Observation Guidelines: Indicators of Health in Newborn Infants

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.