Newborn Peculiarities

[picture]

. . . your newborn is still unused

to being free of your womb and

out in the bewildering world.

The following list describes some of the commonest of these 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 your doctor for advice.

Skin

Bluish hands and/or feet

• These mean that the baby’s circulation is not yet efficient at getting the blood around to the extremities, especially after a long period asleep and still. They turn pink again when the baby is moved.

Half red, half pale

• The blood pools in the lower half of the baby’s body so that the lower half is red and the upper half pale. Again this is caused by immaturity of the circulation. The color difference will go when you turn the baby over.

Blue patches

• 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 Mongolism (despite the name) nor are they anything to do with bruising or with blood disorders.

Spots

• New babies get many kinds of spots. The kind that parents often worry about are red spots with yellowish centers. They are called “Neo-natal urticaria.” These spots form because the baby’s skin and its pores do not yet work efficiently. The spots need no treatment, are not infected (although they look as if they are) and they vanish after the first couple of weeks.

Birthmarks

• 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 the birth. This kind will vanish within a few days.

Peeling

• Most babies’ skin peels a little in the first few days. It is usually most noticeable on palms and soles.

Scurf on the scalp, cradlecap

• 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 is called “cradlecap.” If it upsets you, your doctor may suggest an ointment or oil.

Hair

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 fall out and be replaced. The color of the new hair may be quite different.

Body hair

• In the womb babies are covered with a fine fuzz of hair. Some, especially premature babies, still have traces, usually across the shoulder blades and down the spine. It will rub off in the first week or two.

Head

Oddities of shape

• These are almost always due to pressure during birth and will right themselves over a few months. The head may become slightly flattened if the baby is always put to sleep on one particular side. It is worth making sure that new babies are put on alternate sides, at least until they learn to roll themselves over.

Fontanelles

• These are the soft areas where the bones of the skull have not yet fused together. The most noticeable lies towards 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 babywithout much hair, a pulse may be seen beating under the fontanelle. This is perfectly normal. If the fontanelle ever appears sunken, so that there is a visible “dip” in the baby’s head, it is a sign of dehydration (usually due to very hot weather or a fever). The baby should be offered diluted fruit juice or water at once.
• If the fontanelle should ever appear to be tight and tense and to bulge outwards, the baby should see a doctor urgently as it could be a sign of illness.

Eyes

Swollen, puffy or red-streaked eyes

• These are often noticed soon after birth and result from pressure during it. Swelling and inflammation subside over a few days. Any recurrence of trouble with the eyes, once newborn problems have resolved, should be promply reported to the doctor.

Yellowish discharge and/or crusting on lids and lashes

• This is the result of a very common mild infection known as “sticky eye.” It is not serious but the baby should be seen by the doctor who will recommend drops or a solution for bathing the eyes.

Squinting

• 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 which 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 alignment 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.

Ears

Discharge

• While it is normal for a baby’s ears to produce wax, 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, he will be only too pleased to reassure you. If by any chance it is pus, treatment is urgent.

Protruding ears

• If you think that your baby’s ears stick out too much, it is worth making sure that you smooth back the one your baby is just going to lie on. A good long nap each day with the ear bent forward under the head will not improve matters. Otherwise you can only wait for the ears to become less noticeable as your baby’s head assumes a more mature shape and as more hair grows.

Mouth

“Tongue tie”

• 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 to learn to talk. Now we know that a true “tongue tie”–one which 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 effect on sucking, eating or speech.

White tongue

• While they are being fed only on milk, babies often have tongues which are white all over. This is absolutely normal. Infection or illness produces patches of white on an otherwise pink tongue.

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. They are unimportant.

Breasts

Swollen breasts are perfectly normal for babies of both sexes in the first three to five days after birth. They are caused by 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 milk out might introduce infection. The swelling will die down in a few days as the baby’s body rids itself of the hormones.

Abdomen

Umbilical hernia

• A small swelling close to the navel, which sticks out more when the baby cries, cannot actually be called “normal,” but is very usual indeed. It is caused by a slight weakness of the muscles in the wall of the abdomen, which allows the contents to bulge forward. Most 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.

Cord stump

• Your doctor will check the cord stump and make sure that your baby’s navel heals cleanly. If you should see any redness or discharge, report it immediately.

Sex organs

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 also look red and 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 over-large organs.

Undescended testicles

• A boy’s testicles develop in the abdomen. They descend into the scrotum just before a full-term birth. If the doctor cannot feel them during his examination of the newborn, it may be that they are “retractile”: he can “milk” them down into the scrotum but they can still go up again into the abdomen. Provided that they can “milked” down, they will certainly descend on their own. An undescended testicle is one which cannot be persuaded into the scrotum and does not lodge there of its own accord by the time a premature baby reaches his expected date of birth. If you cannot feel your son’s testes in the scrotum, mention it to the doctor who checks him at around six weeks of age.

Tight foreskin (phimosis)

• The penis and the foreskin develop from a single bud in the fetus. They are still fused at birth and they only gradually become separate during the first few years of the boy’s life. A tight foreskin is therefore a problem which a new baby canot have. You cannot retract his foreskin because it is not made to retract at this age. You cannot wash underneath it because it is only meant to be cleaned from outside in babyhood. Circumcision (surgical removal of the foreskin) is medically advisable in only a minute proportion of babies. When it becomes necessary it is usually because attempts have been made to retract the foreskin forcibly before it was ready to retract of its own accord.

Elimination and secretions

Meconium

• This is a greenish black sticky substance which fills babies’ intestines in the womb and has to be evacuated before ordinary digestion can take place. Almost all babies pass meconium in the first 24 hours. If a baby is born at home, the nurse must be told if none is passed by the second day. Failure to pass meconium might mean that there is an obstruction in the bowel.

Blood in stools

• Very occasionally blood is noticed in the stools in the first day or two. It is usually blood from the mother, swallowed during the delivery. Keep the diaper to show to the doctor or nurse.

Reddish urine

• Very early urine often contains a substance called “urates” which looks red on the diaper. As it looks like blood you may prefer to keep the diaper to show the nurse.

Frequent urine

• Once the urine flow is established the baby may pass water as often as 30 times in the 24 hours. This is entirely normal. On the other hand a baby who stays dry for 4-6 hours at this stage should be seen by the nurse or a doctor. It is just possible that there is some obstruction to the flow of urine.

Vaginal bleeding

• A small amount of vaginal bleeding is common in girls at any time in the first week of life. It is due to maternal estrogens passing into the baby just before birth.

Vaginal discharge

• A clear or whitish discharge from the vagina is also quite normal. It will stop in a very few days.

Nasal discharge

• Many babies accumulate enough mucus in the nose to cause sniffles or some visible “runniness.” This does not mean that the baby has a cold or other infection.

Tears

• Most babies cry without tears until they are 4-6 weeks old. A few shed tears from the beginning. It does not matter either way.

Sweating

• Most babies sweat a great deal around the head and neck. This has no importance unless the baby shows other signs of being feverish or unwell. It is a good reason, though, for rinsing the head and hair frequently as the sweat may irritate the skin in the folds of the neck.

Vomiting

• Spitting up a little milk after feedings is normal.