Head, Eyes, Face, Ears, Nose, Mouth

Question 1

Rubric

Answer 1

Head – 7 points
Shape (1)
Suture lines (1)
Fontanelles – names, location (2)
Hair distribution (1)
Cephalohematoma/Caput – describe each (2)

Eyes – 5 points
Placement - on face and in line with ears (1)
Conjunctiva – look for hemorrhage, inflammation (is it from eye ointment, or could be infection) (1)
Sclera – any sign of hemorrhage, jaundice (1)
PERL (1)
Red reflex (1)

Face – 1 point
Symmetry – looking for abnormal placement of features, palsy, nerve damage (1)

Ears – 4 points
Position – with outer canthus of eyes (1)
Shape – pinna, may be familial (1)
Unusual skin tags, pits, may be familial (1)
Hearing – assessed by screening (1)

Nose – 3 points
Shape (1)
Nares – patency (1)
Nasal septum/turbinates (1)

Mouth – 8 points
Lips (1)
Mucous membranes – moist (1)
Palate – soft and hard (visual and palpation) (2)
Gums – pink, smooth (1)
Tongue /frenulum (1)
Uvula (1)
Epstein’s pearls (1)

Question 2

Head

Answer 2

• Head: Feel all over for the shape of the head. Check for cephalohematoma and caput.
• Fontanelles - assess the anterior and posterior fontanelles, location.
• Assess the suture lines.
• Hair distribution, what is the hair texture like? Assess for whorls which can indicate an anomaly. 2 or fewer are ok/normal. More than 2, let pediatrician know.

Cephalohematoma/Caput – describe each (2)

Question 3

Face

Answer 3

Face – 1 point

Symmetry – looking for abnormal placement of features, palsy, nerve damage (1)

Question 4

Ears

Answer 4

Ears – 4 points

• 1st: Position – with outer canthus of eyes, should be in line or above but not below.
• 2nd: feel the firmness of the cartilage.
• 3rd: check the shape of the pinna. If unusual, compare to the parents as there may be a familiar presentation.
• 4th: check for pre- or post- auricular tags or sinuses; can be normal or an anomaly. Discuss with MD.
• 5th - do not check inside the ear d/t vernix.
• 6th -Unusual skin tags, pits, may be familial (1)
• 7th Hearing – assessed by screening (1)

Question 5

Eyes

Answer 5

• First: check placement on face, are they symmetrical? Then look immediately to the ear, is the outer canthus of the eye in line with the pinna of the ear. The pinna should be in line with the canthus or above it. Below = possible anomaly, tell the MD.
• Second: check the sclera which should be white or bluish white.
• Third: check the conjunctiva, there can be discharge which is normal but if accompanied by inflammation or redness, then consult.
• Fourth: take the ophthalmoscope and check PERL and for the red reflex.

Question 6

Nose

Answer 6

• -Where is the nose on the face?
• -Is the bridge flat?
• -Look up the nose, with a light, to see the septum and the turbinates. Is there any deviation?
• -Check for patency. One way is to have baby suck on finger/nipple. If can breathe, at least one side is patent. Could elicit the root reflex and assess the suck reflex while assessing patency. Occlude one nares and then the other.

Question 7

Mouth

Answer 7

• 1st: Immediately after checking for patency, while finger is still in mouth (insert finger ‘upside down’), palpate the hard and soft palate.
• 2nd: palpate the gums.
• 3rd: look at the lips, gums, tongue, frenulum, and mucosa. The gums should be pink and smooth. The mucosa should be moist. The lips should be symmetric and without lesions. Is the tongue the appropriate size? What does the frenulum look like?
• 4th: visualize the hard and soft palates and the uvula.
• 5th - does the uvula rise in the mid-line - may need to wait until the baby is crying.
• 6th - check for Epstein’s pearls at the junction of the hard and soft palates, or on the gums. If found, inform MD.

Question 8

Caput succedaneum

Answer 8

Diffuse edema (crosses suture lines). Head compression against the cervix impedes venous return, forucing serum into the interstitial tissues. The swelling reabsorbs within 1 - 3 days.

Question 9

Cephalohematoma

Answer 9

Confined by suture lines, a cephalohematoma is a mass composed of clotted blood. It is usually unilateral. the cause is rupture of periosteal bridging veins d/t pressure and friction during labor and delivery. The blood is reabsorbed gradually within a few weeks of birth. Watch for hyperbilirubinemia.

Question 10

Frenulum

Answer 10

A thin fold of mucosa in the middle of the floor of the mouth that runs from the gums behind the lower central incisors to the middle of the underside of the tongue. It divides the space between the tongue in half and can easily be seen when the tongue is raised. At birth this fold of mucosa may be tight, a condition called tongue-tie.

Question 11

Epstein’s pearls

Answer 11

In infants, benign retention cysts resembling small pearls. Sometimes present in the palate. They disappear in 1 - 2 months.