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About Dr. Howard Bennett

Dr. Howard J. Bennett is a practicing pediatrician in Washington, DC and a Clinical Professor of Pediatrics at The George Washington University Medical Center. When he's not sharing humor with patients, Dr. Bennett loves to poke fun at doctors and medicine.

Here are my most recent posts

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.

Common Questions About Newborns—Part I

Heading home with a newborn raises lots of questions and worries in new parents. Here are answers to some of the most common questions I get asked in my office.

My 3-week-old is stuffy all the time and sneezes a lot. Isn’t he too young to have a cold?

Although your 2-week-old is not too young to have a cold, the chances are he doesn’t. Babies have to breathe through their noses for the first few months of life. Their nasal passages are small, however, which explains the “stuffy” sound you hear. Sneezing occurs because of dust and other particles in the air that simply trigger the baby’s sneezing reflex. If your baby gets a real cold, he will have a runny nose just like everyone else.

This morning I saw some blood coming from my 5-day-old’s vagina. Should I worry?

Baby girls commonly have a small amount of whitish discharge from their vagina. In some cases, this discharge turns bright red—it happens because the baby is shedding the lining of her uterus just like women do when they have their periods. This is usually nothing to worry about and will pass in a few days. However, if you notice a lot of blood or the baby has a discharge for more than a few days, contact your doctor.

For the first week of my son’s life, I kept finding a pink stain in his diaper. Does he have blood in his urine?

Your baby was excreting uric acid crystals in his urine. This is a common finding in the first week or two of life. Although parents often report seeing “blood” in their baby’s urine, on further questioning we find out that there is a pink or salmon-colored stain on the diaper. In fact, if the diaper is examined carefully, parents may even see tiny crystals within the matrix of the diaper material.

When I’m changing my baby, I notice tiny opalescent beads around her anus and vagina. If I rub them between my fingers, they have a slight waxy feel. What is this?

These tiny beads come from the lining of the diaper and are not dangerous. Simply wipe them away when you clean your baby with each diaper change.

My 3-week-old’s big toenails are ingrown. Is this normal?

Although this is a common observation, it is not usually due to truly ingrown nails. A newborn’s toenails have the consistency of parchment and because of intrauterine positioning, the nail may grow up against the fleshy part of the toe. The reason it isn’t usually a problem is because the nails break off when the baby moves around. (Most of the time, big toenails do not even need to be cut.) By the time your baby is about 6 months of age, his big toenails should look more “normal” to you.

When my daughter was two weeks old, her doctor said she had a umbilical granuloma. Is that something to worry about?

After the umbilical cord falls off, there is sometimes a little “goo” that remains at the base. This is not a big deal, and I usually recommend that parents clean it with a cotton swab a few times a day until it disappears. In some cases, however, parents will notice red tissue protruding from their newborn’s belly button (it looks a bit like a small raspberry). This tissue is an umbilical granuloma. Although they are not dangerous, if an umbilical granuloma isn’t treated, new skin will grow over its surface and a fleshy lump will remain. Therefore, to ensure that babies have a cute belly button, doctors usually treat granulomas with a medication to make them fall off.

My 10-day-old still has his umbilical cord. It’s gooey and smells bad. What should I do?

It is not unusual for the cord area to have an unpleasant smell a few days before it falls off. The reason for this is because the cord remnant is actually decaying, i.e., the umbilical stump does not have a blood supply and the body’s immune system is rejecting the tissue. However, if the umbilical area smells really bad or you notice redness around the baby’s belly button, you need to contact your doctor to make sure the area isn’t infected.

My son was circumcised three days ago. His penis was red at first, but now there’s some yellow pus on the head. What should we do?

Right after a newborn is circumcised, the head of the penis is bright red and has a “wet” look. Over the next few days, the head becomes drier and takes on a dull red appearance. The head returns to its normal skin color about a week after the circumcision. While the penis is healing, it is very common to see yellowish deposits on the surface of the skin. This is part of the healing process not an infection. If a penis were to become infected, the head would become much redder. In addition, redness and swelling would extend up the shaft towards the body.

If we decide not to circumcise a baby, what do we do to take care of the foreskin? When will it come back over the head?

In the old days, parents were told to pull back forcefully on the foreskin to help it separate from the head of the penis. We don’t recommend this anymore because forcefully separating the foreskin can lead to scarring which might require a circumcision to fix the problem in the future. All you need to do to take care of the foreskin is to gently clean it when you change the baby’s diaper. The foreskin’s attachment to the head of the penis will loosen up over time, and most foreskins are fully retractable once a child enters elementary school. As the foreskin starts to detach, you should pull back very gently to clean the head of the penis during bath time.

My 5-day-old just developed diarrhea. His stools used to be dark green and tarry, but last night they became green, slimy, and runny. Is this diarrhea?

The first stool that a baby has is a thick, green, gooey mess that doctors call meconium. (For the record, meconium consists of all the stuff the baby swallowed during his fetal life: skin cells, hair, and other material floating around in the amniotic fluid.) After passing a handful of these sticky poops, a baby has something we refer to as a “transition stool.” These poops are runny, green, and foamy. In fact, if your baby has one of these poops when his diaper is off, you may see it shoot two or three feet through the air! But rest assured, they are not dangerous and will fade into memory within a couple of days.

When my baby yawns, I see a white pimple on the roof of his mouth. What is this?

It’s called an Epstein’s Pearl and is nothing to worry about. The pearl is composed of mucus cells trapped under a thin membrane. It will go away in the first few weeks of life. Babies often have two variations of this lesion that you may see in other locations. If you see tiny white pimples on the face, they are referred to as milia. If you see a tiny white pimple on the gum, it’s referred to as a Bahn’s Nodule. Although milia may hang around for months, Bahn’s Nodules disappear as quickly as Eptein’s Pearls.

I’m worried that I will hurt my son’s testicles when I clean him up after a poop.

Before puberty, it does not hurt if a boy’s testicles are manipulated. Although it’s logical to be gentle, don’t worry about causing your son any pain when you clean him up after a poop.

What’s the best way to clean the whitish material that builds up between a baby girl’s outside and inside vaginal lips?

Cleaning the material that accumulates between the labia majora (outside vaginal lips) and labia minora (inside vaginal lips) bother parents as much as cleaning a little boy’s testicles. I tell parents two things in this regard: (1) they do not need to clean away the discharge at one time and (2) they can clean it away by gently wiping with a cotton washcloth in a downward direction. (I prefer washcloths to cotton balls because they have better traction.)

Will I hurt my baby’s soft spot if I rub it when I wash his hair?

The medical name for a baby’s soft spot is called the anterior fontanelle. This is an opening in the bones of the skull that allows the cranium to grow. The fontanelle is covered with a very tough membrane so you will not hurt is when washing your baby’s hair. Although we don’t recommend poking the fontanelle, you can scrub it with a brush like the rest of your baby’s scalp.

Click here to read more questions and answers about newborns.

Should You Give Your Child Fever Medicine Before a Doctor’s Visit?

Parents frequently avoid giving their children fever medicine before a sick
visit because they’re afraid it will compromise the doctor’s medical evaluation.
In reality, giving a child something to lower her fever before a visit usually
makes it easier for doctors to determine what’s going on. Fever medicine isn’t
strong enough to mask symptoms, but has the potential to make a young child more
cooperative during the visit.

There is one caveat to this recommendation,
however. NEVER give fever medicine to an infant less than 2 months of age
because it this age group, doctors do need to assess the baby before the fever
is treated.

The Blue Rubber Item You Get After Birth is Not a Nasal Aspirator

After a baby is born, a nurse puts a blue rubber aspirator in his bassinet. Parents commonly take this item home and use it to clean mucus from their baby’s nose. You should know, however, that this device is not a nasal aspirator. Instead, the hospital nurses use it to suck saliva or mucus out of a baby’s mouth after he spits up. The reason it should not be used in the nose is because the tip is pointy and can injure a newborn’s sensitive nasal passages. A true nasal aspirator has a blunt tip that can’t be pushed too far into a baby’s nose. The tip can also be removed so the inside can be cleaned out from time to time.

Stuffy Babies Do Not Usually Have Colds

In the first few months of life, babies are obligate nose breathers. This means that they have to breathe through their noses. By the time babies are three to six months of age, they are able to breath through their mouths, but most still prefer nasal breathing. Because babies breathe through their noses, they make all sorts of noise—snurgles, snorts, and other sounds that mimic a cold. If a baby truly has a cold, he will have a runny nose and a cough.

The reason this distinction is important is because many parents feel the need to clean their baby’s noses if they are stuffy. As long as your baby can feed easily, you do not need to:

(a) put saline drops in his nose of

(b) clean his nose with a nasal aspirator.