Newborn First Looks
Newborn First Looks
Scott Cohen (Pediatrician, Cedars-Sinai Medical Center) gives expert video advice on: What should I expect regarding my baby's physical appearance after birth?; What are the different ways my child could get jaundice?; Why does my newborn's skin look so dry? and more...
What should I expect regarding my baby's physical appearance after birth?
After birth, your baby may look very different in these first couple days compared to what they're going to end up looking like. That's because a lot of babies are very swollen after delivery. Their eyes are swollen shut so they're not going to open their eyes very often. There is also often molding or coning of the head, where the back of their head looks cone-shaped from the delivery process; that goes away very quickly and it doesn't affect dating in any way. There's often bruises, these could be facial bruises, bruises on the head or on the body from delivery, which will also go away. There's a myriad of rashes, that are absolutely normal in newborns, that may be there for the first several weeks to months of life. So what your child initially looks like may change rapidly in the first couple days.
What is "jaundice"?
Jaundice is a yellow color of the skin that is very common in babies. Over half of healthy babies do become jaundiced. There are many different causes and reasons for jaundice. The most common cause is something called physiologic or healthy baby jaundice. This usually happens around day 3 to day 5 of life. Jaundice is caused by a chemical called bilirubin that's in our blood. It's actually a breakdown product of red blood cells. In a newborn, or in all of us, the liver is the part of the body that gets rid of bilirubin, and it takes a couple of days for our liver to rev up, so our whole system is backed up. On top of that, most babies are at least a little bit dehydrated in the first couple days because breast milk hasn't come in yet, so the concentration of that chemical in the blood is higher. As a result, this usually reaches a peak around day 3 to day 5. They turn yellow, and then the breast milk comes in, dilutes out the system, the liver revs up, gets everything moving in the poop and the pee, and the baby's jaundice and yellow color goes away. Any jaundice should be looked at and brought to the attention of your doctor, because there are many other causes of jaundice that have to be watched more closely.
What do I do if my baby has jaundice?
If your baby has jaundice, you need to let your doctor know. For the most part, we often just tell parents that we're just going to feed right through the jaundice, meaning they should continue to breastfeed. Sometimes we need to supplement a little bit extra if the breastmilk isn't in on time. Often your doctor will do a blood test to check the amount of bilirubin in your body, which is the chemical that causes jandice that's in the blood. But the doctor may also look for other causes of jaundice if there is a high degree of jaundice. Jaundice always starts in the face and moves down the body, and as the level increases, more parts of your body will turn yellow.
What is "phototherapy"?
Phototherapy is given when children reach certain levels of jaundice. Now, for every day old you are you are, it takes a higher level of jaundice to be in order to be concerned about it. So, in the first couple of days the level is usually less than ten and we want to see it less than ten. Then, when you get greater than 72 hours of age we are concerned if the level is greater than let's say 17 or 18, and those are the times that we would consider using lights. What the lights do is they shine on the baby, and it's called phototherapy. Usually there are two lights: a lamp that goes over the baby, and a biliblanket, which is a light blanket that the baby lays on. The more surface area of the body that is exposed to the lights, the better. This phototherapy breaks down the bilirubin, the jaundice in the blood, and helps get rid of it more easily. One of the things that the parents can do to get rid of mild jaundice is actually feed their baby in a windowsill and get indirect sunlight, which does the same thing; undressing the baby and having as much of their body exposed to the sunlight as possible. The eyes often look very yellow. That's actually the last part of jaundice that goes away, and that can even last many, many weeks even after the jaundice is getting better.
What are the different ways my child could get jaundice?
Other then the healthy baby, and the physiologic jaundice, other things that your docter is thinking of is if the jaundice starts after one day of age. Certain blood types can cause jaundice. So, if the mom is o positive and the baby is a or b positive, those two blood types can miss match, and that can cause a break down of the red blood cells causing an increase in jaundice. So that's something that your doctor may ask you, your blood type, and check the baby's blood type. Then there's something called breast milk jaundice, which happens around one to two weeks of age, and that is actually caused by an enzyme that is in breast milk. If we think it's breast milk jaundice it's something that we don't worry about and we just breast feed through. So there's many other causes of jaundice; sickness and sepsis and infection in the baby's body can also cause jaundice. Then there are other rare causes of jaundice that your doctor will investigate if their concerned about an elevation of the bilirubin.
What are "delivery bruises"?
Delivery bruises happen because of the trauma of delivery. This includes the coming out of the vaginal canal where often the head is large compared to the vaginal canal. The pressure on the head or different parts of bodies during this can cause delivery bruises. Also, the method the obstetrician uses to deliver the baby may cause delivery bruises. So if they use forceps or suction, wherever those forceps pushed on the head or the suction was used on the head, may cause a large delivery bruise. Delivery bruises are nothing to be worried about. If they're on the head, this is not on the brain - it is between the bone and the skin, so it's just a bruise on the skin. It gets better very quickly, usually within the first week of life.
What is a "birthmark"?
A birthmark is a mongolian spot and there is nothing to worry about.
What is a "stork's kiss birthmark"?
Another type of common newborn rash is something called a "stork's kiss," or a naevus simplex. This looks like a flat red patch that can be anywhere on the baby's body, but very commonly is on their forehead, their upper eyelids, the glabella region, or on the nape of their neck, just where the hairline is. Again these rashes are very common and some of them will fade over time. It is probably the most common birthmark I see, yet I don't remember the last time I saw an adult with one. So even though they say only about 40 percent go away, a lot of them do fade, or as the skin gets thicker, you just don't notice them anymore.
What is a "newborn rash"?
This is another rash that is very common in newborns. A newborn rash happens usually after birth, anywhere from the first couple of days to several weeks after. The newborn rash literally looks like little flea bites and they can be anywhere on the body or the face, with little bumps. It doesn't hurt your child, it doesn't itch and it doesn't cause them any problems, they just come and go.
What are "raised birthmarks"?
So there are some raised birthmarks we see. One very common raised birthmark is called a hemangioma. And this is a vascular birthmark, which means it's made out of blood vessels. Some of them are raised, a raised red patch, or some of them are under the skin, either light red or even bluish in color, and these are called cavernous hemangiomas, which are vascular birthmarks that are under the skin.The hemangiomas are very interesting. They also can be anywhere on your body, and in the majority of cases, again there's nothing to worry about. They will grow over the first year of life, and then after that they disappear. And it may take three years, five years, seven years, but they will eventually fully go away without any problems. You'll never know that they were there. There are certain hemangiomas that your doctor will maybe investigate or do further investigation on. And these are - we have to watch more closely if they're in certain areas. For example if they are in the opening of the ear, in the opening of the nose, or mouth, or eyes, because as they grow, we don't want them to impinge your functions of hearing, or vision or breathing, and so those specific hemangiomas we watch more closely. But in general hemangiomas are nothing to worry about.
What are normal newborn reflexes?
Your child is born with many newborn reflexes. And these are reflexes that you're born with, but that disappear. And most newborn reflexes disappear by about four to six months of age. There are two newborn reflexes that persist to a year, the sucking reflex, which makes sense because your baby needs to be sucking--taking the milk up to a year at least. And the Babinsky reflex, which is when you rub the bottom of the foot, and the toes curl up. If I did that to you, and rubbed the bottom of your foot, your toes would curl down. And that makes sense that you start curling down after a year, because that's when you start walking, and you're sort of grabbing to the ground. Now the Moro newborn reflex is a startle reflex that it can be out of the blue--it could be after a loud noise; it could just be after holding the baby's hands, that they shake and hug the air like this. Or their leg quivers; or their lower lip or chin quivers. All these little quivers are normal newborn reflexes. But the Moro reflex is the shaking of the arms in a hugging position up in the air. And that newborn reflex usually goes away about four to six months of age. It wouldn't make much sense if we were all walking down the street doing that. Some other newborn reflexes are the Moro reflex, where again, the toes curl up. There's the Rooting reflex where you rub the cheek of the baby, and their mouth will go toward it. And that makes sense that the babies need that so that when they feel the breast or the nipple near their mouth, they go to take the nipple. And these are all absolutely necessary reflexes for a newborn.
What is "periodic breathing"?
There are some quirks that your baby will have that are absolutely normal. We always like to go over these with parents because they are scary if you don't know they're normal. One is Moreau reflex which is the shaking which is not a seizure, and is absolutely normal. Another is something called "periodic breathing." You and I breathe at a constant rate, whereas babies breathe fast sometimes and slow sometimes. So you'll actually hear them breathe really fast and really slow, and this is absolutely normal. It's called periodic breathing and it's normal as long as the fast part isn't sustained or there is a change in color. Of couse, in those scenarios you should let your pediatrician know, but the ups and downs of this periodic breathing are very normal.
Why does my newborn's skin look so dry?
One common thing you're going to see on your newborn after delivery is that often their hands, their feet, really all over their body may be very scaly. This is because your child just spent nine months in water and now their skin has to acclimate to the air. And this dry skin or little molting areas you can just leave alone and let the skin breathe the first month of life and let it acclimate to the air. If you'd like to put moisturizer, baby moisturizers on it that's okay as well, but really you don't have to do anything. It's absolutely normal.