There is a world of difference between a newly- born and a six hour old infant. 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.” This is 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. In addition to its protecting the skin from absorbing too much water, it helps to prevent bacterial infection of the skin. Persistence of the vernix continues to prevent bacterial growth, so do not 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 so that he/she can be dried and examined. Keeping warm is important to your baby’s health, especially during the first few days.

There will be watery mucous coming from his/her nose and mouth. This will be suctioned by the obstetrician, the pediatrician, or the 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 he/she is a “blue baby.” With time, and occasionally a little extra oxygen and stimulation, he/she will become a healthy pink. However, even after his/her color improves, you will continue to notice a 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 his/her 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 a elongated or pointed shape. This results from the pressures 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 new child. A number of years ago, physicians saw the necessity to describe the responsiveness of the infant at birth. Dr. Virginia Apgar devised a scoring system that judged five aspects of the newborn’s response. These five aspects of responsiveness were then scored, both at one minute and five minutes of age, as zero, one, or two. The desired score is two for each criteria, for a total of ten.

Shortly after Dr. Apgar devised this scoring system, other physicians, in honor of Dr. Apgar, rearranged the criteria and used the letters of Dr. Apgar’s name to designate each of the five criteria. “A” represents appearance; “P” stands for pulse, or heart rate; “G” is grimace, or the infant’s response to uncomfortable stimulation; the second “A” stands for activity, or the amount of spontaneous movement the child makes; and “R” represents respiratory effort. A score of 8 to 10 is considered “best”ʼ and physicians feel there is no significant difference between scores of8,9,or10. Aoneminutescoreof6or7 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. His/her weight will be monitored while you and your baby are in the hospital, and, if you go home prior to 48 hours of age, will be checked in the office at three to five days of age.

The skin of the newborn infant displays a number of normal variations which often cause parental concern. We have already mentioned vernix which is a white creamy material that covers the skin and protects it from excessive water absorption while bathed in the amniotic fluid as well as providing some protection from bacteria. 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.

Very small, very fine white bumps are commonly found on the nose. These are called milia, and are the result of hormones passed to the baby prior to birth. They disappear during the first few months of life.

A common rash in the first few days of life is called erythema toxicum. This is sometimes called a “newborn rash” or a “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 wax and wane, 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, called “mongolian spots”. These are due to the presence of a specific pigment cell in the skin. They usually disappear by the fourth or fifth year of life.

These are most of the 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 results from a local collection of tissue fluid, called edema, caused by pressures 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 concern.

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, to the baby’s brain, or to the baby’s skull. A cephalohematoma takes months to resolve. It too should cause no alarm, and it requires no treatment.
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 babies. 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, though others feel differently. 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, a milk like material (sometimes referred to as “witches milk”) will be excreted from the breast. Nothing need be done for this either. It is extremely important that no attempt be made to express or squeeze any of this milk from the breast. Leave the enlarged breasts strictly alone.
Most female infants have a vaginal discharge. Just as breast enlargement results from hormone stimulation, this vaginal discharge results from hormone stimulation prior to birth. In addition, some bleeding will be noted with the discharge in rare instances. This occurs because of the withdrawal of hormones following a child’s birth, and is similar to the routine menstrual cycle of the mature woman. No treatment is required, and no 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, and sometimes 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 a special individual. There is no one else like him/her. Do not be concerned if your child has one of these minor variations and you best friend’s child does not. It does not make your child worse, or hers better.

Mothers who have babies who sleep all the time during the first few days are concerned that 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 that their baby’s activity, sleep, and fussiness is different, not normal. This probably occurs for two reasons: most parents have little experience 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 the general behavior of one infant distinguish it from another.

During the first few days the baby will sleep much of the time, most up to 18 to 20 hours per day. When he/she is awake, he/she will demand as much of your attention as you can give. Until birth, he/she has been fed through the umbilical cord. After birth, he/she has to develop a feeding pattern, and that takes time. Do not be surprised or concerned that he/she does not have a regular schedule, or that he/she wants to eat immediately when he/she decides that it is time to eat. For him/her, hunger is a brand new sensation.

When awake, he/she will be looking around, moving arms, 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 him/her, laugh and talk together, and hold him/her. He/she will respond to your voice, to your singing or to your humming. This early stimulation is extremely important.

When a new infant is not looking around or eating, he/she is sleeping. Contrary to the popular belief, an infant’s sleep is not necessarily peaceful and undisturbed. Most will grunt, move about, draw up the legs, and move the head from side to side during sleep. This does not mean he/she is uncomfortable or having difficulty with sleep. It is normal baby behavior and should cause no concern.

Sudden loud noises and sudden movement will cause what is known as a “startle response,” and it is usually followed by a prolonged cry that 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 the first few days help determine his/her subsequent responses to you, and surprisingly, your responses and feelings toward him/her for years to come. Make room in your schedule of activities for quiet, undisturbed periods with him/her. These times of quiet play will pay large dividends in the future.

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