Common Questions About Newborns—Part II

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 that’s 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 of these resolve in the first month of life, some become hard and persist until 6-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?
Although I don’t agree with this recommendation, many baby books say you shouldn’t use soap on a baby’s skin in the first month of life. 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 to get the job done.

My 3-day-old has a blister on her upper lip. Do you know where this came from and when it will go away?
This is called a sucking blister. It doesn’t bother the baby and usually falls off in a few days. Sometimes a baby will get more than one in the first few weeks of life.

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. Unfortunately, by the end of the pregnancy, the concentration 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 job occurs 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 2-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 whites of my baby’s eyes are blue. Is that normal?

The white part of the eye is called the sclera and the tissue inside 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 newborn has overlapping toes. Should I tape them to straighten them out?
Things are pretty tight in the uterus and babies have a few “problems” because of this. Their shins are bowed because their legs were crossed in-utero, and their toes may overlap as well. If your newborn has overlapping toes because of these intrauterine forces, they will straighten out in the next few months. However, if her overlapping toes are a familial trait, they may last forever. Fortunately, they are unlikely to cause her any problems.

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.

If I carry my newborn in a Snuggli, will it hurt his back?
Infants are very flexible and carrying them in an infant carrier will not cause back pain. The main thing to be concerned about when you use an infant carrier is that the baby doesn’t throw up when he is in an awkward position. Therefore, you need to be careful about getting a good burp before putting him in a carrier.

My 6-week-old has a soft bowel movement twice a day. However, before she goes, she strains real hard 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 sometimes grunt and strain with defecation because of a reflex that tells them to push when fecal material enters their 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.

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 pushes 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 gland (the parotid gland) matures. 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.