Skip to 0 minutes and 7 seconds Before we begin, let’s talk about some of the principles of physical assessment of the newborn. Firstly, we need to have an area that is private, is quiet, and, very importantly, is nice and warm. So I’ve got an open cot here, and there’s warmth coming down here on top of my baby. What I also need to ensure is that the family– the parents, in particular– are present, because there are many teachable moments during the physical assessment. So I can relay the findings and discuss them with the parents as I’m going. If you’re a parent watching this video, don’t be afraid to ask your health care professional that’s come in to perform the examination whether they’ve washed their hands.
Skip to 0 minutes and 51 seconds This is really important. And the first thing we do is to thoroughly wash our hands, because that is our first defense against infection. The tools that I’m going to use are very simple. I’m going to have a set of scales so that I can weigh the baby and get that very important statistic of the baby’s birth weight. I’ve got a tape measure here. You can use a paper tape measure, which I tend to prefer, to be honest. But I’ve got my tape measure here that’s for measuring the length of the baby and also the head circumference.
Skip to 1 minute and 23 seconds A simple digital thermometer– and to take the baby’s temperature, I am simply going to turn that on and pop it under the baby’s armpit. That is called the axillary temperature. I have a pencil torch here, and I’m going to use that to look at the baby’s pupils or any other areas of the baby that I need to look at up close. I also have a neonatal stethoscope here. So it’s like any other stethoscope, but you can see that it’s quite a bit smaller. If you don’t have access to a neonatal stethoscope, you can use a paediatric or even an adult stethoscope.
Skip to 2 minutes and 1 second But you need to listen with the bell of the stethoscope, which is this area at the back, and not the diaphragm of the stethoscope, which is that flat area. Otherwise, you get a lot of transmitted sounds. So you can use any size stethoscope if you don’t have access to a neonatal one. With the types of assessment that we’re going to show you, it’s a very systematic approach. So we always start from the head of the baby and go down to the feet. We call this a cephalic caudal approach. And then we look outwards and look at the limbs of the baby. You might think, with such a small person, how could I miss anything?
Skip to 2 minutes and 40 seconds You certainly can, so you need to be very systematic in the way that you approach physical assessment. The final important principle that I want to tell you about is to always start with the most least-invasive type of assessment, and that is simply to observe– to inspect the baby at rest and look at the baby’s overall demeanor and how they appear at rest. And gradually build up– the next step being what we call a auscultation, which is listening with a stethoscope, up to palpation, which is basically feeling and assessing the baby that way. And that is the most invasive way of actually assessing somebody. So very important to start from least invasive and work your way up to most invasive. [CHIMES]
Setting the scene
Before we begin the instructions for the head to toe assessment, let’s first prepare the environment.
This first assessment of the newborn ensures the baby has adapted to life outside the womb (extrauterine life). To avoid missing important findings, use a systematic approach. We recommend ‘head to toe’ (cephalic caudal) and ‘front to back’ (Queensland Clinical Guideline (2014).
Ensure the assessment environment is warm, as you will be fully undressing the baby to conduct your examination. Make sure you have the following items at hand:
- A neonatal or paediatric stethoscope
- A tape measure
- A set of baby weigh scales (as well as growth charts to plot weight and other measurements)
- A digital thermometer
- An ophthalmoscope
- A pencil torch
- Overhead heater - if available and if the ambient temperature is cool.
- Relevant paperwork to document your findings. For example, Infant Personal Health Record and hospital medical records
An important note on timing
The timing of the newborn’s first assessment must be carefully considered. While it should take place soon after birth and certainly within the first 24 hours to detect any problems, it’s not necessary to conduct the assessment immediately following birth. In the first hour or so, the stable mother and baby should have every opportunity for skin-to-skin contact.
This sensitive time, sometimes called the ‘magical hour’, ‘golden hour’ or ‘sacred hour’, requires respect, protection, and support. Disrupting or delaying skin-to-skin care may suppress a newborn’s innate protective behaviors, lead to behavioral disorganization, and make self-attachment and breastfeeding more difficult (Crenshaw, 2014).
Whenever possible, the baby’s parents (or at least the mother) should be present for the assessment. Involving parents when conducting the examination is an excellent opportunity for them to ask questions and for you to provide reassurance and advice. Encourage interactive dialogue during the exam by asking inclusive questions such as ‘tell me about your baby’ and, later in the examination, ‘what have you observed so far?’ (Kain & Mannix, 2018).
Mothers and babies have a physiologic need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and babies together is a safe and healthy birth practice (Crenshaw, 2014).
Directly following your assessment, the baby can be placed back safely on the mother’s chest for skin-to-skin contact and breastfeeding (Kain & Mannix, 2018).
Select the comments link below and share your thoughts on the value of skin-to-skin contact directly following birth.
Crenshaw, J. T. (2014). Healthy Birth Practice #6: Keep Mother and Baby Together— It’s Best for Mother, Baby, and Breastfeeding. The Journal of Perinatal Education, 23(4), 211–217.
Kain, V. & Mannix, T. (2018). Neonatal Nursing in Australia and New Zealand, 1st Edition. Australia: Elsevier
Queensland Health (2014). Queensland Clinical Guideline: Routine newborn assessment.
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