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What's Normal for Your Newborn?

Many new parents are filled with worry when a baby enters their life. After all, infants look fragile and are helpless. And aside from those shrieking cries, newborns can't communicate their specific needs in obvious ways. So it's natural to have concerns when caring for them. Here are the questions parents commonly ask -- with reassuring advice from physicians.

My newborn's eyes sometimes cross, and they have red spots. Should I be worried?
"It's normal for babies to intermittently cross their eyes, even at 6 months," says Christopher Bolling, MD, research director at Cincinnati Children's Hospital Medical Center. But if your baby's eyes are always crossed, tell your pediatrician.

Red spots are also very common. They're apparent at birth and are due to the increased pressure the baby experiences as he passes through the birth canal. They'll go away within a few weeks, but if your baby is born without these spots and they develop later, alert your pediatrician. They could indicate an infection.

Is it normal for a baby's breasts and genitals to appear swollen?
Both girls and boys can have swollen breasts that might express some milk -- possibly due to in utero exposure to hormones. For this reason, a baby girl's labia may also swell, and she might have a little bloody discharge. This is normal as long as it's just a tiny spot and doesn't persist.

On the other hand, swelling around a boy's genital area may be due to a hydrocele. "This is a fluid-filled sac around the testes, so it makes the scrotum look enlarged," Dr. Bolling says. Hydroceles are more likely in premature babies and can be inherited, but any baby boy can be born with one. "A hydrocele will usually resolve on its own within a year," he explains, "but surgery is sometimes necessary." Contact your pediatrician "if you notice a swelling, particularly a difference in the size of the two sides of the scrotum," Dr. Bolling adds.

How should I diaper my baby? Are there special considerations for girls versus boys?
When changing girls, wipe front to back. And don't worry if you see clear or whitish discharge in the genital area. Again, this is from baby's exposure to Mom's hormones while in the womb. If your son is circumcised, you'll replace the gauze bandage at every diaper change, and your pediatrician will probably tell you to also apply some antibiotic ointment (e.g., Bacitracin) or petroleum jelly. In addition, if you notice that your son has only one testicle, it's probably because the other one didn't yet move into place in the scrotum. Point it out to your doctor, though it should descend within the first year. If it doesn't, an operation may be necessary.

Are a baby's bowel movements similar to what an adult experiences?
Not at all. In fact, your baby's first poop will be meconium, a tar-like, blackish-green substance that you'll see for a couple of days. "My husband almost called 911 the first time he changed a diaper," says Tricia Ballad, a mother in Bloomington, Illinois. "He would've amused the paramedic crew!" After the meconium runs its course, greenish-brown transitional stools follow; by the fourth or fifth day, breastfed babies pass yellowish, seedy poop, while formula-fed infants' stool is denser and ranges in color from yellow to brown-green.

Expect variation in how often your infant has bowel movements. A formula-fed infant may poop three or four times a day, while a breastfed infant may go after every feeding or as infrequently as once a week, says Jennifer Shu, MD, a pediatrician and coauthor of Heading Home with Your Newborn: From Birth to Reality (American Academy of Pediatrics).

My newborn sometimes throws her arms out from her sides. Is she okay?
This is the Moro, or startle, reflex, and it usually occurs when a baby is surprised by a loud noise or sudden movement, Dr. Shu says. If you never see it, tell your pediatrician because your baby could have a hearing, nerve, or muscle problem.

When this reflex occurs often and prevents baby from falling or staying asleep, swaddle her in a blanket. Here's how to create a snug wrap: fold back the corner of a blanket and lay baby's head there. Take one pointed edge of the blanket and pull it across her body. Next, bring up the bottom corner of the blanket to her chin, then wrap the remaining side around her body.

The roof of my daughter's mouth is covered with small white bumps. What are they?
Don't stress -- they're just harmless cysts, known as Epstein's pearls, that will disappear as your baby gets older. However, if you spot big, blotchy white areas growing in your child's mouth (even on her tongue), this could be thrush -- a type of yeast infection, Dr. Bolling says. Visit your child's doctor, who'll probably prescribe an antifungal medicine (e.g., Nystatin).

How do I know if my newborn is getting enough to eat?
"Babies will cry for more food if they're still hungry and turn their head away if they're not," Dr. Shu says. Infants who are fed formula drink about 16 to 28 ounces daily during the first month, while breastfed babies often nurse about 15 to 20 minutes on each side every two to three hours. If you breastfeed, you can't tell how much your newborn is drinking. A sign that baby is eating well is her number of wet or dirty diapers -- expect several during the first few days, then look for six or more per day when you stop producing colostrum (a low-volume, high-protein milk) and start to make a creamy milk.

If your baby sleeps past a feeding, there is no need to wake him once he has regained his birth weight. But if he is still below his birth weight (even by a few ounces) and sleeps through or falls asleep during feedings, change his diaper or give him a bath to wake him up to eat, says Dr. Shu.

My baby's skin has a yellow hue. Should I be concerned?
Jaundice is a yellow discoloration of the skin and the whites of the eyes that occurs in many babies. It's caused by bilirubin, a substance that accumulates in the blood. As the baby's liver matures -- usually within a week or two of birth -- the yellowish tone of his skin should fade away, says F. Sessions Cole, MD, director of newborn medicine at St. Louis Children's Hospital. But because many moms and their babies are discharged from the hospital soon after birth, some babies may be home when their jaundice level peaks, typically at 3 to 5 days of age. If the bilirubin levels get too high and go untreated, the jaundice can lead to kernicterus, a type of brain damage. That's why all newborns should be seen by a doctor or nurse within a day or two of coming home from the hospital, Dr. Cole advises. If baby is in the hospital for three days or longer, a doctor will then decide if a follow-up visit is required to check for jaundice following discharge.

My newborn's head is misshapen, and her toes turn inward. Is this normal?
A baby's skull is made up of five head bones and two soft spots in between called fontanels. (Note: call your doctor if your baby has a bulging or sunken fontanel. This could indicate infection or dehydration.) It's built this way to help the head pass through the birth canal, which is why some newborns wind up with cone-shaped heads. But don't fret, his skull will round out.

Likewise, turned-in toes -- a result of baby's curled position in the womb -- are usually nothing to worry about. Mara Berkley, of Providence, Rhode Island, was concerned that her son's feet would remain inward, but they straightened out on their own within a few months, and he took his first step by age 1.

During well-baby exams, your pediatrician will try to move baby's foot into the proper position, Dr. Cole says. If her toes are turned too far inward or her feet cannot be moved into the right position, your child's doctor will refer you to a specialist before your baby begins to walk.

When you're changing baby's diaper or giving him a bath, it would certainly be a surprise to find a strange bulge by his belly button or groin. This bulge is likely a sign of an infant hernia, and while it's a scary sight, the reality is it will go away or can be surgically corrected, if necessary.

Inguinal Hernia: "This occurs in approximately 1 in 10 boys and 1 in 15 girls," says Edmund Kessler, MD, chief of ambulatory outpatient pediatric surgery at the Weill Cornell Medical Center, in New York. The hernia -- caused when parts of the intestine push through weak abdominal muscles in the groin -- is visible as a swelling that comes and goes. If it becomes hard and causes pain, surgery is the only treatment, Dr. Kessler explains.

Umbilical Hernia: Located at the belly button, an umbilical hernia is common, usually doesn't require surgery, and goes away by the time your child is a preschooler. (In fact, a navel referred to as an "outie" may actually be a small hernia.) It looks like a little balloon under the skin that retracts when pressed. If the hernia doesn't retract and it's red or swelling, call your pediatrician right away.

There are several ways to care for the remaining portion of a baby's umbilical cord. The staff in some hospitals may apply an antibacterial substance called triple dye to a newborn's cord stump to help prevent infection and to help it dry out more quickly. (You'll know if this was used if your baby's cord is purple-blue in color.) Other physicians may instruct parents to apply antibiotic ointment or rubbing alcohol with a swab to baby's cord area during diaper changes to help inhibit infection.

Because recent studies have shown that letting the cord dry on its own works just as well, some doctors prefer dry care, says Shu. Whether you use this cord-care method or another one, you'll be told to clean the umbilical area with a washcloth -- using a little soap and water (no bathtubs for baby just yet) -- when the stump gets dirty. It's easiest to use newborn diapers with a semicircle cut out at the waist, or you could just fold down the top portion of the diaper.

Now You See It, Now You Don't

Infants go through several physical changes in the first weeks of life. Here's what will disappear within a few days or weeks.

* When your baby is born, he'll be covered with a waxy substance called vernix. It'll be washed off during his first sponge bath in the hospital.
* A newborn will lose about 10 percent of her birth weight within the first week but should gain it back by the second week. Then she'll typically gain half an ounce to one ounce per day and double her birth weight at around 4 months. Contact your pediatrician if you have any concerns about weight loss or gain.
* Lanugo is fine hair that covers your baby's skin while he's in the womb. He'll lose it a few weeks after birth.
* Your newborn will probably lose the fuzzy hair on his head during the first six weeks. You may notice a little hair in his brush each day, and it could take as long as 18 months for his new head of hair to fully grow in.


Copyright © 2007. Used with permission from the November 2007 issue of American Baby magazine.

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