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Should Your Child See a Doctor?

Newborn Appearance Questions

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Definition

  • This guideline covers common questions asked about the normal newborn's appearance.

Topics Covered 

If your infant is healthy, go directly to the number of the topic that relates to your child for care advice.

  1. Breast Questions
  2. Ear and Nose Questions
  3. Eye Questions
  4. Genital Questions (Female)
  5. Genital Questions (Male)
  6. Hair Questions
  7. Head Questions
  8. Leg and Feet Questions
  9. Mouth Questions

When to Call Your Doctor for Newborn Appearance Questions

Call 911 If…

 
  • Your child is not moving or very weak
  • Unresponsive or difficult to awaken
 

Call Your Doctor Now (night or day) If

  • Age under 1 month old and looks or acts abnormal in any way
  • Fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen)
  • Swollen breast is red or tender to touch
  • Circumcision bleeding more than a few drops
  • Circumcision site looks infected
  • Soft spot on top of head (anterior fontanel) looks swollen
  • You think your child needs to be seen
     
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • Swelling on head from the birth process looks abnormal or too large
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
 

Parent Care at Home If

  • Questions about your newborn's appearance and you don't think your child needs to be seen
     
 

Home Care Advice for Newborn Appearance; Topics 1-9

 

  1. Breast Questions: Swollen Breasts
    • Swollen breasts are present during the first week of life in many girl and boy babies. They are caused by the passage of the mother's estrogen across the placenta. Swollen breasts generally last for 2 to 4 weeks, but some puffiness can persist in breast-fed babies.
    • Never squeeze the breast or nipple because this can cause an injury that becomes infected.
    • Call your doctorif: the swollen breast develops any redness, streaking, or tenderness.
       
     
  2. Ear and Nose Questions:
    • Ear 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.
    • Flattened Nose: 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.
       
     
  3. Eye Questions:
    • Bleeding in Eye: A flame-shaped hemorrhage (red streak) on the white of the eye is not uncommon. It's harmless and due to birth trauma. The blood will disappear completely in 2 to 3 weeks.
    • Swollen Eyelids: The eyes may be puffy due to pressure on the face during delivery. They may be puffy and reddened if silver nitrate eyedrops were used at birth. This irritation should clear in 3 days.
    • Tear Duct, Blocked: If your baby's eye is continuously watery, he or she may have a blocked tear duct. This means that the channel that normally carries tears from the eye to the nose is blocked. See that topic.
       
     
  4. Genital Questions (Female):
    • Vaginal Tags: The hymen can be swollen due to maternal estrogen and have smooth ½ inch projections of pink tissue. These normal vaginal (hymenal) tags occur in 10 percent of newborn girls and slowly shrink over 2 to 4 weeks.
    • Vaginal Discharge: As the maternal estrogen declines in the baby's blood, a clear or white discharge can flow from the vagina at any time between 3 and 10 days of life. Occasionally the discharge will become pink or blood-tinged (false menstruation). This normal discharge should not last more than 3 or 4 days.
       
     
  5. Genital Questions (Male):
    • Swollen Scrotum (Hydrocele): The newborn scrotum can be filled with clear fluid. This fluid is squeezed into the scrotum during the birth process. It is reabsorbed over 6 to 12 months.
    • No Testicle (Undescended): The testicle is not in the scrotum in about 4 percent of full-term newborns. Many of these testicles gradually descend into the normal position during the following months. By 1 year of age only 0.7 percent of all testicles are undescended. These need to be brought down surgically.
    • Tight Foreskin: Most uncircumcised babies have a tight foreskin that doesn't allow one to see the head of the penis. This is normal in infants and should not be retracted.
    • Circumcision: A circumcision is the removal of most of the male foreskin. The incision is initially red and tender for 2 or 3 days. The scab at the incision line comes off in 7 to 10 days. If a Plastibell ring was used, it should fall off by 14 days (10 days on the average). Gently cleanse the area with water 3 times a day and whenever it becomes soiled. Soap is usually unnecessary. Petroleum jelly or an antibiotic ointment can be applied to the incision line after cleansings to keep it soft during healing. Call your doctorif: it bleeds more than a few drops or it starts to look infected.
       
     
  6. Hair Questions:
    • Scalp Hair: Most hair at birth is dark-colored. 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 begin to 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.
       
     
  7. HeadQuestions:
    • Caput is a 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. It's normal, harmless and painless.
    • Cephalohematoma is a collection of blood on the outer surface of the skull. It is due to friction between the skull and the pelvic bones during the birth process. The lump is usually confined to one side of the head and does not cross the midline. It first appears on the second day of life and may increase in size for up to 5 days. It doesn't resolve completely until 2 or 3 months of age. Call your doctor if: the swelling becomes large.
    • Molding: Molding 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 (soft spot). The head returns to a normal shape in a few days.
    • Soft Spot (Anterior Fontanel): The front "soft spot" 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 soft spot will normally pulsate with each beat of the heart. It usually closes over with bone between 12 and 18 months of age. (Normal range is 5 to 24 months of age.) The back "soft spot" is smaller, triangular-shaped and closes between 2 and 3 months.
       
     
  8. Leg and Feet Questions:
    • Bowed Legs: The lower legs (tibia) normally curve in because of the cross-legged posture that the baby was confined to while scrunched up in the womb. If you stand the baby up, you will also notice that the upper legs are bowed. Both of these curves are normal and will straighten out after the child has been walking for 6 to 12 months.
    • Feet Turned In, Out or Up: Feet can turn any which way because of the cramped quarters inside the womb. As long as the feet are flexible and can be easily moved to a normal position, they are normal. The direction of the feet will become more normal between 6 and 12 months of age.
    • "Ingrown" Toenails: Many newborns have soft nails that easily bend and curve. However, they are not truly ingrown because they don't cut into the flesh.
       
     
  9. Mouth Questions:
    • 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. Tongue-tie rarely causes any symptoms.
    • Epithelial Pearls: Little white-colored cysts can occur along the gumline or on the hard palate. These are due to blockage of normal mucous glands from friction associated with sucking. They disappear by 1 to 2 months of age.
    • Teeth:
      • The presence of a tooth at birth is a rare event.
      • Approximately 10 percent of them are extra teeth without a root structure.
      • The other 90 percent are prematurely erupted normal teeth. The distinction can be made with an X-ray.
      • The extra teeth should be removed, usually by a dentist.
      • The normal teeth need to be removed only if they become loose (with a danger of choking) or if they cause sores on your baby's tongue.
       

     
  10. For Newborns, Always Us Doctor If:
    • Your baby starts to look or act abnormal in any way
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Chamnanvanakij S, Rollins N, Perlman JM. Subdural hematoma in term infants. Pediatr Neurol. 2002;26:301.
  2. Davis DJ. Neonatal subgaleal hemorrhage: diagnosis and management. CMAJ. 2001; 164:1452.
  3. Honig PJ, Spitzer A, Bernstein R, et al. Congenital ingrown toenails. Clin Pediatr. 1982;21(7):424-426.
  4. Hsu TY, Hung FC, Lu YJ, et al. Neonatal clavicular fracture: clinical analysis of incidence, predisposing factors, diagnosis, and outcome. Am J Perinatol. 2002;19:17.
  5. Komotar RJ, Zacharia BE, Ellis JA, et al. Pitfalls for the pediatrician: Positional holding or craniosynostosis? Pediatr Ann. 2006;25(5):365-374.
  6. Leung AK. Natal teeth. J Natl Med Assoc. 2006;98:226-228.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 12/16/2009 10:45:36 AM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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