Next, we’re going to
look at the neck.
The neck is important in infants because it
can have abnormalities that are hard to see
unless you really extend
the neck and look at it.
Examples are a thyroglossal
duct cyst which is midline
or a branchial cleft cyst which is
lateral, so we’ll look for abnormalities.
Next, palpate the clavicles.
It’s common for clavicular fractures
to happen in large babies
or with bad shoulder dystocia.
Next, listen to the heart and lungs.
Remember that half of normal newborns will
have a murmur in the first day of life.
We’re moving down to the liver.
It’s normal to feel a liver in a baby.
In fact, if you examine a baby
well and you don’t feel a liver,
you probably didn’t
examine them well enough.
You should be able to palpate
livers in most babies.
It’s even normal to be able
to palpate kidneys in babies.
So you’re going to feel that
liver and it should be generally
no larger than 3 cm below
the costal margin.
Three centimeters is a pretty big distance.
Babies can have big livers.
The spleen and the kidneys may be
palpable and that may be normal.
Next, check for the patent rectum.
Don’t forget to check during
that first newborn exam,
because an inpatent rectum can be a real
critical surgical emergency in an infant,
so take a look and make sure
that rectum is present.
While you’re down there,
inspect the genitalia.
Here’s an example of
an abnormal genitalia.
This child has ambiguous genitalia
which are probably associated with
congenital adrenal hyperplasia.
This child is a girl with a very large
clitoris and a fused labia majora.
We’re done with the genitalia, we’re
going to move on to the extremities.
Check the stability of the hips.
Do a little bit of an Ortolani and
Barlow to make sure that’s okay.
Next, inspect the spine and look
for sacral dimples or tufts.
Acrocyanosis or blue hands and
feet is normal and common,
but syndactyly such as this patient has
or polydactyly which is even more common
with an accessory digit is very common.
We need to look and count fingers
and toes in every patient
and make sure they look normal.
Even subtle findings
like a palmar crease
may be your sign that the patient
has, for example, Down’s syndrome.
Lastly, we’re going to
do our neurologic exam.
We’ve already done
the suck reflex,
but we’re going to comment on
it during the neurologic exam.
Check for their overall tone.
Babies should prefer to be all balled up.
They don’t want to have
their extremities relaxed.
If a child is relaxed and open,
something is wrong neurologically.
Check the suck.
Check for a rooting reflex
where you stroke their chin
and they move towards it to suck.
Check their grasp.
This infant should want
to hold your finger.
Holding your finger is a
normal reflex in infants.
It’s nice to not tell the
mother that this is a reflex.
Let her think her child
wants to hold her finger.
Also, check the Moro reflex.
The Moro, which should
be done carefully,
is when you suddenly lower the head and the
infants arms will come out and spread,
they may shake a little bit
and then come back in again.
If infants do that, that is normal.
What we’re looking for is
asymmetry of the Moro reflex.
If only one arm comes out, that
could be a sign of nerve damage,
perhaps from a brachial plexus
nerve injury as a result of birth.
Lastly, it is good
to check the DTRs.
The deep tendon reflexes are
easy to appreciate in the knees
for example of infants and we can
also check the heels for clonus.
A little bit of clonus might
be okay early in infancy.
So that’s my summary of the neurologic
exam from head to toe in infants.
Thanks for your time.