A newborn baby's physiology is not the same as that of an older baby, a child or an adult. It takes time for this new body to settle into life outside the womb and to become fully efficient. During this settling period some babies display all kinds of color changes, spots, blotches, swellings and secretions, many of which look very peculiar. Most of them would indeed be peculiar if they occurred in an older person, but they are normal, or at least insignificant, when they occur in the first two weeks of life. Hospital staff take these newborn peculiarities for granted and, because they know that they are nothing to worry about, often forget to warn parents about them. The result can be unnecessary panic just when you need all the peace you can get. The following list describes some of the commonest of the phenomena and tells you why they happen and what they mean. If you need direct reassurance or if you are not sure that what you see matches what is described on the list, consult your doctor. Above all, do remember that these things are normal or unimportant only in a newborn baby. If you notice one of them after your baby is two to three weeks old, you should certainly ask for advice from your pediatrician.
Read more from Penelope Leach, Ph.D.
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Newborn skin has an overall pinky-red hue (whatever color it will be eventually) because it is so thin that the underlying blood vessels show through.
Because the circulation is not yet fully efficient, blood may sometimes pool in the lower half of a baby's body, so that when he has been still for a long time, he looks half red and half pale. And sometimes a full ration of circulating blood does not reach the baby's extremities so that as he lies asleep, his hands and feet look bluish. As soon as you pick the baby up or turn him over, the skin color will even out.
Because the skin is fragile it is easily damaged -- diaper rash is not the only kind of common clothes chafing. And because the pores do not yet work efficiently, skin is very liable to develop spots. Common kinds are "neonatal urticaria," consisting of a rash of red blotchy spots with tiny red centers that come and go on different parts of the baby's body, each group lasting only a few hours; tiny white spots, usually on the nose and cheeks, called "milk spots" (milia) that may last for several weeks; and the grimly named but harmless "toxic erythema" -- irregular red blotches with pale middles that look like a collection of insect bites. They may spoil your baby's complexion for a while, but they do no harm and need no treatment.
Called "Mongolian blue spots," these are just temporary accumulations of pigment under the skin. They are more usual in babies of African or Mongolian descent but can also be seen in babies of Mediterranean descent or in any baby whose skin is going to be fairly dark. They are nothing to do with bruising or with any disorder of the blood.
There are many kinds of birthmark; only a doctor can say whether the mark that worries you is a birthmark and if so whether it is the kind that will vanish on its own or not. But remember that red marks on the skin often arise from pressure during birth. This kind will vanish within a few days.
Most new babies' skin peels a little in the first few days. It's often most noticeable on the palms and soles. Post-term babies may have extra-dry skin, and babies of African and Asian descent often have skin and hair that is much drier than babies of European descent. On the whole, the fewer and simpler the products that are applied to a new babies' skins, the better. If dry skin requires an emollient to keep it from cracking, choose a hypoallergenic baby lotion or a pure vegetable oil.
Scurf on the scalp
This is as normal as skin peeling elsewhere; it is nothing to do with dandruff and does not suggest lack of hygiene. A really thick cap-shaped layer of brownish scales, known as "cradlecap," can be a nuisance. It sometimes spreads to the baby's eyebrows and behind the ears. Your doctor may suggest that you try a special shampoo, ointment or oil.
Any amount of hair on the head, from almost none to a luxuriant growth, is normal. Babies born late, after extra time in the womb, may have a great deal of rather coarse hair. Whatever it is like at birth, most of the newborn hair will gradually fall out and be replaced. The color and texture of the new hair may be quite different.
In the womb babies are covered with a fine fuzz of hair called lanugo. Some, especially babies born prematurely, still have traces, usually across the shoulder blades and down the spine. This hair will gradually rub off in the first week or two.
Oddities of Shape
Babies' skulls are designed to "give" under pressure. The second stage of an unassisted labor may dramatically elongate your baby's head, while forceps sometimes leave depressions as well as bruises. Vacuum extraction doesn't usually affect the actual skull but often raises a doughnut-shaped swelling on the top of the head. If your new baby looks like a prize-fighter, being born gave him a hard time. But that doesn't mean it damaged him.
These are areas where the bones of the skull have not yet fused together. The most noticeable lies toward the back of the top of the baby's head. Fontanelles are covered by an extremely tough membrane and there is no danger whatsoever of damaging them with normal handling. In a baby without much hair, a pulse may be seen beating under the fontanelle. This is perfectly normal. If the fontanelle seems sunken, so that there is a visible "dip" in the head, the baby is probably dehydrated (usually due to very hot weather or fever) and should be offered water or a feeding at once. If the fontanelle should ever appear to be tight and tense and to bulge outward even when the baby is not crying, he should see a doctor urgently as it could be a sign of illness.
Many babies whose eyes are perfectly normal have a squinting appearance in the early days of life. If you look at your baby closely you will probably find that it is the marked folds of skin at the inner corners of the eyes that make you think they are squinting. These folds of skin are perfectly normal and become less and less noticeable during the baby's first few weeks. Until the baby has strengthened and learned to control the muscles around the eyes, it is quite usual for there to be difficulty in holding both eyes in line with each other so that they can both focus steadily on the same object. As your baby looks at your face, you may suddenly notice that one eye has "wandered" out of focus. A "wandering eye" almost always rights itself by the time the baby is six months old. But point it out to the doctor at your next visit so that a check can be made on its progress. A true squint means that the baby's eyes never both focus together on the same object. Rather than moving together and then one wandering off, the eyes are permanently out of alliance with each other. If you are the first to notice that your baby has a "fixed squint" you should report it at once to the doctor. Early treatment is both essential and highly successful.
Swollen, puffy or red-streaked eyes
These are very common in the first hours after birth and result from pressure during it. The swelling may make it difficult for your baby to open his eyes at first, but it will soon subside. Any recurrence of trouble with the eyes, once newborn problems have resolved, should be promptly reported to the doctor.
Yellowish discharge/crusting on the lips and lashes
This suggests a very common mild infection, resulting from contact with blood during delivery, and known as "sticky eye." It is not serious but the baby should be seen by the doctor who may recommend drops or a solution for bathing the eyes.
New babies don't usually shed tears when they cry, but may shed them while they are not crying if the tear ducts have not fully opened to allow tears to drain away via the nose. Ducts usually open by the end of the first year.
While it is normal for a baby's ears to produce wax, which is an antiseptic protection for the ear canal, it is never normal for them to produce any other kind of discharge. If you are not sure that the substance you see coming from the ear is wax, consult your doctor. If it is wax, she will be only too pleased to reassure you. If by any chance it is pus, treatment is urgent. Never poke around inside your baby's ears; you could damage the eardrum. Like all body orifices, ears are self-cleaning. Confine yourself to washing around the outside.
Some babies' ears do seem to stick out a great deal, but that doesn't always mean that they are set on in a sticking out position. Newborn ears are soft and malleable and also look very different once the head takes on a more mature shape and more hair grows.
The tongue of a new baby is anchored along a much greater proportion of its length than is the tongue of an older person. In some babies the anchoring fold of skin is so long that the baby has almost no tongue which is free and mobile. In the past such babies were thought to be "tongue-tied." It was believed that unless the anchoring skin was cut so that the tongue was free, the baby would not be able to suck properly or learn to talk. Now we know that true tongue-tie (one that does cause problems and will not right itself with normal growth) is exceedingly rare. Most of the growth of a baby's tongue during the first year of life is in the tip so that by the first birthday the tongue is fully mobile. In the meantime, its close anchorage has no ill effects.
Blisters on the upper lip
These are called "sucking blisters" because the baby makes them himself with his suction. They can occur at any time while the baby is purely milk-fed. They may vanish between feedings and they are unimportant.
While they are being fed only on milk, babies often have tongues that are white all over. This is absolutely normal. Infection or illness produces patches of white on an otherwise pink tongue.
These, found on the gum, are harmless (and common) cysts. Yellowish-white spots might suddenly become visible on the roof of your baby's mouth when he yawns widely. Although they look worrying they are equally harmless. Both will clear up without treatment and will have vanished well before a first tooth is likely.
It is perfectly normal for babies of both sexes to have swollen breasts in the first three to five days after birth. This is due to hormones flooding through the mother just before the birth. The hormones are intended for her but they sometimes get to the baby, too. The swollen breasts may even have a tiny quantity of "milk" in them. They should be left strictly alone as any attempt to squeeze liquid out might introduce an infection. The swelling will die down in a few days as the baby's body rids itself of the hormones.
Your midwife or doctor will check the cord stump and make sure that your baby's navel heals cleanly. If you see any signs of infection -- redness or discharge -- report it immediately.
A small swelling close to the navel, which sticks out more when the baby cries, cannot actually be called "normal," but is very common indeed. It is caused by a slight weakness of the muscles in the wall of the abdomen that allows the contents to bulge forward. Almost all such hernias right themselves completely by one year and most doctors believe that they heal more quickly if they are not strapped up. Very few ever require surgery.
The genitals of both boys and girls are larger, in proportion to the rest of their bodies, at birth than at any other time before puberty. During the first few days after birth they may look even larger than normal because hormones from the mother have crossed the placenta, entered the baby's bloodstream and caused temporary extra swelling. The scrotum or the vulva may look red or inflamed. All in all the baby's sexual parts may look conspicuous and peculiar. But don't worry. The doctor or midwife who delivered the baby will have checked that all is normal. The inflammation and swelling will rapidly subside during the baby's settling period and he or she will soon "grow into" those apparently overlarge organs.
A boy's testes develop in the abdomen. They descend into the scrotum just before a full-term birth. If the doctor cannot feel them during her examination of the newborn, it may be that they are "retractile." They have descended, but they can still go up again into the abdomen and do so in reaction to the touch of cold hands. Provided that they can be "milked" down, they will eventually descend on their own. An undescended testicle is one which cannot be persuaded into the scrotum after a full-term birth or by the time a premature baby reaches his expected date of birth. If you cannot even see or feel both your son's testes in his scrotum, mention it to the doctor who checks him at around six weeks of age.
Tight foreskin (phimosis)
The penis and foreskin develop from a single bud in the fetus. They are still fused at birth and they only gradually separate during the first few years of the boy's life. A tight foreskin is therefore not a problem a new baby can have. You cannot retract his foreskin because it is not made to retract at his age. You cannot wash underneath it because it is only meant to be cleaned from outside in babyhood. Circumcision (surgical removal of the foreskin) of a young baby is very rarely medically advisable and, if it becomes necessary later on, it is often because of attempts to retract the foreskin forcibly before it was ready to retract of its own accord.