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.

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.

©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