Your newborn has a lot of confusing bits and pieces that change quite a lot in the first few days. We tell you what’s normal and what’s not.
New parents often expect their little newborns to arrive chubby and flawless. But instead of a perfectly smooth skinned baby, the newborn infant emerges with some strange attributes – mottled skin, puffy eyes and an odd-shaped head. Then there’s the cord to look after and, in some cases, a circumcision wound.
Fortunately, the vast majority of babies are healthy and develop normally, and most of the little surprises your little one has in store for you are completely normal.
Here are some to look out for:
What’s normal: After birth, the umbilical cord that delivered nutrients and oxygen to your baby is clamped and cut. Over the next two weeks, the remaining stump of the cord dries and drops off. As it shrivels up, the cord changes colour from white and waxy, to brown or black. Parents are sometimes alarmed by the rather odd looking result, but it is completely normal.
Sometimes, there is a small amount of yellowish fluid or blood where the cord has dropped off. This should dry in a day or two, and is nothing to worry about. If you keep the cord area clean and dry, infection is very unlikely. Clean the area twice daily and make sure it’s thoroughly dry. Fold the nappy down to keep the stump free of nappy contents and out in the open air. Only apply ointment that has been recommended by your doctor.
What’s not: You should consult your doctor if you notice any of the following:
- Pus or red, tender skin around the base of the cord stump
- Oozing fluid with a nasty smell from the site a few days after the cord has dropped off (it’s not uncommon in the first day or two, but it should dry in a couple of days)
- A bulging navel. Umbilical hernias often close on their own, but have it checked by your doctor
- Red or pink tissue at the site of the navel, after the cord has dropped off. This condition, called umbilical granuloma, is usually easily treated with silver nitrate (a burning chemical) or, in the case of a larger granuloma, with minor surgery
- Your baby seems to find it painful when you touch or clean the area
What’s normal: Initially, the penis tip may be slightly red and swollen and there may be a drop or two of blood. Occasionally, a slight whitish or yellowy crust appears as the penis heals. The circumcision site should be completely healed in seven to ten days.
- Any sign of infection, such as swelling, pus, smell, discolouration or discharge
- Not urinating normally
- Tip: Keep the area clean and dry it well. Your doctor will give you cream or powder to apply, and may recommend that you put a dab of unscented petroleum jelly on the nappy, to prevent the wound sticking to the nappy.
What’s normal: Jaundice is a fairly common condition amongst newborns, and is generally not cause for too much worry. It refers to the yellow colour of the skin and/or the whites of the eyes, caused by excess bilirubin the baby’s blood. Bilirubin is produced when red blood cells are broken down. The liver processes this bilirubin and gets rid of it.
The reason why jaundice is so common in newborns is that have too much bilirubin and their immature livers are not efficient at breaking it down. This “normal” jaundice usually appears about two days after birth, and clears up in a week or two. In mild cases, your baby’s body will take care of things on its own. In hospital, your baby may be treated with phototherapy – a special light that helps get rid of the bilirubin. Frequent breastfeeding also helps. Premature babies are even less able to process bilirubin, and so are prone to jaundice.
What’s not: Consult your doctor in these instances:
- Jaundice is present in the first 24 hours
- Jaundice persists. It may be a sign of a more serious condition, either liver disease, or blockage of the bile ducts. Infections, genetic problems and metabolic conditions could be involved.
- The colour is getting more intense or spreading
- Your newborn becomes floppy and lethargic and sleeps for more than four hours between feeds
NOTE: High levels of bilirubin can cause brain damage. It is not possible to judge the severity of jaundice just by looking at a baby. Therefore, it is recommended that if your baby appears to have jaundice, you take her to your doctor. He will test bilirubin levels and, based on that, suggest appropriate treatment.
Little bumps around the nose
What’s normal: Milia, those tiny white bumps on the baby’s nose, cheeks or chin are quite common, affecting about 50% of newborns. Some babies have just a couple, others have many. Milia are benign cysts of tiny skin flakes trapped under the surface of the skin. As the outer layer of skin gets sloughed off, the bumps disappear. This happens after a few weeks or months. Do not squeeze, scrub or medicate this harmless condition – your baby will be blemish-free shortly.
What’s not: If you are concerned, or not sure that the spots are in fact milia, ask your doctor or nurse to check them out. The majority of little spots and blemishes on a baby are completely harmless and normal. The more problematic spots tend to be the ones that form part of a rash or are blistery. A rash is a common symptom of a variety of childhood illnesses, in which case it is often accompanied by a temperature. Your baby may be fussy and niggly too, an indication that he’s not feeling well. If this is the case, see your doctor.
More harmless (if odd!) baby skin conditions that should clear up quickly on their own:
Baby acne is slightly different to milia. It is caused by the mother’s hormones coursing through a newborn baby’s bloodstream
Dry and peeling skin is not uncommon in newborns, and will clear up on its own.
Heat rash shows up as small pinkish red bumps, usually on the areas that tend to get hot and sweaty, like the neck and between the skin folds. Don’t overwrap your baby – rather dress your baby in layers that can be stripped off as the day warms.
What’s normal: A thin white coating of milk on your baby’s tongue is nothing to worry about.
What’s not: Thrush, a fungal infection, also presents as a white coating on the tongue, but it is a thicker coating and will usually be present on the inside of the cheeks too, and sometimes the lips and gums. To test whether it’s just milk, use your finger to try and wipe it away.
Milk will wipe away fairly easily, but thrush won’t. A milk coating will tend to be most obvious after a feed, whereas thrush is quite persistent, often going on for weeks if not treated. Your baby may be uncomfortable while feeding. If your baby has a stubborn, red nappy rash too, you are probably dealing with thrush.
Speak to your clinic sister about treatment, and, if you are breastfeeding, about how you should treat yourself – the infection is often passed back and forth between your nipples and your baby.
More strange baby stuff!
A baby’s head is made up of separate boney plates, not one big round bone. This allows the head to squeeze through the birth canal more easily. Sometimes, babies emerge with a slightly asymmetrical or elongated head. This is usually nothing to worry about, and the head will normalise quite quickly.
Occasionally, young babies have a slight yellowish discharge from the eye. Use boiled, cooled water to wipe her eyes and the discharge should go away. Some moms swear that the antibodies in breastmilk will clear up minor eye problems – just express a few drops directly into the eye. If it doesn’t clear in a day or two, or if the discharge worsens, it may be an infection that requires treatment. Consult your doctor.
Occasionally, small blood vessels in the eye burst during delivery. You may notice them in the whites of the eye.
Mom’s hormones flowing through baby’s body may cause swelling of the breasts (in boy babies too). Girl babies may have swollen labia and even have a little bloody discharge from the vagina for the same reason.
Newborn babies often appear mottled due to their immature circulation. Hands and feet may feel cold. That’s all normal. However, if your baby has a persistent bluish tinge, that may indicate a problem. Consult your doctor immediately.
This sticky substance is meconium, baby’s first stool. It is made up of what the baby has ingested in utero, plus cells from the digestive tract.
NOTE: See your doctor if you see any of the following symptoms:
- A cold
- Unusual or high-pitched crying
- Sudden change in behavior
- Loss of appetite
Immediate medical attention should be sought in the case of:
- Floppy limbs or extreme drowsiness
- Blood in the stool or vomit
- High fever
- Difficulty breathing.