How to Use a Ballard Score

Written by jennifer young
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How to Use a Ballard Score
Premature infants receive a Ballard score which estimates gestational age. (Photodisc/Photodisc/Getty Images)

Ballard scores are an assessment tool used to determine approximate gestational age of an infant after birth. The scores are established by rating infants on a scale of negative one through five in areas of neuromuscular and physical maturity. The scores in the different areas are added together to determine the total score. This test can be used in cases where a mother's prenatal history is unknown and doctors must determine the gestational age of the baby to help establish an appropriate care plan.

Skill level:

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  1. 1

    Examine the posture of the infant and the position of all of the limbs. As a pregnancy progresses, a foetus' overall posture will relax and the range of motion in their joints will increase. The changes in posture begin at the head and proceed down the length of the body.

  2. 2

    Bend the wrist to determine the amount of flex present in the infant's wrist. This measurement relates closely to the posture of the infant and tests the range of motion in the wrists.

  3. 3

    Gently extend the arm as far as possible. Release the arm and measure the amount of recoil in the arm. As the posture evaluation continues, this step helps to assess the muscle development of the bicep muscle.

  4. 4

    Bend the knee of the infant to the chest, so that the thigh rests against the abdomen. Hold the leg in position until the infant relaxes. Grasp both sides of the foot with one hand and stabilise the thigh with the other. Extend the knee until resistance is felt. This step will help to determine the development of the knee joint.

  5. 5

    Fold one hand of the infant across the chest and secure the elbow with the thumb of the other hand. Gently push on the elbow towards the chest until resistance is felt. Note the point on the chest where the elbow rests when resistance is felt. This step returns your attention to the development of the upper extremities. The shoulders are examined to determine the range of motion that has been achieved.

  6. 6

    Gently press the leg of the infant towards the corresponding ear; gently pushing on the ball of the foot with the palm of your hand. Note the point on the length of the body where the heel is, when resistance is felt. An extremely premature baby will exhibit the ability to touch their heel to their nose. The less flexion that is present, the more progressed the gestational age.

  7. 7

    Examine the infant's skin. Note the presence of vernix, rash, wrinkled or peeling skin. Note any translucency or leathery textures. Infants with a greater gestational age will have a decreased amount of vernix and wrinkled skin. Full-term infants are more likely to have rashes and peeling skin, due to increased exposure to the womb environment.

  8. 8

    Notate the presence of any lanugo and the corresponding location. Languo is a covering that is used to insulate the foetus during gestation. As the gestational age increases, the languo is shed and replaced with body fat.

  9. 9

    Examine the soles of the infant's feet. Note the presence of any creases, and the corresponding location. Creases on the soles of her feet increases with gestational age. The number of creases -- as well as the location of the creases -- will assist in determining gestational age. Creases will develop starting on the ball of the foot.

  10. 10

    Examine the breast buds of the infant. Note the size of the areola and if any stippling is present. Determine the size of the breast tissue by palpating the area. Breast diameter will increase with gestational age and small bumps will be present on the nipple in well-developed infants.

  11. 11

    Examine the ear to determine if cartilage is present, its thickness, and if the top of the ear folds inward. Note the level of fold and thickness.

  12. 12

    Examine the eyelids to determine the level of fusing by using gentle traction. Eyes and ears continue to develop during gestation. Premature infants will have fused eyelids and ears which curl inward. As the gestational age increases, cartilage develops, ears straighten and the eyes gain the ability to open wider.

  13. 13

    Palpate the scrotum and lower abdomen of male infants to determine testicle location and thickness of the scrotum. Visually examine the genitals of female infants and determine the shape and proportion of the labia in relation to the clitoris. As gestation progresses, the testicles of males will descend from the abdominal cavity into the scrotum. In females, the clitoris will become smaller in size and be covered by the growing labia.

  14. 14

    Review the Ballard Score Sheet and compare your examination findings to the images on the sheet. Choose the image that best represents the tested infant and note the score. Add the score in all of the areas.

  15. 15

    Compare the total score to the Maturity Rating Scale and the corresponding number of gestational weeks. Use the gestational age to understand the level of development of the infant and institute care measures based on the development of the infant.

Tips and warnings

  • The Ballard score or gestational age of the infant can be altered based on substance abuse, malnutrition or other environmental factors which has affected the mother and infant during pregnancy. The score is used as a basis for care. The test can be redone to help assess continued development benchmarks.

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