Observation Guidelines: Indicators of Health in Newborn Infants

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Adjustment After Birth

Look for:

• First breaths are taken within a half minute after birth (the doctor may suction fluid from the mouth and throat).
• Attempts to nurse or suck on a bottle’s nipple occur within a few hours after birth (the baby may lose a few ounces of weight the first few days).
• First urination and bowel movements occur within first 2 days.
• Head may be elongated after birth but gradually regains round appearance; skin may be scratched and contain discolored spots that disappear within a few days.

Example:

Immediately after birth, Trinisha begins crying. Her head is misshapen and she has some blotchy spots on her skin. Her mother places Trinisha on her chest, and the baby quiets down, opens her eyes, and scans the room.

Implication:

Before birth, encourage parents to arrange for appropriate medical care for their newborn babies. After birth, reassure parents about the appearance of newborn infants.

States of Arousal

Look for:

• Quiet sleep: The infant lies still with closed eyelids and relaxed facial muscles.
• Active sleep: Although the infant is sleeping, eyes may open and shut and move from side to side, facial expressions change and include grimaces, and breathing is irregular.
• Drowsiness: The infant’s eyelids may open and close without focus, and breathing is regular and rapid.
• Quiet alert: The infant is awake, calm, happy, and engaged with the world.
• Active waking: The infant wriggles and shows bursts of vigorous movements, breathing is irregular and skin is flushed, and the infant may moan or grunt.
• Crying: The infant cries and thrashes, and the face is flushed and distressed.

Example:

In the first few days after birth, baby Yolance spends most of his time sleeping. Some of his sleep appears peaceful, and at times he appears to be dreaming. When Yolance is awake, he sometimes looks intently at people and objects close to him. At other times, he appears agitated, and these episodes tend to escalate into loud and persistent crying.

Implication:

Help parents to notice the distinct states of arousal that infants experience. Encourage them to develop a sensitive style of responding to infants’ distress. Help parents recognize when infants are in the quiet, alert state, as this is a good time to interact calmly with babies.

Reflexes

Look for:

• Rooting: When touched near the corner of the mouth, the infant turns toward the stimulus, as if in search of breast or bottle.
• Sucking: When a nipple or finger touches the infant’s mouth, he or she begins to suck it.
• Grasping: The infant grasps onto a finger or other small object placed in his or her hand.
• Moro reflex: When startled, the infant stretches arms outward and then brings them together as in a hugging, embracing motion.
• Babinski reflex: When the inner side of the infant’s foot is rubbed from heel to toe, the infant’s big toe moves upward and the other toes fan inward toward the bottom of the foot.
• Stepping: When the baby is held upright under the arms with feet dangling and touching a hard surface, the legs take rhythmic steps.
• Tonic neck reflex: When the infant is lying on his or her back and the head is moved toward one side, the arm on that side extends out and away from the body, and the arm on the other side is flexed close to the head with clenched fist (resembling a fencing position).

Example:

Little Josefina lies on her back on a blanket as her mother washes the dishes. When her mother accidentally drops and breaks a dish, Josefina appears alarmed, extends her arms, and seems to be grasping for something in midair.

Implication:

Gently demonstrate infants’ reflexes to family members. Explain that reflexes show that infants’ brains and bodies are operating as they should. Family members, including the baby’s siblings, may use the grasping reflex as a way to interact with the baby.