By Daniel Feiten MD
All babies are different. Here is a summary of some of the physical characteristics and newborn behavior that your baby may have. Each of them are normal findings. Take a minute to examine your baby, looking for some of these characteristics.
Soft spot: The anterior fontanel, a diamond-shaped soft area at the top of the skull. It's okay to touch it! Don't worry if it pulsates.It should close over between 6 to 18 months.
Caput/Cephalohematoma: Fluid-filled swellings on the top of the scalp. They'll usually go away within a few days to months after birth.
Ears: A pit or dimple in front of the ear is not uncommon. Rarely, these may get infected, so call us if you see redness or swelling. Also, the ears may be soft and folded over, but will assume normal shape soon.
Eyes: Eyelids may be swollen for the first three days. The white of the eye may have a scarlet-colored hemorrhage on it. This will resolve within 6 weeks. Your infant's eyes may occasionally look crossed in the first two months; call us if it persists.
Watery Eyes: This may be a blocked tear duct. Most of these open up by one year. Call us during office hours if there is a lot of mucus or yellow discharge.
Stuffy Noses: It is very common for infant's noses to appear to be stuffy. Hold a mirror directly under each nostril. If mist appears on the mirror, the nostril is open. Try saline drops (one drop each nostril as often as needed) down each nostril. The stuffiness disappears as the nostrils get bigger (around 2 - 4 months).
Mouth with white spots: Epithelial pearls are found on the gum or hard palate and are about the size of a pinhead. They'll go away by 2 months. Thrush consists of white patches on the tongue and inner cheeks. It can be confused with milk or formula (which easily wipes off.) Call and talk to our phone nurse of you think your child may have thrush.
Skin: Many babies get red blotches with a small white lump in the center (about the size of a pencil eraser head) all over their body. They'll come and go for the first 1 - 2 weeks. It's called erythema toxicum. Sounds and looks serious. It's not.
Acne: Begins around 2 weeks of age and lasts until 4 to 6 months. Baby lotion may make it worse. Keep clean with soap and water.
Dry skin: Babies lose their outer layer of skin after they are born. You'll see flaking. Especially around the ankles, feet, hands and extremities. Remember, they've been living inside a fluid environment for the past 9 months. Avoid using a lot of baby lotion. Just let it flake off.
White Bumps: On the face and chest are called milia. They look like pimples. They'll go away in 2 months. Note: if your baby has blisters, call our office immediately.
Stork Bites: These are flat, pink/burgundy birthmarks found on the back of the neck, or above the nose and eyes. Most of the facial marks will go away by 18 months, 25% of the neck birthmarks will remain, but are covered by hair.
Breast enlargement: May occur in male and female newborns in the first few weeks of life and may last for 6 months to 1 year. It's due to hormones that have been passed on by the mother before birth. You may even notice a drop of milk coming from the enlarged breast.
Umbilical cord: You'll sometimes see some yellowish discharge underneath the dried cord. The cord should fall off between 10-30 days of age. There may be some oozing of blood for a few days as the cord separates. This is normal and you should continue cleaning the cord as you were instructed at the hospital. Don't be afraid to lift up the dry part in order to apply rubbing alcohol to the moist part below. Call us immediately if there is red streaking, swelling or inflammation around the cord.
Genitals: Girls may have a white, sometimes blood-tinged discharge from their vagina in the first two weeks. No need to worry. 10% of girls will have a moist pink skin tag coming from the vagina: this will resolve over 1 to 2 months. Boys may have a fluid collection in their scrotum called a hydrocele. If it seems to change in size, call us during office hours.
Circumcision: You may see some yellowish skin on the head of the penis or at the end of the remaining foreskin. This will return to normal in 10 days. If your child has a plastic device after the circumcision (the Plastibell), this will fall off within two weeks. Keep the circumcision clean with water 3 times a day. Apply petroleum jelly (Vaseline) to the circumcision to avoid sticking to the diaper. If there is marked redness or swelling of the skin with streaks running toward the body, call our office.
Bowel Movements: Stools may vary in color and consistency, but are most often mustard yellow with a "cottage cheese" consistency. During the first few months, most babies strain when they stool. This occurs even when the stool is soft. Don't worry about this unless your baby's stool is hard or has a clay consistency. Call us if your breastfed newborn is stooling less than four times a day in the first two weeks of life.
DON'T WORRY ABOUT:
(the following behaviors are normal and should disappear within three months)
- Spitting up
- Straining with bowel movements when stool is soft
- Chin or lip quivering
- Passing gas
- Jitteriness of arms and legs when crying
- Startling to noises with brief body stiffening (called the Moro reflex)
- Mild congestion of the nostrils (very common in a dry climate!)