Let’s take a look at your baby, from head to toe. This will answer a lot of your questions about what is normal and how to care for your baby.
Skin
Your baby has been developing and living in liquid for 9 months, so some skin changes are natural as your baby adapts to its new environment. At birth the skin is covered in sticky vernix. Much of this is dried off when the baby is born or at its first bath in the nursery. It will stick around in the baby’s skin folds for a while, however. You do not need to try too hard to remove it. The skin will dry, crack, and peel in some places. This is perfectly normal. Lotion is generally not necessary; some Vaseline or Neosporin can be used if cracks are particularly deep as sometimes happens at the ankle. A variety of rashes and birthmarks are also normal in newborns and are discussed in a later section. Remember to touch and stroke your baby’s skin. You can give your baby a sponge bath with warm water, washcloth, and a small amount of baby soap if you wish. Baths cannot be given until the cord falls off. You may notice that the baby’s skin appears mottled at times, especially if the baby is cold. This is a normal response in the first few months of life.
Head
During labor the baby’s head is squeezed in the birth canal. Even if the mother had a c-section, if mom was in labor at all the baby’s head was squeezed. Babies were designed for this! The bones in baby’s skulls are designed to move; you may notice that some bones overlap each other causing a ridge; this is called molding and is normal. There may be some bruising and swelling; your baby may even have a cone-shaped head! All of these conditions will resolve within the next few weeks. You will notice a large soft spot (fontanel) where there are no bones on top of the head near the front (and you may notice a smaller one in the back). You may even see it pulsate! The soft spot is not particularly tender or fragile and can be cared for as the rest of the head/scalp. You also might notice that the head is large compared to rest of body.
Eyes
Sometimes a baby wants to open one eye more than the other; this usually resolves in several days. She may cross her eyes at times and this is normal during the first few months of life. Your baby’s eyes may be a little red and irritated or swollen due to the ointment or drops that were put in them. This will resolve in a day or two. Some babies also have tear ducts that are not completely open and may have some clear to white discharge or crusting in the corners. You can clean the baby’s eyes with a warm washcloth. If the baby’s eyes become bright red, the lids swollen, and/or there is a lot of thick discharge, you should take the baby to see its doctor. Sometimes there are broken blood vessels in the eye from the delivery process (subconjunctival hemorrhage); this will resolve in 1-2 weeks.
Ears
You can clean the outside of the baby’s ears with a cotton swab; do not insert it into the canals. There may be some sticky vernix that hangs around for a while in the skin folds. This will eventually dry up and can be cleaned off with warm water. The cartilage of the ear is very soft (some ears will even fold up on themselves); this will harden in the next few months and the ear will take on a more normal contour.
Nose
A baby’s nose is small and makes a lot of noise sometimes as the baby breathes and as mucous dries in the very small passages. Some babies develop some mucous congestion just as a consequence of temperature changes or adaptation to living in air rather than liquid. Some babies sound stuffier than others. You can gently suction the mucous out with a bulb syringe. The baby may sneeze it out as well. Removing the mucous is really only necessary if it is interfering with sucking while feeding (or if the noise is really bothering you)! Cigarette smoke in the air or on clothes irritates the baby’s nose and makes the mucous swell and make more mucous to protect itself and can make the baby stuffy and congested.
Mouth
You may notice small white bumps on the roof of the mouth; these are called Epstein’s pearls and are normal. They will go away in several months. You may also notice that you can see white bone beneath the gums. The tongue often has a white coating; this is usually normal, though it is sometimes thought to be thrush by parents. Thrush will be thick white plaques that are also on the cheeks and inside the lips. The lips should never be blue; if they are, seek medical attention right away. You will notice that the lips tremble or quiver; this too is normal. Babies will sometimes give themselves a blister by sucking on their lip; these are not a concern.
Neck
The neck muscles are not very developed at birth, and the baby’s head needs to always be supported. The baby’s neck is relatively short at this point; therefore there are lots of skin folds, and it can be challenging at times to clean all the milk, spit-up, and other things from between those folds. You may also see a pink birthmark on the back of the neck.
Chest
You may notice the bottom tip of the breastbone sticking up, rather than down as it does in adults. This is normal. Babies may develop some breast swelling, especially if they are breast fed. The baby gets hormones from the mother in the uterus and through breast feeding that can cause slight breast development. It may not be the same on both sides. You may even see a little milk coming from the breast; this is normal as well.
Abdomen
Babies do not have much muscle tone, so their bellies will appear rather round and protuberant. You may notice a ridge poking out in the middle, running up and down their bellies. This is normal and will eventually go away. The umbilical cord remnant will fall off within several weeks; sometimes it leaves behind some wet appearing pink tissue that does not dry up; this is called a granuloma and can be treated in our office with a chemical to help it dry up and heal. If you ever see pus or a lot of fluid like urine coming out, or any redness of the skin around the belly button, the baby should be seen right away. The belly button pokes out somewhat in most babies and this will resolve by itself. Sometimes it can poke out quite a bit, even several inches; this is an umbilical hernia which usually resolves by age 3 or 4 years of age and is benign.
Genitals
The genitals of both boys and girls may appear large, swollen and bruised from the birth process. This will resolve over the first few weeks. Girls may have some vaginal discharge and may even have some vaginal bleeding (a “mini-period”) due to mom’s hormones. Often in newborn girls the labia minora (inner lips) protrude further than the labia majora (outer lips); this will resolve during the first month of life. You may also notice some dried vernix inside the labia; this is normal. You may wipe here, but don’t try to scrub the vernix away. This will irritate your girl’s skin. It will eventually dry up and flake off as you wipe it with diaper changes.
Boys may have extra fluid in the scrotum, making it appear large and it may be difficult to see the outline of the testicles inside. This fluid is normal and will be absorbed during over the next few months. In some boys one or both testicles may rise to the very top of the scrotum and “disappear.” Later, it may descend back into the scrotum again. This is usually normal, as long as both testicles are fully out of the body.
Hands and Feet
You may notice the baby’s hands and feet are blue sometimes, especially when the baby is a little cold. This is called acrocyanosis and is normal; it is due to the baby’s immature nervous system which controls blood vessels. This can come and go for the first few months of life. If the baby’s lips, face, or body are ever blue this is NOT normal and you should call your doctor immediately. The toenails and fingernails grow rapidly and have to be trimmed frequently; if your baby is born after her due date, they may already be long when she is born! Babies have tight fists, which will resolve in the next month or so. You may notice their hands quivering or shaking at times; this is due to their immature nervous system and poor control of their muscles.
Often, a baby’s feet may be turned or twisted inward. This is usually due to positioning while in the uterus. As long as your baby’s foot can be gently turned back to a normal position, then this is normal. Your baby may hold his feet this way for many months, until the muscles in the legs and feet grow stronger.
Breathing pattern
You can notice your baby’s breathing pattern from watching his chest. Babies may have pauses of several seconds in their breathing, and then breathe rapidly to catch up. They may breathe fast or slow and sometimes they sigh. In general, their breathing pattern can be quite irregular. If the chest is caving in with breaths and/or the baby seems to be having trouble breathing, then he should be seen right away. If the baby pauses in his breathing for more than 10 seconds at a time, then this is not normal and the baby should be seen.
Other things babies do
All babies do the following things which are perfectly normal: sneeze, hiccup, burp, pass smelly gas, spit up, sound like they need to clear their throats, cry, grunt and make other various strange noises and do so even more when having bowel movements.
