Cliffside Park 201-840-9922
Pediatric & Adolescent Medicine

Physiologic Conditions of the Newborn

NEWBORN'S NORMAL APPEARANCE

Even after your child's health care provider assures you that your baby is normal, you may find that he or she looks a bit odd. Your baby does not have the perfect body you have seen in baby books. Be patient. Most newborns have some peculiar characteristics. Fortunately they are temporary. Your baby will begin to look normal by 1 to 2 weeks of age.

This discussion of these newborn characteristics is arranged by parts of the body. A few minor congenital defects that are harmless but permanent are also included. Call your health care provider if you have questions about your baby's appearance that this list does not address.

SKIN

  • Teleangiectasia - dilated blood vessels on the eyelids, nape of the neck, on the bridge of the nose etc. They are called “stork bites” or “angel kisses” depending on their location, look like birth marks and fade with time.
  • Erythema of the newborn - blotchy rash which consists of round red spots with light center.
  • Newborn acne - looks like regular acne, happens because of imbalance of oily glands in the skin. Does no require any special care.  

HEAD

  • Molding - This refers to the long, narrow, cone-shaped head that results from passage through a tight birth canal. This compression of the head can temporarily hide the fontanel. The head returns to a normal shape in a few days.
  • Caput - This refers to swelling on top of the head or throughout the scalp due to fluid squeezed into the scalp during the birth process. Caput is present at birth and clears in a few days.
  • Cephalohematoma - This is a collection of blood on the outer surface of the skull. It is due to friction between the infant's skull and the mother's pelvic bones during the birth process. The lump is usually confined to one side of the head. It first appears on the second day of life and may grow larger for up to 5 days. It doesn't resolve completely until the baby is 2 or 3 months of age.
  • Anterior Fontanel - The "soft spot" is found in the top front part of the skull. It is diamond-shaped and covered by a thick fibrous layer. Touching this area is quite safe. The purpose of the soft spot is to allow rapid growth of the brain. The spot will normally pulsate with each beat of the heart. It normally closes with bone when the baby is between 12 and 18 months of age.

EYES

  • Swollen Eyelids - The eyes may be puffy because of pressure on the face during delivery and if silver nitrate eye drops or antibiotic ointments are used. This irritation should clear in 3 days. There can be discharge because of the blocked tear duct.
  • Subconjunctival Hemorrhage - A flame-shaped hemorrhage on the white of the eye (sclera) is not uncommon. It's harmless and due to birth trauma. The blood is reabsorbed in 2 to 3 weeks.
  • Inability to Focus the Gaze - The eyes can roll in all directions, which looks spooky, but is not a reason for concern. By 6-8 weeks your baby will be able to focus better.

EARS

  • Folded Over - The ears of newborns are commonly soft and floppy. Sometimes one of the edges is folded over. The outer ear will assume normal shape as the cartilage hardens over the first few weeks.
  • Ear Pits - About 1% of normal children has a small pit or dimple in front of the outer ear. This minor congenital defect is not important unless it becomes infected.

NOSE: FLATTENED

  • The nose can become misshapen during the birth process. It may be flattened or pushed to one side. It will look normal by 1 week of age.

MOUTH

  • Sucking Callus (or blister) -  A sucking callus occurs in the center of the upper lip from constant friction at this point during bottle- or breast-feeding
  • Tongue-Tie - The normal tongue in newborns has a short tight band that connects it to the floor of the mouth. This band normally stretches with time, movement, and growth.
  • Epithelial Pearls - Little white-colored cysts can occur along the gum line or on the hard palate. These are a result of blockage of normal mucous glands. They disappear after 1 to 2 months.

BREAST ENGORGEMENT

  • Swollen breasts are present during the first week of life in many female and male babies. They are caused by the passage of female hormones across the mother's placenta. Sometimes the breast will leak a few drops of milk, and this is normal. Breasts are generally swollen for 2 to 4 weeks, but they may stay swollen longer in breast-fed and female babies. One breast may lose its swelling before the other one by a month or more. Never squeeze the breast. Call health care provider if a swollen breast develops any redness, streaking, or tenderness.

GENITALS: GIRLS

  • Swollen Labia - The labia minora can be quite swollen in newborn girls because of the passage of female hormones across the placenta. The swelling will resolve in 2 to 4 weeks.
  • Hymenal Tags - The hymen can also be swollen due to maternal estrogen and have smooth 1/2-inch projections of pink tissue. These normal tags occur in 10% of newborn girls and slowly shrink over 2 to 4 weeks.
  • Vaginal Discharge -  As the maternal hormones decline in the baby's blood, a clear or white discharge can flow from the vagina during the latter part of the first week of life. Occasionally the discharge will become pink or blood-tinged (false menstruation). This normal discharge should not last more than 2 to 3 days.

GENITALS: BOYS

  • Hydrocele - Painless collection of clear fluid in the scrotum.It is common and harmless and may take 6 to 12 months to clear completely.  If the swelling frequently changes size, a hernia may also be present and you should call your health care provider during office hours for an appointment.
  • Undescended Testicle - The testicle is not in the scrotum in about 4% of full-term newborn boys. Many of these testicles gradually descend into the normal position during the following months. In 1-year-old boys only 0.7% of all testicles are undescended; these need to be brought down surgically.
  • Tight Foreskin - Most uncircumcised infant boys have a tight foreskin that doesn't allow you to see the head of the penis. This is normal and the foreskin should not be retracted. It is called physiologic phimosis. Until your uncircumcised boy turns 6-8 years old, don’t attempt to pull the foreskin.
  • Erections - This occur commonly in a newborn boy, as they do at all ages. They are usually triggered by a full bladder, so watch out when you change a diaper. Erections demonstrate that the nerves to the penis are normal.

BONES AND JOINTS

  • Tight Hips - Your child's health care provider will test how far your child's legs can be spread apart to be certain the hips are not too tight. Upper legs bent outward until they are horizontal is called "90 degrees of spread." (Less than 50% of normal newborn hips permit this much spreading.) As long as the upper legs can be bent outward to 60 degrees and are the same on each side, they are fine. The most common cause of a tight hip is a dislocation.
  • Tibial Torsion - The lower legs (tibia) normally curve in because of the cross-legged posture your baby was confined to while in the womb.

HAIR

  • Scalp Hair - Most hair at birth is dark. This hair is temporary and begins to shed by 1 month of age. Some babies lose it gradually while the permanent hair is coming in; others lose it rapidly and temporarily become bald. The permanent hair will appear by 6 months. It may be an entirely different color from the newborn hair.
  • Body Hair (Lanugo) - Lanugo is the fine downy hair that is sometimes present on the back and shoulders. It is more common in premature infants. It is rubbed off with normal friction by 2 to 4 weeks of age. Many newborns have soft nails that easily bend and curve. However, they are not truly ingrown because they don't curve into the flesh.

Copyright © 2008 (Dr. Stein,  Pediatric and Adolescent Medicine, PA)