Understanding Your Newborn
While each baby is a unique individual there are certain characteristics and behaviors that are common to newborns. This section will describe some of the physical and behavioral traits you may notice in your baby during the first few weeks of life.
Weight and Length
The average baby weighs between six and nine pounds, and is between 18 to 21 inches long. Infants may lose up to five to ten percent of their birth weight during the first week of life, due mainly to loss of extra fluid accumulated by the mother and baby as the pregnancy nears term. If the baby is approaching a ten percent weight loss we will advise you as to frequency and type of feedings to ensure proper regain of weight.
Shape: Because of pressure before or during birth, your baby’s head may be temporality misshapen. Normal head shape usually returns by the end of the first week. Babies delivered by Cesarean usually don’t have as much of this head molding.
Soft Spots: Your baby has two obvious soft spots or fontanelles. One is on the top of the head and the other is near the back of the head. Both the fontanelles are covered by a tough membrane and with normal handling care, you can’t damage the soft spots when shampooing, brushing, or stroking your baby’s head.
Color, tears, and swelling: Caucasian infants usually have grayish-blue eyes at birth. Infants of other ethnic backgrounds may have grayish-brown or brown eyes. However, an infant’s true eye color may not be known for several months. Tears are usually not produced in noticeable amounts with crying until your baby is one to two moths of age. Swollen and puffy eyelids or red hemorrhages on the white conjunctivae are normal after birth and result from pressure during birth. Swelling and inflammation usually go away in a few days.
Eye discharge: Occasionally, a baby may have irritation from the antibiotic ointment given at birth. You may notice a small amount of yellow discharge from your baby’s eyes during your hospital stay. This usually clears within 24 hours. If you notice a small amount of yellow discharge form your baby’s lids or lashes after you get home, just gently wipe it away with a warm moist cloth or cotton ball. If the discharge is purulent (yellow or green), in large amounts and accumulates frequently, please notify us; this can be a symptom of an infection or a blocked tear duct in need of antibiotic drop therapy.
Newborns have a wide variety of ear sizes, shapes, and positions that are normal. At birth your baby’s ears may bend easily. In time, the ear will feel firmer.
Ear Discharge: It is normal for a baby’s ears to produce wax. It is not normal for them to produce any other kind of discharge. If you think the discharge from your baby’s ears is not wax, please call us. Cotton swabs should not be used in your baby’s ears at any time; one can inadvertently be tamping wax down into the canal deeply without realizing it. Ears can be cleaned well with the corner of a clean, damp washcloth. Just clean what you can see.
Swollen breasts: During the first days after birth, it is normal for both boys and girls to have swollen breasts. This swelling is caused by hormones a baby gets from the mother during pregnancy. Occasionally a baby may produce a small amount of milk. If your baby does produce milk or have breast swelling, do not attempt to squeeze out the milk, as this might cause infection. The swelling will go down as the baby’s body metabolizes the mother’s hormones. If the breasts are markedly swollen, tender or reddened, please call us so that we can evacuate the child for the possibility of mastitis.
Color: The skin is thin and dry. You may see some veins through it. The skin is the Caucasian newborn is a pink or reddish color. As babies cry, they may become a deeper red. In the Black infant, the skin color appears as a reddish-black color that darkens as the baby gets older. In Asian babies the skin is a tea rose color. Frequently, dark bluish spots may appear on the lower portion of the back or buttocks of babies of Black, Asian, or Mediterranean descent. These are called Mongolian spots. They are caused by a temporary accumulation of pigment under the skin and they fade without treatment during preschool years. Despite the names, these spots have nothing to do with Mongolism or Down’s Syndrome. In the newborn it is common for the baby’s hands and feet to appear bluish. This is called acrocyanosis. This is common in the first few days of life a decreases gradually.
Milia: These are tiny white spots often seen on the nose and chin. They are caused by obstruction of oil or sebaceous glands. You should not squeeze these spots. They usually disappear in several weeks.
Lanugo: your baby’s body is covered with fine downy hair. This hair is most noticeable on the back, shoulders, and ear lobes. It will fall out in time.
Vernix: A white, cheese-like substance called vernix at one time covered your baby’s skin to protect it while in the bag or waters. Traces of it are usually found in the body’s creases. It is not necessary to scrub this off.
Peeling: Most babies’ skin peels after birth because they have been in fluid for many months. This generalized peeling is completely normal and requires no treatment, including oils or lotions.
Rashes: A temporary rash, called erythema toxicum, may occur during the first few weeks. It is small areas of redness with raised yellowish-white centers and it may resemble a flea bite or hives. This rash requires no treatment. Washing clothing with a mild detergent, such as Dreft or Ivory, omitting fabric softeners and double rinsing if necessary, will help minimize rashes.
Red blotches: Many babies have reddened areas of skin on their upper eyelids and forehead. These are areas of dilated blood vessels. These areas usually fade with time (months to years) as the blood vessels contract and as the baby’s skin grows thicker and less transparent. Redness may reappear when your baby cries. These are often called Stork Bites or Angel Kisses and are distinct from the deeper purple Port-Wine stains which are permanent. they are areas of tangled capillaries. As the baby gets older ,these vessels contract and the visible redness fades.
Diaper rash: Diaper rash is often caused by irritants in the urine or stool. To minimize diaper rashers, be sure to change your baby’s diaper frequently (every two to three hours during the day). Always wash the diaper area with plain water at each change. If you launder your own diapers, double rinses with one-half cup of vinegar per rinse load may help eliminate any soap and neutralize the ammonia. If your baby develops a rash in spite of these precautions, try to change diapers more frequently and expose the reddened area to the air several times a day. A diaper rash ointment (vaseline or A&D) applied to the rash area after air-drying may be helpful. Occasionally babies develop a yeast infection of the diaper area. This is usually a deep red colored rash covering a continuous area and with accentuation in the skin folds and satellite lesions at the outer edge. If you suspect this, use Lotrimin AF ointment (clotrimazole) which is available over-the-counter or call us for further guidance.
Genitals- Swelling & Vaginal Discharge: The genitals of both boys and girls are usually large and swollen from hormones passed from the mother through the placenta. Girls may also have a white, mucoid, and sometimes blood-tinged vaginal discharge. As your baby metabolizes your hormones, these changes will disappear.
Moro (Startle): The Moro reflex is a sudden reaction to a loud noise or change in position. It appears as jerky, generalized muscular activity with a flinging out of your baby’s arms and legs, then bringing them back in towards the body.
Rooting: When an object touches your baby’s cheek, your baby turns his head toward the side touched, opens his mouth and begins to suck.
Sucking and Swallowing: Touching your baby’s lips will trigger the sucking reflex which is followed by the swallowing reflex.
Gag: The gag reflex helps your baby get rid of mucus in his stomach that he swallowed during birth or to regurgitate excess milk taken at a feeding.
Hiccups: Hiccups are a common occurrence. They do not bother your baby and will go away without any special treatment.
Cough & Sneeze: These reflexes help your baby remove irritating substances from him nose and throat. They are not necessarily signs of a cold.
Blinking: Your baby’s eyes will blink when they are exposed to bright light. Blinking also protects the eyes from foreign objects.
Walking: When you hold your baby around the chest in an upright position with his feet touching a hard surface, he will make prancing movements with his feet.
Grasping: This reflex is present in both the hands and the feet. Your baby will grasp any object put into his hands, hold it briefly and then drop it.
Deep Sleep: In this state your baby is nearly still except for an occasional startle or twitch. Breathing is regular. There are no eye movements and few facial movements. It is very difficult to arouse your baby in this state.
Light Sleep: In this state your baby shows some body movement. Breathing is irregular. You can see rapid eye movements beneath the eyelids and your baby may smile or briefly fuss. This state usually comes just before awakening or you may be able to awaken your baby to feed at this time.
Drowsy: In the drowsy state you baby’s activity level varies. The eyes may open and close occasionally and seem heavy. Breathing is also irregular in this state. Your baby may go back to sleep or awaken more.
Quite Alert: When your baby is in the quiet alert state, his eyes are wide open, his breathing is regular, and he is very attentive to what is going on around him. During this time, your baby is most interested in eating and learning about his new world.
Active Alert: In this state your baby becomes very active and may fuss. His breathing is again irregular and he is increasingly sensitive to stimulation or personal needs such as hunger, discomfort, fatigue, etc. At this time it is best to comfort your baby and bring him to a lower state.
Crying: Crying is your baby’s way of telling you that he needs something or that something is bothering him. Some causes of crying include hunger, physical discomfort, fatigue, boredom, needing to be burped, being over stimulated, or needing close physical contact. As you live with your baby, you will learn to tell the difference in his cries and discover what works best to soothe him.