General Appearance of Newborns
In delivery room scenes on TV and in the movies, the
mother-to-be, often a famous actress in full makeup and with every
hair in place, "delivers" a baby after a few token grunts
and groans. Seconds later, the doctor presents the glowing parents
with a picture-perfect, neatly combed and scrubbed, cooing
several-month-old infant.
Contrast that picture with how a baby really looks just after
emerging from the womb: bluish, covered with blood and cream-cheesy
glop, and looking as though the little one has just been in a
fist-fight.
The fact that your newborn doesn't resemble one of those
Hollywood "stand-ins" shouldn't come as a great
surprise. Remember that the fetus develops immersed in fluid,
folded up in an increasingly cramped space inside the uterus. The
whole process usually culminates with the baby being pushed
forcibly through a narrow, bone-walled birth canal, sometimes
requiring the assistance of metal forceps or suction devices.
Still, it helps to remember two things:
- Usually, the features that may make a normal newborn look
strange are temporary.
- In the eyes of the adoring parent, every infant looks like
the perfect baby anyway.
When you first get to see, touch, and inspect your newborn may
depend on the type of delivery, your condition, and the condition
of your baby. Following an uncomplicated vaginal delivery, you
should have the opportunity to hold your baby within minutes after
the birth.
Bonding
In most cases, infants seem to be in a state of quiet alertness
during the first hour or so after delivery. It's a great time
for you and your newborn to get acquainted and begin the
bonding
process. But don't despair if circumstances prevent you from
meeting your infant right away. You'll have plenty of quality
time together soon, and there's no scientific evidence that the
delay will affect your infant's health, behavior, or
relationship with you over the long run.
During the first several weeks, you'll notice that much of
the time your baby will tend to keep his or her fists clenched,
elbows bent, hips and knees flexed, and arms and legs held close to
the front of his or her body. This position is similar to the fetal
position during the last months of pregnancy. Infants who are born
prematurely
may display several differences in their posture, appearance,
activity, and behavior compared with full-term newborns.
Primitive Reflexes
Infants are born with a number of instinctual responses to
stimuli, such as light or touch, known as
primitive reflexes
, which gradually disappear as the baby matures. These reflexes
include the:
-
sucking reflex
, which triggers an infant to forcibly suck on any object put in
the mouth
-
grasp reflex
, which causes an infant to tightly close the fingers when
pressure is applied to the inside of the infant's hand by a
finger or other object
-
Moro reflex, or startle response
, which causes an infant to suddenly throw the arms out to the
sides and then quickly bring them back toward the middle of the
body whenever the infant has been startled by a loud noise,
bright light, strong smell, sudden movement, or other
stimulus
Also, due to the immaturity of their developing nervous systems,
young infants' arms, legs, and chins may tremble or shake,
particularly when they're crying or agitated.
Sleeping and Breathing Patterns
In the first weeks, infants usually spend most of their time
sleeping
. This may be even more exaggerated during the first day or two of
life in newborns whose mothers received certain types of pain
medications or anesthesia during the labor or delivery.
Frequently, new parents become concerned about their
newborn's
breathing pattern
, particularly with the increased attention that
sudden infant death syndrome (SIDS)
has received in recent years. But rest assured that it's normal
for young infants to breathe somewhat irregularly.
When an infant is awake, his or her breathing rate may vary
widely, sometimes exceeding 60 breaths per minute, particularly
when the little one is excited or following a bout of crying.
Newborns will also commonly have periods during which they stop
breathing for about 5 to 10 seconds and then start up again on
their own. This is known as
periodic breathing
, which is more likely to occur during sleep and is considered very
normal. However, if your infant turns blue or stops breathing for
longer stretches of time, it's considered an emergency and you
should contact your child's doctor immediately or go to the
emergency room.
Although talking won't come until much later, your newborn
will produce a symphony of noises - especially high-pitched squeaks
- in addition to the obligatory crying. Sneezing and hiccups also
occur very frequently and don't indicate infection, allergies,
or digestive problems in newborns.
Head
Because the infant's head is usually the first part through
the birth canal, it can be affected by the delivery process. The
newborn's skull is made up of several separate bones that will
eventually fuse together. This situation permits the large head of
the infant to be squeezed through the narrow birth canal without
injury to mother or baby.
The heads of infants born by vaginal delivery often show some
degree of
molding
, which is when the skull bones shift and overlap, making the top
of the infant's head look elongated, stretched out, or even
pointed at birth. This sometimes bizarre appearance will go away
over the next several days as the skull bones move into a more
rounded configuration. The heads of babies born by cesarean section
or breech (buttocks or feet first) delivery usually don't show
molding.
Because of the separation of your newborn's skull bones,
you'll be able to feel (go ahead, you won't harm anything)
two
fontanels
, or soft spots, on the top of the head. The larger one, located
toward the front of the head, is diamond-shaped and usually about 1
to 3 inches wide. A smaller, triangle-shaped fontanel is found
farther back on the head, where a beanie might be worn.
Don't be alarmed if you see the fontanels bulge out when the
infant cries or strains, or if they seem to move up and down in
time with the baby's heartbeat. This is perfectly normal. The
fontanels will eventually disappear as the skull bones close
together - usually in about 12 to 18 months for the front fontanel
and in about 6 months for the one in back.
In addition to looking elongated, a newborn's head may have
a lump or two as a result of the trauma of delivery.
Caput succedaneum
is a circular swelling and bruising of the scalp usually seen on
top of the head toward the back, which is the part of the scalp
most often leading the way through the birth canal. This will fade
over a few days.
A
cephalohematoma
is a collection of blood that has seeped under the outer covering
membrane of one of the skull bones. This is usually caused during
birth by the pressure of the head against the mother's pelvic
bones. The lump is confined to one side of the top of the
baby's head and, in contrast to caput succedaneum, may take a
week or two to disappear. The breakdown of the blood collected in a
cephalohematoma may cause these infants to become somewhat more
jaundiced than others during the first week of life.
It's important to remember that both caput succedaneum and
cephalohematoma occur due to trauma outside of the skull - neither
indicates that there has been any injury to the infant's
brain.
Face
A newborn's face may look quite puffy due to fluid
accumulation and the rough trip through the birth canal. The
infant's facial appearance often changes significantly during
the first few days as the baby gets rid of the extra fluid and the
trauma of delivery subsides. That's why the photos you take of
your baby later on at home usually look a lot different than those
"new arrival" nursery shots.
In some cases, a newborn's facial features can be quite
distorted as a result of positioning in the uterus and the squeeze
through the birth canal. Not to worry - that folded ear, flattened
nose, or crooked jaw usually comes back into place over time.
Eyes
A few minutes after birth, most infants open their eyes and
start to look around at their environment. Newborns can
see
, but they probably don't focus well at first, which is why
their eyes may seem out of line or crossed at times during the
first 2 to 3 months. Because of the puffiness of their eyelids,
some infants may not be able to open their eyes wide right away.
When holding your newborn, you can encourage eye opening by taking
advantage of your baby's "doll's eye" reflex,
which is a tendency to open the eyes more when held in an upright
position.
Parents are sometimes startled to see that the white part of one
or both of their newborn's eyes appears blood-red. Called
subconjunctival hemorrhage
, this occurs when blood leaks under the covering of the eyeball
due to the trauma of delivery. It's a harmless condition
similar to a skin bruise that goes away after several days, and it
generally doesn't indicate that there has been any damage to
the infant's eyes.
Parents are often curious to know what color eyes their infant
will have. If a baby's eyes are brown at birth, they will
remain so. This is the case for most black and Asian infants. Most
white infants are born with bluish-gray eyes, but the pigmentation
of the iris (the colored part of the eye) may progressively darken,
usually not becoming their permanent color until about 3 to 6
months of age.
Ears
A newborn's ears, as well as other features, may be
distorted by the position they were in while inside the uterus.
Because the baby hasn't yet developed the thick cartilage that
gives firm shape to an older child's ears, it isn't unusual
for newborns to come out with temporarily folded or otherwise
misshapen ears. Small tags of skin or pits (shallow holes) in the
skin on the side of the face just in front of the ear are also
common. Usually, these skin tags can be easily removed (talk to
your doctor).
Nose
Because newborns tend to breathe through their noses and their
nasal passages are narrow, small amounts of nasal fluid or mucus
can cause them to breathe noisily or sound congested even when they
don't have a cold or other problem. Talk with your doctor about
the use of salt-water nose drops and a bulb syringe to help clear
the nasal passages if necessary.
Sneezing
is also common in newborns. This is a normal reflex and isn't
due to an infection, allergies, or other problems.
Mouth
When your newborn opens his or her mouth to yawn or cry, you may
notice some small white spots on the roof of the mouth, usually
near the center. These small collections of cells are called
Epstein's pearls
and, along with fluid-filled
cysts
sometimes present on the gums, will disappear during the first few
weeks.
Neck
Yes ... it's there. Normally the neck looks short in
newborns because it tends to get lost in the chubby cheeks and
folds of skin.
Chest
Because an infant's chest wall is thin, you may easily feel
or observe your baby's upper chest move with each heartbeat.
This is normal and isn't a cause for concern.
Also, both male and female newborns can have
breast enlargement
. This is due to the female hormone estrogen passed to the fetus
from the mother during pregnancy. You may feel firm, disc-shaped
lumps of tissue beneath the nipples and, occasionally, a small
amount of milky fluid (called "witch's milk" in
folklore) may be released from the nipples. The breast enlargement
almost always disappears during the first few weeks. Despite what
some parents believe, you shouldn't squeeze the breast tissue -
it will not make the breasts shrink any faster than they will on
their own.
Arms and Legs
Following birth, full-term newborns tend to assume a posture
similar to what their position in the cramped uterus had been: arms
and legs flexed and held close to their bodies. The hands are
usually tightly closed, and it may be difficult for you to open
them up because touching or placing an object in the palms triggers
a strong grasp reflex.
Fingernails
Infants'
fingernails
can be long enough at birth to scratch their skin as they bring
their hands to their faces. If this is the case, you can carefully
trim your baby's nails
with a pair of small scissors.
Sometimes parents are concerned about the curved appearance of
their newborn's feet and legs. But if you recall the usual
position of the fetus in the womb during the final months of
pregnancy - hips flexed and knees bent with the legs and feet
crossed tightly up against the abdomen - it's no surprise that
a newborn's legs and feet tend to curve inward. You can usually
move your newborn's legs and feet into a "walking"
position; and this will happen naturally as the infant begins to
bear weight, walk, and grow through the first 2 to 3 years of
life.
Abdomen
It's normal for a baby's abdomen (belly) to appear
somewhat full and rounded. When your baby cries or strains, you may
also note that the skin over the central area of the abdomen may
protrude between the strips of muscle tissue making up the
abdominal wall on either side. This almost always disappears during
the next several months as the infant grows.
Many parents are concerned about the appearance and care of
their infant's
umbilical cord
. The cord contains three blood vessels (two arteries and a vein)
encased in a jelly-like substance. Following delivery, the cord is
clamped or tied off before it's cut to separate the infant from
the placenta. The umbilical stump is then simply allowed to wither
and drop off, which usually happens in about 10 days to 3
weeks.
You may be instructed to swab the area with alcohol periodically
or wash the area with soap and water if the stump becomes dirty or
sticky to help prevent infection until the cord falls off and the
stump dries up. The baby's navel area shouldn't be
submerged in water during bathing until this occurs. The withering
cord will go through color changes, from yellow to brown or black -
this is normal. You should consult your baby's doctor if the
navel area becomes red or if a foul odor or discharge develops.
Umbilical
(navel)
hernias
are common in newborns, particularly in black infants. A hole in
the wall of the abdomen at the site of the umbilical cord/future
navel allows the baby's intestine to protrude through when he
or she cries or strains, causing the overlying skin to bulge
outward. These
hernias
are generally harmless and aren't painful to the infant. The
majority of them close on their own during the first few years, but
a simple surgical procedure can fix the hernia if it doesn't
close by itself. Home remedies for umbilical hernias that have been
tried through the years, such as strapping and taping coins over
the area, should
not
be attempted. These techniques are ineffective and may result in
skin infections or other injuries.
Genitalia
The genitalia (sexual organs) of both
male
and
female
infants may appear relatively large and swollen at birth. Why?
It's due to several factors, including the exposure to hormones
produced by the mother and fetus, bruising and swelling of the
genital tissues related to birth trauma, and the natural course of
development of the genitalia.
In girls, the outer lips of the vagina (
labia majora
) may appear puffy at birth. The skin of the labia may be either
smooth or somewhat wrinkled. Sometimes, a small piece of pink
tissue may protrude between the labia - this is a
hymenal tag
and it's of no significance; it will eventually recede into the
labia as the genitals grow.
Due to the effects of maternal hormones, most newborn girls will
have a vaginal discharge of mucus and perhaps some blood that lasts
for a few days. This "mini-period" is normal
menstrual-type bleeding from the infant's uterus that occurs as
the estrogen passed to the infant by the mother begins to
disappear. Although it's much more common in boys, swelling in
the groin of an infant girl can indicate the presence of an
inguinal
(groin)
hernia
.
Hydrocele
In boys, the scrotum (the sack containing the testicles) often
looks swollen. This is usually due to a
hydrocele
, a common collection of fluid in the scrotum of infant boys that
usually disappears during the first 3 to 6 months. You should
consult your doctor about swelling or bulging in your son's
scrotum or groin area that persists beyond 3 to 6 months or that
seems to come and go. That may indicate the presence of an inguinal
hernia, which usually requires surgical treatment. The testicles of
newborn boys may be difficult to feel in the swollen scrotum.
Muscles attached to the testicles pull them up into the groin
briskly when the genital area is touched or exposed to a cool
environment. Infant boys also normally experience frequent
penile erections
, often just before they urinate.
More than 95% of newborns urinate within the first 24 hours. If
your baby is delivered in a hospital, nursery personnel will want
to know if this happens while your infant is with you. If a newborn
doesn't urinate for what seems like a while at first, it may be
that he or she urinated immediately after birth while still in the
delivery room. With all the activity going on, that first urination
may not have been noticed.
If your infant son was
circumcised
, it usually takes between 7 to 10 days for the penis to heal.
Until it does, the tip may seem raw or yellowish in color. Although
this is normal, certain other symptoms are not. Call your
child's doctor right away if you notice persistent bleeding,
redness around the tip of the penis that gets worse after 3 days,
fever
, signs of infection (such as the presence of pus-filled blisters),
and not urinating normally within 6 to 8 hours after the
circumcision.
Bathing
With both circumcised and uncircumcised penises, no cotton
swabs, astringents, or any special bath products are needed -
simple soap and warm water every time you bathe your baby will do
the trick.
No special washing precautions are needed for newly circumcised
babies, other than to be gentle, as your baby may have some mild
discomfort after the circumcision. If your son has a bandage on his
incision, you might need to apply a new one whenever you change his
diaper for a day or two after the procedure (put petroleum jelly on
the bandage so it won't stick to his skin). Doctors often also
recommend putting a dab of petroleum jelly on the baby's penis
or on the front of the diaper to alleviate any potential discomfort
caused by friction against the diaper. How you take care of your
baby's penis may also vary depending on the type of
circumcision procedure the doctor performs. Be sure to discuss what
after-care will be needed.
If your baby boy wasn't circumcised, be sure to never
forcibly pull back the foreskin to clean beneath it. Instead,
gently tense it against the tip of the penis and wash off any
smegma (the whitish "beads" of dead skin cells mixed with
the body's natural oil). Over time, the foreskin will retract
on its own so that it can be pulled away from the glans toward the
abdomen. This happens at different times for different children,
but most boys can retract their foreskins by the time they're 5
years old.
Skin
There's little doubt about the origin of the expression
"still wet behind the ears," used to describe someone new
or inexperienced. Newborns are covered with various fluids at
delivery, including amniotic fluid and often some blood (the
mother's, not the baby's). Nurses or other personnel
attending the birth will promptly begin drying the infant to avoid
a drop in the baby's body temperature that will occur if
moisture on the skin evaporates rapidly. Newborns are also coated
with a thick, pasty, white material called
vernix caseosa
(made up of the fetus' shed skin cells and skin gland
secretions), most of which will be washed off during the baby's
first bath.
The hue and color patterns of a young infant's skin may be
startling to some parents.
Mottling
of the skin, a lacy pattern of small reddish and pale areas, is
common because of the normal instability of the blood circulation
at the skin's surface. For similar reasons,
acrocyanosis
, or blueness of the skin of the hands and feet and the area
surrounding the lips, is often present, especially if the infant is
in a cool environment.
When bearing down to cry or having a bowel movement, a young
infant's skin temporarily may appear beet-red or bluish-purple.
Red marks, scratches, bruises, and
petechiae
(tiny specks of blood that have leaked from small blood vessels in
the skin) are all common on the face and other body parts.
They're caused by the trauma of squeezing through the birth
canal or by the pressure from obstetrical forceps used during the
delivery. These will heal and disappear during the first week or
two of life.
Fine, soft hair, called
lanugo
, may be present on a newborn's face, shoulders, and back. Most
of this hair is usually shed in the uterus before the baby is
delivered; for this reason, lanugo is more frequently seen on
babies born prematurely. In any case, this hair will disappear in a
few weeks.
The top layer of a newborn's skin will flake off during the
first week or two. This is normal and expected and doesn't
require any special skin care. Peeling skin may be present at birth
in some infants, particularly those who are born past their due
date.
Birthmarks
Despite what the name says, not all babies come with a
birthmark
. However, pink or red areas, sometimes called
salmon patches
, are common and generally disappear within the first year. Most
frequently found on the back of the neck or on the bridge of the
nose, eyelids, or brow (hence the fanciful nicknames "stork
bite" and "angel kiss"), they can occur anywhere on
the skin, especially in light-skinned infants.
Mongolian spots
, flat patches of slate-blue or blue-green color that resemble ink
stains on the back, buttocks, or elsewhere on the skin, are found
in more than half of black, Native American, and Asian infants and
less often in white babies. These spots are of no significance and
almost always fade or disappear within a few years.
Strawberry
or
capillary hemangiomas
are raised red marks caused by collections of widened blood vessels
in the skin. These birthmarks may appear pale at birth and then
typically become red and enlarge during the first months of life.
Then, they usually shrink and disappear without treatment within
the first 6 years.
Port-wine stains
, which are large, flat, reddish-purple birthmarks, won't
disappear on their own. As the child gets older, concerns (your or
the child's) about cosmetic appearance may require the
attention of a dermatologist.
Cafe-au-lait spots
, so called because of their "coffee with milk"
light-brown color, are present on the skin of some infants. These
may deepen in color (or may first appear) as the child grows older.
They're usually of no concern unless, they're large or
there are six or more spots on the body, which may indicate the
presence of certain medical conditions.
Common brown or black moles, known as
pigmented nevi
, may also be present at birth or appear or deepen in color as the
child gets older. Larger moles or those with an unusual appearance
should be brought to a doctor's attention because some may
require removal.
Rashes
Several harmless skin
rashes
and conditions may be present at birth or appear during the first
few weeks. Tiny, flat, yellow or white spots on the nose and chin,
called
milia
, are caused by the collection of secretions in skin glands and
will disappear within the first few weeks.
Miliaria
- small, raised, red bumps that often have a white or yellow
"head" - is sometimes called infant acne because of its
appearance. Although miliaria often occurs on the face and may be
present on large areas of the body, it's a harmless condition
that will go away within the first several weeks with normal skin
care.
Despite the frightening sound of its medical name,
erythema toxicum
is also a harmless newborn rash consisting of red blotches with
pale or yellowish bumps at the center, which give the rash a
hive-like appearance. This rash usually blossoms during the first
day or two after birth and disappears within a week.
Pustular melanosis
, a rash present at birth mainly in black infants, is characterized
by dark brown bumps or blisters scattered over the neck, back,
arms, legs, and palms, which disappear without treatment. Also, it
isn't unusual to see infants born with
sucking blisters
on the fingers, hands, or arms because the fetus can suck while
still in the uterus.
Newborn
jaundice
, a yellowish discoloration of the skin and white parts of the
eyes, is a common condition that normally doesn't appear until
the second or third day after birth and disappears within 1 to 2
weeks. Jaundice is caused by the accumulation of bilirubin (a waste
product produced by the normal breakdown of red blood cells) in the
blood, skin, and other tissues due to the temporary inability of
the newborn's immature liver to clear this substance from the
body effectively. Although a certain degree of this is expected, if
an infant becomes jaundiced earlier than expected or their
bilirubin level is higher than is normal, then the doctor will
follow the baby very closely.
Getting to Know Your Little One
The first days and weeks of a newborn's life are a time of
great wonder and delight for most new parents. However, being
responsible for such a seemingly fragile creature can be
intimidating, particularly if you're unfamiliar with how a
normal newborn looks and behaves. If you feel anxious or uncertain
about any aspect of caring for your infant, don't hesitate to
consult your doctor, other health care professionals, or family or
friends who have had experience caring for a newborn, too.
Reviewed by:
Steven Dowshen, MD
Date reviewed: November 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
© 1995-2009 The Nemours Foundation/KidsHealth. All rights reserved.