The Ballard Score Maturational Assessment of Gestational Age in Newly Born Infants

Heel to Ear measurement using the Ballard Score

This maneuver measures passive flexor tone about the pelvic girdle by testing for passive flexion or resistance to extension of posterior hip flexor muscles.

The infant is placed supine and the flexed lower extremity is brought to rest on the mattress alongside the infant's trunk.

The examiner supports the infant's thigh laterally alongside the body with the palm of one hand. The other hand is used to grasp the infant's foot at the sides and to pull it toward the ipsilateral ear.

Heel to Ear measurement using the Ballard Score


Heel to Ear measurement

The examiner fells for resistance to extension of the posterior pelvic girdle flexors and notes the location of the heel where significant resistance is appreciated. Landmarks noted in order of increasing maturity include resistance felt when the heel is at or near the: ear (-1); nose (0); chin level (1); nipple line (2); umbilical area (3); and femoral crease (4).



Heel to Ear Score

SIGN NEURO-MUSCULAR MATURITY SCORE SIGN SCORE
-1 0 1 2 3 4 5
Heel To Ear