Child Care: Normal Aspects of Newborn Babies

1. Normal parameters of a newborn

A baby is term if it is 37-42 weeks’ gestation. If it is less than 37 weeks, it is preterm and if it is more than 42 weeks, it is post-term. A pregnancy is typically 40 weeks. The EDD (expected date of delivery) = LMP (last menstrual period) + 9 months and 7 days. Supposing a pregnant woman had her LMP on 1.1.96. Then the EDD will be 8.10.96, which is equal to 40 weeks of pregnancy. If the baby is born between 17.9.96 (i.e. 3 weeks prior to 8.10.96 = 37 weeks) and 22.10.96 (i.e. 2 weeks after 8.10.96 = 42 weeks), then it is term.

A term baby’s normal weight lies between 2.5 kilos to 3.8 kilos. A term baby loses some of its birth weight for 3-4 days and regains it by the end of 1 week. A baby weighing less than 2.5 kilos is “small for date” while a baby weighing more than 3.8 kilos is “large for date”. The normal length of a term baby is approximately 48-52 cms. The normal head circumference of a term baby is 33-36 cms. When your baby is born, these parameters (i.e. the gestational age, birth weight, length and head circumference) should be preferably recorded in the discharge slip of the baby. These parameters should be monitored regularly (once every 1-2 months till the baby is 1 year old and twice a year thereafter: excepting head size which is of importance only till the age of 2 years) and plotted on a “growth card” because they are very good indicators of the growth and development of a child. A good doctor will usually record them during the time of routine immunization.

2. Feeding

Babies may bring out some whitish, curd like semi-digested milk from the corner of their mouths after feeds. This is called “Regurgitation” and is normal. It should not be mistaken or confused with vomiting, in which the baby will throw out most of the milk in its original liquid consistency. Vomiting is not normal and a doctor should always be consulted.

3. Stool and urine

If the baby passes stools within the first 24 hours and urine within the first 48 hours, it is normal. Very often, I have seen parents worrying that their child has not passed urine even once after birth. A simple reassurance that the baby will do so within 48 hours is all that is required, as barring an occasional baby, all of them do pass it.

The stool that the baby initially passes is called “meconium.” It is greenish black and sticky in consistency. After 3-4 days, the baby passes what is called “transitional stools”, which is a bit soft/liquid and yellowish green in colour. By the end of 1 week, the baby passes normal stools, which in the breast-fed baby are golden yellow and soft. Formula fed babies pass stools that are pale yellow and firm to hard. Generally, the frequency of motions is more in breast-fed babies than formula fed babies. Some babies may pass stools after each feed (i.e. 10-12 times/day) while some may not pass stools even for a whole day (even if breast-fed). The next day, they may pass stools, which is soft in consistency (they may pass stools once in 1-2 days). All this is normal. Some babies groan and grunt, strain a lot and may even cry before voiding stools or urine, which again is normal.

There is such a wide range of normalcy regarding voiding of urine and stools that the parents need not be perturbed as long as the stools that are passed are not watery or hard and infrequent. Counting the number of times the baby has voided urine or stool is not advisable.

4. The skull (head)

At birth, there is a diamond shaped gap (about 1″ in diameter) between the bones of the anterior part of the skull in the midline covered by a tough canvas like covering. This gap is soft and compressible. It is called “anterior fontanel”, and it closes by 1-2 years of age.

The head of a baby born by operation or born breech (buttocks first) is typically round, while the head of a baby born vertex (head first) may be elongated and asymmetric, being depressed or elevated on one side. You need not worry about it as in a few days the head will assume its natural round contour. Babies who lie most of the times on one side may develop a flattening of the skull on that side. For e.g. if the baby is sleeping on his back most of the times, then the back of the head may become flat. Again this is no cause for concern as the head resumes its natural shape when the baby starts sitting up.

A swelling of the skull, which is soft and compressible, may rarely persist for 1-2 months. This is called “cephal-haematoma” and is due to collection of some blood under the scalp. This regresses and disappears spontaneously, and doesn’t require any intervention like taking out the collection of blood. Still, sadly, one sees some babies, whose such swellings have been incised by a knife or a needle was used to aspirate out the blood.

5. Eyes

The babies have a natural aversion to strong light called “photophobia.” Therefore they keep their eyes closed under bright light and open it only in dimly lit areas. Sometimes they may open only one eye, which is normal. The babies don’t usually spill tears while crying till the age of 3-4 months. So, if there is watering of the eyes, it may be abnormal (see below). The baby’s eyes may deviate momentarily towards each other, giving the impression of cross-eyedness or squint. Such a phenomenon is normal. However, if there is persistent squinting, particularly after 6 months of age, you should definitely consult your child specialist.

A discreet red blotch may be seen on the conjunctiva of the baby on one side of the cornea, which is nothing else but a minor bleed called “subconjunctival haemorrhage.” It requires no treatment and subsides of its own within a few days. If there is any discharge from the eyes, it is best to show it to your doctor.

6. Mouth

Sometimes the babies may have 1 or 2 teeth in the midline on the lower gums. These are called “natal teeth” and should not be pulled out unless they are loose. The tongue may be bound to the floor of the mouth with a short cord like structure called the frenulum, as a result of which it may not be able to protrude out fully. Popularly called as “tongue tie”, nothing has to be done for it as long as it doesn’t interfere with eating and speech (which usually it doesn’t). A rule of thumb is that if the tongue is able to come out up to the lower lip’s outer margin, it is normal and will not interfere with the speech of the baby (because when we speak we don’t protrude our tongue!) If there is any hole or gap in the roof of the mouth (called cleft palate), it is abnormal and requires medical consultation.

7. Nose

The bridge of the baby’s nose may be slightly depressed. The babies till the age of 3 months are obligatory nose breathers (i.e. they do not open their mouth to breathe, as adults do, if their nose is blocked). Thus a blocked nose makes breathing very difficult for them and they end up crying and getting irritated. Many babies have a “stuffy nose” right from birth till the age of 3-4 months. Some sound may come from the nose while breathing. This stuffiness of the nose, which doesn’t interfere with the breathing (as compared to the blocked nose) usually doesn’t require any treatment. Sneezing is a normal mechanism in the babies (as in adults) and is not indicative of a cold or a respiratory infection.

Some babies make an audible whistling sound (called stridor), which if you carefully listen doesn’t come from the nose but rather appears to be coming from the throat of the baby. The sound comes when the baby is breathing in. A doctor should be consulted for such a sound. In most cases, such a sound is due to congenital weakness of the muscles of the “voice box (larynx)” and the condition is called as “laryngomalacia.” It is benign and self-limiting. The muscles become stronger as the baby grows up and so the baby outgrows the sound, without any medicines, usually by the age of 1-2 years.

8. Skin

“Toxic erythema” is a flea bitten type of rash seen frequently in term babies on the 2nd day. It has to be differentiated from boils, which have a yellowish centre with surrounding redness. Most of the skin rashes are benign and self-limiting for which no medicines, lotions or creams are required. Do not apply cosmetics on the area of skin rashes.

Scaling and peeling of the skin is seen in some new-borns, particularly those who are post-term or are small for date. There may be numerous transverse creases on the abdomen. Hands and feet may also show peeling. Usually the skin is dry in these babies. An emollient like glycerine or paraffin or even oil is sufficient for the dryness and peeling of the skin.

Newborns and infants may sweat a lot, particularly in the area of the neck and head as a result of which parents complain that they have to change the clothes of the newborn often as it becomes wet due to sweating. This sweating is normal and not a sign of any underlying disease. However, if the baby sweats with some shortness of breath, show to the doctor as it may signify an underlying heart disease.

Slate blue spots may be present over the buttocks and back of the baby called “Mongolian spots.” They are of no consequence and usually disappear by the age of 1 year.

Small red or bluish red well-demarcated blotches, which blanch on pressure and may be raised from the level of the skin, may be seen on the neck, back of the scalp, eyelids etc. Called hemangiomas, these do not require any therapy unless they are increasing in size.

Parents may find the hands and feet of the baby to be cold and the nails having a bluish hue. Called “acrocyanosis”, this is usually due to exposure to cold. As long as the tongue is pink, there is nothing to worry. If however, the tongue also is blue, it is very serious and immediate medical help should be sought.

9. Jaundice

The skin of the baby and the eyes may show a yellowish hue. Parents consider it as jaundice (which it is) and are anxious about it. However, the yellowness in most babies is not due to a liver problem, but is what is called as “physiological jaundice”. As the term “physiological” suggests, there is nothing to be alarmed about it. It requires no treatment and will subside spontaneously in 1-2 weeks. However, all babies with jaundice should be once shown to the doctor, who is the best judge of whether the jaundice is physiological or not.

10. Breasts

Some babies may have larger than normal breast nodules, out of which sometimes some milk may also be expressed. This is due to the influence of the maternal hormones. It is benign, self-limiting and doesn’t require any treatment. Do not squeeze or massage the enlarged breast tissue or try to express milk out of it. However, if the skin around the breast tissue becomes red, consult your doctor.

11. Genitalia

Males: One or both testis may not be felt in the scrotum. In many cases, one of the testes is retractile, which means that it retracts into the abdomen and comes back into the scrotum off and on. This is a normal entity. So, absence of testis from the scrotum doesn’t necessarily mean that there is something wrong with the baby, particularly if the testis were seen or felt in the scrotum even once anytime. Sometimes one testis may be actually absent. The parents need not be anxious as a single normally functioning testis is as good as two testes in carrying on the reproductive function i.e. your child will not be sterile.

The skin over the tip of the penis is tight in the newborn and no attempt should be made to forcibly retract it. It is called “physiologic phimosis” and usually corrects itself by the age of 6 years. However, if there is a bulbous swelling of the skin at the tip of the penis while passing urine or the urinary stream is weak, a doctor should be consulted. In these cases, excision of the tight skin i.e. circumcision may be required.

Females: Sometimes, female babies bleed through the vagina (just like menstruation in the females) due to the influence of maternal hormones. Parents often interpret it as blood coming in the urine. It is benign for which no treatment is required. A slight whitish vaginal discharge in newborn female babies is also normal.

12. Limbs of the baby

The limbs of the baby, particularly the legs are a bit bowed and turn outwards. This condition is called bow legs and is normal till the age of 6 years. After that also if the legs are bowed, one should consult a doctor. Similarly the limbs of a baby are in a flexed (drawn together position). Attempts should not be made to extend them, e.g. the legs by swathing them in cloth wrap. Parents do so in the belief that the legs should be “straightened” so that they don’t remain bent, which they feel may lead to problems like walking later on in life.

However, no attempts should be made to extend the limbs. Babies may have hip dislocated from the time of birth (called CDH = congenital dislocation of the hip joint). It is difficult to pick up, but the doctor should make efforts to diagnose it as early treatment is better. If delayed for too long, beyond the age of 1 year, it may lead to a limp in the child.

Sometimes the ankle of the baby is twisted inwards. This is called CTEV = congenital talipes equino varus). If the ankle is stiff, it requires early physiotherapy and maybe even the application of a cast to keep the ankle straight so as to correct the twist.

13. Crying / sleeping

Parents are requested to refer to the chapters on “Crying and Sleeping” in this book. Newborn babies often jerk their limbs during sleep, but not while they are awake. This is called myoclonus and is a normal phenomenon.

14. Trembling

Babies often tremble or quiver momentarily in their sleep or while awake. They may appear jittery with momentary trembling of their extremities. All this is normal and as long as the baby is feeding and sucking well and is active; parents need not concern themselves.

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