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Setting the scene

Watch Dr. Victoria Kain in this video as she leads learners through the steps of preparing for the head to toe assessment of the newborn.

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).

The image shows a newborn baby, immediately after birth, having skin to skin contact with his mother

©Shutterstock

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).