1
Guide to Performing a Head-to-Toe Newborn Assessment
Before initiating the hands on assessment, look at the color, tone, respiratory effort, flexion, and general
condition of the newborn (assessing for extra-uterine adaptation); assess for any gross abnormalities of the skin
such as rashes, pigmentation, skin turgor, etc.
Obtain T, P, R – suggest that you auscultate the heart rate for a full minute, auscultate the respirations for a full
minute, auscultate the lung sounds in all lung fields anteriorly and laterally, and lastly obtain an axillary
temperature; note if heart rhythm/rate regular
Obtain head, chest and abdominal circumference – note the measurements in inches and centimeters
[remember do not pull the measuring tape out from under the newborn as you could shear the skin easily)
NOW YOU WANT TO START THE HEAD-TO-TOE ASSESSMENT
Assess the head – note the shape, any caput, molding, cephalohematoma, any abnormalities/concerns
Follow the suture line, finding the anterior fontanel (noting shape, size, describing whether
flat/bulging/depressed); continue on finding the posterior fontanel (again noting shape, size, describing whether
flat/bulging/depressed)
Note the suture lines horizontally and vertically noting if the baby has overriding sutures or not
Eyes – note placement, symmetry, edema, drainage, s/s conjunctival hemorrhage (remember check both eyes)
Nose – note placement, symmetry (versus off to one side s/p delivery, for example); check for deviated septum
by being sure the mouth is closed (either sucking or closing the mouth by gently holding the chin upward) and
occlude one nare watching for the chest to rise and fall. If it does, there is not an occlusion in that nare. Let the
newborn (neonate) take a couple breaths, do the same for the other nare, again watching for the chest to rise
and fall to verify there is not an occlusion to the other nare. Be sure to be able to visualize the chest and not
have your hand in the way; assess for milia
Mouth – note symmetry (is there any drooping), the color (any s/s circum-oral cyanosis, any abnormalities
noted; visualize the gums for color (should be pink and moist); visualize the roof of the mouth and gums for
Epstein pearls; place your finger in the neonate’s mouth, run your fingers over the upper and lower gums
checking for prenatal (or called percocious) teeth; palpate the hard palate; palpate the soft palate; check gag
reflex; as you bring your finger forward, check for tongue extrusion reflex (to help evaluate for tight frenulum),
sucking reflex, and rooting reflex
Ears – assess for symmetry and placement; make imaginary line from the outer portion of each eye to the ear;
the imaginary line should be at the pinna; check for recoil of the pinna (helps assess for maturity/gestational
age); assess for tags/masses on and behind the ear; assess for periauricular sinuses; assess for normal/abnorm
formation of the external ear canal; check both ears; remember, if you have ear abnormalities, you have to think
possible renal disorders as well (as they develop simultaneously); if low-set ears, not diagnostic of chromosoma
abnormality, but should raise your suspicion (those “red flags”); assess for lanugo
Neck – gently lift the head up off the shoulders so you can visualize the neck assessing for any s/s masses that
could be hidden between the head and shoulders
Clavicles – palpate the clavicles bilaterally and simultaneously for s/s crepitus (s/s fracture); start at sternum an
move outward
Upper Extremities – look for symmetry of movement and flexion; palpate brachial pulses and check for
symmetry of strength of pulses simultaneously; assess and count fingers for polydactyly (extra digits) and
syndactyly (webbing); check crease for simian crease (again, not diagnostic of chromosomal abnormality, but
should raise your suspicion [those “red flags”]; assess grasper (palmar) reflex
Chest/Breasts – note shape of chest (circumference should be approximately 1 to 2cm smaller than head
circumference); assess breast buds for development, appearance of swelling and assess for s/s drainage (calle
witch’s milk); noting the appearance of swelling and/or drainage is due to maternal hormones and this will
disappear once the newborn metabolizes the hormones and excretes them through the renal system and
excretes; assess for any supernumerary nipples (also known as “accessory nipple” which is a congenital benign
anomaly); note the skin how superficial it is with the veins very close to the surface of the skin due to the lack of
subcutaneous tissue; might note the xyphoid process being somewhat protuberant and this will disappear once
the newborn begins gaining weight and develops more subcutaneous tissue
Guide to Performing a Head-to-Toe Newborn Assessment
Before initiating the hands on assessment, look at the color, tone, respiratory effort, flexion, and general
condition of the newborn (assessing for extra-uterine adaptation); assess for any gross abnormalities of the skin
such as rashes, pigmentation, skin turgor, etc.
Obtain T, P, R – suggest that you auscultate the heart rate for a full minute, auscultate the respirations for a full
minute, auscultate the lung sounds in all lung fields anteriorly and laterally, and lastly obtain an axillary
temperature; note if heart rhythm/rate regular
Obtain head, chest and abdominal circumference – note the measurements in inches and centimeters
[remember do not pull the measuring tape out from under the newborn as you could shear the skin easily)
NOW YOU WANT TO START THE HEAD-TO-TOE ASSESSMENT
Assess the head – note the shape, any caput, molding, cephalohematoma, any abnormalities/concerns
Follow the suture line, finding the anterior fontanel (noting shape, size, describing whether
flat/bulging/depressed); continue on finding the posterior fontanel (again noting shape, size, describing whether
flat/bulging/depressed)
Note the suture lines horizontally and vertically noting if the baby has overriding sutures or not
Eyes – note placement, symmetry, edema, drainage, s/s conjunctival hemorrhage (remember check both eyes)
Nose – note placement, symmetry (versus off to one side s/p delivery, for example); check for deviated septum
by being sure the mouth is closed (either sucking or closing the mouth by gently holding the chin upward) and
occlude one nare watching for the chest to rise and fall. If it does, there is not an occlusion in that nare. Let the
newborn (neonate) take a couple breaths, do the same for the other nare, again watching for the chest to rise
and fall to verify there is not an occlusion to the other nare. Be sure to be able to visualize the chest and not
have your hand in the way; assess for milia
Mouth – note symmetry (is there any drooping), the color (any s/s circum-oral cyanosis, any abnormalities
noted; visualize the gums for color (should be pink and moist); visualize the roof of the mouth and gums for
Epstein pearls; place your finger in the neonate’s mouth, run your fingers over the upper and lower gums
checking for prenatal (or called percocious) teeth; palpate the hard palate; palpate the soft palate; check gag
reflex; as you bring your finger forward, check for tongue extrusion reflex (to help evaluate for tight frenulum),
sucking reflex, and rooting reflex
Ears – assess for symmetry and placement; make imaginary line from the outer portion of each eye to the ear;
the imaginary line should be at the pinna; check for recoil of the pinna (helps assess for maturity/gestational
age); assess for tags/masses on and behind the ear; assess for periauricular sinuses; assess for normal/abnorm
formation of the external ear canal; check both ears; remember, if you have ear abnormalities, you have to think
possible renal disorders as well (as they develop simultaneously); if low-set ears, not diagnostic of chromosoma
abnormality, but should raise your suspicion (those “red flags”); assess for lanugo
Neck – gently lift the head up off the shoulders so you can visualize the neck assessing for any s/s masses that
could be hidden between the head and shoulders
Clavicles – palpate the clavicles bilaterally and simultaneously for s/s crepitus (s/s fracture); start at sternum an
move outward
Upper Extremities – look for symmetry of movement and flexion; palpate brachial pulses and check for
symmetry of strength of pulses simultaneously; assess and count fingers for polydactyly (extra digits) and
syndactyly (webbing); check crease for simian crease (again, not diagnostic of chromosomal abnormality, but
should raise your suspicion [those “red flags”]; assess grasper (palmar) reflex
Chest/Breasts – note shape of chest (circumference should be approximately 1 to 2cm smaller than head
circumference); assess breast buds for development, appearance of swelling and assess for s/s drainage (calle
witch’s milk); noting the appearance of swelling and/or drainage is due to maternal hormones and this will
disappear once the newborn metabolizes the hormones and excretes them through the renal system and
excretes; assess for any supernumerary nipples (also known as “accessory nipple” which is a congenital benign
anomaly); note the skin how superficial it is with the veins very close to the surface of the skin due to the lack of
subcutaneous tissue; might note the xyphoid process being somewhat protuberant and this will disappear once
the newborn begins gaining weight and develops more subcutaneous tissue
