It’s time to get to know your baby! Many of the most common questions have to do with how your baby looks and behaves. Babies usually have lumps on their heads, swollen body parts, and marks on their skin. They also move in strange ways and make strange noises! Every baby is unique! Let’s take a look at your baby, from head to toe. This will answer a lot of your questions about what is normal and when you should be concerned.
Skin
Skin concerns may be the most common question parents have about their baby. Your baby has been developing and living in liquid for nine months, so some skin changes are natural as your baby adapts to his or her new environment.
Vernix
In the womb a baby’s skin is covered with a sticky coating called vernix. Babies are usually born with at least some of this coating still on the skin. Much of this comes off when the baby is dried off; more comes off with the first bath. It may stick around in the baby’s skin folds for a while. It is commonly found in the armpits, neck folds, and genitals. You do not need to try to remove it. It protects your baby’s skin (which is one reason that the first bath is now delayed). The remaining vernix will dry up and come off, or will be absorbed into your baby’s skin. Some babies, especially if born a little early, have soft, fine hair on their skin called lanugo.
Skin color
Your baby’s skin color depends on ethnicity and activity level. It will change over time. Newborns tend to look darker and redder than their parents. They have extra red blood cells in general, and delayed cord clamping gives them even more. This tends to make their skin look darker for a few weeks to months.
Hair
Some babies have lots of hair and some not as much. It is usually dark but not always. Several things may happen next:
The hair falls out and new hair grows in, but your baby may be somewhat bald for a time. The new hair may be a different color or the same color as at birth.
The new hair grows in under the old hair and gradually replaces it. It may be the same color or a different color.
Nails
The toenails and fingernails grow rapidly and have to be trimmed frequently; if your baby is born after her due date, they may already be long when she is born!
Sometimes it looks like the toenails are digging into the skin (ingrown toenail), but it’s not. They are so soft they sometimes look that way, but they are not really ingrown.
Darker skin at the base of the fingernails is common and normal.
Mottling
You may notice that the baby’s skin appears mottled (dark and light patches) at times, especially if the baby is cold. This is a normal response in the first few months of life. It is called cutis marmorata. It usually goes away by 6 months old.
Purple hands and feet (acrocyanosis)
Babies often get dark red or purple hands and feet. It may happen when they are cold but it can also happen anytime. This is called acrocyanosis and is normal; it is due to the baby’s immature nervous system which controls blood vessels. This can come and go for the first few months of life. It will not harm your child.
If the baby’s lips, face, or body are ever blue this is NOT normal. This is an emergency and does need to be checked right away.
Skin peeling
The skin of newborns tends to peel; they lose the outer layer of skin they had in the womb. You do not need to use lotion but you can if you like. It will not stop the peeling. Be sure to use unscented lotion. You can also use petroleum jelly (Vaseline®)on the skin; it is an excellent protectant. Sometimes the skin around the wrists or ankles cracks a little and you may see a little blood in the cracking; you can use some petroleum jelly in those areas until they heal.
Bruises and scratches
There are often scratches to the scalp, face, or anywhere on the body that happen during the labor process. These heal quickly. Bruising can also appear on the arms and legs, and sometimes the trunk as well. This is also a normal part of the delivery process.
If your baby had a probe attached to the scalp for monitoring, this leaves a scab for a few weeks. It does not usually cause any problems or need treatment.
Mongolian spots
This is a common birthmark in newborns affecting up to 85-90% of Asian babies, more than 60% black, 40-70% of Hispanic, and less than 10% of white babies. Mongolian spots are dark, bluish-gray, flat birthmarks which can be rather large. They are collections of skin pigment cells (melanocytes) close to the skin surface. They are harmless and do not predispose the child to skin cancer or any other diseases. Then medical term for them is congenital dermal melanocytosis. It is the most common pigmented birthmark in children. They can occur anywhere, but tend to be seen over the buttocks, back, and shoulders. They also are relatively common on the arms and legs. They vary greatly in size and shape. A child may have one spot or several. They are darkest at birth and fade during the first few years of life. Most fade away by 2 or 3 years of age and are gone completely by age 5. However, they can persist faintly into adulthood, especially those not over the upper buttocks. They do not cause any problems.
Salmon patches/nevus simplex (“Stork bites” & “angel kisses”)
These are very common birthmarks on the face and the back of the neck. They are flat, pink, irregularly shaped birthmarks caused by dilated blood vessels (capillaries) in the skin. They can turn redder when the baby is crying. They are most common at the nape of the neck (“stork bites”) and on or near the eyelids (“angel kisses”) or on the forehead, often between the eyes. They can also appear on other areas of the face.
About 30% to 40% of newborns have at least one salmon patch. Most patches fade and resolve completely by 1 to 2 years of age. The ones on the back of the neck sometimes last into adulthood. They do not cause any problems.
Café au lait spots
Cafe au lait spots are flat, light brown birthmarks that may be present on any part of the skin. They are common and harmless. They usually get lighter in color as your child gets older.
Sacral dimples
A sacral dimple is a small depression or dimple near the top of the cleft between the buttocks at the base of the spine. It is usually shallow and if the skin is stretched, you can see the bottom of it. Aside from making it difficult sometimes to clean all the poop off the baby’s bottom, they are almost always harmless and cause no problems. They can be a sign of a birth defect involving the spinal cord or the vertebra (bones of the spine) beneath it. However, in these cases the dimple is not usually shallow or closed, and there is usually a birthmark or tuft of hair along with the dimple. Small, closed sacral dimples with no other birthmarks are not usually a cause for alarm or further testing.
Pustular melanosis
This common newborn rash appears as tiny pustules which open to leave a darker freckle on the skin. It only lasts a few days, and the freckles will go away. Babies may be born with both pustules and freckles or only freckles.
Baby acne
Some babies get pimples on their face and sometimes neck and shoulders; these are small red bumps with a whitehead in the center. This may be related to hormonal changes and will go away in several weeks to months. No treatment is necessary. Learn more here.
Milia
These are tiny pinhead-sized white to yellow bumps on the nasal bridge. They are common and are related to blocked sweat glands. No treatment is necessary; they will go away in several weeks.
Heat rash
This rash is common in infants. It appears as small, flat red spots on the face, neck and chest, often in skin creases. It tends to come and go. Keep your baby dressed in light, cotton clothing in hot weather. Sometimes a small amount of baby powder (cornstarch based only) can help to keep the skin dry.
Erythema toxicum
This scary sounding rash is completely normal and harmless. It appears as red blotches, most commonly on the chest and neck. Some will have a yellow or white bump in the center. These blotches tend to come and go rather rapidly. This is a common newborn rash and no treatment is necessary. They usually start to appear on the second or third day of life and can keep occurring, often moving to different parts of the body. It usually resolves by 2 weeks of age.
Head
Babies are born with their skull bones separated so that the head can be compressed to fit through the birth canal. After birth, a baby’s head and face is often somewhat misshapen and are not perfectly round. Even if the mother had a c-section, if mom was in labor at all the baby’s head was squeezed. Babies were designed for this! The bones in babies’ skulls are designed to move. The head usually returns to a normal shape in a few weeks.
You also might notice that your baby’s head is large compared to rest of the body.
Molding
Molding refers to shifting of the bones which makes the head and face not perfectly round. You may notice that some bones overlap each other and cause a ridge. They may also be spaced out with a gap between them.
Caput
Swelling of the scalp is called caput succedaneum. It can make your baby’s head appear pointed or cone-shaped. There may be some bruising as well. This occurs when fluid is squeezed into your baby’s scalp from pressure on the head during labor and delivery. It is normal and usually goes away quickly.
If a vacuum was used to assist in the delivery, there is often increased swelling where the vacuum was applied. There is sometimes some bruising there as well.
Cephalohematoma
A cephalohematoma is caused by bleeding under the outer lining of a bone in the head. It causes swelling, usually in a smaller area than caput. It is not harmful or dangerous, but unlike caput it can take a few weeks or months to go away.
Soft spots (fontanels; yes, there are two!)
You will notice a large soft spot (fontanel) where there are no bones on top of the head near the front (and you may notice a smaller one in the back). You may even see it pulsate! The soft spot is not particularly tender or fragile and can be cared for as the rest of the head/scalp. You can touch it! They allow your baby’s brain and head to grow. The one in the back of the head closes in a few months, but the one in front is open until 12-18 months of age.
Facial bruising and swelling
Your baby may have swelling or bruising of the face. The face may also appear to be non-symmetric or misshapen from the swelling and shifting of bones in the head. Both are normal and usually go away quickly.
Eyes
Sometimes a baby wants to open one eye more than the other or not open them very often; this usually resolves in several days. The eyelids are often puffy after delivery. Your baby’s eyes may be a little red and irritated or swollen due to the ointment or drops that were put in them. This will resolve in a day or two.
Red spot in eye (subconjunctival hemorrhage)
It is normal for blood vessels in the eye to break and bleed a little during birth. It is due to pressure in the birth canal. It usually appears as a small, crescent-shaped red spot in the eye. It will go away in several weeks as the body absorbs the blood.
Crossed eyes
It is normal for babies eyes to cross. It should resolve by the time he is 4 months old.
Jerky eye movements
Sometimes babies have jerking eye movements instead of the smooth movement that we are used to seeing. This is usually temporary.
Eye color
This is an extremely common question. Most babies have dark eyes; if they are going to be lighter, this usually happens by 6 months old. However, the eye color can change at any time in childhood.
Your baby’s vision
Babies are born with about 20/200 vision. Your baby can see about a foot clearly, which is about the distance from a breast to a mother’s face, which makes perfect sense. When you talk to your baby, put your face about a foot from the baby’s face.
Ears
While everyone’s ears are soft and bendable, they are especially so in newborns! Sometimes parts of them are folded over; this will go away in a few weeks. The cartilage will stiffen and the ear will take on a more normal contour.
Abnormal curves
Sometimes the overall shape and curves of the ear are not formed properly; it is easier to tell this in a few weeks after the cartilage stiffens up a little and the ear recovers from pressures in the womb and during delivery. The latest guidelines are to treat this early with a device that molds the ear into shape. It is usually treated by plastic surgeons, though surgery is not usually necessary.
Dimples (pits) and skin tags
You may notice small pits or skin tags near the ear; these are common and do not usually cause problems. We used to check hearing in babies who have these; however, now all babies have their hearing checked. Babies with pits or tags or other abnormalities of the outer ear should have another hearing test by 9 months of age.
Since hearing loss is one of the most common birth defects, has no symptoms, and is important for language development at a very early age, all newborns are screened for hearing loss before discharge.
Nose
The nose can appear flattened or pushed to one side. It is made from cartilage, like the ear lobe, which bends easily. The baby’s position in the womb, or more likely pressure during labor, can push or flatten the baby’s nose. This usually goes away in a week or two.
Milia
Milia are tiny pinhead-sized white to yellow bumps on the nasal bridge. They are common and are related to blocked sweat glands. No treatment is necessary; they will go away in several weeks.
Mouth
You may notice small white bumps on the roof of the mouth; these are called Epstein’s pearls and are harmless. They will go away in several months. Sometimes these white bumps appear on the gums.
You may notice the lips trembling or quivering; this too is normal. Babies will sometimes give themselves a blister by sucking on their lip; these are not a concern.
Milk tongue
Babies often get a white coating on the tongue; this is sometimes confused with thrush, a yeast infection in the mouth that is common in babies. Milk tongue is normal; it is usually thin, lasts an hour or two after a feeding, and will wipe off with a cloth. Thrush causes thick white plaques on the tongue and also the cheeks, and a thin white coating inside the lips. Thrush needs to be treated; milk tongue does not.
Neck
The neck muscles are not very developed at birth, and the baby’s head needs to always be supported. The baby’s neck is relatively short at this point; therefore there are lots of skin folds, and it can be challenging at times to clean all the milk, spit-up, and other things from between those folds. You may also see a pink birthmark on the back of the neck (see Salmon Patches).
Chest
You may notice the bottom tip of the breastbone (xiphoid process) sticking up, rather than down as it does in adults. This is normal.
Breast swelling
It is normal for the breasts to swell in both girls and boys. It may not be the same on both sides. This is normal and will usually go away, typically in a few weeks. It may last for several months in breastfed babies. It is due to maternal hormones (estrogen) passed to the baby while in the womb. Some babies may have a few drops of clear to milky discharge. Do not squeeze the breasts. If the breast becomes red and swollen, see your baby’s doctor.
Abdomen
Babies do not have much muscle tone, so their bellies will appear rather round and protuberant. You may notice a ridge poking out in the middle, running up and down their bellies; this is called diastasis recti. This is normal and will eventually go away.
Umbilical cord
After the cord is cut, a stump remains that has to dry up and fall off on its own. There will be a clamp on the end to stop any bleeding; this is usually taken off before you leave the hospital, unless the cord is very thick and the hospital staff is concerned about any possible bleeding.
Genitals
The genitals of both boys and girls may appear large, swollen and bruised from the birth process. This will resolve over the first few weeks.
Girls
The labia are often swollen and enlarged due to maternal hormones. Often in newborn girls the labia minora (inner skin folds) protrude further than the labia majora (outer skin folds); they will shrink some during the first month of life. The clitoris may be enlarged as well; it will also decrease in size.
You may also notice some dried vernix inside the labia; this is normal. You may wipe here, but don’t try to scrub the vernix away. This will irritate your girl’s skin. It will eventually dry up and flake off as you wipe it with diaper changes.
Vaginal discharge and bleeding
It is normal for baby girls to have some clear to white vaginal discharge; it can be pretty thick and sticky, and there may be a lot of it. They can also have a “mini-period” with some slight vaginal bleeding or blood-tinged discharge. This is perfectly normal and is from maternal hormones. The discharge usually starts in the first few days of life and lasts for a few days. During the rest of childhood, you may notice a small amount of vaginal discharge. This is normal as well.
Vaginal tags
There are often small little tags of tissue which protrude from the vaginal opening. These tags are also due to maternal hormones and will go away in the next month or so.
Boys
Penis
In newborns, the foreskin covers the entire penis and the opening is tight at the end. This is normal and urine can pass easily out of the opening. However, the skin will not retract and the head of the penis is not visible. This is normal; do not try to pull the skin back. It can get stuck and cause serious harm to the penis. The skin will gradually loosen over time and by about 4 years old will retract fully.
If you choose to have your baby boy circumcised, the foreskin at the end of the penis will be removed and you will see the head of the penis. There will be a wound there that will heal over the next 1-2 weeks; you will see some blood, redness, swelling, and yellow tissue as it heals. Keep it covered with petroleum jelly (Vaseline®) and follow the care instructions you receive. Watch for pus, drainage, or increasing redness or swelling.
Testicles
In some boys one or both testicles may rise to the very top of the scrotum and “disappear.” Later, it may descend back into the scrotum again. This is usually normal, as long as both testicles are fully out of the body. Sometimes one or both testicles is still inside the abdomen and have not descended (undescended testicle). This is more common in premature infants. Often they will descend in the first few months. If not descended by 4 months old, the baby will need surgery; they should see a specialist at 4-6 months of life.
Swollen scrotum (hydrocele)
Boys may have extra fluid in the scrotum, making it appear large and it may be difficult to see the outline of the testicles inside. This fluid is normal and will be absorbed during over the next few months.
Hands and Feet
You may notice the baby’s hands and feet are blue sometimes, especially when the baby is a little cold. This is called acrocyanosis and is normal; it is due to the baby’s immature nervous system which controls blood vessels. This can come and go for the first few months of life. If the baby’s lips, face, or body are ever blue this is NOT normal and you should call your doctor immediately.
The toenails and fingernails grow rapidly and have to be trimmed frequently; if your baby is born after her due date, they may already be long when she is born!
Babies have tight fists, which will resolve in the next month or so. You may notice their hands and/or quivering or shaking at times; this is due to their immature nervous system and poor control of their muscles.
Often, a baby’s feet may be turned or twisted inward. This is usually due to positioning while in the uterus. As long as your baby’s foot can be gently turned back to a normal position, then this is normal. Your baby may hold his feet this way for many months, until the muscles in the legs and feet grow stronger.
Bowed legs & flat feet
It is normal for babies to have legs that look bowed out. They will straighten over time. It is also normal for the feet to be turned in, as long as you can straighten them easily. This is usually due to positioning in the womb. Babies also have flat feet. The arch will develop later, around 6 years old.