The Newborn Head (Nursing)

by Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN

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    00:01 Hi. Welcome to our lecture on the newborn head.

    00:03 We thought this might be helpful for you before you start learning about abnormalities in the newborn head.

    00:08 We have a few other lectures dedicated to that.

    00:11 The newborn head is relatively pliable compared to ours.

    00:15 This is really special. It's a special unique quality it has which allows it to go through the birth canal.

    00:22 The newborn skull is similar to ours in that it has the same regions, the occipital, parietal and frontal bones.

    00:31 However, as you can see here, the borders between the regions are kind of large and there's two areas called fontanelles that are especially large.

    00:41 These fontanelles allow for brain growth and they eventually close up.

    00:46 They're made of a fibrous material that eventually ossifies and turns into part of the skull.

    00:52 The posterior fontanelle is present until about one to two months of age and then, it closes.

    01:00 The anterior fontanelle is present until about 18 months of age.

    01:05 It's a little bit different for every infant but those are the average times of closure.

    01:11 The sutures are just the borders in between each region.

    01:16 You're more likely to see the terms for the sutures used in x-ray reports or CT reports.

    01:22 It's not super important always that nurses know what - which sutures are which.

    01:27 This is how a newborn's head circumference is measured.

    01:31 A tape measure is put above the eyebrows at the widest part of the head, around the widest part of the head. It's done always during routine checkups.

    01:40 Then, it's plotted on a graph and compared to previous measurements.

    01:46 These measurements are plot on a graph that basically considers the age and gender because the different - there are differences, slight differences in head circumference based on age and gender.

    02:00 The average head circumference for a newborn is about 33 to 35 centimeters or 13 to 14 inches.

    02:08 It may temporarily vary after birth because of what we already talked about, the molding, the squishing that occurs, especially during a vaginal delivery.

    02:18 However, this should self-adjust and get back to normal size and contour after about two to three days.

    02:25 One fun fact that some people don't know is that one quick little reference for head circumference is to measure head circumference and then, compare it to the newborn's crown rump length or sitting length if you can put a newborn into sitting position.

    02:44 Basically, the top of their head is extended to the bottom - to their bottom.

    02:48 This is a measurement that's used a lot in early pregnancy to try to date a fetus and figure out their gestational age.

    02:56 It can also be used as a quick reference for whether the head circumference of a newborn is about right because they should be similar.

    03:03 If the newborn's head circumference is about four centimeters or more, more, greater than their crown rump length.

    03:14 Hydrocephalus should be considered.

    03:17 Let's take a quick look at the child's skull versus the adult skull.

    03:22 As you can see, the cranium or the bones of the head are more elongated and bulbous in a child's skull.

    03:30 They eventually grow into it, but at first, they're quite top-heavy.

    03:34 The frontal and parietal areas specifically are larger.

    03:39 A child's brain actually does most of its growth in the first two years of life.

    03:46 By the age of two, the brain is about 75% of its adult size which is pretty incredible.

    03:54 And now, you may understand a little more as to why toddlers especially are so top-heavy and so prone to injury.

    04:01 This is the NCSBN Clinical Judgment Measurement Model.

    04:06 It's a framework being used now for many NCLEX Next Generation case studies and exam questions.

    04:13 You'll probably hear about it in nursing school if you haven't already and you may have some test questions that use it as a framework.

    04:20 Let's relate some of the content from this lecture on normal findings in the newborn head to recognizing cues and analyzing cues.

    04:30 Really, we're going to flip it this time.

    04:32 Since we just talked about normals, think about why that's so important.

    04:37 In order to recognize cues or analyze cues, an infant or a newborn that has - that may have an abnormal finding, you have to first know what normal findings are.

    04:48 So as pertaining to the head, the head circumference at birth should be on average on a full-term infant about 33 to 35 centimeters if you measure it correctly, above the eyebrows, around the widest part of the head.

    05:02 Any misshapen head due to birth and any cone heads should be pretty resolved by the first two or three days.

    05:11 The infant's skull is normal to feel kind of pliable, a bit soft, softer than ours for sure, and the infant's skull should definitely have two open fontanelles at birth.

    05:22 There's probably a larger one in the front called the frontal fontanelle and a smaller one in the back called a posterior fontanelle.

    05:29 These fontanelles among other things allow for brain growth in the first couple years especially.

    05:35 So those are the major normal newborn head findings that'll help you recognize cues and analyze cues when you don't see them.

    About the Lecture

    The lecture The Newborn Head (Nursing) by Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN is from the course Neurologic Disorders – Pediatric Nursing.

    Included Quiz Questions

    1. Two
    2. One
    3. Three
    4. Four
    1. Putting the tape measure above the ears and eyebrows.
    2. Putting the tape measure around the head over the ears.
    3. Putting the tape measure above the ears and under the eyebrows.
    4. Putting the tape measure between the mouth and nose.

    Author of lecture The Newborn Head (Nursing)

     Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN

    Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN

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