Understanding Your Newborn

While each baby is a unique individual, there are certain characteristics and behaviors that are common to newborns. There are many typical physical and behavioral traits you may notice in your baby during the first few weeks of life.

Bowel Movements
Constipation and Diarrhea
Diaper Rash
Ear Discharge
Ears
Eye Color, Tears, and Swelling
Eye Discharge
Head Shape
Milia
Mucus
Pain
Peeling
Rashes
Red Spots
Skin Color
Soft Spots
Spitting Up and Vomiting
Swollen Breasts
Urinating
Vision

Head Shape
Your baby’s head may be temporarily misshapen from pressure occurring during birth. Normal head shape usually returns by the end of the first week. Babies delivered by Cesarean birth may not have this head molding.

Soft Spots
Your baby has two obvious soft spots or fontanelles. One is on the top of the head and the other is near the back of the head. A tough membrane covers both fontanelles. With normal handling and care, soft spots can’t be damaged from shampooing, brushing, or stroking your baby’s head. The soft spot in the front usually closes by 18 months of age and the one in the back by two to six months.

Eye Color, Tears, and Swelling
Caucasian infants usually have grayish-blue eyes at birth; some will have blue-brown eyes. Infants of other ethnic backgrounds may have grayish-brown, blue-brown, or brown eyes. An infant’s true eye color may not be known for several months.

Tear ducts are small at birth. Tears are usually not produced in noticeable amounts with crying until your baby is one to two months of age.

Swollen, puffy, or red-looking eyes are often noticed after delivery and result from pressure during birth. Swelling and inflammation usually go away in a few days.

Eye Discharge
Occasionally, a baby’s eyes may be irritated from the antibiotic ointment given at birth. You may notice a small amount of yellow discharge from your baby’s eyes during your hospital stay. This usually clears up within 24 hours. Continued yellow discharge or crusting on your baby’s eyelids and lashes could be symptoms of infection and your baby’s doctor should be notified. White matter collecting in the inner corner of the eye may be from a blocked tear duct. Gently wash it away with a soft cloth.

Vision
A newborn’s eyes often do not seem to work together. As the eye muscles strengthen, the baby’s eyes should focus in line with each other. Babies are near-sighted at birth. They see objects best that are 8 to 12 inches from their noses. When you talk to your baby, hold him close to your face so he or she can see you. Your baby sees in color and prefers bright colors, black and white, and circular shapes  

Ears
Newborns have a wide variety of ear sizes, shapes, and positions that are normal. At birth, your baby’s ears may bend easily. In time, the ear will feel firmer.

Ear Discharge
It is normal for a baby’s ears to produce wax. It is not normal for them to produce any other kind of discharge. Consult your baby’s doctor if you think the discharge from your baby’s ears is not wax. Q-tips should not be used in your baby’s ears at any time. Ears can be cleaned well with the corner of a clean, damp washcloth.

Swollen Breasts
It is normal for both male and female newborns to have swollen breasts during the first days after birth. Hormones transferred from the mother to the baby during pregnancy cause this swelling. Occasionally a baby may produce a small amount of milk. If your baby does produce milk or have breast swelling, do not attempt to squeeze out the milk. Doing so can cause infection. The swelling goes down as the baby’s body rids itself of mother’s hormones.

Skin Color
A newborn’s skin is thin and dry. You may even see blood veins through your baby’s skin. The skin of Caucasian newborns is a pink to reddish color. African-American infants’ skin appears as a reddish-black color that darkens as the baby gets older. In Asian babies, the skin is a tea rose color. When babies cry, they all may become a deeper red.

Frequently, dark bluish spots may appear on the lower portion of the back, buttocks, or limbs of babies who are African-American, Asian, Mediterranean, or American Indian. They are caused by a temporary accumulation of pigment under the skin and they usually fade during the preschool years.

It is common for a newborn’s hands and feet to appear bluish. This is called acrocyanosis. In the first few days of life, a baby’s circulatory system is not yet efficient at getting blood to the extremities.

Milia
Milia are tiny white spots that often appear on a newborn’s nose and chin. They are caused by obstruction of oil or sebaceous glands. You should not squeeze these spots. They usually disappear in several weeks.

Rashes
A temporary rash, called erythema toxicum may occur during the first few weeks. This rash consists of small areas of redness with raised yellowish-white centers. It may resemble a fleabite. No treatment is required, and it does not make the baby uncomfortable.

Red Spots
Red spots can often be seen at the nape of the neck. They do not fade. Many babies also have reddened areas of skin on their upper eyelids and forehead. These areas usually fade with time, as the baby’s skin grows thicker and less transparent. Redness may reappear when your baby cries.

Peeling
Most babies’ skin peels after birth because they have been in fluid for many months. This generalized peeling is completely normal and requires no treatment.

Pain
All newborns are assessed for pain once per nursing shift, and before and after painful procedures. Newton- Wellesley Hospital uses the Newborn Infant Pain Scale (NIPS) to determine your newborn’s comfort based upon behavioral responses.

Mucus
For the first few days of life, your baby may have excess mucus that may cause gagging and vomiting. Feeding can loosen the mucus in your baby’s stomach so gagging may be more noticeable at this time.

If your baby gags or spits up mucus, turn the baby on his or her side. Gently pat your baby’s back. Once your baby has calmed down, the feeding may be continued. You may need to use a bulb syringe to gently suction the mucus out of the lower cheek area of the baby’s mouth or from the nose. Ask your nurse for instructions.

Spitting Up and Vomiting
All babies tend to spit up during their first week or so. This is usually a small amount of milk solids associated with a feeding, such as a wet burp. The baby usually brings up only about a teaspoon of formula or breast milk. If it has been awhile since a feeding, the milk may be partially digested and look curdled.

Spitting up can also be caused by air trapped in the stomach. Burp your baby prior to feeding if your baby has been crying for a while. Babies swallow air when they cry. It is also helpful to hold your baby slightly upright during feeding. In this position, air can rise above the milk. Be sure your baby has a good hold on the nipple to prevent taking in a lot of air.

Spitting up in a forceful way, causing milk to hit the floor as much as three or four feet away, is called projectile vomiting. Your physician should be notified if this type of vomiting occurs regularly or any time your baby is vomiting and also has a fever, diarrhea, or is listless.

Diaper Rash
Irritants in the urine or stool often cause diaper rash. Change your baby’s diaper frequently (every two to three hours during the day). Always wash the diaper area with plain water at each change. If you launder your own diapers, double rinses with one-half cup of vinegar per rinse load may neutralize ammonia and help to eliminate any soap.

If your baby develops a rash in spite of these precautions, try to change diapers more frequently and expose the reddened area to the air several times a day. A diaper rash ointment applied to the rash area after air-drying may be helpful. Occasionally, babies develop a yeast infection of the diaper area. This must be treated with medication prescribed by the baby's physician. If any rash doesn't improve within a few days, please contact your baby’s doctor.

Bowel Movements
During your baby’s first day or two of life, his or her stools will be thick, tar-like and greenish-black. This substance is called meconium. Stools will change to a brown-green and then yellow color as your baby begins to feed.

Breastfed babies have frequent loose yellow stools by their third or fourth day. During the first several weeks it is not unusual for your baby to have a bowel movement with every feeding. If your breastfed baby is not having two to ten bowel movements per day by the third to fifth day of life, it is suggested that you call your baby’s physician to assess the baby’s feeding patterns and possibly arrange for a weight check. After a month or so, your baby may begin to have a bowel movement only every few days.

If your baby is formula fed, stools at first may look seedy and then change to a pasty yellow. For the first week, your baby may have bowel movements with each feeding. After awhile, this will change to one to four bowel movements a day.

Constipation and Diarrhea
A breastfed baby will not become constipated as long as breast milk is his or her only food. Formula-fed infants are more likely to become constipated. A constipated stool is one that is hard, painful to pass, and may resemble pebbles. Recommendations for relieving constipation are varied. Therefore, we suggest you do not use any type of enema, suppository, or laxative without first contacting your baby’s physician.

Because they are loose and frequent, normal breast milk stools are sometimes misidentified as diarrhea. It is unusual for a breastfed baby to have diarrhea if he or she is only fed breast milk.

• Contact the baby's physician right away if:
  • Your breastfed or formula-fed baby has unusually frequent bowel movements that are watery, greenish in color and/or contain mucus and/or blood.
  • Your baby exhibits other signs of illness such as fever, fussiness and poor appetite, or floppiness.

Urinating
A baby’s urine is normally clear and light yellow in color. Occasionally, brick-colored flecks may appear in a baby’s diaper or urine. This is normal in the first few days of life. Usually, a baby has one wet diaper a day for each day old until about the sixth day. A baby will begin to have six to eight wet diapers a day for the next several months. It is very difficult to know how many wet diapers a baby has if you are using disposable diapers. If you are concerned that your baby is not urinating, place a Kleenex or small piece of paper towel in the disposable diaper to detect urination. If you have concerns, please contact your baby’s physician.