dislocation of the hip.
Limbs and fingers
Palms haveusual creases, Soles are flat
Muscle tones are assessed by extending and
flexing the extremities.
Observe length movement of limbs and
observe fingers
Polydactyl (extra fingers) or syndactyly
(finger connection)
43

44. polydactyle
44

45. Syndactyle
45

46. Observe for congenital clubfoot, 
46

47. Single palmer crease 
47

48. Normal palmer crease 
48

49. Ortolanis test
49

50. Neurological System Reflexes
50
Definition
Neonatal reflexes or primitive reflexes ( an
action or an involuntary movement in response
to a stimuli) are the inborn behavioral
patterns that develop during uterine life.
They should be fullypresent atbirth and are
gradually inhibited by higher centers in the brain
during the first three to 12 months of postnatal
life.

51. These reflexes, which are essential for a
newborn's survival immediately after birth,
include sucking,swallowing,blinking,urinating,
hiccupping, anddefecating.
These typical reflexes are not learned; they
are involuntary and necessary for survival
primitive reflex, any unthinking action (reflex)
51

52. Reflex Stimulation Stimulation duration
Babinski Sole offoot
stroked
upward from
heel across
ball offoot
Dorsiflex of
big toe &
Fans out toes
Disappears at
nine months
to a year
Blinking Flash light Closes eyes Permanent
Grasping Grasping Grasps
tightly
Weakens at
three
months;
disappears at
a year
52

53. Reflex Stimulation Stimulation duration
Startle
Used to
check
hearing
acuity
Sudden loud
voice
Abduction
of arms with
flexion of
elbows;
hands remain
closed
Disappears at
three to four
months
Rooting Cheek
stroked or
side of
mouth
touched
source,
opens mouth
and sucks
Turns towardDisappears at
53
three to four
months

54. Reflex Stimulation Stimulation duration
Stepping Infant held
upright, sole
of foot
touches flat
surface
Moves feet
as ifto walk
Disappears at
three to four
months
Sucking Mouth
touched by
object
Sucks on
object
Disappears at
three to four
months
54

55. Reflex Stimulation Stimulation duration
Tonic neck Placed on
back ,
turning head
quickly to
side
Arms and
leggs ofthat
side extend,
and opposite
arm&leg
flexed
Disappears at
4 months
moro reflex Sudden
movement
s
Extension &
abduction of
extremities,
followed by
thumb &
index finger
forming C
Disappears at
three to four
months
55

56. Rooting reflex
56

57. Moro or startlereflex
57

58. babinski
58

59. 59

60. Keep newborn on side lying position
60

61. W hy:
61
to promote drainage of mucus. Note that
he is supported by apillow to his
backside