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Is My Baby Normal?

Oh, the relief! You’ve just given birth after a long and possibly difficult pregnancy. Or perhaps your wife
or girlfriend has. Or maybe you just brought home your adopted newborn or young infant. You may find
yourself parenting a newborn for the first time in many years after raising older children. You may be a
new grandparent. Whatever the case may be, the waiting and worrying are over…NOT!
First there are the phone calls with the necessary stats:
“It’s a girl! “
“Finally, a son!”
“7 pounds, 11 ounces! 21 inches long!”
“All ten fingers and ten toes in place.”
“What a perfect baby!”
Next, you gaze at that angelic face and think, “There is something not right about this kid! Nobody is
saying anything. Are they keeping it secret from me? Maybe it’s not a big deal medically and my baby is
just funny-looking. Do they tell everyone that their baby looks great? Will I seem stupid if I ask?”

Take a deep breath! Let me first say that as someone who has attended and cared for thousands of
newborns and who loves babies, they are all homely! (For those of you not familiar with the term,
homely is a folksy word that basically means funny-looking. It is often followed by “Poor thing!” or
“Bless her heart” to soften any harshness.) Appearance will improve quite a bit just in the first few days,
and even more after a few weeks. Have you ever seen those pictures of Hollywood stars in their high
school yearbooks? Just think, if they can look that bad in their teens and still become beautiful and
famous, your child is probably going to be alright, too. Now let’s talk about some of those odd-looking
newborn things you may be wondering about.

The Head
Unless your baby was born by C-section without going through much labor, it is likely that he has a
funny-shaped head. Your baby does not have brain damage because his head looks weird! A
newborn’s skull is made up of several bony plates that do not fully fuse together for about a year-and-a
half. This helps the baby fit through the birth canal during delivery, and allows room for your infant’s
brain to grow quickly during infancy and early toddlerhood. Those bony plates shift and realign
themselves under the pressures of the birth process to help prevent the baby from getting stuck. This
phenomenon, which doctors call molding, may make your little one look like a cone head, but it usually
improves dramatically within a day or so. Sometimes the crown of a baby’s head gets swollen, puffy and
bruised from the constant impact against the mother’s pelvic bone or the use of a vacuum device to
help the baby out. Doctors refer to this as a caput, and it usually goes away within a week or so. Even
more impressive-looking is the cephalhematoma, a large bruise or pool of blood that collects within the
tough membrane covering one of those bony plates of the skull. They can be over one or more areas
and have a distinct outline. Some may be quite large; making it look like your baby has horns waiting to
break through the skin! These are also caused by the pressures of the birth canal against the baby’s
skull and do not cause brain injury. They do, however take longer to completely resolve and often
become rock-hard (calcified) until they disappear within a few months.
Soft-spots, or fontanels, are soft areas where the plates of the skull have not yet fused together. There
is a large diamond-shaped one on the top of the head and a much smaller, rectangular one at the back
of the head. It is normal to see pulsations as your baby’s breathing and heart rate change. Your baby
will not die if you touch a fontanel! The membrane that covers these areas is very tough.

The Hair
Just as in adults, newborn hair comes in all colors, textures and thicknesses; however, it looks
nothing like it will as the child grows. A baby with a sparsely covered head of wispy hairs may
end up with thick curls. Brown hair may become blonde and straight hair curly. Infants usually
develop a nearly bald area at the crown within a few months, but that will fill back in later.
Don’t panic if your baby looks unusually hairy. Fine hair on the ears, back and forehead is
common and usually becomes unnoticeable.

The Face
Because of the cramped quarters of the womb and an economy-class trip through the birth canal, ears
and noses may appear squished or misshapen at first. These areas of the face are made up of cartilage,
which is much softer and more flexible than bone, and they usually spring back to normal fairly quickly.
Nearly all newborns have eyes that are dark blue. It can take several months for eyes to achieve their
permanent color. As a rule, brown eyes turn brown before blue or green eyes reach their final color in
about four months or so. Red spots on the white part of the eye result from broken capillaries- small
blood vessels that have burst from the pressures of birth. They usually go away within four weeks and
do not have any effect on your baby’s vision. During the first week after birth you may notice the whites
of the eyes turning yellow. This is part of the process of jaundice, which happens to varying degrees in
most infants but can be serious in some cases. We will talk more about this later.
Some babies may develop scratches over their face from their fingernails as they cry and flail their arms
about. The nurses in the hospital can show you how to clip your baby’s nails or do it for you as you
watch, if you are too nervous. Nail scissors designed for infants are easier and less intimidating than
clippers, but either will work just fine. If you gently pull the skin back away from the top edge of the nail
and only cut off a small amount at a time, you will not have to worry about accidentally injuring your
child.
Most babies are born toothless, and those rare few that have teeth at birth usually have them removed
in the nursery. These natal teeth are not well-anchored and may fall out and be aspirated (inhaled into
the baby’s lungs). Newborn gums have ridges that are often mistaken for teeth that are about to break
through, and some infants develop firm white bumps on their gums that look like an erupting tooth.
Although they feel quite hard, these small secretion-filled cysts eventually go away by themselves. You
may also see a pearly white bump near the center of your baby’s hard palate, called an Epstein’s pearl,
which will also disappear on its own and has nothing to do with teeth.
Many newborns have a somewhat short frenulum, the cord-like piece of tissue that holds the tongue
down in the front of the mouth. This usually stretches over time as the baby uses the tongue to eat and
suck and cry. Occasionally the frenulum is too short to allow the infant to feed properly and will require
clipping by a physician. Contrary to popular myth, it is fairly uncommon for a tongue-tie to cause
significant speech issues in older children. If you are worried about your baby’s tongue or how she is
feeding you should definitely mention this to your pediatrician!

The Extremities
Hands and feet usually have a bluish tint for the first week or so. This is not due to low blood oxygen
levels, but rather immature circulation in the small capillaries that bring blood to these parts of the
body. The blue color is more prominent when infants are cold, or held in a position that squeezes an
arm or leg a little too tightly. It is NEVER normal for a baby to have blue lips or tongue, and if your
baby suddenly has a bluish color to his face or body, call 911 or seek help immediately!
Nail beds may sometimes appear blue also, and nails grow quickly and may require clipping as
mentioned above. Many parents worry that their child has ingrown toenails. The natural curvature of
the nails and the puffiness of the skin around it create this appearance. Once again, time usually takes
care of this issue (though it may take up to two years to look “normal”).
Newborn legs are very flexible, which is helpful when it comes to changing diapers and clothes. Infants
who have been in a breech position prior to birth may even hold their feet closer to their ears than the
foot of the bed! Because of the baby’s tightly folded position while in the womb, it is normal for an
infant to appear somewhat bowlegged.

The Abdomen
Abdomens tend to protrude slightly, and the lower ribs can be seen moving with each breath. There is a
v-shaped protrusion at the lower breast bone where the two sides of the rib cage meet. This moves
with the rib cage as the baby breathes. Although it may have an upward bend that makes it appear freefloating, it is very rare for this xiphoid process to break off or cause any problems.
Umbilical cords come in different sizes, lengths and shapes. “Innies” and “outies” are determined
before birth and are partially a result of genetics. The cosmetic appearance of a child’s belly button has
nothing to do with how the umbilical cord was cut. Keep the cord clean and dry. It will come off in a
week or two. Slight bleeding is normal (from the blood trapped inside the vein and artieries of the
drying stump) and there may be scant oozing. If there is a foul odor from the cord, or redness of the
skin around it, have a doctor look at it. Umbilical cords are not wounds and are not painful to the baby.

The Skin
Infants are born with a thick coating of vernix, a sticky white substance that is hard to wipe off. It
protects the skin before birth as the baby is surrounded by amniotic fluid, and provides an added layer
of warmth. After your newborn is bathed, you may notice that her skin is cracked, especially around the
creases of the wrists and ankles. Subsequently, this top layer of skin will peel off. Vaseline can be used
to soothe any irritated areas and to temporarily improve appearance (for photos or visiting relatives),
but it will not stop this natural peeling process.
Normal infant skin may have small white bumps around the nose and mouth. These milia are similar to
whiteheads and are temporary and harmless. During the first few days after birth, many infants also
develop ETN, a rash that looks like small red flea-bites. This is due to a normal immune process that
takes place in the baby’s skin. The “bites” may come and go for up to a week and require no treatment.
There are several common birthmarks that are seen in newborns. Nevi flammeus are pinkish-red marks
that lie flat on the skin. They are also known as “salmon patches”, “stork bites” or “angel’s kisses” and
often appear on the nape of the neck, forehead or eyelids. Blue-gray or greenish discolorations, that
may look like bruises, are frequently seen at the base of the spine or along the buttocks. These are
known as Mongolian spots and are more commonly seen in children of Asian, African, Mediterranean or
Hispanic descent.
Most infants develop some degree of jaundice during the first week or two. Jaundice is seen as a
yellowish skin color that also affects the whites of the eyes. If the yellow discoloration becomes severe,
or if your baby is unusually sleepy, feeding poorly, or not making stools as expected, you should contact
your pediatrician.

The Genitalia
If you are not used to seeing newborns, you may be shocked at the sight of your little one’s genitals.
Baby boys often have swollen or fluid-filled scrotal sacs that gradually reduce to normal size after a few
weeks or months. Infant girls frequently have darkened, puffy labia, along with a sticky white discharge.
This is largely due to the mother’s hormones that were shared before birth. Another result of these
hormones is a temporary bloody discharge, similar to a “mini period”, that can be seen in newborn girls.
Maternal hormones also cause breast enlargement in both boys and girls, and may even lead to the
production of a small amount of breast milk. Do not attempt to squeeze out this milk! You will not be
able to reduce swelling or milk production this way, and you could cause inflammation or a more serious
infection.
Though they appear alarming, these are normal processes and do not usually need any special
treatment or intervention.

The Nervous System
Twitches, jerks and jumpiness are all part of the normal newborn’s make-up. “Jitters” or tremors,
where the hands or lip quiver uncontrollably, are different and may indicate low blood sugar or
withdrawal from certain drugs (including nicotine and caffeine.) True seizures are uncommon, but do
occur. Simply holding the baby’s hands gently or lightly resting your hand on the twitching leg will
usually stop most harmless movements. Please note that it is never normal for a baby to jerk
uncontrollably, have blue lips or tongue, or act unresponsive! Call for help immediately if your baby is
having a seizure or if you are unsure.
Other aspects of the newborn nervous system are more entertaining than stressful. Infants have a grasp
reflex which causes them to hold onto a finger or small toy that touches their palm. The toes react the
same way when you gently press the soles of their feet. The toes spread out in a fan when you run a
finger up the side of the foot. Infants will root, or turn toward anything that rubs near the side of their
mouth, and healthy babies have a suck reflex that helps them naturally attempt to feed from a breast,
bottle, pacifier or finger that is placed in their mouth. Healthy newborns will demonstrate a startle or
Moro reflex, which causes them to flail their arms and spread their hands and cry when picked up or
“dropped” ( gently placed onto a mattress).

Keep in Mind
Hopefully you are now aware of the more unusual, but mostly normal, things you may notice in your
newborn. Like all things in the field of medicine, there is a multitude of variations- some normal and
some not- that may puzzle a parent. Take advantage of every opportunity to ask questions of your
doctors, nurses, lactation consultants and the rest of the support staff during your hospital stay and at
each office visit. I speak from personal experience when I tell you that, no matter how hectic my day, I
would rather give each parent the opportunity to leave the office feeling confident and reassured, than
keep an on-time schedule by rushing through a “routine” appointment. A wise physician realizes that
parents who know what is normal for their child will also recognize when something is wrong, and call
appropriately.

Bottom Line: If you are concerned, call your physician’s office or their
overnight answering service. Your baby’s health and safety take priority!

*This is a free resource provided by Parenting For Humans and is for general information purposes
only.      Created by Marcia S. DeFreese, MD.

Copyright 2015 All rights reserved. Not to be used without permission of the author. Individual
copies for personal use are permitted.
www.ParentingForHumans.com

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