Your “New” Newborn
There is a world of difference between newly born and six-hour old infants. Immediately following delivery your baby will appear somewhat wrinkled and extremely wet. Newborns have been bathed in the amniotic fluid since the earliest stages of their development. This is the fluid that is lost when the membranes rupture during labor.
The baby’s skin is protected in this watery environment by vernix, a white, cheesy material that you may notice in the skin folds and over the scalp. It is nature’s hand cream, and protects the skin from “soaking up” too much water and also helps prevent bacterial infection of the skin. Persistence of the vernix continues to prevent bacterial growth, so don’t be too quick to wipe it off and “clean the baby up.”
Shortly after the baby is delivered and the umbilical cord is clamped and cut, the baby will be taken to a warmer, dried and examined. Keeping warm is important to your baby’s health, especially during the first few days.
There will be watery mucus coming from their nose and mouth. This will be suctioned by the obstetrician, pediatrician or nurse. Part of this material comes from amniotic fluid in the mouth, and part of it comes from fluid that filled the lungs prior to birth and the first breath. It is normal and no cause for concern.
Shortly after birth most babies are bluish to dark red in color. This does not mean that they are a “blue baby.” With time, and occasionally a little extra oxygen and stimulation the baby’s color becomes a healthy pink. However, even after color improves, you will continue to notice persistent blue color to hands and feet. This is called acrocyanosis and is normal. Do not be alarmed.
One of the most prominent features of a newborn is the shape of the baby’s head. Generally, instead of the round, smooth, well formed head you are accustomed to seeing in a two day old infant, the head will be molded into an elongated or pointed shape. This results from the pressure within the birth canal. It is natural and will disappear within days.
Most mothers and fathers want to know what the APGAR score is for their baby. A number of years ago, physicians saw the need to describe the responsiveness of the infant at birth. Dr. Virginia Apgar developed a scoring system that judged five aspects of newborns responsiveness. These five aspects were then scored at one and five minutes of age as zero, one or two. The desired score is two for each criterion, for a total of ten.
Shortly after the Apgar system was introduced, other physicians, in honor of Dr. Apgar, rearranged the criteria and used the letters of her name to designate each of the five criteria:
A = appearance
P = pulse
G = grimace
A = activity
R = respiratory effort
A score of 8 to 10 is considered best and physicians feel there is no significant difference between 8, 9 or 10. A one minute score of 6 or 7 indicates mild depression usually requiring intervention and resuscitation. Any score below 5 indicates significant depression which frequently requires intensive neonatal care.
Just as there is no “normal” height or weight for adults, there is no “normal” height or weight for infants. However, seventy percent of term newborns will weigh between six pounds, ten ounces and eight pounds, six ounces with an average of seven pounds, eight ounces.
Almost all infants will lose four to ten ounces during the first days of life. It is acceptable to lose up to ten percent of birth weight. This is a normal loss and represents loss of stool, urine and excess body water. Your baby’s weight will be monitored while in the hospital, and if you go home within 48 hours of delivery, we will want to do a weight check in the office at three to five days of age.
The skin of a newborn displays a number of normal variations which often cause parental concern. We have already mentioned vernix. Some infants have a fine, downy hair covering the body, usually the shoulders back and extremities. This is called lanugo. In dark skinned babies this can be quite prominent. Invariably, this fine hair is lost in the first few months and does not predict the amount of body hair the child will have in the future.
A common rash in the first few days of life is called erythema toxicum. This is sometimes called “newborn rash” or “flea bite” rash. This rash consists of very small, 1/16th to 1/8th inch raised areas with a mild redness topped by a very small bump. It is a normal condition and no cause for concern. It will come and go and eventually disappear without treatment.
A reddish, flame shaped mark is commonly seen over the forehead, especially between the eyes, over the eyelids, on the upper lip and frequently over the nape of the neck. These marks are referred to as flame nevi or “stork bites” and usually disappear without a trace within the first 2 years.
Many infants will have a bluish discoloration of skin over the lower back and occasionally mid back commonly referred to as “Mongolian spots.” These are due to the presences of a specific pigment cell in the skin. They usually disappear by the fourth or fifth year of life.
These are the most common skin variations that you are likely to see in your baby. Of course, if you should have questions about any of these, or any other markings on the skin, be sure to tell us.
The shape of the baby’s head has already been mentioned in terms of the molding that occurs during birth. As part of this molding, two other conditions occur that sometimes last longer than the first 24 hours. The first is referred to as “caput succedaneum.” This is the result of a local collection of tissue fluid called edema and is caused by pressure exerted by the uterus during the birth process. Uterine contractions place a great deal of pressure on all parts of the baby except the top of the head (which is on its way out!) This results in the same processes that would occur if suction was applied to the top of the baby’s head and causes the local accumulation of tissue fluid where the pressure was lowest. This caput will disappear within the first few days. It is harmless and no cause for worry.
Another accumulation of fluid under the scalp is referred to as a cephalohematoma. This initially looks like a caput. However, instead of simple accumulation of fluid in the tissues of the scalp, a cephalohematoma results from bleeding over the surface of the skull bone. This results in no damage to the baby, the brain or skull. Although a cephalohematoma can take months to resolve, it requires no treatment and should not cause concern for you.
Grandmothers and occasionally mothers are concerned about tongue tie. This is a term that has been used to describe the very thin ridge of tissue that extends from the tip of the tongue to the floor of the mouth in some infants. There is considerable variation in the size and length of this ridge of tissue which is called a frenulum. Most physicians feel that there is no indication for “clipping” this tissue. We believe, based on clinical studies, that this frenulum causes no problems and should be left alone except in extreme cases.
Full term babies have a firm enlargement of the breasts. This is true for both girls and boys and results from hormones that are passed from mother to infant prior to birth. No treatment is required. This enlargement will disappear during the first six months of life. Rarely, milk like substance will be excreted from the breast. It is extremely important that no attempt be made to express or squeeze any of this milk from the breast. The enlarged breasts should be left to resolve on their own.
Most female infants have a vaginal discharge. This is also stimulated by hormone stimulation prior to birth. In addition, in rare instances, some bleeding can be noted with the discharge. This occurs because of the withdrawal of hormones following a child’s birth and is similar to the routine menstrual cycle of a mature woman. No treatment or special cleansing is necessary. Do not attempt to clean this area with soap and water.
Most children will have some slight peeling of hands and feet or other areas of the body. This is normal and typically does not require lotions or oils. Occasionally, the peeling will be severe and cracks will appear in the skin. There may even be some oozing and redness. If this should occur, bring it to our attention. Usually, a moisturizer applied to the skin two or three times per day is all that is required to resolve the problem.
As you can see, there are a number of normal, minor variations from child to child that should cause no concern or worry. Each variation makes your child individual! There is no one else like them. Do not be concerned if your child has one of these minor variations and your best friend’s child does not.
Mothers who have babies that sleep all the time during the first few days are concerned their babies sleep too much. Other mothers whose babies are active, awake and crying during the same first days are worried they do not sleep enough. Most parents express concern their baby’s activity, sleep and fussiness is different, not normal. This probably occurs for two reasons: most parents have little experiences to draw upon in making a judgment about their child, and there is considerable variation in behavior, activity and sleep during infancy. Just as the variations in physical appearance distinguish one individual infant from another, so too does general behavior.
During the first few days the baby will sleep much of the time, most up to 18 to 20 hours per day. When awake, they will demand much of your attention. Until birth, the baby was fed through the umbilical cord. After birth a feeding pattern develops over time. Do not be surprised or concerned that the baby does not have a regular schedule, or wants to eat immediately when they decide it’s time. This is a brand new sensation for them.
When awake, your baby will be looking around, moving arms and legs, mouth and head. It is during this period of alert activity that parents find the most enjoyment from their new baby. Pay attention to them by laughing, talking and holding them. They will respond to your voice, your singing and humming. This early stimulation is extremely important.
When a new infant is not looking around or eating, they are sleeping. Contrary to popular belief, an infant’s sleep is not necessarily peaceful and undisturbed. Most will grunt, move about, draw up their legs and move their head from side to side during sleep. This does not mean they are uncomfortable or having difficulty with sleep. It is normal baby behavior.
Sudden loud noises and sudden movement will cause what is known as a “startle response” and is easily stopped with a little soothing. Some infants startle more readily than others. Occasionally, the startle response is exaggerated and this can indicate an abnormality of blood sugar or calcium, or the effects of the withdrawal from drugs or medicines taken by mother before birth. If you feel that your baby’s startle response is more exaggerated than other children with whom you have had experience, discuss it with us.
The first few days of your baby’s life are extremely important. Such simple things as holding, touching, looking, talking and loving during this time help determine their subsequent responses to you and surprisingly, your response and feelings toward them for years to come. Make room in your schedule of activities for quiet, undisturbed periods with your baby. These times will pay large dividends in the future.