Is My Newborn Normal?

To help prepare you for those first hours, days, and weeks of life, here's a head-to-toe guide to newborn health.

From the WebMD Archives

The moment your newborn is delivered, you're bound to heave a heavy sigh of relief now that baby has come. But if you're like most first-time parents, that relief doesn't last long, because now you will have new challenges facing you.

Unexpected birthmarks, a pulsating soft spot, jaundice, skin rashes, eyes that cross, head lumps and bumps: It can all be downright scary and can easily send new parents into panic mode.

"If you don't know what to expect, or especially if you are expecting that sort of 'Hollywood' version of the doll-perfect newborn, seeing and examining your baby for the first time can be quite shocking to some parents -- and even cause some serious anxiety attacks," says Tia Hubbard, MD, nursery pediatrician at the University of California at San Diego Medical Center.

But experts say no matter how frightening things may appear during those first hours or even days after birth, most if not all of what you see is temporary and a part of normal infant development.

Of course, experts say it's always a good idea to bring any disturbing/concerning or lasting newborn symptoms to your pediatrician's attention. To help calm your fears and prepare you for that first look at your little cherub, WebMD asked several experts to offer new parents a quick glimpse of what the first few days and weeks of a baby's life may be.

Your Baby, Head to Toe

If you've ever giggled through a Saturday Night Live "Coneheads" skit, then brace yourself. You may very soon be cradling your own little "cone head" in your arms!

"Following a vaginal birth, the baby's head is fairly elongated and cone-shaped, and parents are immediately worried that's the way the kid's head is going to be forever," says Steven P. Shelov, MD, chairman of pediatrics at Maimonides Medical Center in New York City, and director of the Maimonides Infants & Children's Hospital.

But Shelov says not only will the head shape change (usually within 48 hours or less), but that cone shape you see at birth is quite normal.

"The bones of the skull of a newborn are intentionally mobile. The birth canal is tight, and the bones are meant to give, allowing the head to pass through, which is what actually causes that elongated shape," says Shelov.  It is the pressure on the head coming through the canal that gives the baby the cone head shape which will resolve in a few days.  Babies born via C-section do not usually display much of the cone head shape.

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Pediatrician Fred Hirschenfang, MD, says you should also be prepared for some swelling at the top of your newborn's head or sometimes even over the entire scalp.

The condition is caused by fluids that are squeezed into the area during a normal delivery. Sometimes, enough fluid collects so that when pressed lightly, you can even see a small indentation. But again, it's nothing to worry about.

"It will resolve pretty quickly, usually before the baby leaves the hospital," says Hirschenfang.

What may take a little longer to disappear, however, is a condition known as cephalohematoma, a collection of blood trapped between the skull and skin lining. It frequently appears on day two of life and looks like an odd-shaped lump on the top of your newborn's head.

As scary as that sounds, doctors say don't fret.

"It happens as part of the normal birthing process, it's not serious and not anyone's fault, and it does go away on its own, usually within a few months," says Hirschenfang. It may get bigger before it starts going away which is normal too.  As long as there are no concerns for any accidents or traumas, a spontaneous cephalohematoma during the birthing period is usually normal.

And while you probably already know about your newborn's fontanel (those "soft spots" on the top and back of the head) don't be surprised if they start to throb with every beat of your baby's heart!

Although this too looks scary, Hubbard says relax; the pulsating is normal, and the "soft spot" is tougher that you think.

"It is supposed to be soft, because it allows for the rapid growth of the brain that occurs in the first year of life. But you can touch it; it's not that fragile," she says. Within 12 to 18 months the soft spot will usually resolve but it can take until the middle of the second year of life to close and your baby's skull will uniformly harden.  There is also a soft spot in the back of the head which is smaller and many times not noticed, this spot resolves within 6 months of birth.   

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That Adorable Face!

While you may be expecting to behold a cuddly, soft cherub, don't be surprised if your baby is just a tiny bit blue in color -- particularly fingers, toes, hands, and feet.

"Universally parents panic over this, but it's really quite normal, especially if the baby is chilly," says Shelov. It occurs, he says, because the baby doesn't effectively regulate temperature or circulation yet, especially to his organs.

Cuddle your baby close, and the blueness should start to disappear. Blueness in babies could also signify more serious medical problems, particularly if seen in the face, around the lips or tongue (central cyanosis). It is important to discuss this with your doctor.

But blue isn't the only unexpected color you might see after birth. Hirschenfang says to be prepared for a little yellow discoloration or jaundice to appear, especially in the whites of your newborn's eyes. "It occurs in 70% of all babies," he says. It should clear in four to 10 days, he says. But it is important to notify your doctor about it. Some cases of newborn jaundice require special treatment. Many hospitals may also test for the bilirubin level before your baby leaves the hospital to re-assure you that the lab value is within normal limits or if further treatment is needed.

Your baby's eyes can also be a little bloodshot following birth and might reveal a subconjunctival hemorrhage, which is a bright red spot caused by a tiny burst blood vessel that has burst in the white of the eye due to pushing/stress during labor.

Hirschenfang says it's a normal result of the pressures of delivery and usually clears on its own in a few days.

And while you're looking into your baby's eyes, don't be surprised if the color is not what you expected or if the eyes are crossed. Hubbard says all babies are born with dark eyes (they change color during the first year), and crossing may also be present, so don’t be surprised!

"Eyes just don't move in the same direction at the same time until a child is about 3 months of age, so don't worry," says Hubbard.

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Rashes, Lumps, and Bumps

Newborns are notorious for developing what seem like strange transitory rashes, the most common being erythema toxicum, red spots with a yellow or whitish center that often resemble flea bites.

But before you send Fido packing, Hubbard says take heart; it's probably just a normal newborn rash.

"It can be scary because lesions can pop up, go away, and new ones pop up within hours, and the skin can redden. But it's not serious, does not hurt or bother your baby and it usually resolves within seven days or less," says Hubbard.

Slightly less common -- but still normal -- are Mongolian spots. These are bluish patches frequently found on the lower back or buttocks, though they can crop up almost anywhere on your newborn's body. They can look like bruises and usually occur on babies that have darker skin. Hubbard says they usually disappear within the first year of life.

Blotchy red patches can occur on the face and neck of up to one-third of all newborns. These lesions known as "stork bites"  may become more noticeable when your baby cries. The spots spontaneously disappear usually within 18 months.

Surprises Down Under

No matter how prepared you are for most newborn "surprises," there's hardly a parent alive who isn't just a little shaken up when they gaze at their baby's genitals for the first time.

That's because they are usually abnormally large. In fact they are much larger and darker in color than you might expect on any child.

"In boys, swelling of the scrotum can be quite impressive and the tissue very red. In girls, the vulva is extremely swollen and also darker in color, both largely the result of the mother's hormones," says Shelov.

This is normal in the newborn period and will resolve on its own.

Something else that takes most parents by surprise is that baby girls often have a white vaginal discharge following birth, as well as one or two days of blood streaks.

"The vaginal mucosa is very hormone sensitive, so once the mother's hormones are out of the baby's system, there will be a little bleeding. It usually occurs within 72 hours and then stops," says Shelov. The enlarged genitals in boys and girls lasts a bit longer -- about a month.

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When it comes to the umbilical cord, Hirschenfang says many new parents get a little bit hysterical. It typically falls off within seven to 10 days, resulting in a temporary bloody discharge.

"It's nothing to worry about. Just try to diaper below the cord so no urine sits on it, and don't bathe your baby in a tub of water until the cord falls off and there is no more discharge," he says.

And while he says the cord area can be red or smell just a bit "gamy," neither problem is cause for alarm. Touching the cord doesn't cause baby any pain! 

"As with most issues with newborns -- including hiccups and excess gas and spitting up -- it hurts the parents more than the baby, in terms of worry and fear. In most instances, the baby is just fine, and when left alone, most if not all of these newborn problems clear quickly," he says.

The bottom line: Trust Mother Nature -- she knows what she's doing!

WebMD Feature Reviewed by Amita Shroff, MD on September 04, 2009

Sources

SOURCES: 

Tia Hubbard, MD, nursery pediatrician, University of California San Diego Medical Center, Hillcrest; clinical instructor, University of California San Diego School of Medicine. 

Steven P. Shelov, MD, chairman, pediatrics, Maimonides Medical Center, New York City; director, Maimonides Infants & Children's Hospital. 

Fred Hirschenfang, MD, section chief, pediatric ambulatory care, Hackensack University Medical Center, New Jersey. 

Bouchez, C. Your Perfectly Pampered Pregnancy: Health, Beauty and Lifestyle Advice for the Modern Mother-To-Be.

© 2007 WebMD, Inc. All rights reserved.

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