Skip to 0 minutes and 7 secondsWhen you examine the baby's mouth, you need to take note of the mucous membranes within the mouth and ensure that they're pink, and intact, and moist. You need to inspect, using your pen torch, once again, you'll need to actually inspect the baby's palate, or the roof of their mouth, to make sure that they have an intact hard palate and soft palate. So that needs to be visualised. You can't just rely on palpation of that. And we know that because cleft palates, or poorly formed palates, are quite a common neonatal congenital abnormality. And that will, of course, interfere with, if there are palate issues, that can interfere with breastfeeding and normal feeding for the baby.

Skip to 1 minute and 2 secondsSo you need to check the palate. When you're inspecting the mucous membranes and the tongue in the mouth, you may see some whitish discoloration, that might be oral thrush. There may also be tiny little yellow or white-coloured cysts, and they're known as Epstein's Pearls, which are benign, or nothing to worry about, and usually will resolve. So when you're inspecting the baby's tongue, you need to note the position of the baby's tongue. And remember, you're thinking that it should be midline. You'll also look at the size of the tongue, as there are some congenital problems where the tongue will be quite large and protruding from the baby's mouth.

Skip to 1 minute and 53 secondsSo it should be midline and settled within the baby's mouth, so not protruding out of the baby's mouth. You need to also look at any movement of the tongue, as well, in the oral cavity. And then there's a piece of tissue known as the frenulum, which anchors the tongue to the floor of the baby's mouth. And in some cases, that tissue can be quite tight and is known as tongue-tie or ankyloglossia. And in those cases, sometimes intervention might be needed just to assist with effective breastfeeding, and feeding, and also with speech later on. But that's something to note when you do that inspection.

Skip to 2 minutes and 42 secondsThe other thing you need to look at is the baby's jaw, as some babies will actually have quite a small sized jaw. But that finding is actually sometimes associated with other congenital conditions, as well. So note the size of the baby's jaw. When you're inspecting the baby's mouth, you also need to look for the presence of any teeth. There are some babies who'll actually have some primary teeth already erupted at birth. And this can sometimes be quite a shock to parents. And it's an OK finding, it's nothing to worry about, and we just make note of that. But normally, there would be no teeth present and you'd just inspect the gums.

Skip to 3 minutes and 31 secondsWhen you're inspecting the baby's jaw, you need to note that the upper and lower jaw, or the maxilla and the mandible, actually fit together and are equal bilaterally, on both sides of the baby's mouth. And you also need to look at the baby's chin, as some babies will actually have small, or underdeveloped, jaw or chin, which will be quite noticeable. However, it is also a sign of some congenital syndromes. For example, Pierre Robin syndrome is one where babies have quite a small and underdeveloped jaw. The other thing that, when you're looking at the baby's whole face, that you need to be aware of are what we call dysmorphic features.

Skip to 4 minutes and 23 secondsAnd there's a whole range of dysmorphic features that paediatric geneticists are very familiar with and of course, paediatricians. And so these abnormal findings-- and they may relate to placement of the eyes, the ears, the nose, the mouth in the lower third of the face. They can relate to fingers and toes-- these will be important to take note of and report in your overall assessment of the baby.

Assessing the mouth, jaw and chin

We finish our observation of the head and face, by investigating the lips, oral cavity and jaw of the newborn.

When assessing the newborn’s mouth, you should not see evidence of drooling. The baby should be able to manage any saliva within their mouth. The lips should be pink in colour and symmetrical in shape. The inside of the mouth should be pink, moist and the mucous membranes intact.

Look at the size, position, shape and movement of the newborn’s tongue. It should be midline and contained within the baby’s mouth (Kain & Mannix, 2018). Also be on the lookout for white spots or patches on the tongue, which may indicate oral thrush.

Two images show examples of oral thrush on the newborn tongue (pictured right) and ankyloglossia, also known as 'tongue tie' (pictured left) Ankyloglossia (left) and oral thrush (right). ©Shutterstock.

Next, observe the small band of tissue that anchors the tongue to the base of the baby’s mouth. This is known as the frenulum. In some infants this may be quite tight, thick and short in length - a condition known as ankyloglossia or tongue tie. It needs to be reported, as it may cause problems with breastfeeding and have an impact on speech development (Campbell, 2018).

It is also important to observe and feel the roof of the newborn’s mouth. You need to ensure both the hard and soft palates are intact. Cleft palate (which involves an opening in the palate or roof of the mouth) is a congenital abnormality that may be present in newborn babies. We will discuss this in greater detail next week.

You may also observe some small, whitish-yellow cysts on the roof of the mouth. These are known as Epstein’s Pearls and are quite common.

When inspecting the gums, make note of the colour and moisture levels. The gums should also be moist and pink. If you discover the presence of primary teeth, this might be surprising, but is ok. In some newborns, teeth may have already erupted.

A close up of a newborn baby’s open mouth, gums and jaw.©Shutterstock

Lastly, assess the newborn’s jaw. The upper and lower jaw should fit together and also open at equal angles on both sides. Take a moment to observe the alignment and symmetry of the upper and lower jaw in the image above. You will also note the chin is normal sized. Sometimes there may be an undersized jaw, known as micrognathia. This normally corrects as the baby grows. In some cases however, it may be an indicator of craniofacial conditions or syndromes.

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References

Campbell, J. (2018). Frenotomy for tongue-tie in newborn infants. International Journal of Nursing Studies.

Kain, V. & Mannix, T. (2018). Neonatal Nursing in Australia and New Zealand, 1st Edition. Australia: Elsevier

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This video is from the free online course:

Assessment of the Newborn

Griffith University