Common Questions About Newborns—Part I

By Howard J. Bennett, MD

Having a baby raises lots of questions and worries in new parents. Here are answers to some of the most common questions parents ask at the hospital and in my office.

What is Group B strep?

Up to 40% of women have the bacteria Group B strep in their rectal/vaginal area. The presence of this bacteria is not an infection and causes no problems for the women who have it. However, if a baby is born vaginally to a woman who carries Group B strep, it puts the infant at increased risk of getting a serious infection after birth. (The baby is at similar risk if he’s born by C-section after the mother’s membranes have ruptured.)

Obstetricians culture pregnant women for Group B strep at 36 weeks. If the culture is positive, they recommend giving two or more doses of antibiotics before the baby is born. Getting intravenous antibiotics prior to birth greatly reduces the chances that the baby will become infected by this bacteria.

Is hypoglycemia (low blood sugar) dangerous for babies?

Prior to birth, babies get all of their oxygen and nutrients through the placenta. After a baby is born, the glucose and other nutrients that arrive via the umbilical cord are cut off. In most cases, the baby handles this transition without difficulty. In some situations, however, a baby’s glucose may drop after birth. The nurses know to watch for this and will check the baby’s blood sugar with a simple blood test (heel stick) to make sure everything is okay. However, if the blood sugar continues to fall, the nurse may recommend giving the baby formula to stabilize the glucose level.

Breastfeeding mothers know that it’s important to avoid giving babies formula because it can cause “nipple confusion.” Although this is true in normal circumstances, giving the baby formula to correct hypoglycemia is unlikely to cause nursing problems. To the contrary, a bottle of formula in the right situation can prevent low blood sugar from causing a serious problem in the baby.

For the first week of my son’s life, I kept finding a pink stain in his diaper. Does he have blood in his urine?

Your baby was excreting uric acid crystals in his urine. This is a common finding in the first week or two of life. Although parents often report seeing “blood” in their baby’s urine, on further questioning we find out that there is a pink or salmon-colored stain on the diaper. In fact, if the diaper is examined carefully, parents may even see tiny crystals within the matrix of the diaper material.

This morning I saw some blood coming from my 5-day-old’s vagina. Should I worry?

Baby girls commonly have a small amount of whitish discharge from their vagina. In some cases, this discharge turns bright red. This happens because the baby is shedding the lining of her uterus just like women do when they have their periods. This is usually nothing to worry about and will pass in a few days. However, if you notice a lot of blood or the baby has a discharge for more than a few days, contact your doctor.

My 3-day-old has a blister on her upper lip. Do you know where this came from and when it will go away?

This is called a sucking blister. It doesn’t bother the baby and usually falls off in a few days. Sometimes a baby will get more than one in the first few weeks of life.

My son was circumcised three days ago. His penis was red at first, but now there’s some yellow pus on the head. What should we do?

Right after a newborn is circumcised, the head of the penis is bright red and has a “wet” look. Over the next few days, the head becomes drier and takes on a dull red appearance. The head returns to its normal skin color about a week after the circumcision. While the penis is healing, it is common to see yellowish deposits on the surface of the skin. This is part of the healing process not an infection. If a penis were to become infected, the head would become much redder. In addition, redness and swelling would extend up the shaft towards the body.

If we decide not to circumcise a baby, what do we do to take care of the foreskin? 

In the old days, parents were told to pull back forcefully on the foreskin to help it separate from the head of the penis. We don’t recommend this anymore because forcefully separating the foreskin can lead to scarring which might require a circumcision to fix the problem in the future. All you need to do to take care of the foreskin is to gently clean it when you change the baby’s diaper. The foreskin’s attachment to the head of the penis will loosen up over time, and most foreskins are fully retractable once a child enters elementary school. As the foreskin starts to detach, you should pull back very gently to clean the head of the penis during bath time.

When I’m changing my baby, I notice tiny opalescent beads around her anus and vagina. If I rub them between my fingers, they have a slight waxy feel. What is this?

These tiny beads come from the lining of the diaper and are not dangerous. Simply wipe them away when you clean your baby with each diaper change.

When my two-day-old opens her eyes, I see a crescent-shaped red mark next to the colored part of her eye. What caused this?

The birth process generates a lot of pressure for baby and mom alike. In addition to sometimes causing a “football-shaped” head, babies can develop broken blood vessels in white part of their eyes. This is a superficial problem that does not damage the inner structures of the eye. The marks resolve in three to five days.

My 5-day-old just developed diarrhea. His stools used to be dark green and tarry, but last night they became green, slimy, and runny. Is this diarrhea? 

The first stool that a baby has is a thick, green, gooey mess that doctors call meconium. (For the record, meconium consists of all the stuff the baby swallowed during his fetal life: skin cells, hair, and other material floating around in the amniotic fluid.) After passing a handful of these sticky poops, a baby has something we refer to as “transition stools.” These poops are runny, green, and foamy. In fact, if your baby has one of these poops when his diaper is off, you may see it shoot two feet through the air! But rest assured, they are not dangerous and will fade into memory within a couple of days.

When my baby yawns, I see a white pimple on the roof of his mouth. What is this?

It’s called an Epstein’s Pearl and is nothing to worry about. The pearl is composed of mucus cells trapped under a thin membrane of skin. It will go away in the first few weeks of life. Babies often have two variations of this lesion that you may see in other locations. If you see tiny white pimples on the face, they are referred to as milia. If you see a tiny white pimple on the gum, it’s referred to as a Bahn’s Nodule. Although milia may hang around for months, Bahn’s Nodules disappear as quickly as Epstein’s Pearls.

My husband and I are African American. Our baby is light-toned, but his scrotum is very dark. What caused this?

The epidermis contains pigment-producing cells called melanocytes. These cells produce black pigment (melanin) that determines a person’s skin tone. Like other aspects of newborns, their skin is immature at birth. For some reason, a newborn’s ears and genitals often appear darker than the rest of the body. This “two-toned” appearance usually resolves by the time a baby is six months of age.

Another finding that results from immature skin are blue patches of the newborn (formerly referred to a Mongolian Spots). In this instance, there are dark blue or black patches on the baby’s body. They are most commonly seen on the buttocks or low back, but can also be seen in other locations. Blue patches generally resolve by the time a child is four years of age. Some spots persist indefinitely.

My baby had something called a hydrocele at birth. What is it?

Although a baby’s gender is determined at conception, male and female infants develop the same until the third month of pregnancy. At that point, a primitive group of cells in the baby’s pelvis develops into ovaries or testicles depending on the sex of the baby. In females, the newly formed ovaries are in the correct anatomical position. Testicles, however, are in the wrong place and need to descend into the scrotum. This process takes about six months. After the testicles pass through the inguinal canal (in the groin area), they move into the scrotum. Fluid sometimes makes its way into the scrotum with the testicle, which results in a hydrocele, i.e., fluid around the testicle.

This is not a serious condition and in most cases, the fluid will be reabsorbed by six to nine months of life. If it persists after 12 months, your baby may have a hernia and will be referred to a surgeon for further evaluation.

Will I hurt my baby’s soft spot if I rub it when I wash his hair?

The medical name for a baby’s soft spot is called the anterior fontanel. This is an opening in the bones of the skull that allows the cranium to grow. The fontanel is covered with a very tough membrane so you will not hurt it when washing your baby’s hair. Although we would never recommend poking the fontanel, you can scrub it gently with a brush like the rest of your baby’s scalp.

Do you recommend limiting visitors the first week we are home with our baby?

Taking your newborn home from the hospital is both exciting and anxiety provoking. On the one hand, you’ve made in through delivery and the first few days adjusting to your new role as parents. On the other hand, there are no nurses around to help with feeding and other questions.

Having people visit during the first week at home is a mixed blessing. Doctors routinely encourage new mothers to feed their baby eight or nine times a day. Immediately after giving this advice, they tell you to get lots of rest. If you do the math, you will quickly see that it’s impossible to feed babies that much and still get enough rest.

While it helps to have friends or relatives assist you in taking care of the baby, what begins as a five-minute visit can easily stretch to an hour or more. As a result, loved ones can unintentionally prevent you from taking a catnap or just closing your eyes to rest.

My advice to new parents is to restrict or even discourage visitors during their first week at home. It’s terrific for people to bring food or do some shopping for you, but they shouldn’t stay for more than 30 minutes. In addition, it’s a good idea for fathers to take on this responsibility so moms can concentrate on feeding. This is especially true if the mother is breastfeeding.

Do fathers “bond” with their babies later than mothers?

Many years ago, I read an article by a first time mother and father. Although the authors spent a lot of time talking about getting used to diaper changes and middle-of-the-night feedings, there was one seminal point that I took away from the article.

The mom described bonding to her baby immediately. The dad, on the other hand, did not feel the same attachment as his wife. He didn’t tell anyone about this for months because he was embarrassed about not immediately “falling in love” with his baby. He did everything he was supposed to in terms of supporting mom and baby, but he felt a bit like an outsider in the beginning of his son’s life.

Ever since I read that article, I have made a point of telling new fathers that it is common for moms to bond to babies before they do. My explanation for this is as follows:

• The baby was biologically connected to the mom for the entire pregnancy.

• Men typically grow up playing with guns and balls instead of dolls.

• Adult men are less likely to interact with other people’s babies before they become parents themselves.

I find that new fathers are often relieved to hear this information. I joke that this situation does not get them out of chores. I also reassure them that they will become deeply attached to their babies in time.

© 2012 Howard J. Bennett. All Rights Reserved.

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