Clinical Reference Systems: Pediatric Advisor 10.0
The Normal Newborn's Appearance
Even after your child's physician assures you that your baby
is normal, you may find that he or she looks a bit odd.
Your baby does not have the perfect body you have seen in
baby books. Be patient. Most newborns have some peculiar
characteristics. Fortunately they are temporary. Your baby
will begin to look normal by 1 to 2 weeks of age.
This discussion of these transient newborn characteristics
is arranged by parts of the body. A few minor congenital
defects that are harmless but permanent are also included.
Call your physician if you have questions about your baby's
appearance that this list does not address.
Molding refers to the long, narrow, cone-shaped head
that results from passage through a tight birth canal.
This compression of the head can temporarily hide the
fontanel. The head returns to a normal shape in a few
This refers to swelling on top of the head or throughout
the scalp due to fluid squeezed into the scalp during
the birth process. Caput is present at birth and clears
in a few days.
This is a collection of blood on the outer surface of
the skull. It is due to friction between the infant's
skull and the mother's pelvic bones during the birth
process. The lump is usually confined to one side of
the head. It first appears on the second day of life
and may grow larger for up to 5 days. It doesn't
resolve completely until the baby is 2 or 3 months of
- Anterior fontanel
The "soft spot" is found in the top front part of the
skull. It is diamond-shaped and covered by a thick
fibrous layer. Touching this area is quite safe. The
purpose of the soft spot is to allow rapid growth of the
brain. The spot will normally pulsate with each beat of
the heart. It normally closes with bone when the baby
is between 12 and 18 months of age.
- Swollen eyelids
The eyes may be puffy because of pressure on the face
during delivery. They may also be puffy and reddened if
silver nitrate eyedrops are used. This irritation
should clear in 3 days.
- Subconjunctival hemorrhage
A flame-shaped hemorrhage on the white of the eye
(sclera) is not uncommon. It's harmless and due to
birth trauma. The blood is reabsorbed in 2 to 3 weeks.
- Iris color
The iris is usually blue, green, gray, or brown, or
variations of these colors. The permanent color of the
iris is often uncertain until your baby reaches 6 months
of age. White babies are usually born with blue-gray
eyes. Black babies are usually born with brown-gray
eyes. Children who will have dark irises often change
eye color by 2 months of age; children who will have
light-colored irises usually change by 5 or 6 months of
- Tear duct, blocked
If your baby's eye is continuously watery, he or she may
have a blocked tear duct. This means that the channel
that normally carries tears from the eye to the nose is
blocked. It is a common condition, and more than 90% of
blocked tear ducts open up by the time the child is
12 months old.
(For further information, see Blocked Tear Duct.)
- Folded over
The ears of newborns are commonly soft and floppy.
Sometimes one of the edges is folded over. The outer
ear will assume normal shape as the cartilage hardens
over the first few weeks.
About 1% of normal children have a small pit or dimple
in front of the outer ear. This minor congenital defect
is not important unless it becomes infected.
The nose can become misshapen during the birth process.
It may be flattened or pushed to one side. It will look
normal by 1 week of age.
- Sucking callus (or blister)
A sucking callus occurs in the center of the upper lip
from constant friction at this point during bottle- or
breast-feeding. It will disappear when your child
begins cup feedings. A sucking callus on the thumb or
wrist may also develop.
The normal tongue in newborns has a short tight band
that connects it to the floor of the mouth. This band
normally stretches with time, movement, and growth.
Babies with symptoms from tongue-tie are rare.
(For further information, see Tongue-Tie. )
- Epithelial pearls
Little cysts (containing clear fluid) or shallow white
ulcers can occur along the gumline or on the hard
palate. These are a result of blockage of normal mucous
glands. They disappear after 1 to 2 months.
The presence of a tooth at birth is rare. Approximately
10% are extra teeth without a root structure. The other
90% are prematurely erupted normal teeth. The
distinction can be made with an x-ray. The extra teeth
must be removed by a dentist. The normal teeth need to
be removed only if they become loose (with a danger of
choking) or if they cause sores on your baby's tongue.
Swollen breasts are present during the first week of life in
many female and male babies. They are caused by the passage
of female hormones across the mother's placenta. Breasts
are generally swollen for 2 to 4 weeks, but they may stay
swollen longer in breast-fed and female babies. One breast
may lose its swelling before the other one by a month or
more. Never squeeze the breast because this can cause
infection. Be sure to call your physician if a swollen
breast develops any redness, streaking, or tenderness.
- Swollen labia
The labia minora can be quite swollen in newborn girls
because of the passage of female hormones across the
placenta. The swelling will resolve in 2 to 4 weeks.
- Hymenal tags
The hymen can also be swollen due to maternal estrogen
and have smooth 1/2-inch projections of pink tissue.
These normal tags occur in 10% of newborn girls and
slowly shrink over 2 to 4 weeks.
- Vaginal discharge
As the maternal hormones decline in the baby's blood, a
clear or white discharge can flow from the vagina during
the latter part of the first week of life. Occasionally
the discharge will become pink or blood-tinged (false
menstruation). This normal discharge should not last
more than 2 to 3 days.
The newborn scrotum can be filled with clear fluid. The
fluid is squeezed into the scrotum during the birth
process. This painless collection of clear fluid is
called a "hydrocele." It is common in newborn males. A
hydrocele may take 6 to 12 months to clear completely.
It is harmless but can be rechecked during regular
visits. If the swelling frequently changes size, a
hernia may also be present and you should call your
physician during office hours for an appointment.
- Undescended testicle
The testicle is not in the scrotum in about 4% of
full-term newborn boys. Many of these testicles
gradually descend into the normal position during the
following months. In 1-year-old boys only 0.7% of all
testicles are undescended; these need to be brought down
- Tight foreskin
Most uncircumcised infant boys have a tight foreskin
that doesn't allow you to see the head of the penis.
This is normal and the foreskin should not be retracted.
For more information see Foreskin Care and Problems.
Erections occur commonly in a newborn boy, as they do at
all ages. They are usually triggered by a full bladder.
Erections demonstrate that the nerves to the penis are
BONES AND JOINTS
- Tight hips
Your child's physician will test how far your child's
legs can be spread apart to be certain the hips are not
too tight. Upper legs bent outward until they are
horizontal is called "90 degrees of spread." (Less than
50% of normal newborn hips permit this much spreading.)
As long as the upper legs can be bent outward to 60
degrees and are the same on each side, they are fine.
The most common cause of a tight hip is a dislocation.
- Tibial torsion
The lower legs (tibia) normally curve in because of the
cross-legged posture your baby was confined to while in
the womb. If you stand your baby up, you will also
notice that the legs are bowed. Both of these curves
are normal and will straighten out after your child has
been walking for 6 to 12 months.
- Feet turned up, in, or out
Feet may be turned in any direction inside the cramped
quarters of the womb. As long as your child's feet are
flexible and can be easily moved to a normal position,
they are normal. The direction of the feet will become
more normal between 6 and 12 months of age.
- Long second toe
The second toe is longer than the great toe as a result
of heredity in some ethnic groups that originated along
the Mediterranean, especially Egyptians.
- "Ingrown" toenails
Many newborns have soft nails that easily bend and
curve. However, they are not truly ingrown because they
don't curve into the flesh.
- Scalp hair
Most hair at birth is dark. This hair is temporary and
begins to shed by 1 month of age. Some babies lose it
gradually while the permanent hair is coming in; others
lose it rapidly and temporarily become bald. The
permanent hair will appear by 6 months. It may be an
entirely different color from the newborn hair.
- Body hair (lanugo)
Lanugo is the fine downy hair that is sometimes present
on the back and shoulders. It is more common in
premature infants. It is rubbed off with normal
friction by 2 to 4 weeks of age.