Use both inspection with a tongue depressor and flashlight and palpation to inspect the mouth and pharynx (Fig. 1). One method employs the parent to hold the infant's head and arms. The newborn's mouth is edentulous and the alveolar mucosa is smooth with finely serrated borders. Occasionally, pearl-like retention cysts are seen along the alveolar ridges and are easily mistaken for teeth; these disappear within 1 or 2 months. Petechiae are commonly found on the soft palate after birth.
FIGURE 1. Parental assistance helps with oral assessment.
Palpate the upper hard palate to make sure it is intact. Epstein pearls, tiny white or yellow, rounded mucous retention cysts, are located along the posterior midline of the hard palate. They disappear within months.
Cysts may be noted on the tongue or mouth. Thyroglossal duct cysts may open under the tongue.
Infants produce little saliva during the first 3 months. Older infants produce a lot of saliva and drool frequently.
Inspect the tongue. The frenulum varies in tightness; sometimes it extends almost to the tip and other times it is short, limiting protrusion of the tongue (ankyloglossia or tongue tie).
You will often see a whitish covering on the tongue. If this coating is from milk, it can be easily removed by scraping or wiping it away. Use a tongue depressor or your gloved finger to wipe away the coating.
While there is a predictable pattern of tooth eruption, there is wide variation in the age at which teeth appear. A rule of thumb is that a child will have I tooth for each month of age between 6 and 26 months, up to a maximum of 20 primary teeth.
The pharynx of the infant is best seen while the baby is crying. You will likely have difficulty using a tongue depressor because it produces a strong gag reflex. Infants do not have prominent lymphoid tissue so you will probably not visualize the tonsils which increase in size as children grow.
Listen to the quality of the infant's cry. Normal infants have a lusty, strong cry. The following box lists some unusual types of infant cries.
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