A Tour of Your Newborn

By. Ann Douglas

Many first-time parents are more than a little shocked to discover that newborn babies are wet, wrinkled, and red-faced—not exactly the plump, chubby-cheeked cherubs that they may have envisioned before the birth. And, what’s more, newborn babies may also have a few other features that may be worrying to their parents—bluish hands and feet, body hair, a moulded head, and so on. Here’s a quick tour of a healthy newborn from head to toe.

Head:

- Don’t be alarmed if your baby looks a bit like one of “the Coneheads” of Saturday Night Live fame. Your baby’s head will assume a more rounded appearance within a few days of the birth as the plates in your baby’s skull shift back into their pre-labour positions.

- Wondering why there seems to be an abundance of extra skin at the back of your baby’s head? Blame it the on shifts in your baby’s body fluid balance as he adjusts to life outside the womb. (Don’t worry. It won’t be long before your newborn “grows into” his skin.)

- Worried about touching your baby’s “soft spot”? The membranes that cover your baby’s anterior (front) and posterior (back) fontanels provide a fair bit of protection, so as long as you handle your baby with care, you don’t have to worry about accidentally injuring your baby.

- If your baby was delivered with the aid of forceps (medical instruments that look like salad tongs), he may arrive with a few minor bumps and bruises. And if he hitched a ride down the birth canal with a vacuum extractor (another type of medical device), he may end up with a temporary suction mark on his head as well.

- Labour isn’t just physically demanding for the mother: it’s hard work for the baby, too. Some babies are born with a caput succedaneum (a swelling of the soft tissues of the skull that can occur during labour as the baby’s head pushes against the cervix). Fortunately, this swelling tends to subside on its own shortly after the birth. Other babies are born with a cephalohematoma—a raised bump that is caused by the pooling of blood between the skull bone and the tough covering of the skull during the birthing process. While cephalohematomas can be alarming to look at, they usually disappear on their own within a couple of weeks.

Hair:

- Some babies are born with a full head of hair: others are completely bald. Rest assured that any amount of hair is “normal.”

- Your newborn may have some soft, downy hair on his upper back and other parts of his body. This hair—known as lanugo—usually disappears within the first week of life and is more abundant in slightly premature infants.

Face:

- Don’t panic if your baby’s face is swollen or if there are patches of bluish bruising or flat streaks of broken blood vessels on his face. These changes are all temporary and result from the tight squeeze during birth.

- Concerned about your baby’s flat nose or receding chin? There’s nothing to worry about on that front either. Over time, your baby’s nose and chin will start to look more normal.

Eyes:

- Your baby may be born with puffy, droopy eyelids and eyes that are tightly squeezed together. Don’t worry: it’ll only be a matter of time before your baby starts flashing his baby blues (or browns).

- Your baby’s eyes may ooze sticky secretions. This happens because your baby’s eyes are not yet capable of producing tears. It doesn’t mean your baby has picked up an eye infection.

- Some babies are born with a flame-shaped red streak on the white of their eye—the result of pressure during the birthing process. The streak will disappear on its own over time.

Ears:

- Your baby’s ears may be folded over or otherwise misshapen, common side effects of labour that tend to correct themselves.

Skin:

- Your baby is likely to be covered in amniotic fluid and blood and to have traces of vernix caseosa (a cheese-like substance that protects your baby’s skin in the watery uterine environment) in his creases. Vernix caseosa is made up of cells and grandular secretions and is responsible for that intoxicating newborn baby smell.

- Your newborn’s skin is fairly translucent—something that helps to explain why your baby turns bright red when he cries.

- Don’t freak out if you notice blood pooling in your baby’s extremities or in the lower half of his body. Your baby’s circulatory system still isn’t quite up to speed yet. Simply change your baby’s position and the problem will correct itself.

Umbilical cord stump:

- Your baby’s umbilical cord stump is initially wet and yellowish, but becomes dry and brownish black until it dries out and falls off entirely—something that typically happens 10 to 14 days after birth. Health Canada no longer recommends swabbing the umbilical cord with rubbing alcohol, so just let nature takes its course and avoid giving your baby a bath until after the cord has fallen off.

Hands and feet:

- Your baby’s hands and feet may have a slight bluish tinge and feel cool to the touch. This is because your baby’s circulatory system is not yet working at peak efficiency. Rest assured that the problem will correct itself over time.

- Your baby’s feet may look out of proportion to his body, and his feet may turn out or his toes may overlap—all par for the course for this stage of infant development.

Arms and legs:

- Your baby’s arms and legs may look short and bird-like compared to the rest of his body.

Genitals:

- Your baby’s genitals may initially appear large and swollen due to hormonal changes and fluid retention. These changes are temporary and will reverse themselves in the days following the birth.

- If you have a baby girl, she may pass some thin white or blood-tinged mucus (psuedomenses) from the vagina during the first week of life. This discharge is triggered by withdrawal from maternal hormones.

- Approximately 1 per cent of baby boys are born with one or more undescended testicles. Some testes spontaneously descend on their own. If this does not occur, hormonal treatment and/or surgery may be required to preserve the baby’s future fertility.

Try This On For Size:

A typical newborn weighs in at 7.5 lbs. (3.4 kg) and is 20 inches (51 cm) long. Girls tend to weigh less than boys, and African-American, Asian-American, and Native-American babies tend to be somewhat smaller than their Caucasian counterparts. Other factors that influence a baby’s size include his mother’s health and lifestyle during pregnancy, the duration of the pregnancy, whether the baby is a singleton or a multiple (e.g., a twin), and whether the baby has a congenital problem.

Seeing Spots:

Don’t be surprised if your baby develops one or more of the following temporary newborn skin conditions.

- Neonatal urticaria (newborn acne): Red spots with yellowish centres that form because the baby’s skin and pores are not yet fully functional.

- Milia: Tiny white bumps that tend to be found on a baby’s nose, forehead, and cheeks. They are caused by a buildup of sebum (skin lubricant).

- Miliaria: A raised rash consisting of small blisters that contain clear or milky white fluid.

- Erythemia toxicum: Red splotches with tiny white bumps in the centre that tend to appear at two days of age.

- Pustular melanosis: Small blisters that quickly dry up and peel away, leaving dark freckle-like spots underneath. Note: All of these skin conditions clear up on their own over time, so resist the temptation to poke at your baby’s pimples or otherwise attempt to treat these skin conditions.

Birth Marks 101:

Here’s what you need to know about the most common types of birth marks.

- Stork bites : Flat, red marks that are typically found at the nape of the neck and on the eyelids. They are caused by the dilation of small blood vessels and gradually disappear on their own.

- Spider nevi: Thin, dilated spider-shaped blood vessels. They typically fade during a baby’s first year of life.

- Congenital pigmented nevi (common mole): Tan to black coloured moles that may have hair growing from them. There is only cause for concern if the mole is very large, bleeds or changes colour, shape, or size.

- Mongolian spots: Dark blue or slate grey bluish discolorations of the skin that are common in babies of African-American, Native-American, or Mediterranean descent. They are most often found on the buttocks and the arms and legs and are caused by deposits of melanin (skin pigment). They gradually disappear on their own.

- Port wine stains: Flat, reddish-purple coloured patches on the skin that darken with age and can become raised and vulnerable to injury. They can be associated with certain types of genetic disorders. If a large part of a baby’s face or neck is affected, plastic surgery may be recommended.

- Strawberry hemangioma (capillary hemangioma): Raised birthmarks with a soft texture. They may be pale-coloured initially, but usually turn red over time. They occur when certain areas of the skin develop an abnormal blood supply, causing the affected tissue to enlarge. Strawberry hemangiomas tend to disappear during late childhood (ages five to nine), leaving behind a small amount of brownish pigmentation, but they can be removed prior to that if they’re close to the eye and threatening the child’s vision.

- Café au lait marks: Permanent, tan-coloured patches that can appear at birth or any time during the first two years of life. A large numbers of café au lait marks can be associated with certain types of neurological disorders, so your baby’s doctor will want to give him a thorough checkup if he’s covered in café au lait marks.