CARE OF MOTHER, CHILD, ADOLESCENT • Clamp the cord at 2 cm above the baby’s base using the
PEDIATRICS plastic cord clamp
THE NEWBORN (NEONATE)
THE UNANG YAKAP STRATEGY: ESSENTIAL
INTRAPARTAL NEWBORN CARE (EINC)
• The Unang Yakap strategy or Essential Intrapartal
Newborn Care (EINC) was developed by the Department
of Health of the Philippines upholds evidence-based
standards set by the World Health Organization
- Administrative order 2009-0025
- Ideally, should have full implementation; however,
not all hospitals do not implement this strategy
• Development goal: reduction of newborn deaths
PREPARATION OF MATERIALS
• 2 pairs of surgical gloves for obstetrician
• 1 pair of surgical gloves for the pediatrician
• 2 warm blankets
- 1st for drying the baby
- 2nd for covering and warmth
• Bonnet
• Cord care set
• Erythromycin
• Vitamin K
• Hepatitis B shot
STEPS FOR EINC
• 5 second count handwash and antisepsis
• Double gloving step
• Once the baby is out of the perineum, note the time of birth
and the sex of the baby
- Should be announced so that people are aware and to
prevent the chances of baby switching
• Towel the baby with the first linen and dry for 30 seconds
- Dry the whole body except for the hands to enhance
breastfeeding relationship
• Do not wash the baby within the first 6 hours of life – may
lead to hypothermia and infection
• Do a rapid assessment
• Remove the wet cloth
• Initiate skin to skin contact – baby prone on the mother’s
abdomen or between the mother’s breasts
- Allowed prone position because the mother’s
breathing initiates the breathing of the baby
- Prone helps get rid of body fluids
- Side-lying position for the baby is also allowed
- The primary purpose of the skin to skin contact is to
create a bond between the mother and child
- Skin to skin contact decreases chances of developing
infection, hypothermia, and hypoglycemia
• Place bonnet and second linen on baby’s back to promote
warmth and avoid hypothermia
• Remove first set of gloves to maintain sterility
• Allow the cord pulsations to stop without milking the cord
- Wait 3 minutes if it does not stop sooner
• Apply the 2nd clamp at 5 cm above the baby’s base or 3 cm
above the 1st clamp using the metal cord clamp
• Cut the cord about 1 cm above the 1st plastic cord clamp
- Ideally, do not place betadine or alcohol – discourage
applying
• Inject 10 IU of oxytocin to the mother’s arm to promote
uterine contractions and avoids further bleeding
• While maintaining skin to skin contact, deliver the placenta
• Examine the mother’s perineum and vulva for tears
• The baby will start licking movements, which will indicate
that the baby is ready for breastfeeding
• Nudge breast to the baby to initiate rooting reflex
• After first breastfeed, carry out the eyecare procedure and
administer vaccines needed
• The newborn stays with the mother throughout the hospital
stay to increase bond and promote breastfeeding
- Exclusive breastfeeding for 6 months and may be
continued until 2 years of age or beyond
• After at least 6 hours, the baby may be washed
4 IMPORTANT POINTS OF EINC
1. Immediate and thorough drying
2. Skin to skin contact
3. Properly timed cord clamping
4. Non-separation because of breastfeeding
DEVELOPMENTAL TASKS OF A NEWBORN
A. BIOLOGIC TASKS
• Establishing and maintaining respiration
• Circulatory changes
• Regulation of body temperature
• Ingesting, retaining, and digesting nutrients
• Elimination of waste
• Regulation of weight
B. BEHAVIORAL TASKS
• Establishing a regulated behavioral tempo independent of
the mother
• Processing, storing, and organizing multiple stimuli
• Establishing a relationship with caregivers the environment
TRANSITION PERIOD AFTER DELIVERY
FIRST PERIOD OF REACTIVITY
1. FIRST STAGE: lasts up to 30 minutes after birth; the most
important stage to perform the Unang Yakap
2. SECOND STAGE: lasts up to 2-4 hours
SECOND PERIOD OF REACTIVITY
• Lasts about 2-5 hours
• When the mother and baby are not able to bond at the first
period of reactivity, bonding between the mother and child
may be done during this period
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PHYSIOLOGIC STATUS OF SYSTEMS
A. RESPIRATORY SYSTEM
• Onset of breathing initiated by chemicals (decreased PO2
and increased PCO2) and thermal factors (cold receptors)
- CHEMICAL FACTORS: the fetal lungs do not
function as an organ for oxygenation intrauterine; the
placenta is responsible for oxygenation inside
o Once the baby is delivered, the expansion of
lungs begins
o The baby should cry to promote the expansion
of lungs
- THERMAL FACTORS: the placenta’s temperature is
warmer than the temperature extrauterine; so
healthcare practitioners promote a warm environment
to prevent hypothermia
• Tactile stimulation
• Fetal lung fluid is removed during normal process of labor
and delivery
- During normal delivery, the compression of the
thorax evacuates fetal lung fluid
B. CIRCULATORY SYSTEM
• Transition from fetal circulation to postnatal circulation
through functional closures of the fetal shunts:
- FORAMEN OVALE: opening between the right
atrium and the left atrium
- DUCTUS VENOSUS: blood vessel that connects the
umbilical vein to the inferior vena cava; bypasses the
liver
- DUCTUS ARTERIOSUS: the opening between the
pulmonary artery and the aorta
- UMBILICAL ARTERIES: two arteries that carry mixed
blood away from the heart and back to the placenta
- UMBILICAL VEIN: one vein that carries oxygenated
blood back to the heart from the placenta
INTRAUTERINE CIRCULATION: LOWER EXTERMITIES
• From the placenta, oxygenated blood enters the umbilical
vein to the ductus venosus; and to the inferior vena cava
• From the fetal heart, right atrium to the left atrium through
the foramen ovale
• From the left atrium, goes to the left ventricle to the aorta
• Mixed blood enters the descending aorta
• Back to the placenta
INTRAUTERINE CIRCULATION: HEAD & UPPER
EXTREMITIES
• Unoxygenated blood enters the superior vena cava to the
right atrium to the right ventricle
• Mixed blood enters the pulmonary artery and should supply
blood to the lungs
• Pulmonary artery is connected to the aorta through the
ductus arteriosus
• Descending aorta back to the placenta via the umbilical
arteries
C. THERMOREGULATION
• Most critical next to respiration
• Temperature at birth is usually 37.2o
• Factors that predispose the newborn in heat loss
- Large surface relative to his weight
- Thin layer of subcutaneous fats; newborns have really
thin skin, which makes them prone to hypothermia
- Newborn’s mechanism of producing heat
- NON-SHIVERING THERMOGENESIS (NST):
newborns do not express cold and shivering; the client
will be making use of other mechanisms to conserve
heat, such as vasoconstriction and metabolism of
brown adipose fats
4 PROCESSES OF HEAT LOSS
1. CONVECTION: flow of heat from body surface to cooler
or ambient air
2. RADIATION: loss of heat from the body surface to cooler
solid surfaces not in direct contact but in relative proximity
to each other
3. EVAPORATION: loss of heat that occurs when a liquid is
converted to a vapor
4. CONDUCTION: loss of heat from the body surfaces in
direct contact
D. HEMATOPOIETIC SYSTEM
• The blood volume depends on the placental transfer
• 80-110 ml/kg BW is the average blood volume (300 mL)
Hemoglobin (Hbg) 17-18 g/dL
Hematocrit (Hct) 45-50%
Red blood cells (RBC) 6M/mm3
White blood cells (WBC) 15,000-30,000/mm3
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E. FLUID & ELECTROLYTE BALANCE G. RENAL SYSTEM
• Fetus is 73% water while an adult is 58% water • Unable to concentrate urine and cope with the fluid and
• Has more extracellular fluids than adults electrolyte imbalances
• Newborns are more prone to dehydration, acidosis, and • Should urinate within 24 hours
overhydration • Total urine output = 300 mL by the end of the first week
• Bladder involuntary empties with a volume of 15 mL,
F. GASTROINTESTINAL SYSTEM approximately 20 voids
• The GI tract is usually sterile at 24 hours of life • Urine is colorless, odorless, and has a specific gravity of
- Does not allow the growth of microorganisms, 1.008-1.010
including the normal flora that are needed by the body
- Vitamin K is necessary for blood clotting factors H. INTEGUMENTARY SYSTEM
• Enzymes are available to catalyze proteins and simple • Epidermis and dermis loosely bound and are very thin
carbohydrates but not complex carbohydrates and fats • Eccrine glands functional at birth
because of the absence of the pancreatic enzymes • Apocrine glands remain small and non-functioning
• Liver is the most immature of all GI organs (jaundice,
bleeding, edema, hypoglycemia) I. MUSCULOSKELETAL SYSTEM
• Salivation at 2-3 months • The skeletal system contains larger amounts of cartilage
• Stomach capacity = 60-90 mL (around 2-3 oz per feeding) than ossified bones, which make them more prone to
• Changes in the stool pattern injuries

STOOL CHARACTERISTICS J. IMMUNE SYSTEM

TIME STOOL CHARACTERISTIC • Limited immunologic protection until about 2 months
• Born with passive antibodies (immunoglobulin G)
1st 24 hours MECONIUM: greenish to black in • Includes antibodies against poliomyelitis, measles,
color, which is pasty diphtheria, pertussis, chicken pox, etc.
The combination of sloughed off GI
mucosa and swallowed maternal blood K. ENDOCRINE SYSTEM
• Effect of the maternal sex hormones evident in newborns
2nd to 3rd TRANSITIONAL STOOL: greenish and
day seedy L. NEUROLOGIC SYSTEM
• Primitive reflexes
4th day BREAST FED BABIES: 3-4x golden to • Myelination follows the principles of growth and
light yellow, loose, sour smelling, non- development
irritating to the skin
FORMULA FED BABIES: 2-3x pale NEONATE REFLEXES
yellow soft but formed stool with 1. BLINKING
noticeable odor and irritating to the 2. ROOTING
skin 3. SUCKING
4. SWALLOWING
5. EXTRUSION
VARIATIONS IN STOOL CHARACTERISTICS
6. PALMAR GRASP
• BRIGHT GREEN: for those placed under phototherapy for
7. STEP / WALK-IN-PLACE / DANCING
jaundice
- In phototherapy, the male genitalia must be covered 8. PLACING
to avoid the risk of infertility 9. PLANTAR GRASP
- Causes the bilirubin to be more soluble for excretion 10. TONIC NECK / FENCING / BOXER
• WITH MUCUS: may be related to milk allergy, lactose 11. MORO
intolerance, or other irritants 12. BABINSKI
- The most hygienic way of disposing phlegm is by 13. MAGNET
swallowing it 14. CROSSED EXTENSION
• CLAY COLORED / GRAY STOOL: with bile duct 15. TRUNK INCURVATION
obstruction 16. LANDAU
• BLOOD-FLECKED: with anal fissure; blood-tinged stool 17. DEEP TENDON
that is fresh red blood
• BLACK, TARRY STOOL: intestinal bleeding and should be see table: neonate reflexes
inspected

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SENSORY FUNCTIONS HOW TO PROVIDE WARMTH
HEARING • Dry the newborn’s skin
• Functional at 25-27 weeks AOG reacts to sound once the • Wrap using warm soft blanket
amniotic fluid has been drained from the middle ear • Use of preheated bassinet or crib, radiant warmer, droplight
• Most developed sense intrauterine or floor lamp

VISION INITIAL ASSESSMENT OF CONDITION

• Structurally incomplete and completes at around 6 years APGAR SCORING
• Tear glands do not begin to function until 2-4 weeks of age • Was developed by Dr. Virginia Apgar in 1952
• At birth, visual acuity of a newborn is between 20/100 and • Done on the 1st minute, 5th minute, and 10th minute of life
20/400 – the client will not be able to appreciate features • The perfect score is 10, but the highest score you can get is
• Cannot follow objects past midline 9 only
• Focuses best on black and white colors at 9-12 inches - Because you cannot obtain the pink coloration of the
- Best colors you can offer to the newborn are red, baby, which usually occurs after 30 minutes
black, and white to stimulate the vision - Adequate perfusion for the central circulation causing
acrocyanosis
TOUCH • Based on the 5 parameters ranked in order of importance
• Most developed sense extrauterine - Appearance
• Face, mouth, hands, and soles are the most sensitive parts - Pulse
• Babies appreciate different textures - Grimace
- Activity
TASTE - Respiration
• As the ability to discriminate taste, the newborn shows
preference for sweet over bitter tastes SILVERMAN-ANDERSEN INDEX
• Follows the taste of breastmilk or milk formula • Used to estimate degrees of respiratory distress in newborn

SMELL
• Present as soon as the nose is clear of lung and amniotic
fluid
• Reacts to strong odors

PRINCIPLES OF IMMEDIATE CARE

AIRWAY PATENCY
• Most critical adjustment a newborn must make at birth

TECHNIQUES TO MAINTAIN PATENT AIRWAY

• Wipe off mouth and nose with sterile gauze
• Suctioning with the use of rubber bulb syringe or suction
catheter
- Suction the mouth first before the nose because
newborns are obligatory nasal breathers usually up to
4 months of age
- To prevent aspiration of secretions in the mouth; nasal
secretions are not as quantifiable compared to the
secretions of the mouth
- Suctioning up to 5-10 seconds only
• POSITIONING
- For Unang Yakap, the baby must be placed on prone
position at the mother’s abdomen or between her
breasts
- Side-lying position
- Head to the side to prevent aspiration of fluids

HEAT PRODUCTION
• Non-shivering thermogenesis
• Metabolism of brown adipose fat (also known as vest fats)
• Gluconeogenesis

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BALLARD SCALE / DUBOWITZ TEST
• Assessment of gestational age
- PRE-TERM BABY: less than 38 weeks
- FULL TERM BABY: 38 to 42 weeks
- POST-TERM BABY: more than 42 weeks
PROPER IDENTIFICATION OF INFANT
• Through foot printing, nametag or bracelet, or built-in
sensory units
- Prepare two bracelets for the infant: one for the wrist
and for the ankle
- Bracelet includes the mother’s hospital number,
name, sex, date, and time of the infant’s birth
• Done before leaving the delivery room to prevent
switching of babies
• Done before the cord is cut
UMBILICAL CORD
• Normal: 1 vein and 2 arteries (AVA)
• Abnormal cases:
- 2 arteries and 2 veins in chromosomal aberration
- 1 artery and 1 vein in congenital defects, such as
kidney agenesis
CORD CARE
• The 1st clamp (plastic) is placed 2 cm from the base and 2nd
clamp (metal) placed 5 cm from the base
• Asepsis should be observed; present care needs no dressing
after cord has been clamped or ligated and cut; if left
exposed, will dry because water is lost and separates more
quickly than when covered
• Frequently inspect for bleeding
SKIN CARE
• Done to prevent infection
• Ideally given in 2-4 hours when vital signs and body
temperature have stabilized at 37oC
• Done from the cleanest to the most soiled area
• Oil bath for high risk premature
• Soap and water bath for full term
EYE CARE (CREDE’S PROPHYLAXIS)
• To prevent ophthalmia neonatorum or gonorrheal
conjunctivitis caused by Chlamydia trachomatis
• Use of antibacterial ophthalmic ointments like terramycin,
tetracycline, or erythromycin
• Applicable to all babies, whether they are delivered vaginal
or caesarian
TECHNIQUE
• Apply from the inner to outer canthus while exposing the
lower conjunctival sac
- There is difficulty in opening the eyes of a baby
because the eyelids are inflamed or swollen due to
the underdeveloped renal system
- The urine may not yet be concentrated and the
kidneys are not able to excrete the urine; hence,
causing water retention
• Could be delayed for 1 hour to promote bonding
HYPOPROTHROMBINEMIA PROPHYLAXIS
• Prescribed with single dose 0.5-1 mg of Phytomenadione
solution (Aquamephyton) per IM, vastus lateralis
- 0.5 g is given to a small baby
- 1 mg is given to normal babies
- You cannot use the dorsogluteal muscles because
they are still underdeveloped and you may hit the
cyatic nerves, which may lead to paralysis
• Aquamephyton, a Vitamin K water soluble preparation –
acts as a preventive measure against neonatal hemorrhagic
disease
• Most newborns are born with prolonged coagulation or
prothrombin time due to low blood levels of Vitamin K
• Vitamin K is necessary for the formation of clotting factors
II, VII, IX, and X, which are synthesized through the action
of intestinal flora
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MOTHER & CHILD BONDING
• An effective bond between the mother and infant that is
specific for them from which both gain security
• First social relationship for the infant
• Interferences from bonding: sickness, caesarian section, or
difficult labor
NUTRITION
• Plays a role in bonding, involution, and breastfeeding
stimulation
BAPTISM OF INFANT
• If there is a probability that the infant is imminent danger
and may not live, question of baptism should be considered
if the family is Roman Catholic
• Is an essential duty, means a great deal to the family
• Should be reported to the family after
NORMAL CHARACTERISTICS OF A NEONATE
ANTHROPOMETRIC MEASUREMENT
• LENGTH: 46-50 cm (18-20 inches)
• WEIGHT: 2.5-3.5 kg (5.5-7.5 lbs)
- The most accurate parameter of determining the
hydration of the client
- Weigh the client on the same scale, on the same time
of day, wearing the same type of clothes
- Weight is usually taken before feeding and before
bathing in the morning
- Newborns are weighed without clothing
• Newborn loses 5-10% of his body weight during the first
few days of life due to: withdrawal of hormones, voiding
and passing out of stool, and limited intake
• Will regain weight in 10-14 days of age later on, he will be
gaining 1 lb per month for the 1st 6 months of life, thus:
- 2x the weight at 6 months
- 3x the weight at 1 year
- 4x the weight at 2 years
HEAD CIRCUMFERENCE
• Crown to rump circumference or the sitting height is equal
to the head circumference
- From above the eyebrow to the sacrum
• Normal: 34-35 cm or 13.5-14 inches
• Measures at the widest part, which is the occipito-frontal
diameter, located across the center of the forehead and
most prominent portion of the posterior occiput
- Find the most prominent area in both the front and
back of the head, and measure the head circumference
from there
• Increases by 50% at one year
CHEST CIRCUMFERENCE
• Normal: 32-33 cm or 12-13 inches
• Usually measures about 2 cm less than the head
• Tape measure placed at the level of the nipple
ABDOMINAL CIRCUMFERENCE
• The abdominal circumference is generally the same as
chest circumference
• Usually measured at the level of the umbilicus
• Must be cylindrical in shape and protrude slightly
- A missing abdominal organ may show a sunken
abdomen
VITAL SIGNS
• Temperature, pulse rate, and respiratory rate are always
obtained
• Blood pressure is not routinely assessed unless there is a
potential for cardiac, bleeding, or renal problems
- Take the blood pressure of the client at 3 years of age
once or twice a year
- The blood pressure is not a routine requirement for
pediatric clients
A. TEMPERATURE
• Normal temperature: 37.2oC or 99oF
• Axillary temperature is the most temperature
• Rectal perforation may be a result of rectal temperature
taking
• Patency of the anus can be checked by stool elimination or
passage of the meconium
B. RESPIRATION
• Normal respiratory rate: 30-60 breaths per minute
• Varies with state of alertness: are shallow, irregular and
abdominal in nature
- Do not take the respiratory rate when the baby is
crying
- The client should be calm
• With periods of apnea, 5-15 seconds; thus, count the
respiratory rate for 1 full minute
• If higher than 60, place temporary NPO because of danger
of aspiration
C. HEART RATE
• Normal heart rate: 120-140 beats per minute
• Influenced by the newborn’s activity
• May be irregular
• Taken between the left nipple line and sternum for 1 minute
D. BLOOD PRESSURE
• High immediately after birth and falls to a minimum within
3 hours after birth
- Use a neonatal cuff; do not fold the normal cuff for
adults
• Normal at birth: 80/46 mmHg
• Normal at 10th day onward: 100/50 mmHg
HEAD TO TOE ASSESSMENT
• GENERAL APPEARANCE: generally flexed posture – the
more flexed the baby is, the more mature
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A. THE SKIN
• PRE-TERM: thin, translucent, ruddy skin with easily seen
veins and venules especially over the abdomen
• TERM: thick, pinkish, mottled because of temperature
changes (Cutis Marmorata)
- CUTIS MARMORATA: white patches due to
hypothermia
• POST-TERM: thick, parchment-like with peeling and
cracking; few blood vessels over the abdomen
- Looks like an old person being born
COLOR VARIATIONS OF THE SKIN
• GRAY: indicative of infection
• PALLOR: usually as a result of anemia that is due to the
following:
- Excessive blood loss at the time the cord was cut
- Inadequate flow of blood from cord into infant at birth
- Low iron stores due to poor maternal nutrition during
pregnancy
- Fetal-maternal transfusion
- Blood incompatibility
- Internal bleeding
• CUTIS MARMORATA: transient mottling when infant is
exposed to decreased temperature
• ACROCYANOSIS: bluish discoloration of the hands and
feet due to immature peripheral circulation and vasomotor
instability
• CENTRAL CYANOSIS: indicates decreased oxygenation
as a result of a temporary respiratory obstruction
- Suction the mouth first before the nose to prevent
trigger of the reflex gasp
- Cyanotic when quiet and grows pink when cries may
suggest a respiratory problem (atelectasis)
- With normal color when quiet then cyanotic when
crying may suggest a cardiac disease (congenital heart
disease)
• HARLEQUIN SIGN: clearly outlined color change as
infant lies on the side; lower half body becomes pink and
the upper half is pale
- Darker pink color on the dependent area and pale pink
on the non-dependent side
- Transient phenomenon caused by immature blood
circulation – normal to neonatal period (first 10 days
of life)
• PHYSIOLOGIC JAUNDICE (NEONATAL
HYPERBILIRUBINEMIA): appears in 50% of all newborns
as a normal process of the breakdown of RBC causing
infant’s skin and sclera to become yellowish in color
- When the infant experiences jaundice within the 1st 24
hours of life, it is pathologic jaundice (caused by the
disease)
- When jaundice occurs after the 1st 24 hours of life, it
is physiologic jaundice (normal process)
- When the RCBs are destroyed extrauterine, jaundice
will occur after 24 hours onset
- If the bilirubin levels reach 12 mg/dl, the physiologic
jaundice can become pathologic because the normal
bilirubin levels are only 0.8-1.2 mg/dl
- If bilirubin levels increase to 20 mg/dl, it will destroy
the blood brain barrier and destroy brain cells; hence,
causi kermictirus or bilirubin encephalopathy
- TERM: appears after 24 hours; becomes definite
between 2-7 days and disappears after the 7th day
- PRE-TERM: appears after 18 hours; becomes definite
between 3-10 days and disappears at the 9th to 10th day
OTHER TEXTURE VARIATIONS OF THE SKIN
• LANUGO: fine downy hair that covers a term newborn’s
shoulders, back, upper arms, forehead, and ears; common
in pre-term
- The more the lanugo, the more pre-term
• VERNIX CASEOSA: whitish, creamy, cheesy, odorless
substance that serves as skin lubricant in utero; usually on
folds of the skin; more in full term; protects the skin and
prevents heat loss
• FORCEP MARKS: circular or linear contusion matching
the rim of the blade of forceps on infant’s cheeks;
disappears in 1-2 days
- Assess the face of the newborn, especially during
crying for any facial asymmetry to detect potential
facial asymmetry to detect potential cranial nerve
injuries
- The forceps are inserted inside the cervix and anchors
the head of the baby; used like a thong
• MILIA: distended sebaceous glands that appear as tiny
white papules on cheeks, chin, and nose
• TELANGIECTATIC NEVI (STORK BITES): flat, deep pink
spots found at the back of the neck and above the eyelids
• MONGOLIAN SPOTS: collection of pigment cells
(melanocytes) that appear as slate-gray patches across the
sacrum or buttocks, and possibly on the arms and legs of
newborns
- Seen predominantly in newborns of African, Native
American, Asian, or Hispanic Descent
• ERYTHEMA TOXICUM NEONATORUM: newborn flee-
bite rash; pink papule rash with vesicles superimposed on
the skin
- May appear in the 1st to 4th day of life, but may appear
as late as 2 weeks of age and resolve after several days
- Probably caused by eosinophils reacting to the
environment
• DESQUAMATION: dry peeling of the skin particularly on
the palms and soles, more in post-term infants
• HEMANGIOMAS: vascular tumors of the skin
- NEVUS FLAMMEUS
- TELANGIECTASIA
- INFANTILE / STRAWBERRY HEMANGIOMA
- CAVERNOUS HEMANGIOMA
B. THE HEAD
• Proportionately large and is ¼ of total length
• Forehead appears large and prominent chin appears to be
receding and quivers easily
• May have full-bodied hair
• FONTANELLES: spaces or openings at points of union of
skill bones
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 - ANTERIOR: located at the junction of the two parietal
bones and the two frontal bones; diamond shaped and
closes at 12-18 months
- POSTERIOR: located at the junction of the parietal
bones and the occipital bone; triangular in shape and
closes at 2 months
- The normal fontanelle is flat; a sunken fontanelle may
indicate dehydration; the fontanelle bulges when the
baby cries and coughs; but when the bulge is
prolonged and tense, it may indicate an increase of
ICP, hydrocephalus, and subdural hematoma

VARIATIONS IN THE HEAD

• MOLDING: asymmetric adjustment in the shape of the
head to fit the cervix during delivery
• CAPUT SUCCEDANEUM: swelling or edema (water
retention) of the presenting portion of the scalp, usually the
occiput area
- Disappears within 3-4 days with no treatment needed
- Movable or passes to the other cranial plate because
water is fluid
• CEPHALHEMATOMA: collection of blood between the
periosteum of the skull bone and the bone itself
- Appears by 24 hours and is confined to one area; does
not cross the cranial plate
- Caused by rupture of a periosteal capillary during
delivery; will take weeks for absorption
- With possibility of jaundice after absorption
• CRANIOTABES: localized softening of the cranial bones
- More common in first born infants due to pressure of
fetal skull against the mother’s pelvic bone
- No treatment needed
- Normal in newborn but pathologic in older children
and adults (may be as a result of faulty calcium
metabolism or kidney dysfunction)

C. THE EYES
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