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Face, eyes, ears and nose

In these videos, Dr Elizabeth Forster discusses what to take note of when assessing the newborn's face, with focus on the eyes, ears and nose.

Checking for symmetry is a key focus when assessing the newborn’s eyes, ears and nose.

Start by imagining a straight line down the centre of the newborn’s face. Observe and determine whether each side is similar. Ideally, there will be symmetry in terms of the shape and placement of the baby’s facial structures.

To assess the positioning of the newborn’s eyes and nose, this time imagine a vertical plane of three sections across the baby’s face. The left and right eye, along with the nose should each occupy roughly one third of spacing on the face. An abnormally small distance between the eyes is called hypotelorism and may be a sign of fetal alcohol syndrome. A particularly wide distance between the eyes (hypertelorism) may also be indicative of a problem and should be reported (Kain & Mannix, 2018).

Next, inspect the sclerae (white of the eyes). Sometimes there are small hemorrhages (bleeding) in the sclerae, which can occur during birth. Also assess the eyelids. They may be swollen and in very premature neonates, may even be fused (Kain & Mannix, 2018). Make a note of any skin folds over the medial (middle) aspect of the eyes. These are known as epicanthal folds and are present in babies with some syndromes, such as Down syndrome (Kain & Mannix, 2018).

Use your pen torch or an ophthalmoscope to shine light into the eye. You will need to observe the size, shape and location of the pupil. Check the baby’s reaction to light. The pupil should constrict briskly in the eye you shine the light into and have a similar reaction in the other eye at the same time (Forster & Marron, 2018).

Also look for the red eye reflex. This is a uniform reflection of red that can been seen in both eyes. It indicates that the cornea and lens of the eye are normal. If the red eye reflex is absent or only apparent in one eye, report this finding immediately to paediatric medical staff (Forster & Marron, 2018). Look out for the additional resource at the end of this step, which will guide you on what to look for.

Assessing the ears and nose

This is an additional video, hosted on YouTube.

The newborn’s ears

Observe the ears and note their position and symmetry. Again, imagine a line extending from the outer corners of the eye to the top of the pinna (Kain & Mannix, 2018). The ears should each have an external ear meatus (opening). You may note some small skin tags, which are usually not of concern.

Observe the size of the ears and the folding of the helix (outer rim of the ear). If the helix is over-folded and the ear is small, this may indicate a genetic syndrome. Hearing can be tested by clapping to see the newborn’s response, however many maternity hospitals provide newborn hearing screening to all babies.

The nose

The newborn’s nose should be located in the middle third of the baby’s face. Both nares (nasal passages) should be patent (open). If not, it may indicate a condition known as choanal atresia, where one or both nasal passages are blocked. This interferes with breathing, as newborns are obligatory nasal breathers.

Sometimes, the newborn’s nose can be squashed during the birth process and this will usually resolve within a few days (Kain & Mannix, 2018). Also note whether the nose is thin or broad and whether the nasal bridge is depressed, as this may indicate a genetic condition (Kain & Mannix, 2018).

Your task

Once you have watched both the videos, post your questions and comments in the link below.


Forster, E. & Marron, C. (2018). Paediatric Assessment Skills. In E.Forster & J.Fraser. Paediatric Nursing Skills for Australian Nurses. Port Melbourne, Victoria: Cambridge.

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

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Assessment of the Newborn

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