How to assess a newborn's EYES and EARS// PART I FACE// NCLEX 5

Let's start with the eyes. A super common question that you're going to get from parents is, what color are my baby's eyes? And the answer is normally a bluish grayish dark brownish grayish color. Generally, the darker the color of the skin, the darker the color of the eyes. But it doesn't really mean anything because you can't really tell the color of the baby's eyes until they're about nine months old. So when you're actually examining the eyes, make sure that the eyes are symmetrical so they look similar to each other and that they are spaced at a normal distance from each other. So the way that you can tell whether the eyes are normally spaced is that the difference between the eyes, the space between the eyes should be about the length of one eye from canthus to canthus. So this eye should fit in the space between my two eyes and that's a normal distance. Make sure that the baby can actually open its eyes and there is an eyeball within the eyes. Sometimes this is really hard to see because the baby's faces are so swollen from the whole delivery process, especially kind of like around the eyebrows and everything else. So sometimes you actually have to pull open the eyelids to make sure that there is eye back there. When you look inside the eyes, make sure that the conjunctiva, kind of the clear outer surface of the eye, is clear and that there is no discharge. The extraocular muscles, so the muscles that control the eyeball movement in babies, are generally weaker than in older kids. So it's very common for babies to appear cross-eyed or like have a lazy eye. If you do notice this, even though it can be normal in neonates, make sure that you document it so that it can be followed by the pediatrician to make sure that it is getting better. Also examine the pupils, which is kind of like the little black dot area. Make sure that they're round and small and that they do react to light, which means that if you shine a flashlight on them, the pupils will appropriately get smaller. If you look into the pupils with an ophthalmoscope, then you should be able to see the red vessels at the back of the eye of the retina. This is called the red reflex. So if you remember those kind of old unfiltered photos of babies, sometimes you'd see like the two red points on the baby's eyes. That's exactly what we're seeing, the red reflex. Seeing a red reflex is a good thing. It means that nothing is blocking the view from the eye all the way back to the retina, which means that there's no cataracts or tumor or increased pressure like glaucoma or something that's blocking the view. So we like to see a good red reflex. At birth, babies may have a blink reflex, which is if you touch their conjunctiva, then automatically they blink. More often than not, this develops over the first few weeks of life. Also, babies may briefly be able to fix on you. So kind of look at your face and they look like they're concentrating on you and then kind of move away. Again, though, this normally develops over the first few weeks of life as well. Okay, what about the ears? So one of the first things that you should do is see exactly where the ears are on the face. So there's kind of a bit of controversy about exactly where ears should land. But generally, if you trace back the line backwards from the middle of the eye, then the top part of the ear should kind of cross that line. So if that is the case, then the ear is probably in a good position. If the ears are lower than where that line is, then we call them low set ears. And this could be indicative of something chromosomal going on. For example, patients with Down syndrome have low set ears. Also, look at the orientation of the ears. You can see that they're not perfectly straight up. They're not parallel. They're back a little bit. But some babies have even more posteriorly rotated ears. This could also be a sign of something kind of genetic going on. Normally at birth, the ears are kind of cartilaginous and they have like really good recoil. The younger the babies, the less springy that ears are. And obviously make sure that the ears are symmetrical and you can see like a good ear canal. Obviously on all babies, we do need to do a hearing screen, but make sure that you get kind of a good external view as well. Also look for any other mild abnormalities you might see, like little skin tags or little pit, like little holes in the ears. Very often these are genetic. So if you see it on a baby, either the mommy or the daddy or an uncle or somebody has one too. Right? Go watch the next video on the continuation of the examination of the face and the neck.