Newborn Nursery Exam

Once the newborn has been moved to the nursery, the pediatrician conducts a more thorough physical examination. The physician listens to the heart and lungs using a stethoscope and palpates the abdomen to feel for abnormalities. He or she examines the following:

  • Skin (e.g., to detect bruising, broken blood vessels, swelling, dryness, pallor [paleness] or cyanosis [bluish coloring], jaundice [yellowing caused by high blood levels of bilirubin], birthmarks, cysts, blocked ducts, rashes, and vernix caseosa [whitish coating] and lanugo [fine hair], which are heavier in preterm infants)
  • Head (e.g., to detect swelling, bleeding beneath the scalp, and skull fractures, and to evaluate the presence and size of the fontanelles [soft spots])
  • Face (e.g., to detect abnormalities associated with congenital conditions, bruising caused by forceps or face presentation during birth, facial nerve palsy [causes a distorted grimace when the infant cries])
  • Eyes (e.g., to detect bleeding [hemorrhage], damage to the cornea [tear or rip], abnormal eye movements, and other abnormalities)
  • Nose (e.g., to detect nasal obstruction, nasal discharge)
  • Ears (e.g., to detect malformations associated with congenital conditions, assess the ear drum [tympanic membrane], and look for signs of hearing impairment)
  • Mouth (e.g., to detect cleft lip, cleft palate, or abnormal oral secretions [may indicate a swallowing disorder] and evaluate the jaw and tongue)
  • Neck (e.g., to detect abnormal masses and excess skin [may be associated with congenital conditions])
  • Chest (e.g., to detect abnormal breath sounds and congenital heart defects)
  • Abdomen (e.g., to detect softness, distension [abdominal bloating], and bowel sounds, and to evaluate the kidneys, liver, spleen, and bladder)
  • Genitals (e.g., to detect an undescended testicle in males)
  • Bones (e.g., to detect fractures, abnormalities [clubfoot, webbing, extra digits], hip dislocation, and spinal deformities [scoliosis])

Newborn babies have a number of reflexes and sensory abilities that help them survive. Evaluation of a newborn baby also involves a neurological examination to assess the nervous system (e.g., brain, spinal cord, nerves).

During the neurological exam, the pediatrician observes the infant's movements, checks his or her muscle tone, and assesses his or her cry (high pitched crying may indicate a neurological disorder).

The physician also evaluates the following reflexes:

  • Sucking reflex (in response to placing a nipple or finger into the newborn's mouth)
  • Rooting reflex (infant turns his or her head to the side in response to a light touch on the cheek)
  • Traction (when the infant is gently pulled to a sitting position by the arms, his or her head will initially lag, come to midline briefly, and then fall forward)
  • Palmar grasp reflex (infant will close his or her fist around an object [e.g., finger] placed in the palm)
  • Placing reflex (when the top of the foot is rubbed, the infant will bend his or her knee to bring the foot up)
  • Moro reflex (also called the startle reflex; if the infant's head position changes suddenly, his or her arms, hands, and fingers will extend)
  • Tonic neck reflex (when the infant's head is turned to one side, his or her arm and leg on that side will extend and the arm and leg on the opposite side will flex [called the "fencing position"])

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 15 Nov 2008

Last Modified: 28 Sep 2015