Newborn's Normal Appearance
Even after your child's healthcare 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 healthcare 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 healthcare
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 healthcare
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 healthcare 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.
Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
Published by
RelayHealth.
Last modified: 2006-04-26
Last reviewed: 2008-06-09
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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