Your Newborn

Normal Newborn Health Sheet

Use this diagram to locate a specific area of concern.  The numbers in the diagram correspond to the numbers listed on the left for information.

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.

1.  SOFT SPOT

 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.

•  IT IS NORMAL FOR
  the soft spot to bulge intermittently and pulsate.
•  CALL YOUR PEDIATRICIAN IMMEDIATELY IF
  the soft spot bulges and your baby is irritable, has a fever, is vomiting, or has any other signs of illness.

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2.  RIDGES ON THE HEAD

 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.

•  IT IS NORMAL FOR
  a ridge or two to be seen or felt for several weeks after birth.
•  BRING IT TO YOUR PEDIATRICIAN'S ATTENTION AT THE NEXT CHECKUP IF  
  the ridge persists after the second month and your child's head appears to be growing off kilter. This could be a sign of craniosynostosis, in which one or two bones stop growing prematurely. Because the skull can become distorted, surgery before age six months minimizes the chances of deformity and prevents possible pressure on the brain.

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3.  BUMP ON THE SIDE OF THE HEAD (CEPHALOHEMATOMA)

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 touch it.
 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.

•  IT IS NORMAL
  to feel a soft bump on the side of the head for weeks after birth.
• CALL YOUR PEDIATRICIAN IF
  1. The bump was not there at birth but you notice it sometime later.
  2. It seems to hurt the baby when you touch it or there is redness or drainage in the area.
  3. You see a pimple or sore on the skin overlying the bump.

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4.  SCALY CRUSTS ON THE SCALP (CRADLE CAP)

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.

•  IT IS COMMON FOR
  Newborns to have cradle cap.
• CALL YOUR PEDIATRICIAN FOR
  Instructions on how to control it.
• SEE YOUR PEDIATRICIAN FOR
  cradle cap that is severe, extends beyond the scalp, or will not improve with simple treatment by age six months.

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5.  PIMPLES ON THE FACE, FOREHEAD, NECK, AND SHOULDERS (INFANT ACNE)

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.

•  IT IS NORMAL
  to have acne on the face and chest from one month until two or three months of age.
• CALL YOUR PEDIATRICIAN IF
  the pimples are not small and firm and are not confined to the head and shoulders. Loose, large yellow blisters or pimples elsewhere on your baby's body may mean there is a skin infection, which should be treated promptly with antibiotics.

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6. SPITTING UP FOOD OR BLOOD

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.

•  IT IS NORMAL FOR
  1. babies to spit up occasionally.
  2. breastfed babies to vomit a small amount of blood from their mother's cracked nipple.
  3. babies to spit up through their nose once in a while.
• CALL YOUR PEDIATRICIAN IF
  1. spitting up is forceful and constant.
  2.  spit-up persistently comes  through  the nose— this can be a sign of a defect in the roof of the mouth, which may not be easily visible on routine examination.
      a.  your baby spits up blood and
      b.  you do not find a source of bleeding from your nipples,
      c. your baby is formula-fed, or the amount of blood is more than a small spot.

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7.  BREAST LUMP WITH OR WITHOUT DISCHARGE

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 sides.
 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.

•  IT IS NORMAL FOR
  your full-term baby to have breast lumps and discharge for about two months after birth.
• CALL YOUR PEDIATRICIAN IF
  there is any redness around the nipple or the discharge looks like pus or blood. On rare occasions breast lumps can become infected. 

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8.  HICCUPS

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.

•  IT IS NORMAL FOR
  babies to get hiccups frequently.

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9.  IRREGULAR BREATHING

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.

•  IT IS NORMAL FOR
  your baby to breathe irregularly.
• CALL YOUR PEDIATRICIAN IF
  1. breathing is interrupted by several seconds of no breath at all, especially during sleep.
  2.  your baby's lips or face turn blue or pale during periods of slow or no breathing.
  3. you notice the chest sinking in when your baby breathes.
•  CALL YOUR PEDIATRICIAN OR GO TO AN EMERGENCY ROOM IMMEDIATELY IF
  breathing is rapid (more than forty breaths per minute) or associated with a grunting ("uh") or groaning sound. This can be a sign of serious medical problems and should be evaluated immediately.

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10.  PROTRUDING BREASTBONE

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 bulging stom­ach.
 This bone eventually flattens out as your baby be­comes a toddler.

•  IT IS NORMAL FOR
  the tip of the breastbone to protrude.
• CALL YOUR PEDIATRICIAN IF
  you notice that the chest is asymmetrical—bulging on one side or sinking in on the other. This may be a sign of an underlying abnormality of the ribs, lungs, or heart.

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11.  JITTERS AND TWITCHES

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 nervous system.
 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.

•  IT IS NORMAL FOR
  newborns to tremble and shake for a second or two when startled.
• CALL YOUR PEDIATRICIAN IF
  1. there are abnormal eye movements associated with the trembling.
  2.  movements are jerky, irregular, and not associ­ated with a noise or movement.
  3.  trembling lasts more than a second or two.
  4.  movements do not quiet down with holding or swaddling.

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12.  BLUE HANDS AND FEET

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.

•  IT IS NORMAL FOR
  newborns to have blue hands and feet.
• CALL YOUR PEDIATRICIAN IF
  1. you notice blueness of the lips.
  2.  blue hands and feet remain even when the baby is warm.
  3.  blue legs persist after the baby lies down.

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13.  YELLOW DISCHARGE OR SWELLING OF THE CIRCUMCISION

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 healing normally.
 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.

•  IT IS NORMAL FOR NEWBORN BOYS TO
  1. have a little swelling at the edge of the plastic ring.
  2.  form a little blackened tissue around the string.
  3.  ooze yellowish material which dries on the end of the penis or develop redness on the end of the penis.
• CALL YOUR PEDIATRICIAN IF
  1.  urine comes out in little dribbles or in less than a good stream.
  2.  your newborn strains with urination.
  3.  the head of the penis is dark blue or black.
  4.  there is more pus oozing than just the little bit described above.
  5.  you see more than a few drops of blood on the diaper once in a while.
  6.  there is significant swelling or redness of the penis or the skin around it.
  7.  the ring does not fall off in fourteen days.
  8.  your baby acts sick in any way.

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14.  MARBLED SKIN

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.

•  IT IS NORMAL FOR
  newborns to have marbled or mottled looking skin when they are cold.
• CALL IT TO YOUR PEDIATRICIAN'S ATTENTION IF
  an area of skin appears marbled all the time. This may be a sign of an abnormal formation of blood vessels under the skin.
•  CALL YOUR PEDIATRICIAN IMMEDIATELY IF
  mottling occurs with sweating, fever, or any other sign that your baby might be sick; this could mean a serious medical emergency.

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15.    YELLOW SKIN AND EYES (JAUNDICE)

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.

•  IT IS NORMAL FOR
  newborns to have mild jaundice for as long as four to six weeks after birth, especially if they are breastfed.
• CALL YOUR PEDIATRICIAN IF
  1.  jaundice was not there at two to three days of age but you noticed it sometime later.
  2.  jaundice appears to be deepening in color. your baby is acting sick, feeding poorly, or has a fever over 100°F.

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16.  PINK PATCHES ON THE EYELIDS, FOREHEAD, AND NECK

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.

•  IT IS NORMAL FOR
  have salmon-colored patches on the forehead, eyelids, and the nape of the neck.

17.  STEAMY-LOOKING EYE; MUCUS OR EYELASHES IN THE EYE

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 eye.
 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.

•  IT IS NORMAL FOR NEWBORNS TO
  have mucus or an eyelash swimming around on the surface of the eye.
• CALL YOUR PEDIATRICIAN IF
  1. you notice any haziness to the eye, even if it comes and goes, or discoloration of the pupil.
  2. yellow mucus or pus collects in the inner corner of an eye.
  3. one eye seems larger than the other.

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18.  STUFFY NOSE, NOISY BREATHING

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.

•  IT IS NORMAL FOR NEWBORNS TO
  1. have mucus in their noses.
  2. breathe noisily.
  3.  sneeze.
• CALL YOUR PEDIATRICIAN IF
  1. your baby has any signs of illness, other than a stuffy nose, such as irritability or a temperature over 100.5°F.
  2. the stuffiness is interrupting sleep or feeding.
  3.  stuffiness is accompanied by yellow or green dis­charge from the nose.

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19.  BLUE SPOTS ON THE TRUNK AND BUTTOCKS

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.

•  IT IS NORMAL FOR
  newborns  to  have Mongolian  spots  on  their trunks or buttocks at birth.
• CALL YOUR PEDIATRICIAN IF
  you notice bruiselike marks appearing after birth.

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20.  TINY PIT AT THE BASE OF THE SPINE

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.

•  IT IS NORMAL FOR
  newborns to have a small pit at the base of the spine.
• CALL YOUR PEDIATRICIAN IF
  1. there is any drainage of clear or cloudy fluid.
  2. there are hairs growing from the pit.
  3. there is a lump near or under the pit. the skin is discolored around or near it.

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21.  RAISED, RED SPOTS ON THE SKIN

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 several inches.
 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.

•  IT IS NORMAL FOR
  newborns to develop strawberry marks in the weeks after birth.
• CALL YOUR PEDIATRICIAN IF
  1. you notice many red spots forming.
  2. the red spots are accompanied by bruising.

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22.  GREEN STOOL

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 stool.
 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.

•  IT IS NORMAL FOR
  newborns to have a green stool now and then.
• CALL YOUR PEDIATRICIAN IF
  1. the stool is red at any time or tarry black after the first few days or if it is chalky white.
  2. green stool is accompanied by any signs of illness.

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23.  SOFT OR WATERY STOOL

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.

•  IT IS NORMAL FOR
  newborns to have loose, watery stools with a little seedy, yellow material mixed in.
• CALL YOUR PEDIATRICIAN IF
  1. your formula-fed baby used to have firm stools but now has frequent, loose stools.
  2. loose stools are accompanied by vomiting.
  3. the normal loose, watery stool of your breastfed baby turns hard and dry.

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24.  VAGINAL BLOOD OR MUCUS

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 tissues vigorously.
 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.

•  IT IS NORMAL FOR
  newborn females to have mucus and sometimes even a little bright red blood from the vagina during the first week or two.
• CALL YOUR PEDIATRICIAN IF
  1. the bleeding continues or is more than a little spot.
  2. mucus becomes yellow, green or foul-smelling.

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25.  STRAINING AT STOOL

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.

•  IT IS NORMAL FOR
  babies to strain, grunt, cry, and turn red when passing a stool.
• CALL YOUR PEDIATRICIAN IF
  1. stools are hard and difficult to pass.
  2. straining occurs with urination, not defecation.
  3. your baby strains frequently but produces stool infrequently.

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26.  STRAINING DURING URINATION

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 not always.
 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.

•  IT IS NORMAL FOR
  infants to strain while urinating.
• CALL YOUR PEDIATRICIAN IF
  1. you notice your baby straining while urinating.
  2. the urinary stream is weak and dribbling.

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27.  PINK-COLORED URINE

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.

•  IT IS NORMAL FOR
  newborns to have a pink color to their urine once or twice.
• CALL YOUR PEDIATRICIAN IF
  if this persists or if it looks like blood. Bring in the stained diaper. There is a simple test for blood that your doctor can do right on the diaper immediately.

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28. CLEAR BEADS OR GRANULES ON THE DIAPER

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.

1.  IT IS NORMAL FOR
   a little clear, granular material to ooze from a superabsorbent diaper.

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29. BOWED LEGS AND CURVED FEET

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.

1.  IT IS NORMAL FOR
   newborns to have bowed legs and in-curving feet.
2.  BRING IT TO YOUR PEDIATRICIAN'S ATTENTION AT THE NEXT CHECKUP IF  
   if the curve seems excessive, especially in the feet.

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30.  OOZING BELLY BUTTON

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.

1.  IT IS NORMAL FOR
   belly buttons to get smelly and oozy.
2. CALL YOUR PEDIATRICIAN IF
   leaving it open to the air and dousing it with alcohol does not solve the problem.
3.  CALL YOUR PEDIATRICIAN IMMEDIATELY IF
   there is any redness to the skin around the belly button. This could mean a potentially serious infection.

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31.  INGROWN TOENAILS

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.

1.  IT IS NORMAL FOR
   newborns to have mild ingrown toenails once in a while.
2. CALL YOUR PEDIATRICIAN IF
   1. the area looks infected or the toe is swollen.
   2.  if the simple remedies above do not clear it up in a few days.

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32.  FEVER

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.

1.  IT IS NORMAL FOR
   newborn infants to have a fever.
2.  CALL YOUR PEDIATRICIAN IMMEDIATELY IF
   1. if your newborn (up to age two months) has a temperature over 100.5°F.
   2. your baby is acting sick and her temperature is under 97.5°F.
    See the Chapter IX, "Fever," for more details.

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33.  VOMITING

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.

1.  IT IS NORMAL FOR
   newborns to spit up or vomit now and then. It is even normal to have projectile vomiting once in a while.
2. CALL YOUR PEDIATRICIAN IF
   the vomiting happens more than once a day or occurs frequently over several days.
3.  CALL YOUR PEDIATRICIAN IMMEDIATELY IF
   1. projectile vomiting persists.
   2. your baby does not seem to be keeping anything down.
   3.  your baby looks sick, she has poor color, the vomiting is associated with a fever over 100.5°F, or there are any other signs of illness.

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34.  NEWBORN JAUNDICE CHECK

1. We ask you to come into the office with your new baby 1-2 days after you leave the hospital. We call this a “jaundice check”.
2.  We are indeed checking for jaundice, which can increase 2-3 days after birth, but we are also making sure that the infant has not lost an excessive amount of weight, that no new heart murmurs have appeared, that the umbilical stump is dry and clean, etc.
3. If you are nursing, we also will ask how breast feeding is going and give you any help you may need.
4. Appointments are scheduled in the morning.
5. Please bring your completed New Patient paperwork to the appointment.

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Excerpted from When Do I Call the Doctor? By Loraine Stern, MD Doubleday 1992