NEWBORN APPEARANCE: COMMON QUESTIONS  

Definition

This guideline covers common questions asked about the newborn's appearance. If your infant is healthy, go directly to the number of the topic that relates to your child for care advice.

  1. Breast Questions.

  2. Eye Questions.

  3. Genital Questions (Female).

  4. Genital Questions (Male).

  5. Head Questions.

  6. Umbilical Cord Questions.

  7. Leg and Feet Questions.

NEWBORN APPEARANCE ADVICE (TOPICS 1-7)

  1. Breast Questions:
    • Swollen Breasts
      • Swollen breasts are present during the first week of life in many girl and boy babies.  They are caused by the passage of the mother's estrogen across the placenta.  Swollen breasts generally last for 2 to 4 weeks, but some puffiness can persist in breast-fed babies.
      • Home Care Advice: Never squeeze breast or nipple because this can cause an injury that becomes infected.
      • Call your doctor if the swollen breast develops any redness, streaking, or tenderness.
  2. Eye Questions:
    • Bleeding in Eye:  A flame-shaped hemorrhage (red streak) on the white of the eye is not uncommon.  It's harmless and due to birth trauma.  The blood will disappear completely in 2 to 3 weeks.
    • Tear Duct, Blocked:  If your baby's eye is continuously watery, he or she may have a blocked tear duct.  This means that the channel that normally carries tears from the eye to the nose is blocked.  More than 90% of blocked tear ducts open up by 12 months old. Call your doctor if it looks infected (see EYE, PUS OR DRAINAGE guideline). Otherwise, discuss with your doctor on next regular visit.
  3. Genital Questions (Female):
    • Vaginal Tags:  The hymen can be swollen due to maternal estrogen and have smooth ½ inch projections of pink tissue.  These normal vaginal (hymenal) tags occur in 10 percent of newborn girls and slowly shrink over 2 to 4 weeks.
    • Vaginal Discharge:  As the maternal estrogen declines in the baby's blood, a clear or white discharge can flow from the vagina at any time between 3 and 10 days of life.  Occasionally the discharge will become pink or blood-tinged (false menstruation).  This normal discharge should not last more than 2 or 3 days.
  4. Genital Questions (Male):
    • Swollen Scrotum (Hydrocele):  The newborn scrotum can be filled with clear fluid.  This fluid is squeezed into the scrotum during the birth process.  It is reabsorbed over 6 to 12 months.
    • No Testicle (Undescended):  The testicle is not in the scrotum in about 4 percent of full-term newborns.  Many of these testicles gradually descend into the normal position during the following months.  By 1 year of age only 0.7 percent of all testicles are undescended.  These need to be brought down surgically.
    • Tight Foreskin:  Most uncircumcised babies have a tight foreskin that doesn't allow one to see the head of the penis.  This is normal in infants and should not be retracted.
    • Circumcision:  A circumcision is the removal of most of the male foreskin. The incision is initially red and tender for 2 or 3 days.  The scab at the incision line comes off in 7 to 10 days.  If a Plastibel ring was used, it should fall off by 14 days (10 days on the average).  Gently cleanse the area with water 3 times a day and whenever it becomes soiled.  Soap is usually unnecessary. Petroleum jelly or an antibiotic ointment can be applied to the incision line after cleansings to keep it soft during healing. Call your doctor if it bleeds more than a few drops or it starts to look infected.
  5. Head Questions:
    • Swollen Head:
      • Caput is a swelling on top of the head or throughout the scalp due to fluid squeezed into the scalp during the birth process.  Caput is present at birth and clears in a few days.  It's harmless and painless.
      • Cephalhematoma is a collection of blood on the outer surface of the skull.  It is due to friction between the skull and the pelvic bones during the birth process.  The lump is usually confined to one side of the head and does not cross the midline.  It first appears on the second day of life and may increase in size for up to 5 days.  It doesn't resolve completely until 2 or 3 months of age.  Call your doctor if the swelling becomes large.
      • Soft Spot (Anterior Fontanel):  The front "soft spot" is diamond-shaped and covered by a thick fibrous layer.  Touching this area is quite safe.  The purpose of the soft spot is to allow rapid growth of the brain.  The soft spot will normally pulsate with each beat of the heart.  It usually closes over with bone between 12 and 18 months of age. (Normal range is 5 to 24 months of age.)  The back "soft spot" is smaller, triangular-shaped and closes between 2 and 3 months.
  6. Leg and Feet Questions:
    • Bowed Legs:  The lower legs (tibia) normally curve in because of the cross-legged posture that the baby was confined to while scrunched up in the womb.  If you stand the baby up, you will also notice that the upper legs are bowed.  Both of these curves are normal and will straighten out after the child has been walking for 6 to 12 months.
    • Feet Turned In, Out or Up:  Feet can turn any which way because of the cramped quarters inside the womb.  As long as the feet are flexible and can be easily moved to a normal position, they are normal.  The direction of the feet will become more normal between 6 and 12 months of age.
    • "Ingrown" Toenails:  Many newborns have soft nails that easily bend and curve.  However, they are not truly ingrown because they don't curve into the flesh.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Pediatric SelfCareNavigator. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 8/2003

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