Newborn Appearance Questions

When To Call

Call 911 Now

• Can't wake up
• Not moving or very weak
• Bluish (or gray) lips, tongue or face now
• You think your child has a life-threatening emergency

Go to ER Now

• Hard to wake up
• Weak or absent cry and new-onset

Call Doctor or Seek Care Now

• Age less than 1 month old and looks or acts abnormal in any way
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Swollen breast is red or tender to touch
• Soft spot on top of head looks swollen
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Urine color is pink, orange or peach
• Swelling on head from the birth process looks abnormal or too large
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Normal newborn's appearance

Care Advice

Breast Questions: Swollen Breasts

• Swollen breasts are present during the first week of life in many babies. Breasts can be swollen in both girl and boy babies. The nipple area is always firm.
• Cause. The passage of the mother's estrogen across the placenta.
• Newborn Milk. Sometimes, the nipples leak a few drops of milkish discharge. This is normal and can last a few weeks.
• Normal Course. Swollen breasts often last for 2 to 4 weeks. In breastfed babies, some breast swelling can last for 6 months.
• Caution: never squeeze or massage the breast or nipple. Reason: can cause a serious infection.
• Call your doctor if: swollen breast develops any redness, streaking, or tenderness.

Ear and Nose Questions:

• Ear Folded Over. The ears of newborns are commonly soft and floppy. Sometimes one of the edges is folded over. The cartilage will slowly harden over the first few weeks. This will cause the outer ear to assume a normal shape.
• Flattened Nose. The nose can become misshapen during the birth process. It may be flattened or pushed to one side. It will look normal by 1 week of age.

Eye Questions:

• Bleeding in Eye. A flame-shaped red streak on the white of the eye is common. It's harmless and due to a birth canal injury. The blood will go away in 2 to 3 weeks.
• Swollen Eyelids. The eyes may be puffy due to pressure on the face during delivery. They may be puffy and reddened if silver nitrate eyedrops were used at birth. This irritation should clear in 3 days.
• Tear Duct, Blocked. A constantly watery eye may be a sign of a blocked tear duct. A channel normally carries tears from the eye to the nose. A blocked tear duct means this channel is blocked. See that care guide.

Genital Questions (Female):

• Vaginal Tags. The hymen can be swollen due to maternal estrogen. It can have smooth ½ inch (12 mm) projections of pink tissue. These normal vaginal (hymenal) tags occur in 10 percent of newborn girls. They slowly shrink over 2 to 4 weeks.
• Newborn Vaginal Bleeding. Baby girls can have some minor vaginal bleeding. It can start any time from 2-10 days of life. This is normal and called false menses. The cause is the sudden drop-off in the mother's estrogen (a hormone) after birth. The blood-tinged or pink discharge should not last more than 3 or 4 days.

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 slowly goes away over 6 to 12 months.
• No Testicle (Undescended). The testicle is not in the scrotum in about 4% of full-term newborns. Many of these testicles gradually descend into the normal position during the following months. By 1 year of age, less than 1% of all testicles are undescended. These need to be brought down surgically.
• No Testicle (Undescended). The testicle is not in the scrotum in about 4% of full-term newborns. Many of these testicles gradually descend into the normal position during the following months. By 1 year of age, less than 1% of all testicles are undescended. These need to be brought down surgically.
• Tight Foreskin. Most babies that aren't circumcised have a tight foreskin. Because of this, you can't see the head of the penis. This is normal in infants. The foreskin should not be pulled back.
• Circumcision. A circumcision is the removal of most of the male foreskin. For questions about circumcisions, see that care guide.

Hair Questions:

• Scalp Hair. Most hair at birth is dark-colored. This hair is temporary and begins to shed by 1 month of age. Some babies lose it slowly while the permanent hair is coming in. Others lose it quickly and become bald for a short time. The permanent hair will begin to appear by 6 months. It may be an entirely different color from the newborn hair.
• Body Hair (Lanugo). Lanugo is the fine, downy hair that is sometimes on the back and shoulders. It is more common in premature infants. It is rubbed off with normal friction by 2 to 4 weeks of age.

Head Questions:

• Caput is a swelling on top of the head or throughout the scalp. It is due to fluid squeezed into the scalp during the birth process. Caput is present at birth and clears in a few days. It's normal, harmless and painless.
• Cephalohematoma is a collection of blood on the outer surface of the skull. It is due to friction between the skull and the pelvis during birth. The lump is usually confined to one side of the head. It does not cross the midline. It first appears on the second day of life. It may increase in size for up to 5 days. It doesn't go away completely until 2 or 3 months of age. Call your doctor if: the swelling becomes large.
• Molding refers to the long, narrow, cone-shaped head. This is from passage through a tight birth canal. This compression of the head can temporarily hide the fontanel (soft spot). The head returns to a normal shape in a few days.
• Soft Spot (Anterior Fontanel). The front "soft spot" is diamond-shaped. It is 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. It 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 and triangular-shaped. It closes between 2 and 3 months. The soft spot normally looks flat or a little sunken. It may pulsate with each beat of the heart. This is normal. The only abnormal soft spot is one that is bulging (swollen).
  A sunken soft spot is not a sign of illness unless the baby is dehydrated. Then it would be very depressed and the baby would not act well.
  

Leg and Feet Questions:

• Bowed Legs. The lower legs (tibia) normally curve in. This is because of the cross-legged posture while in the womb. If you stand your baby up, the upper legs will be bowed. Both of these curves are normal. These curves 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. This is due to the cramped quarters inside the womb. This is normal if the feet can be easily moved to a normal position. The feet should be flexible. 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 cut into the flesh.

Mouth Questions:

• Tongue-Tie. A short, tight band that connects the tongue to the mouth in newborns. This band normally stretches with time, movement, and growth. Tongue-tie rarely causes any symptoms.
• Epithelial Pearls. Little white-colored cysts can occur in the mouth. Look along the gumline or on the hard palate. These are due to blockage of normal mucus glands from friction with sucking. They go away by 1 to 2 months of age.
• Teeth:
• The presence of a tooth at birth is a rare event.
• About 10 percent of them are extra teeth without a root structure.
• The other 90 percent are prematurely erupted normal teeth. The distinction can be made with an X-ray.
• The extra teeth should be removed, usually by a dentist.
• The normal teeth need to be removed only if they become loose. Reason: risk of choking. They should also be removed if they cause sores on the tongue.

For Newborns, Always Call Your Doctor If:

• Your baby starts to look or act abnormal in any way
• You think your child needs to be seen

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