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Part 1: Pregnancy, Childbirth and the Newborn  >  Normal Variations in a Newborn



The doctor will first look at baby’s skin. Her hands and feet may appear blue. This blue colour should not cause anxiety as it disappears without any treatment within a few hours. If the doctor finds that the rest of the body is pink and that her breathing is normal, he will reassure you that the baby is normal. 

Some babies have a dark skin that may become darker in the successive weeks. The nipples and genitals may show a deeper pigmentation. 

Some babies have Mongolian spots. These are patches of greyish blue colour over the lower back. Sometimes, they are also seen on the limbs or inside the cheeks. While they may last for 2 to 3 years, they disappear spontaneously without affecting the child.

Some may have permanent patches of pigmentation called cafe au lait spots. In about a quarter of such children, a single spot less than 3 cm. (about an inch) in size is seen. Such spots would attract the attention of your doctor, as they may indicate certain other conditions.

Another interesting condition is the Harlequin colour change. For a few minutes, one half of the baby’s body seems pink and the other half white. This condition is normal and may last for even a month or a month and a half. 

White or yellowish pin-head sized spots called milia may be noticed on the nose or other parts of your baby’s face. They disappear within a few days. At times, you may also notice a transient red rash on the body.

Stork bites, seen as red patches on the forehead, eyelids and the back of the neck, are quite common. They may last for a year or so.

A few days or weeks after birth, you may observe what is commonly termed strawberry naevus. It begins as a tiny red spot that grows rapidly for about 6 months. When fully developed, it becomes raised from the skin and looks like a strawberry. As far as possible, this should be left alone. About 60% of these disappear by the age of 5 years and most by the age of 10 years. In very rare cases, a doctor may consider removal or treat them with some medicines.

Some babies develop a harmless condition termed cutis marmorata. This happens if the temperature of the environment suddenly falls. Temporary lacy, reddish or bluish patterns appear on the skin. The baby is otherwise normal. An arm exposed to cold may also become swollen and, at times, turn blue. This swelling subsides on its own within a few hours.

A baby’s skin may normally peel in the first few days after birth. As the skin at this stage is very delicate, avoid unnecessary friction or pressure, to prevent blisters and infection.

Vernix is a waxy material that covers the baby’s skin at birth. It protects the skin from getting infected. No deliberate attempt should be made to remove it. Some of it gets left behind on the linen in which the baby is wrapped after birth. The rest is gradually shed after a few baths.

Fine, silky hair covers the baby’s skin. This is especially pronounced in a ’s skin. In the first few weeks, babies normally lose hair, especially on the back of the head, but this loss is temporary.

Sometimes, a baby’s head may look bigger or smaller than average. Consider whether you or your husband have largersized heads. Also, larger babies have bigger heads as compared to smaller babies. A ’s head is bigger in proportion to her body. Your doctor or paediatrician will maintain a serial measurement of your baby’s head size as she grows, to ensure that everything is normal. At times, a newborn’s head looks elongated, because it gets moulded during the passage from the uterus to the outside world. The head regains its usual roundness within a few days after delivery. The odd head shape may also be acquired from the parents.

A baby who lies habitually on one side may also have a head temporarily flattened on that side. This is normal. Sometimes, a soft diffused swelling called caput succedaneum is seen on the head soon after birth. This is due to the collection of a little fluid in the scalp that gets absorbed on its own within a day or two. A swelling that may last longer is cephalhaematoma, which is caused by the collection of blood between the periosteum (the thin but firm layer of tissue covering bones) and the skull bone. It looks like a bun tied on one side of the head by some Hindu women from Kerala. At times, the swelling occurs on both sides of the head. Nothing needs to be done and the swelling subsides after a couple of weeks or months. However, the doctor will make sure that there is no associated complication.

If forceps are used at birth to assist the expulsion of the head, they may leave behind temporary marks on the face in front of the ears.

The anterior fontanelle, a soft spot on the top of the head, is normally present at birth. It widens in the first few weeks, but gradually contracts and closes after 6 months or by 2 to 3 years. The posterior fontanelle is at the back of the head and closes within 2 months or so.

The skull bone on the side of the head, when pressed, may tend to go inwards. This is called craniotabes and is usually normal.

Cradle cap, which presents itself, as black patches on the scalp, often clears with 1% cetrimide solution. It should be used as a shampoo, after which the scalp is to be dried gently with a towel. Soap and oil should be avoided for a few days. At times, stronger measures may be needed.

It is likely that your little one sweats profusely around the head when asleep. Treat this sweating as normal.

The iris is the coloured part of the eye. Its colour may change as your baby grows. The whites of the eyes may appear bluish in the first 3 months. The baby’s eyelids may be a little puffy on waking up from sleep. A slight squint, which disappears by about 6 months, is not uncommon. An eye specialist should be consulted if it is marked.

Some normal babies have the so-called ‘setting-sun sign’. In this condition, the white portion of the eye is prominently seen above the pupil. While this is one of the features of hydrocephalus — a condition in which fluid under pressure collects in the brain — the doctor will look for other important signs and symptoms before diagnosing this.

Your baby may have a visible small patch of blood in the eye called a subconjunctival haemorrhage. In the absence of bleeding anywhere else, this is considered normal and disappears spontaneously within a few days.

Watering of the eyes is commonly seen in babies who have a partial blockage of the tear duct (nasolacrimal duct). This duct connects the eye to the nose. The watering increases if the child catches a cold. The eyes may also become sticky. The duct generally opens on its own within the first year.

For sticky eyes, your doctor may advise massage at the junction of the eye and the nose, and prescribe some local eye medicine. Instead of eye drops or an ointment, you can try putting a drop of breast milk into the eye every hour or so. It seems to work in many cases.

About half of all babies develop yellowness of the eyes and of the skin on the second or third day. This jaundice, termed physiological jaundice, is usually harmless and needs no treatment. Sometimes, however, phototherapy (light therapy) may be required.

Some normal babies have a slightly sticky discharge from the nose that does not interfere with feeding and stops after 2 to 3 months.

Sneezing is normal in newborn babies and so is occasional coughing.

Your baby may be born with a tooth. It should generally be left alone. Do not worry that baby will inhale it or hurt you while breastfeeding.

In a tongue-tie, the fold of tissue connecting the underside of the tongue to the floor of the mouth is too short and this restricts the movement of the tongue. It is over-diagnosed; true tongue-tie that requires surgery is extremely rare. If the child can touch the roof of the mouth with her tongue, surgery is not required. If at all surgery is needed, it should be postponed until the child is 3 years old. The tongue grows bigger as the child grows older.

A uniform white coating on the tongue is normal. Leave it alone. No effort should be made to clean the tongue with glycerine or a piece of cloth. 

Some babies may have thick sucking blisters on the lips. These are normal and disappear after a few weeks.

Some babies normally have mucous cysts (also termed ‘epithelial pearls’) in their first weeks, near the margin of the gums or even the palate.

Some babies may have a bloodstained vomit after birth. This is possibly due to irritation of the stomach by the amniotic fluid or mother’s blood swallowed by the baby. The bleeding does not recur and the baby is otherwise normal. Some babies swallow blood from the mother’s cracked nipple. This also does not need any treatment. However, in such cases, a condition called the haemorrhagic disease of the newborn, commonly due to Vitamin K deficiency, should be excluded. Hiccup in newborns is normal.

Swollen breasts and milk-filled breasts may be seen in several 2 or 3-day-old babies. Do not attempt to remove the milk or to massage the breasts. Severe infection needing surgery has been seen when such advice was not followed. The swelling will disappear on its own.

Your doctor may hear a heart murmur over the chest. It doesn’t necessarily mean that baby has a heart disease. The murmur may disappear within a few days. If it persists, your doctor will ask for some tests. 

A newborn has a breathing rate of about 45 per minute. This can vary from child to child. Sometimes, the rate becomes fast, followed by a slower rate. If your baby is suckling and is otherwise well, such variations are usually normal.

Although 2 transverse creases across each palm are normal, do not jump to the conclusion that your baby has Down’s Syndrome or some other chromosomal disorders just because she has a single crease.

Umbilical Cord
The umbilical cord starts drying up within the first week and separates towards the end of the first week or in the second week. 

If you find blood oozing from the cord, report it to the nurse. It should be kept clean and dried properly after the bath. Nothing need be applied on it. If your doctor gives you spirit to clean the skin around the cord, use it 3 or 4 times a day.

It is important to keep the skin dry. Do not use any binder to cover the cord. Also, do not allow urine to come in contact with the cord. When the cord falls off, a drop or two of blood may be noticed around the base. This is normal. If you notice pus at the base of the cord or redness of the skin around the navel, bring it to the attention of your doctor to rule out infection of the cord. If required, the doctor may prescribe some medicine.

In a male newborn, the foreskin (prepuce) is not completely separated from the front (glans) of the penis. No effort should be made to retract the foreskin. It can be harmful. If left alone, the foreskin often separates fully before the child starts schooling.

The doctor will also check if both the testes are felt in the scrotum. If not, it should be seen whether these are undescended testes or whether they are just retracted (see Undescended Testes in THE A-Z OF CHILDHOOD ILLNESSES). On most occasions, I find that the testes are not undescended but simply retract, specially when the scrotum is examined with cold hands. These testes can be easily pushed down into the scrotum. In such cases, the parents only need reassurance and nothing else need be done.

In girl babies, the external genitalia may appear unduly prominent in the first month. In the first or second week, the baby may have a white discharge from the vagina, with or without blood. All these changes are related to certain hormones that the baby gets from the mother via the placenta.

Anal And Urinary Openings
Meconium is the first stool that the baby passes. It is dark green and sticky. Most babies pass meconium within 12 hours of birth. The doctor should be informed if the baby does not pass meconium within 24 hours. Some babies first pass a yellow or greyish-white ‘meconium plug’, followed by the typical meconium. It changes to green-brown after 2 or 3 days. Gradually, over the next few days, it changes to greenish yellow and then to the so-called normal orange-yellow loose stool of an exclusively breastfed child.

These motions are often quite frequent. The newborn baby may pass a motion after each feed or after every hour. At times, the motions are watery, may come out with force and contain mucus. At times, they may also be green. As long as the child is being given only mother’s milk and is thriving well, such frequent motions are normal. On the other hand, some babies may pass a motion every 5 to 6 days, but the motions are soft, not hard. This is also normal and there is absolutely no need to give purgatives or use a suppository.

Most babies would pass urine within 24 hours after birth. Some may do so a little later. But special note is to be taken of babies who have not passed urine within the first 36 hours. 

Straining or crying a little before passing urine is normal. The stream of urine should be checked. An interrupted stream should be brought to the notice of your doctor, who may ask for a urine examination. Similarly, so long as the stools are not hard, straining before passing a motion is also normal.

Hips, Legs And Spine
The doctor will examine your baby’s hips to rule out an uncommon condition called congenital dislocation of hip. If diagnosed, this needs immediate treatment.

Bowlegs are normal in most cases and usually disappear by the time the child turns 3 years. While handling your baby, you may note a click in your baby’s knee. Leave it alone.

Over the back of the head and spine, a congenital dermal sinus may be observed sometimes in the mid-line of the head or spine. It appears like a hole in the overlying skin going inwards, mostly near the lower end of the spine. It does not pose any problem in most cases, but a surgeon’s opinion should be sought if it remains deep after the age of 2. An early consultation is advised for sinuses situated higher up.

7 March, 2016

Part 1
Pregnancy, Childbirth and the Newborn
Planning A Baby
Making Preparations
Labour and Delivery
Management of the Newborn
Normal Variations in a Newborn
Care of the Newborn
Holistic Bonding
Guide to Child Care
1 Pregnancy, Childbirth ...
2 The Growing Years
3 Feeding Infants, ...
4 Keeping Your Child Healthy
5 Keeping Your Child Happy
About Dr. R. K. Anand

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