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.
HEAD
- 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. 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. They may also be puffy and reddened if silver nitrate eyedrops are
used. This irritation should clear in 3 days.
- 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.
- Iris color
The iris is usually blue, green, gray, or brown, or
variations of these colors. The permanent color of the iris is often
uncertain until your baby reaches 6 months of age. White babies are usually
born with blue-gray eyes. Black babies are usually born with brown-gray
eyes. Children who will have dark irises often change eye color by 2 months
of age; children who will have light-colored irises usually change by 5 or 6
months of age.
- 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. It is a common condition, and
more than 90% of blocked tear ducts open up by the time the child is 12
months old.
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.
- Earpits
About 1% of normal children have 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. It will
disappear when your child begins cup feedings. A sucking callus on the thumb
or wrist may also develop.
- 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 gumline or on
the hard palate. These are a result of blockage of normal mucous glands.
They disappear after 1 to 2 months.
- Teeth
The presence of a tooth at birth is rare. Approximately 10%
are extra teeth without a root structure. The other 90% 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.
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 because this can cause infection. Be sure to call your 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
The newborn scrotum can be filled with clear fluid. The
fluid is squeezed into the scrotum during the birth process. This painless
collection of clear fluid is called a "hydrocele." It is common in newborn
males. A hydrocele may take 6 to 12 months to clear completely. It is
harmless but can be rechecked during regular visits. 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.
- Erections
Erections occur commonly in a newborn boy, as they do at all
ages. They are usually triggered by a full bladder. 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. If you
stand your baby up, you will also notice that the legs are bowed. Both of
these curves are normal and will straighten out after your child has been
walking for 6 to 12 months.
- Feet turned up, in, or out
Feet may be turned in any direction inside the cramped
quarters of the womb. As long as your child's 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.
- Long second toe
The second toe is longer than the great toe as a result of
heredity in some ethnic groups that originated along the Mediterranean,
especially Egyptians.
- "Ingrown" toenails
Many newborns have soft nails that easily bend and curve.
However, they are not truly ingrown because they don't curve into the flesh.
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.