> Newborn Topics
New parents often have many questions about their babies. We've got the answers!
The following is helpful information on various topics affecting newborns, including birthmarks, fussiness, and SIDS.
Many birthmarks are present at birth, some actually show up months later but are still called birthmarks. The most common are:
- Angel's Kisses: Flat, reddish areas on the eyelids, forehead, nose, or upper lip. They fade over time.
- Stork Bites: Similar reddish areas on the nape of the neck or back of the head, sometimes along the spine. They fade over time.
- Mongolian Spots: Purplish areas most commonly in darker pigmented babies. They tend to be over the sacrum (tailbone) but can be anywhere on the body, sometimes extensive. They fade over time.
- Hemangiomas: Reddish areas that start flat but grow, sometimes to large sizes. They are called "strawberries" because they resemble strawberries growing out of the skin. They are not treated unless they obstruct vision or obstruct the airway/breathing. Most grow the first 18 months of life and then shrink until gone by school age.
- Cafe au Lait: Tan, flat areas that develop during life. Most people develop 1-2 of these. More than 6 may be associated with medical conditions, especially if the child has freckles in the armpits or groin or there is a family history of neurofibromatosis.
Newborns have the thick, black, tarry meconium the first week or so. It transitions into a greenish color before becoming yellow after feeding is established. Babies may grunt and turn colors (red or purple face) as they try to pass stool. This is normal.
In babies not eating solid foods, constipation is defined by the consistency of the stool, not the frequency or behaviors associated with stooling. Any formed stool is constipation. Talk with our staff during office hours if you think your baby is constipated. Normal stool colors may change from yellows to browns to greens.
Formula fed babies transition from the meconium stool to yellow stools faster than breast fed babies since they get food from the beginning. Their stools are pasty yellow/brown and usually 1-3 times per day.
Breastfed babies take longer to develop the transition stools, then their stools typically are yellow, watery and seedy (looks a lot like watery yellow cottage cheese). Stool color changes depending on what the mother eats. They may poop every time they eat (plus in between) or may stretch out their bowel movements once their gut matures to once every 2 weeks. That's right: Once every 2 weeks is normal as long as the stool is soft!
For more on poop, see Dr. Stuppy's blog Infant Poop: What's Normal and What's Not?
Term newborns usually have lumps under their breasts. This is breast tissue, normal in males and females. It is from mother's hormones acting on the baby's tissues. It may be prolonged in breastfeeding babies since they get hormones through the milk, but is not a cause for concern. Do not squeeze or press hard on the enlarged breast. Milky discharge is normal, but call the office during regular hours if the breast discharge becomes bloody.
Breastfeeding is discussed in our Breastfeeding section
Newborns breathe faster than older children and adults and 30-60 breaths per minute can be normal. Be sure to count their rate for a complete minute because over- or under-estimation is possible.
- Many infants will breathe very rapidly for a few seconds, followed by a pause for several seconds. This is called periodic breathing.
- If the overall respiratory rate is persistently over 60 breaths/minute, if it becomes difficult for your baby to eat and breathe, or if you see the belly moving up and down and ribs sucking in, your baby might be having respiratory distress and should be evaluated.
- Pauses that last longer than 15-20 seconds are abnormal. (A pause less than 15 seconds with periodic breathing is normal, but seems like an eternity to the parent!)
- All infants must be rear facing in the back seat of the car in an approved car seat.
- For car seat information, see the Car Seat Guide.
- Do not put baby in too many layers or thick clothing, as the seatbelt cannot be tight enough. If cold, put blankets on top of the seatbelt.
- Ask our staff for a car seat identification sticker.
- Do not use any head rests or other products that were not sold with (and therefore tested with) your seat. If baby's head needs support, roll a couple blankets and put them on the sides of baby's head.
At the bottom of the breastbone is the xyphoid process (near the bottom of the ribs). This sticks out in many babies and is perfectly normal.
- Many newborns seem to have sniffles "all the time", worsening with sleep or feeding.
- Positioning the head above the heart, by elevating the head of the bed about 45 degrees, can often help with this. (Never put baby's head on a pillow! Place folded towels under the mattress of a bassinette or elevate one half of the crib and put a rolled blanket in a "U" shape under baby's knees/around his buttocks to keep baby from slipping.)
- If baby has mucus in the nose, put saline drops in the nose (1-2 drops per nostril). Sometimes this makes the baby sneeze out mucus: Great! Sometimes you have to use suction to try to get mucus out. You receive a bulb syringe in the hospital, but we find that it can be difficult to use and prefer the Nosefrida or similar product.
- Most often there is no visible mucus causing the noisy breathing. As long as the baby is feeding well and not working hard to breathe or breathing fast, it is usually not cause for concern. Bring it up at a routine check up. If it is causing problems with feeding or breathing, your baby should be seen for an evaluation.
Delicate skin and frequent stooling predispose to diaper rashes. Some parents prefer to prevent them with routine use of a diaper cream. Some might just pay close attention to when the diaper is soiled and change frequently. Diaper wipes irritate the skin, even if they are alcohol free. If there is a rash, wash with water on a soft cloth. Air dry the buttocks before putting cream or the diaper on. A hair dryer on cool setting can be helpful if used carefully. (Don't underestimate the power of air!) Applying a layer of diaper rash cream helps to protect the skin from the next stool. Zinc oxide heals the skin well, but may burn when applied to open or irritated skin. Using a petrolatum jelly based diaper cream works well in this instance. We do not recommend any powders, even Baby Powder can be harmful to babies.
A common problem in babies is a clogged tear duct in one or both eyes. Tears are made in the upper eyelid and drain into the nose through a duct on the lower eyelid. A blocked tear duct causes the eye to appear to water excessively. This is called lacrimal duct disorder. Sometimes a thick, yellow drainage occurs. Unless the white of the eyeball looks red, this is not pink eye. Treatment for a blocked tear duct is massaging the area over the duct with clean hands. Firmly rub the area between the lower eye and the nose. The area will be red when you are finished if you rubbed hard enough. Use a wet cotton ball or clean cloth to wipe any goo out of the baby's eye. Babies fuss with treatments, but it does not hurt them at all. Repeat this process 3-4 times daily until all symptoms are gone for a few days. You may notice that when the baby gets a cold, symptoms return. This is because the tear duct swells again along with other mucus membrane swelling. Simply massage the area again. This problem commonly lasts up to 9 months of age. If it persists at 9 months, we refer to an ophthalmologist (eye specialist) to have the tear ducts probed.
Feeding is discussed in our Feeding section
. If you are concerned that your baby cannot properly latch due to tongue tie please read the information provided below on tongue tie.
Newborns may either get too cold or too warm if they are ill. Usually this is accompanied by poor feeding, excessive sleepiness, or irritability. Dehydration can make the baby's temperature high. Environmental temperature, if too hot or too cold may artificially alter your baby's temperature. Keep room temperature 68°F to 72°F. If baby feels cool, put another layer of blankets on. If baby feels too warm, take off a layer or 2 of blankets/clothing. If after 30 minutes your baby still is too hot or cold, a rectal temperature is most accurate. Do not use any fever reducers/medications. If your newborn baby's temperature is abnormal, call the office or provider on call.
Fussiness is common in babies and has many causes.
- Babies can fuss and turn red or purple in the face when trying to pass gas. Burping more frequently during feedings may help. Using Dr. Brown's bottles, if bottle feeding, may decrease the amount of swallowed air. Gas drops containing simethicone are safe and effective for many babies. Give them 10 min before each feed for a few days to see if they help.
- If a baby is formula fed, sometimes switching formula can help, but talk with the office staff first. Lactose-free milk base formula, soy formula, and formulas with broken down proteins (GoodStart, Ailmentum, and Nutramigen) may help, but knowing which will help an individual baby is trial and error. Please visit our page on how to choose what to feed your baby by clicking here.
- Breastfeeding mothers can alter their diet to eliminate (at least temporarily) certain foods (only dairy has shown evidence of causing gas, but legumes, broccoli, cabbage, tomatoes, caffeine, and chocolate are also sometimes blamed). If the elimination diet works, slowly re-introduce foods one at a time to see if that is tolerated. If baby remains happy after a few days to a week, add another food in. If baby begins being fussy again, stop that food again. After a few months you can try that food again, as baby's gut matures.
- Colic occurs between 3 weeks and 3 months. It has no known cause, but babies tend to cry for hours, usually in the evenings, at least 3 times per week. Changing rooms, wrapping tightly, putting in a vibrating seat, taking a car ride, rocking, holding, singing, and massage have all been helpful, though none is full proof. Gripe Water is an herbal solution that many claim to help fussiness and colic. Ask your pharmacist if they carry it. A great resource is the website The Period of Purple Crying.
- Hair only needs to be washed 1-2 times per week.
- The scalp (and even face) may develop scales, otherwise known as cradle cap. You can use a soft brush to massage the scalp. Unless the baby scratches it a lot, it does not need to be treated. In that case, using hydrocortisone cream twice a day for a week usually helps. After 6 months of age, use a dandruff shampoo containing selenium sulfide twice a week to loosen the scales. Do not get this shampoo in the eyes!
- It is common that babies get a bald spot on the back of their heads by 4 months of age. This is from friction breaking the hairs as they move their head back and forth. It will grow back when baby spends more time off the back of his head, so practice tummy time to strenghen muscles!
Head Shape and Contour
- Molding: The head is often molded from birth, and the cone head disappears within a few days.
- If there is a hematoma from birth (soft, squishy, bruised part of the scalp) this may take months to go away completely and sometimes hardens first.
- The soft spot typically is open until about 2 years of age to allow for rapid head growth the first 2 years. It sometimes appears to pulsate, this is normal. If you touch the soft spot, it is ok, you will not hurt the brain.
- Lymph nodes: Often you can feel pea-sized bumps under the scalp (most commonly behind the ears). These are lymph nodes and are normal in infants.
- Flat head: Prevent flat head by alternating the side of the head your baby sleeps on. Tummy time also prevents flat head.
- For more on head lumps and bumps see Bumps, Ridges and Soft Spots on Baby's Head.
All babies tend to hiccough often (many begin in the womb, and mothers complain of a repetitive pounding on their bladder). This is caused by an immature neurologic system and usually does not bother the baby at all. If it does, feeding or burping may stop the hiccoughs.
Newborn Screening Tests
In the hospital your baby will be screened for many conditions that affect their health.
- Before leaving the hospital they will have a test for yellow jaundice (see below).
- They will also have a check of their oxygen level on a hand and foot to screen for a serious type of heart defect.
- A few drops of blood from their heel will be sent to the state lab to test for many conditions on the State Newborn Screen.
- A hearing screen will be done.
Postpartum depression (PPD)
is the most common complication of childbearing. The Edinburg Postpartum Depression Scale is a simple questionnaire that we will give over several visits during the first months of your new motherhood. If you have concerns, even if you score in the normal range, please speak with your doctor.
Whoever said "clear as baby soft skin" wasn't looking at a real baby!
- Newborns typically have blotchy, red, dry and scaly skin.
- Acne is common during the first 1-3 months. It usually goes away on it's own with gentle cleaning with water and a light moisturizer, such as Cetaphil. We will occasionally prescribe a medication for severe acne that causes discomfort to the baby (not just annoyance to the Mom!)
- Care of Skin: They do not get very dirty, so babies only need to be bathed a couple times per week. Use a mild soap, such as a baby wash or Dove. Use plain water on the face. Acne on the face or spreading to the chest does not require any treatment. Do not pop the "zits" or put any creams on it. If the skin is flaking the first 1-2 weeks, that is normal and you do not need to use lotions. If the skin develops rough, dry patches, use a white, non-fragranced lotion. Some good products include Cetaphil, Aveeno, Eucerin, Moisturel, Aquaphor, and plain petrolatum jelly.
- Babies should sleep on their backs on a firm surface without soft bedding to reduce SIDS (Sudden Infant Death Syndrome).
- Amount of sleep varies greatly, but all newborns should be awake long enough to feed at least 8 times per 24 hour period. Some seem to have alert times for a few hours per day (often in the middle of the night).
- To encourage your baby to sleep at night and be alert during the day: Talk, sing, coo, and play during the day when baby is up for feeds. At night just feed and change diapers.
- Swaddling babies tightly often helps encourage sleep, but keep their legs loose so they can move them within the swaddle. Stop the swaddle when baby starts to roll over, typically between 4 and 6 months of age. Swaddling is associated with SIDS in babies who roll.
- Getting sleep for parents: Help Baby learn to sleep longer stretches at night instead of the day by being more fun during the day. Talk, sing, and interact during daytime wakeful periods. Just feed and diaper change at night without the fun stuff. Baby will eventually learn that you want to play more during certain times and rearrange sleeping schedules. Be patient and take naps during the day if possible.
- Baby 411 by Denise Fields and Dr. Ari Brown gives a great review of various books on encouraging your baby to sleep. A good reason to read the reviews is to see what the advice is before buying the book. For instance, if you will never co-sleep, do not buy books that encourage 24/7 contact with the baby! If you cannot listen to your baby cry, do not rely on a method that supports crying it out.
If your baby seems to have trouble latching or effectively breastfeeding, we should evaluate for possible tongue tie. For more information, view the tongue clipping information in the Babies and Infants section
Start putting baby on his or her tummy for play time
from day one. The earlier you start, the less baby hates it. Some even enjoy it. The more awake time they spend on their tummies, the earlier they roll and crawl. Be sure to keep a close eye on baby whenever doing tummy time, and roll baby to the back for sleep.
- The regular use of alcohol to clean the umbilical cord is no longer recommended. Simply keeping the cord dry is all that is needed.
- Be sure the diaper doesn't cover the area, or it will stay moist.
- If the cord gets goopy, it is ok to use rubbing alcohol to clean the area by pulling back on the cord and wiping around the base of it.
- Cords often bleed a little when they fall off. Unless the blood soaks into the clothing or diaper, this is ok.
- Cords typically fall off by 2 weeks of age. If not off by 2 months, discuss options with your doctor at the 2 month visit.
- It is common to have a grey/brown dark area at the base of the belly button once the cord falls off. This is not dirt and does not need to be cleaned. It fades over time.
Before babies get feeding well established, they are at risk for dehydration. Count to be sure they urinate 3 times a day the first day home, then at least 6 times a day after the 4th day of life. Putting a square of tissue paper in the diaper helps to identify the urine, since the diapers are super absorbent. One of the early signs of dehydration is uric acid crystals in the urine. These look red, pink or orangish on the diaper - often referred to as "brick dust". These crystals go away when your baby feeds well and rehydrates. If your baby urinates less than twice per 24 hour period or is feeding poorly after leaving the hospital, please call the office.
As babies start to soak their diapers, some of the diapers lose gel-like crystals onto the skin. This is actually part of the diaper itself and is of no concern.
Most female newborns develop a mucousy vaginal discharge. Some even have vaginal bleeding, similar to a period. This is all normal from the mother's hormones acting on the baby's uterus. It may be prolonged in breastfeeding babies since they get hormones through the milk, but is not a cause for concern.
All newborns should receive Vitamin K to prevent severe bleeding during the first several months of life. For more on this, please see Dr. Stuppy's blog 7 Vitamin K Myths Busted
Sixty percent of newborns have at least some amount of yellow jaundice. That is why all hospitals in this area currently check a level before discharge. It is caused by the normal breakdown of red blood cells making bilirubin (similar to when your bruise breaks down into a yellow-green color). Until the liver matures at about 4 days of age, the newborn's bilirubin level can rise. Low levels are very safe, even helpful in some ways for the newborn, but high levels are dangerous.
For whatever reason, the yellowness shows first in the eyes, then the face, then progresses down the body. If the upper body (above the breasts) is the only place that shows the yellow color, it is generally low enough. As it is seen on the abdomen and legs, it is high enough to monitor with labs and possibly need treatment.
Treatment of higher levels may include phototherapy with blue lights and improving hydration. Many people place babies in front of a sunny window to let sunlight fall on exposed skin, but this is not
recommended. If they are exposed, babies are at risk of getting too cold. The UV protection found in most windows blocks the light from helping break down the bilirubin. Direct outdoor sunlight is not recommended because of sunburn.