Is Your Little Baby Normal? How to Recognize Normal and Abnormal Signs in Newborns?

Is Your Little Baby Normal? How to Recognize Normal and Abnormal Signs in Newborns?

At the moment your little bundle of joy enters this world, your heart undoubtedly fills with pure delight. However, like all new parents, this delight may not last indefinitely. Unexpected occurrences can happen at any time, such as birthmarks, unclear patches, jaundice, rashes, strabismus, and head lumps on your baby's delicate body. These phenomena can understandably cause confusion and leave you at a loss.

After your baby is born, you naturally hope for a perfectly flawless infant. When you first notice any imperfections on your baby's body, it might shock you and even lead to severe anxiety. The truth is, within the first few hours or days after birth, some minor imperfections on your baby's body are normal and transient manifestations of a newborn. If any of these conditions persist, it is essential to seek advice from a pediatrician and have your little angel thoroughly examined.

A comprehensive physical examination of a newborn after birth is necessary. Let's now introduce some common normal or temporary abnormal phenomena:

(1) Caput Succedaneum and Cephalohematoma: After vaginal delivery, a baby's head may appear elongated and cone-shaped, which might make you worry about the appearance of your baby's head. The cone-shaped head of a newborn is a natural change during birth. When the birth canal is tight, and the labor is prolonged, the skull bones might become compressed to facilitate the passage of the baby's head, resulting in scalp swelling known as caput succedaneum. It presents as a noticeable swelling on the head, also called a cephalic lump, mainly caused by scalp edema. It feels soft to the touch and may show slight indentations with gentle pressure. The swelling may extend beyond the suture lines, with unclear boundaries, but you don't need to worry. This type of scalp swelling typically resolves quickly before the newborn is discharged from the hospital and does not require special treatment.

However, if the caput succedaneum persists for an extended period, it might be cephalohematoma, which refers to blood that collects between the skull and the inner layers of the scalp. It is caused by blood vessel rupture and bleeding within the skull bones due to friction or pressure during delivery, assisted delivery using forceps, or vacuum extraction. Cephalohematoma usually appears two days after birth and feels fluctuant when touched, with clear borders. Around 4 to 5 days after birth, it stops progressing due to the pressure from the hematoma itself and the increase in the newborn's coagulation function. It gradually resolves within 3 to 8 weeks and does not require any intervention like massaging or bloodletting, as that may lead to infections and abscess formation.

(2) Fontanelle: You might already know that a newborn has fontanelles (soft spots) on the top and back of their head. These spots pulsate with each heartbeat, which may seem alarming, but they are actually softer than you think. The fontanelles need to be soft to accommodate the rapid growth of the baby's head in the first year after birth. You can touch them. The posterior fontanelle typically closes around 6 to 8 weeks after birth, while the anterior fontanelle closes and disappears around 12 to 18 months, by which time the baby's skull becomes harder.

(3) Weight Loss: Within the first week after birth, newborns may experience weight loss due to insufficient milk production, sleeping more, and eating less. Additionally, the water loss from daily excretion, respiration, and skin evaporation, which is not visible to the naked eye, contributes to this weight loss. The weight loss can reach up to 10% of the birth weight. As breast milk production increases and the baby adapts to their growth needs, their weight will gradually increase after the first week. If the weight does not increase or even decreases ten days after birth, it might be due to improper feeding or an underlying illness, which requires medical examination and analysis to identify the cause and take appropriate measures.

(4) Spitting Up: In babies under 3 months old, the lower esophageal sphincter is not yet fully developed, and their stomach capacity is relatively small. Meanwhile, breastfeeding mothers might have an abundant milk supply, causing the milk to spray quickly when the baby sucks. As a result, if the baby feeds too quickly and excessively while hungry, they may spit up small or large amounts of milk when crying and being fussy after feeding. To prevent or reduce spitting up, after feeding, mothers can hold the baby upright and gently pat their back for a few minutes to help the baby burp and release gas. As the baby grows older, this symptom of spitting up will gradually ease. However, if the baby spits up with force, expelling a large amount of milk, or if the spit-up contains yellow-green stomach contents, further examination by a doctor is necessary.

(5) Natal Teeth: Around the edges of a newborn's gums or near the midline of the upper jaw, there may appear small white granules. They have a smooth surface and vary in number from one to several. These granules are called natal teeth, and they are the most primitive tissue in tooth development. They form when the oral mucosa's epithelial cells thicken and proliferate at around 6 weeks of embryonic development. Generally, they will be absorbed on their own in about two weeks and should not be picked with a needle or rubbed with cloth to avoid damaging the mucosa and causing infection.

(6) Reddish Urine: Some newborns may cry while passing urine, and you might observe that the urine stains the diaper red. This is known as newborn red urine, mainly caused by the relatively low urine output in newborns and increased urate excretion due to white blood cell breakdown. Newborn red urine is usually considered normal and may be more noticeable between the 4th and 10th days after birth. However, it is essential to inform a doctor, as certain jaundiced newborns might require specific treatment.

(7) Decreased Responsiveness in Newborns: Decreased responsiveness is a group of clinical symptoms that include mild lethargy, reduced muscle tone, decreased limb movements, weak crying, and weak sucking. Various high-risk newborns include premature and low-birth-weight infants, infants born after difficult or cesarean deliveries, and infants born to mothers who received anesthesia during delivery. Within a few hours after birth, these newborns may experience transient decreased responsiveness. However, it is crucial to be vigilant, as conditions like central nervous system diseases, severe septic shock, dehydration, acidosis, electrolyte imbalances, anemia, hypothermia, and respiratory failure may cause more severe manifestations of decreased responsiveness, which are often used to assess the severity of various diseases.

(8) Cyanosis: If you notice slight cyanosis on your baby's body, especially on the fingers, toes, hands, or feet, do not be alarmed. In most cases, this is normal, especially when the baby is exposed to cold, and their body is not yet efficient in regulating temperature and blood circulation. Holding the baby close and warmly wrapped will make the cyanosis disappear. However, it is worth noting that cyanosis in newborns can also be an indication of more severe conditions such as pulmonary diseases, various types of congenital heart diseases, sepsis, or cyanotic congenital heart diseases. If cyanosis is accompanied by poor mental status, diminished responsiveness, refusal to eat, rapid or interrupted breathing, immediate medical attention is required.

(9) Neonatal Jaundice: It is normal for a newborn's skin to appear slightly yellow, particularly on the sclera of the eyes, 2 to 3 days after birth. This condition is observed in about 70% of all newborns and becomes more apparent between the 4th and 10th days after birth. However, it is essential to inform a doctor as some jaundiced infants might require specific treatment.

(10) Subconjunctival Hemorrhage: It is possible for a newborn's eyes to have mild bloodshot eyes due to the rupture of small blood vessels in the conjunctiva. This is a normal occurrence resulting from pressure during delivery and usually disappears within a few days after birth.

(11) Strabismus: If you notice strabismus while gazing into your baby's eyes, there is no need to panic. Early on, a baby's eye movements might not be coordinated, leading to the eyes occasionally not moving in sync when focusing on one object. This type of strabismus generally resolves around 3 months of age.

(12) Rashes: The most common skin rash in newborns is neonatal urticaria, also known as erythema toxicum neonatorum or toxic erythema. The center of the rash appears yellowish or whitish, resembling flea bites. It occurs in approximately 30% to 70% of newborns and typically emerges within 2 weeks after birth. This rash can appear and disappear suddenly within a few hours and then reappear. While the baby's skin may turn red, it is usually not a serious issue and usually resolves within 7 days.

(13) Generalized Peeling: Around 3 to 4 days after birth, a newborn's skin may start to "flake off," and sometimes, large chunks of skin may peel off. This is also a normal physiological phenomenon. Within 1 to 2 weeks, the peeling will naturally subside, revealing a pink, smooth, and soft skin. Newborn skin has a thin keratin layer and rich subcutaneous capillaries. When the skin peels, parents should avoid forcibly removing the flakes to prevent skin damage and infections.

(14) Birthmarks: Another skin discoloration that may occur in newborns is birthmarks, typically blue in color, and they can appear on the lower back or buttocks or suddenly anywhere on the baby's body. They may resemble bruises and are more commonly seen in babies with darker skin tones. These birthmarks generally fade and disappear within the first year of a baby's life.

(15) Simple Hemangiomas: Simple hemangiomas are caused by the dilation of subcutaneous capillaries, and the color may deepen when the baby cries or when the room temperature is high. Over 80% of babies may have this type of hemangioma. They vary in size and can appear at birth or shortly after. Simple hemangiomas can spontaneously resolve at different times. Commonly known as "salmon patches," they are pinkish and flat and may occur on the baby's forehead, eyelids, nose, upper lip, and back of the neck. Generally, they disappear by the age of 18 months. However, if a hemangioma occurs on the back of the neck, it might not completely resolve, but it usually does not affect aesthetics as the hair can cover it. If the child finds it unappealing as they grow older, laser treatment can be considered to remove it.

(16) Breast Swelling: Around 3 to 5 days after birth, babies may experience breast swelling, even as large as pigeon eggs, and some might secrete a small amount of pale yellow milk. The swelling peaks around 8 to 10 days after birth and can occur in both boys and girls. This is due to the abrupt cessation of maternal hormones in the baby's body after birth. The breast swelling typically resolves on its own within 2 to 3 weeks. If it persists, medical attention should be sought.

(17) Neonatal Hydrocele: A neonatal hydrocele is the accumulation of fluid within the scrotal sac due to incomplete closure of the processus vaginalis. It often occurs in male newborns. The hydrocele might cause scrotal swelling, and the scrotum may appear red. In female newborns, the labia might be swollen and darker in color. These manifestations are mainly caused by maternal hormones. The swelling in male babies may take a little longer to subside, usually around 1 month.

(18) Vaginal Discharge or Bleeding in Female Infants: Shortly after birth, some female infants may have white discharge from the vagina, followed by blood-streaked discharge within 1 to 2 days. The vaginal mucosa in female infants is sensitive to hormones, so when maternal hormones are expelled from the baby's body, it may lead to slight bleeding. Usually, this occurs within 72 hours after birth and then stops.

(19) Umbilical Cord: The umbilical cord usually falls off 7 to 10 days after birth. During this time, a little bloody secretion might be noticed, but it is nothing to worry about. You should place the diaper under the umbilical cord to prevent urine from coming into contact with it. Before the umbilical cord stump falls off, it should be kept dry. After bathing, use a disinfected dry towel to pat the stump to prevent infection. It may appear reddish or have a small scab before falling off, which is normal. However, if there is purulent discharge or a foul odor, it might indicate infection, and medical attention should be sought.

Regarding other common issues in newborns, such as hiccups, bloating, and lactation, in most cases, these are normal occurrences. As long as the baby is in good general condition, you can allow them to resolve naturally, as these phenomena will gradually disappear.