Common Questions About Newborns—Part II

By Howard J. Bennett, MD

This is the second part of an article that answers the most common questions parents ask after they go home with their newborn.

My 2-week-old has a small amount of milk coming from his nipples. Is this normal? 

Male and female infants both get swollen breasts in the first few weeks after birth—this is due to the effect of maternal hormones on their breast tissue. A small percentage of babies also get a milky discharge from their nipples called “witches milk.” This discharge is normal and resolves in a few days. You should not squeeze the baby’s nipples to try and remove the “milk” because it may irritate the tissue and cause an infection.

My 1-month-old developed bruises on his scalp shortly after birth. My doctor said they would go away, but they haven’t. What should I do?

It’s very common for babies to develop scalp bruises after birth. Doctors divide them into two types. The first is a diffuse swelling of the scalp called a caput succedaneum. This resolves within a week. The other is a more localized swelling that is called a cephalohematoma. Cephalohematomas typically occur in the posterior aspect of the skull. Although most resolve in the first month of life, some become hard and persist until six months of age. Both of these swellings occur between the skull and the scalp and do not harm the baby’s brain.

Can I use soap on my baby’s skin when I wash her?

Many baby books say you should not use soap on a baby’s skin in the first month of life. (I don’t agree with this recommendation.) Although most babies will become clean with water alone, some infants will get rashes if soap isn’t used. This is particularly true for babies with oily skin, i.e., water doesn’t dissolve oil like the fat does in soap. Of course, it’s a good idea to use a mild soap like unscented white Dove or Cetaphil cleanser to get the job done.

My 1-week-old is peeling and has very dry skin around his wrists and ankles. What should I do about this? 

During the pregnancy, babies are floating in amniotic fluid. For most of this time, they are covered with a greasy, white material called vernix caseosa. By the end of the pregnancy, the production of vernix lessens, and the baby’s skin is directly exposed to the amniotic fluid. Because babies don’t slough their skin efficiently while they are in the uterus, this happens after they are born. (Children and adults have a new top layer of dead epidermal cells every month.) So by the time a baby is about a week of age, the epidermis on his body starts to dry out and he may look like he has dry skin. This is particularly noticeable around the wrists and ankles. I tell parents that the baby will slough this skin over a two-week period and that his nice smooth baby skin won’t be apparent until then. Parents can put creams on this “dry skin” if they want, but it will only look good for a little while until the cream evaporates.

The hospital nurses took armpit temperatures on my newborn. Do I continue with this practice once the baby comes home?

Hospital nurses take armpit temperatures for two reasons. First, they want to be sure a baby’s temperature doesn’t drop as he adjusts to being outside the uterus. Second, because the nurses take temperatures multiple times per day, they do it in a way that is quicker and less disruptive to the baby.

Once you take your baby home, you should take rectal temperatures if you are concerned the baby is sick or has a fever. The reason for this is because rectal temperatures are the most accurate way to check for fever and our diagnostic approach to fever is based on rectal temperatures.

It’s much easier to take rectal temperatures on newborns than older infants. I prefer doing this by having a baby lying across my legs with her bottom facing up. I separate her buttocks with one hand and gently insert a lubricated digital thermometer with the other hand. I insert the tip about ½ inch and hold the thermometer in place with two fingers of the same hand I used to separate the baby’s buttocks. That way I don’t have to worry that the device will poke the baby if she wiggles or moves.

What do you consider a fever in a baby?

In the first two months of life, a fever is a rectal temperature of 100.4 degrees Fahrenheit or greater. If your baby is acting sick or develops a fever, you should call your doctor right away because we get very concerned if newborns have a fever. The reason for this is not because the fever is dangerous, but a newborn’s immune system is immature and even a low-grade fever can be caused by a serious bacterial infection.

Why does my baby have pink patches on her eyelids and the side of her nose?

These flat, superficial skin markings have two medical names: salmon patches and nevus flammeus. They are caused by dilation of tiny blood vessels in the baby’s skin. In addition to the eyelids and nose, salmon patches are also found on the upper lip and base of the neck. (The ones at the base of the neck are sometimes called “stork bites” in honor of the bird that delivered the baby to your home!) No treatment is required, and most salmon patches disappear by 18 months of age. The ones at the base of the neck persist about 50% of the time.

The whites of my baby’s eyes are blue. Is that normal? The white part of the eye is called the sclera and the tissue underneath the sclera is called the choroid. The choroid is bluish in color and it can be seen through the sclera in the first few months of life because the sclera is thin. If an older baby has very blue sclera, your doctor may check for a rare condition that results in a persistence of this color phenomenon.

When will I be able to tell the color of my baby’s eyes?

Babies of European descent usually have dark, slate blue eyes at birth. Babies of Asian or African descent usually have brown eyes at birth. Final eye color is usually apparent by six months of age, but occasionally remains a mystery until a baby is closer to 12 or 18 months.

My 2-month-old is losing her hair. When will it grow back?

It’s common for babies to lose their hair in the first few months of life. For some infants, the hair grows back quickly. For others, they may look like little old men until they are 9- to 12-months of age.

My 6-week-old has a soft bowel movement twice a day. However, before she goes, she strains a lot and gets red in the face. What should I do to treat her constipation?

If your baby is feeding well and gaining weight, I don’t think she is actually constipated—the definition of constipation is producing hard, dry stools. Babies often grunt and strain with defecation because of a reflex that tells them to push when fecal material enters the rectum. However, you should mention this to your doctor at the baby’s next checkup to make sure there is no hidden blood in the stool and to check her anus to make sure it is in the correct position. These observations relate to two problems that could cause discomfort with the passage of stool.

What’s the best way to clean the whitish material that builds up between a baby girl’s outside and inside vaginal lips?

Cleaning the material that accumulates between the labia majora (outside vaginal lips) and labia minora (inside vaginal lips) bothers parents as much as cleaning a baby’s testicles. I tell parents two things in this regard: (1) they do not need to clean away the discharge at one time and (2) they can clean it away by gently wiping with a cotton washcloth in a downward direction. (I prefer washcloths to cotton balls because they have better traction.)

My 10-day-old still has his umbilical cord. It’s gooey and smells bad. What should I do?

It is not unusual for the cord area to have an unpleasant smell a few days before it falls off. The reason for this is because the cord remnant is actually decaying, i.e., the umbilical stump does not have a blood supply and the body’s immune system is rejecting the tissue. However, if the umbilical area smells really bad or you notice redness around the baby’s belly button, you need to contact your doctor promptly to make sure the area isn’t infected.

When my daughter was two weeks old, her doctor said she had an umbilical granuloma. Is that something to worry about?

After the umbilical cord falls off, there is sometimes a little “goo” that remains at the base. This is not a big deal, and I usually recommend that parents clean it with a cotton swab a few times a day until it disappears. In some cases, however, parents will notice red tissue protruding from their newborn’s belly button (it looks a bit like a small raspberry). This tissue is called an umbilical granuloma. Although they are not dangerous, if an umbilical granuloma isn’t treated, new skin will grow over its surface and a fleshy lump will remain. Therefore, to ensure that babies have a cute belly button, doctors usually treat granulomas with a medication called silver nitrate to make them fall off.

I’m worried that I will hurt my son’s testicles when I clean him up after a poop.

Before puberty, it does not hurt if a boy’s testicles are manipulated. Although it’s logical to be gentle, you don’t need to worry about causing your son any pain when you clean him up after a poop.

My 3-week-old is stuffy all the time and sneezes a lot. Isn’t he too young to have a cold? 

Although your 2-week-old is not too young to have a cold, the chances are he doesn’t. Babies are nasal breathers because they are unable to breathe through their mouths for the first few months of life. However, their nasal passages are small, which explains the “stuffy” sound you hear. Sneezing occurs because of dust and other particles in the air that simply trigger the baby’s sneezing reflex. If your baby gets a real cold, he will have a runny nose just like everyone else.

My baby poops while she is nursing. Is the milk going right through her?

When a person’s stomach fills with food, it triggers a reflex that stimulates peristalsis. (Peristalsis is the name for the rhythmic contraction of muscles that push food from the beginning of the gastrointestinal tract to the end.) This explains why adults and older kids often have a bowel movement after eating. However, the reflex that causes this action is much more active in babies than older people. So the poop that comes out when your baby eats is waste from the feeding that went in hours ago.

Although my baby takes her bottle without any problems, she spits her pacifier out. Why doesn’t she like it?

Babies don’t suck on things the way we do. Instead of creating negative pressure with their cheeks (that’s what kids and adults do), they lick with their tongues at the same time they work their jaws. Therefore, when a baby sucks on a pacifier, she will unintentionally push it out of her mouth. So the only way to get a young infant to use a pacifier is to hold it for her so it stays in her mouth. Over time, a baby learns to purse her lips to keep the pacifier in place.

Why does my baby get hiccups after she nurses? 

Breastfed and bottle fed babies both get hiccups after feeding. This happens because they reflux some stomach contents into their esophagus after eating and the acid stimulates a nerve that causes the hiccups. Hiccups generally resolve after a few minutes and do not need to be treated. Most parents don’t like seeing their baby have hiccups because hiccups bother adults when they get them. Fortunately, babies aren’t bothered by hiccups so just ignore them until they go away.

My 3-month-old is drooling a lot and chewing on things. Does that mean she’s teething?

A few interesting things happen at three months of age: (1) a baby has enough motor skills to confidently grab objects and pull them to her mouth, (2) a baby likes chewing on things more than before, and (3) a baby’s major salivary glands (the parotid glands) mature. So now you have a baby that can grab objects, bring them to her mouth, and chew with abandon. This behavior creates lots of saliva that drips all over the place. Doctors refer to this as developmental drooling. Since the first tooth usually does not appear on the scene until the baby is six months, I suspect that your baby is not actually teething.

© 2012 Howard J. Bennett. All Rights Reserved.

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