1. Soft spot
2. Ridges on the head
3 Bump on the side of the head
4. Scaly crusts on the scalp (cradle cap)
5. Pimples on the face, forehead, neck, and
shoulders (infant acne)
6. Spitting up food or blood
7. Breast lump with or without discharge
9. Irregular breathing
10. Protruding breastbone
11. Jitters and twitches
12. Blue hands and feet
13. Yellow discharge or swelling of the
14. Marbled skin
15. Yellow skin and eyes (jaundice)
16. Pink patches on the eyelids, forehead,
17. Steamy-looking eye; mucus or eyelashes
in the eye
18. Stuffy nose, noisy breathing
19. Blue spots on the trunk and buttocks
20. Tiny pit at the base of the spine
21. Raised, red spots on the skin
22. Green stool
23. Soft or watery stool
24. Vaginal blood or mucus
25. Straining at stool
26. Straining during urination
27. Pink-colored urine
28. Clear beads or granules on the diaper
29. Bowed legs and curved feet
30. Oozing belly button
31. Ingrown toenails
34. Jaundice Check
Most insurance companies require you to add your newborn within a 30 day period.
Please contact your insurance company to find out how to do this.
Newborn babies up to two months are
different from older infants. First of all, they do peculiar things.
They snort, twitch, develop spots that come and go, spit up milk and
sometimes even blood, and generally find ways to make parents,
particularly first-time parents, crazy.
They are also medically different from older babies. A six-month-old with a fever is most likely not seriously ill; a newborn with a fever must be treated as though there is a serious problem until proven otherwise.
Therefore, although the rest of this book is organized according to the area of your child's body that you might be concerned about, this chapter deals exclusively with all parts of the newborn. To find information about a specific issue, refer to the illustration.
The skull of an
infant is not a solid mass of hardened bone like that of an adult.
Instead, it is made up of several individual bones loosely joined
together. Where four of these bones meet on top of the head, a
diamond-shaped space is left open. It may be as small as a fingertip
or up to an inch or more across.
During the first eighteen months to two years, this soft spot gradually disappears. You may also find a small triangular soft spot in the back of the head, but that is usually gone by birth or disappears shortly afterward. Some babies have no discernible soft spot at birth or it disappears abnormally early. As long as your pediatrician is pleased with how fast your baby's head is growing, there is no need to worry.
Even though there is no bone over the soft spot, tough membranes and fluid-filled space under the scalp protect the brain. You will not harm your baby by pressing down when shampooing or brushing hair. Don't be afraid of it. When your baby is crying, the soft spot may protrude, but it should become flat or slightly sunken after the baby calms down. Also, when your baby is quiet, you may see regular pulsations. These are normal and are a reflection of your baby's heartbeat.
Persistent bulging of the soft spot, on the other hand, may signal a problem with excess pressure in your baby's brain.
On the way through the birth canal during labor, your baby's head takes quite a beating. Because the bones of the skull are loosely connected, the pressure of labor can cause one or more of these bones to overlap another, creating a ridge that you can feel easily. If your baby has little or no hair, you may even see it. Usually the bones even out within a few weeks.
Another result of the banging around your baby's head endures
during birth is a soft bump on one or both sides of the head. It may
be small or up to several inches across and feels squishy when you
This cephalohematoma is really just a large bruise made of fluid and blood which collects between the scalp and the skull. It may take weeks, months, or—in rare cases—years to completely disappear. As time goes by, you may feel a firm ring or ridge around the edge, which gradually closes in.
If the bump is extremely large, especially if your baby had a difficult birth, your pediatrician may order a skull x-ray to see if there is a fracture underneath. Even if there is, most of the time nothing is done about it except to make sure your child's head grows normally over the first few months.
Some newborns develop greasy-looking, white or brownish scales
that stick tightly to the scalp. These scales are not itchy or
painful, and mainly just look bad. The same scaly rash may break out
on the eyebrows, forehead, and behind the ears.
Your pediatrician can give you specific instructions for reducing the severity of the scaling but it will usually go away on its own by six months even if you do nothing. If cradle cap is severe and does not improve with simple measures, or is not better by six months, it could be due to a rare condition called Histiocytosis X. This is diagnosed by a skin biopsy.
Around one month red bumps with a small amount of yellow or white material appear on the face and may spread to the rest of the head, the neck, or the shoulders. Although this outbreak often looks worse when the baby has been warm, such as after a nap or a bout of crying, it is not strictly speaking a heat rash. It is called "infant acne" because it resembles the pimples of adolescent acne. As far as I know, nobody has studied whether babies who have acne as newborns are more likely to have it as teenagers. I do know, however, that it always seems to be at its worst just when relatives come over to see the new baby or right at the time you plan to have a picture taken. There is no treatment for infant acne except time. It will go away in a month or two and will leave no scars.
A little spitting up is normal. Formula-fed babies spit up
material that looks like cottage cheese, while breastfed babies
spit up a thin, milky liquid. One of the many arguments in favor of
breastfeeding, by the way, is that spit-up breast milk smells better
and stains less than spit-up formula.
It is also not uncommon for babies to spit up occasionally through the nose as well as the mouth.
You may understandably be worried if your baby spits up some bright red or brown blood along with the milk, but if you are breastfeeding there may be no cause for alarm. Check your nipples for cracks. Most of the time, an otherwise healthy breastfeeding infant who spits up a little blood has swallowed it from mother's bleeding nipple. Blood irritates the stomach and is usually vomited. If you don't see or feel a crack, express a little milk to see if it is blood-tinged.
If you find blood on your nipple or in your breast milk, give your baby plain water or sugar water for one feeding to clear the rest of the blood from the stomach. Then avoid using the cracked nipple for a few feedings to give it a chance to heal. A nipple shield—which you can get at most pharmacies or from your local La Leche League—avoids irritation to a healing nipple while still allowing the baby to feed from that breast.
Swallowed blood may pass through the intestinal tract of a newborn with little change, so you might see some blood mixed with stool as well.
If you see no evidence of blood from your nipple, if your baby is formula-fed, or if there is more than just a little bit of blood, your baby should be examined promptly.
Female hormones which stimulate a mother's breasts to enlarge and
produce milk are transferred from mother to baby during pregnancy,
so many babies—male as well as female—are born with lumps of
enlarged breast tissue underneath their nipples. In some babies this
is no more than a little nubbin on one side that can be felt but not
seen, while other babies may have large lumpy breasts on one or both
Breast lumps do not occur in premature babies; in fact, they are one of the signs your pediatrician looks for on the first examination after birth to make sure your baby was born at full term.
Large swollen breasts may release a drop or two of whitish, watery liquid when gently squeezed. The larger the breast lump, the more likely there is to be some discharge. About one in twenty term babies has this milky fluid.
In the seventeenth century it was thought that if this "witch's milk" was not squeezed from the breasts regularly, it would be stolen by witches and goblins and used in casting spells. Not only is this obviously not true, but you can cause problems by repeatedly and vigorously irritating this delicate tissue.
Most babies hiccup now and again, perhaps because swallowed air in the stomach pushes up on the diaphragm. You do not need to do anything about it, and hiccups will stop on their own.
Except for times when your baby is in deepest sleep, breathing is rarely regular and even. When your baby is excited and active, rapid, shallow breaths with occasional loud inhalations are normal. At rest, you may note periods of rapid breathing alternating irregularly with deeper, slower breaths.
The chest cavities of newborns are much smaller than their
abdominal cavities. In fact, you can't help but notice how that
sweet little belly sticks out farther than the chest, especially
after eating. The tip of the breastbone, called the xiphoid
process, is a small triangle of bone that is not tightly anchored to
the rib cage. It often sticks out just where the chest meets the
This bone eventually flattens out as your baby becomes a toddler.
Newborns make all sorts of seemingly random movements, some of
which are trembly or jittery. Smaller newborns and premature babies
have more of these movements than larger, more mature babies. In the
newborn nursery, your pediatrician may check your baby for low
blood sugar, low calcium, or some other medical problems. Most of
the time, however, this is merely due to an immaturity of the
During the first weeks, your baby should startle at a sudden movement or a loud noise. When infants are startled, they open their eyes widely, raise their hands, and bring them somewhat jerkily together over their head. This normal response, called the Moro Reflex, disappears after the first month.
Immediately after birth virtually every full-term newborn
develops blue hands and feet because the outside world is so much
colder than the comfy, body temperature amniotic fluid inside the
womb. One of the reasons your baby might have been placed under an
overhead warmer in the delivery room when not in your arms was to
minimize the stress of this drop in temperature.
It can take as long as several hours for the initial blueness to disappear, and you may notice that it reappears from time to time when your baby is being changed or bathed.
Also, in the first few weeks, you may notice that your baby's legs turn a deep blue when the baby is held upright. This should clear up once the baby is laid down again.
After surgical removal of the foreskin, known as circumcision, a
freshly circumcised penis is immediately wrapped in a diaper into
which the baby urinates and defecates—hardly the best environment
for healing. Therefore, the penis can look pretty strange even when
If the circumcision was done with a clear plastic ring held on with a string, you may see blackened tissue around the outside edge of the string and a slight swelling at the inside edge. The ring should fall off within ten days.
If no plastic ring was used, the end of the penis will probably be red for a few days with a small amount of yellowish material adhering firmly to it. If there is no swelling and the baby is comfortable and urinating well, just wait for this to clear up on its own. Sometimes leaving the diaper off for a few hours every day—taking appropriate precautions for squirts, of course—may speed healing.
When older children and adults are cold, they conserve their body
heat by shivering and developing goose bumps, but newborns cannot do
this. The only way they can preserve heat is to pull back the blood
vessels near the surface of the skin. When they do that, their hands
and feet turn blue, and the skin on the arms, legs, and trunk
appears mottled or marbled.
This usually goes away once the baby is warm.
Approximately 10 percent of all healthy term newborns and an even
higher proportion of premature babies develop jaundice, a yellow
discoloration of the skin and the whites of the eyes. In older
infants or children, jaundice is always a sign that there is
something wrong— hepatitis, for example. In newborns, however, it is
not usually a sign of serious disease.
Jaundice might result because the baby was born with too many red blood cells, or develops mild dehydration because of too little fluid intake in the first few days of life when mother's breast milk is not yet flowing in sufficient quantity. Possible medical causes of jaundice, which are much less common, are blood group incompatibility between mother and baby, infection, and liver abnormalities.
Your pediatrician will decide what is the likeliest cause based on a combination of blood tests, birth history, and physical examination.
The yellow pigment that causes jaundice is called bilirubin. If bilirubin in the blood rises to a very high level, there is a slight chance of brain damage. Therefore, pediatricians do not allow the level to become high enough to endanger the baby. Before it reaches the danger stage, newborns are placed under a special light that breaks down bilirubin through the skin into a harmless by-product that is excreted through the kidneys.
Breastfed babies may remain slightly jaundiced for as long as six weeks. The cause for this is obscure— perhaps there is some naturally occurring substance in mother's milk. At any rate, it is normal and not a reason to stop nursing. Sometimes a drop in jaundice after 8-12 hours off the breast is enough to prove the cause, and breastfeeding can be resumed.
Known as "angel kisses" or "stork bites," these flat, red, or
salmon pink patches turn pale when you press on them and may turn
more deeply red when your baby cries. They are more common in white
babies, although they can be seen in Asians and blacks as well. They
start to fade at about six months and are usually gone from the face
by one year, a little later for ones on the back of the neck.
In a few light-complexioned people these areas may remain visible into adulthood, especially when they become angry or upset.
If I had a little bit of mucus, blanket fuzz, or an eyelash
swimming around on the surface of my eye, it would drive me crazy,
but those things do not seem to affect infants. There is no need to
do anything about a little fuzz or a hair if your baby is
comfortable—the natural flow of tears and blinking will clear the
On the other hand, if you see haziness or a steamy film over the colored part of the eye, especially if one eye appears large compared to the other, your baby may have congenital glaucoma—increased pressure in the eye.
If left untreated, congenital glaucoma can lead to blindness. The sooner your pediatrician diagnoses this possibility and refers you to an opthalmologist, the more likely it is that normal vision will be preserved. The cloudiness may come and go, so see your pediatrician even if you are not sure.
Cloudiness or discoloration of the pupil, the dark spot in the center of the eye, can be caused by a congenital cataract or tumor. These also must be treated as soon as possible.
If mucus collects on the inner corner of one or both of your baby's eyes without any swelling or redness, a tear duct may be blocked. Often there is an overflow of tears, but not always. This common condition almost always clears up before age one, but sometimes the duct must be opened by an opthalmologist.
At first, newborns can breathe only through their nose, not
through their mouth. Not until after the first month or two do they
learn to alternate breathing between nose and mouth. This is handy
because while they learn to eat there is less danger of choking.
Since babies must breathe through their nose and cannot sniffle or blow, any mucus or swelling of the lining of the nose causes snorting, sneezing, gurgling, and other musical sounds. New parents often think that this means their newborn has a cold, but usually that is incorrect.
If your baby is sleeping and eating well and has no cough or fever, there is no need to worry. If the stuffy nose is accompanied by irritability, fever, poor feeding, or any other signs of illness, on the other hand—especially if someone in your household has a cold—you may need to see your pediatrician.
Dark-skinned babies such as black, American or East Indian,
Mediterranean, Asian, or Central American children often have large,
flat blue spots on the trunk and buttocks. Known as "Mongolian
spots," they usually disappear in a few years, although they can
sometimes persist into adulthood.
Mongolian spots look an awful lot like bruises, and people who are not familiar with these birthmarks might mistake them for signs of child abuse. Most doctors are familiar with them, however.
While your baby is still a microscopic embryo, the spinal cord and vertebrae start forming from the middle of the back outward toward the head and buttocks. Sometimes a small pit remains at the bottom of the backbone. This is usually of no concern. If, however, there is any drainage, if there is hair growing out of it, a lump near or under it, or if the crease between the buttocks is crooked below it, be sure to bring it to your pediatrician's attention. There may be an underlying malformation of the end of the spinal cord which should be investigated and corrected as soon as possible.
Many of the spots we call "birthmarks" are not really present at
birth. Bright red spots with an irregular or bumpy surface, called
"strawberry marks," can appear anywhere on your baby's body in the
first weeks after birth and can vary in size from a pinhead to
Almost all of these eventually disappear. Even if a strawberry mark is disfiguring, most pediatricians, dermatologists and plastic surgeons will urge you to wait until age four or so to see if it goes away by itself. If treatment is necessary, such as when a large strawberry mark on an eyelid interferes with vision because it overlaps the eyelid, laser therapy is the current choice.
A newborn's stool is normally sticky and black the first day or
two of life. After that it turns yellow if the baby is breastfed,
brown if formula-fed. Once in a while you may see a bright green
Green stools probably happen because the liver produces a little bit more bile, or sometimes a particular brand of formula is responsible. Babies with intestinal infections may have green stools, but there usually are other signs of illness such as diarrhea, fever, etc.
Whatever the reason, there is no need to make any dietary changes if your baby is otherwise well; it is a common occurrence.
Breastfed babies may have one stool every few days or a small
stool with every feeding. No matter how many stools are normal for
your baby, they usually are a little loose and watery, sometimes
squirting out. This does not mean the baby has diarrhea.
Formula-fed babies develop firmer stools after the first week or so, but breastfed babies should always have loose ones.
The vaginas of newborn girls normally produce clear or milky
white mucus on and off during the first weeks. You need only wipe it
away with a moist cotton ball. Do not scrub the delicate vaginal
This discharge is the result of hormones in the baby's bloodstream which came from mother—the same hormones that cause breast swelling (see Number 7, page 27). When the level of these hormones in the bloodstream decreases a few days after birth, "withdrawal bleeding," a condition similar to a period, may occur. A little bright red blood appears on the diaper mixed with mucus.
If there is only a little blood and it stops right away, there is no need to do anything. If bleeding continues, however, there may be a problem with blood clotting, a polyp, or some other abnormality in the genital tract.
At first, the only way you know when your baby has had a bowel
movement is when you find it in the diaper. Newborns pass their
first stools with a minimum of fanfare. As the weeks wear on they
begin to participate more and more, grunting, straining, and turning
red before the stool comes out.
If your baby is grunting and straining but the stool that comes out is soft, there is no need to do anything but wait for practice to make it easier for your baby to pass a stool. Straining is not necessarily a sign of constipation.
Constipation means the difficult passage of infrequent, hard stools. Breastfed babies should never be constipated; although they may have only one stool a week, it should be soft. Formula-fed babies may develop constipation from certain formulas.
Make sure your baby is straining to produce stool and not urine; straining with stool is normal, straining with urination is not.
While straining at stool may be normal, straining with urination
is not. Malformed structures in and around the bladder can make
passing urine difficult. Sometimes the urinary stream in boys will
also be weak or dribbling rather than the usual little fountain, but
If you notice your baby straining with urination, bring it to your pediatrician's attention at once. Early detection and correction of an obstruction to urine flow can preserve kidney function.
During the first week or two, some babies excrete a chemical in their urine which stains diapers a soft pink. This is not the same color as blood, but is is reasonable for you to think it might be at first. Usually this only happens once or twice and never appears again.
A few years ago this caused considerable consternation until we
all figured out what it was. In some of the superabsorbent
disposable diapers, a gel that absorbs urine may leak onto the
surface of the diaper and deposit tiny clear or whitish granules
which look as though they have come from the baby's urine.
This material is not harmful and you need do nothing about it.
My father used to love to tell a story about my uncle seeing me
for the first time shortly after I was born. A look of horror spread
over his face and he said, "Her legs are crooked!"
Infants have to fold up substantially in order to fit into a uterus, so their legs are usually crossed over each other and over the baby's belly. In the process, an inward bend to the legs and feet results.
This bend to the legs almost always straightens out in the first few weeks, although a slight bowing to the legs can be normal even through toddlerhood.
Sometimes the feet were so tightly folded in the uterus that there is a crease across the instep and the front part of the foot curves so far inward that gentle pressure cannot straighten the foot. In that case, special shoes or even a small cast for a few weeks may be necessary.
As the tissue of the umbilical stump starts to decay, it usually dries up and falls off neatly. Sometimes, however, it stays soft, oozes, and smells terrible. Before seeing your doctor, try getting some peroxide or alcohol way down under the stump by moving it a little to the side or picking it up gently. Also, leave the belly button open to the air for a few hours each day. If that doesn't work, your pediatrician can cauterize it with a little silver nitrate and it will dry up in a jiffy.
There is a minor design flaw in even the most perfect baby. For
some reason, their soft toenails can grow crookedly and the edge of
the nail can irritate the surrounding skin.
If you notice the corner of the nail on the big toe start to turn red or collect a little yellow material, put some antibiotic ointment on a Band-Aid and keep the toe covered for a few days in socks or pajamas with feet. Usually that is enough to relieve the irritation and allow the nail to grow out.
Newborns have a limited ability to fight infections so what might
be a minor illness in an older child can be a dangerous one in a
newborn. For that reason, any fever over 100.5°F in a newborn should
be treated as though there is a serious infection until proven
otherwise. If treatment is delayed until a newborn acts really sick,
precious time will have been lost.
(Note: A sick newborn may also have an abnormally low temperature.)
If there is a cold running through your family and your pediatrician feels strongly that your baby has the family virus, you may be told to go home but to keep in close contact every few hours. In many cases, however, a newborn with a fever will at least have some blood tests, a urinalysis, perhaps a chest x-ray, and even a spinal tap. Your pediatrician may even want to hospitalize your baby for a day or two for precautionary treatment until cultures are completed and your baby is all right.
Spitting up is normal, vomiting is not. The distinction between
the two is not always so obvious, however. Sometimes it is hard to
tell one from the other. The major difference is force and quantity.
Vomiting means forceful ejection of most or all of the stomach
contents; spitting up is gentler and smaller in quantity.
It does not make any difference whether what is spit up is curdled or not. Milk curdles when it reacts with acid in the stomach. If milk hasn't stayed long enough in the stomach, it won't be curdled yet; if it was there for a while, it will be.
Forceful, "projectile" vomiting, when stomach contents are shot several feet from the baby, can be perfectly normal if it happens only from time to time. Persistent projectile vomiting, however, especially at about four weeks of age, might be due to an overgrowth of the muscle at the end of the stomach, called pyloric stenosis. It is more common in males than females and often runs in families. Characteristically, the baby will be hungry right after vomiting and want to feed again right away.
Vomiting beginning in the first days or weeks of life can signal serious problems such as an obstruction in the gastrointestinal tract or an infection. Babies who are fed formula, however, may vomit merely because of difficulty digesting a particular formula. There usually are other symptoms of formula intolerance such as abdominal pain, excessive gas, or diarrhea, but sometimes vomiting is the only sign.
Excerpted from When Do I Call the Doctor? By Loraine Stern, MD Doubleday 1992