Head, Eyes and Ears


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:
Swelling of the soft tissue of the scalp caused by pressure of the fetal head on a cervix that is not fully dilated. Swelling crosses suture line and decreases rapidly in a few days after birth.


photo of baby with caput succedaneum
Photo used with permission*
Molding of fontanels and suture spaces

drawing of molding of fontanels and suture spaces photo of baby with molding of fontanels
Drawing and photo used with permission*

Signs of potential distress or deviations from expected findings:


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.

photo of baby with cephalhematoma
Photo used with permission*
  • Hydrocephalus
  • Macrocephaly
  • Closed sutures


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
photo of baby with edematous eyelids
Photo used with permission*
  • May focus for a few seconds
photo of baby with eyes focused
Photo used with permission*
  • 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
photo of baby with chemical conjunctivitis
Photo used with permission*
  • Subconjunctival hemorrhage
photo of baby with subconjunctival hemorrhage
Photo used with permission*


Expected findings:
  • Loud noise elicits Startle Reflex
  • Flexible pinna with cartilage present
  • Pinna top on horizontal line with outer canthus of eye
Photo showing pinna top in line with outer canthus of eye
Photo used with permission*
Common variations:
  • Skin tags on or around ears
photo of baby with skin tags
Photo used with permission*
Signs of potential distress or deviations from expected findings:
  • Ear placement low
  • Clefts present
  • Malformations
  • Cartilage absent


  • Preauricular sinus
photo of baby with preauricular sinus
Photo used with permission*
* Photo used with permission of Mead Johnson (1978). Variations and Minor Departures in Infants. Nutritional Division Mead Johnson & company, Evansville, Indiana.