A nurse is performing a head-to-toe assessment of a newborn.

What finding should alert the nurse to a potential problem with the newborn’s fontanelles?

Normal finding.

The anterior fontanelle is the soft spot on the top of an infant’s head that allows for brain growth and skull expansion.

It normally feels soft and flat when the infant is lying down, and may bulge slightly when the infant is sitting up or crying due to increased blood flow and pressure.

This is not a sign of any problem and should be documented as a normal finding.

Dehydration is wrong because dehydration would cause the fontanelle to feel sunken or depressed, not elevated. Dehydration can also cause other signs such as dry mouth, decreased urine output, and lethargy.

Increased intracranial pressure is wrong because increased intracranial pressure would cause the fontanelle to feel tense or bulging at all times, not only when sitting up or crying. Increased intracranial pressure can also cause other signs such as vomiting, irritability, seizures, and altered level of consciousness.

Infection is wrong because infection would cause the fontanelle to feel warm or tender, not elevated. Infection can also cause other signs such as fever, rash, poor feeding, and fussiness.

Thin and transparent skin is a sign of prematurity in newborns.The New Ballard Scale is a scale that estimates the gestational age of a newborn infant based on physical and neuromuscular characteristics.

The other choices are signs of maturity or postmaturity in newborns:

• Choice B: Well-developed breastbuds indicate a gestational age of 38 to 44 weeks.

• Choice C: Creases on the bottom of feet indicate a gestational age of 32 to 44 weeks.

• Choice D: Developed labia indicate a gestational age of 40 to 44 weeks.

The normal range for gestational age is 37 to 42 weeks.Premature infants are those born before 37 weeks, and postmature infants are those born after 42 weeks.