Head, Eyes and Ears

Head

Expected findings:

• Anterior fontanel diamond shaped 2-3 - 3-4 cms
• Posterior fontanel triangular 0.5 - 1 cm
• Fontanels soft, firm and flat
• Sutures palpable with small separation between each

Common variations:

Drawing and photo used with permission*

Signs of potential distress or deviations from expected findings:

CEPHALHEMATOMA
Subperiosteal extravasation of blood due rupture of vessels. Swelling increases in size on second and third day after delivery. Often associated with delivery by forceps. Swelling does not cross suture line and may take several weeks after birth. Jaundice may occur as blood cells are broken down as the swelling resolves.

• Hydrocephalus
• Macrocephaly
• Closed sutures

Eyes

Expected findings:

• Slate gray or blue eye color
• No tears
• Fixation at times - with ability to follow objects to midline
• Red reflex

• Blink reflex
• Distinct eyebrows
• Cornea bright and shiny
• Pupils equal and reactive to light

Common variations:

• Edematous Eyelids

• May focus for a few seconds

• Uncoordinated movements

Signs of potential distress or deviations from expected findings:

• Discharges
• Opaque lenses
• Absence of Red Reflex
• Epicanthal folds in newborns not of Oriental descent
• Reflexes absent

• "Doll's Eyes" Reflex (beyond 10 days of age):
  When the head is moved slowly to the right or left, the eyes do not follow nor adjust immediately to the position of the head. This reflex should not be elicited once fixation is present. The persistence of the Doll's Eyes Reflex suggests neurologic damage.

• Chemical conjunctivitis

• Subconjunctival hemorrhage

Ears

Expected findings:

• Loud noise elicits Startle Reflex
• Flexible pinna with cartilage present

• Pinna top on horizontal line with outer canthus of eye

Common variations:

• Skin tags on or around ears

Signs of potential distress or deviations from expected findings:

• Ear placement low
• Clefts present
• Malformations
• Cartilage absent

• Preauricular sinus