In assessing a sleeping infant, which step is performed last?

• A. Auscultate first.
• B. Palpate head to toe.
• C. Perform traumatic procedures like eyes, ears, mouth.
• D. Moro reflex assessment.

Answer: (D)

In a sleeping infant, the exam sequence is organized to get essential data with the least disturbance. Start with noninvasive observations and measurements, such as auscultating the heart and lungs to establish baseline function, then proceed to palpation from head to toe to assess overall status and detect any tenderness or distention. The Moro reflex is a neurological check that requires a brief stimulus to elicit a startle response, which can wake or arouse the baby. Waiting to test reflexes until the end preserves the infant’s sleep and allows you to observe the reflexes without prior disruption affecting the response. The Moro reflex is a primitive reflex present at birth and typically fades in the first few months, making it a final step in the neuro assessment after the rest of the exam data have been gathered. Therefore, the last step is the Moro reflex assessment.