Parent and Baby

Written on April 5, 2008 – 3:58 pm | by Staff |

Your baby has just been through one of the toughest battles he will ever face. It’s a big job to be pushed down the birth canal and out into the world. Sometimes mother and baby need help, and baby must be delivered with a vacuum extractor or forceps, or by Cesarean section. No matter how your baby arrives, it is wonderful to meet him!

Your newborn is amazing. When he enters the world, all his major organs are functioning. He can see, hear, smell, taste and feel. He may look as though he has no awareness of what’s going on, but he is sensitive to events taking place around him.

What Does Baby Look Like?

If you’re like most new parents, the first thing you do when you see your baby is to examine him from head to foot. What does he look like? Does he have hair? Does he have 10 fingers and 10 toes? Is he all right? These concerns are universal-we felt the same way when our children were born.

If your baby is average size, he’ll weigh between 7 and 8 pounds, and be between 18 and 22 inches long.

Baby’s Head and His Face

You may notice that your newborn’s face is puffy, and his head is slightly misshapen and has a “mashed” or “conehead” look. It’s common for a baby’s head to look like this because the skull, which is actually made up of several bones, had to change shape (mold) to move through the birth canal. You may think his head looks enormous—it is! At this time, his head accounts for 25% of his body, which is one reason his skull had to reshape to fit through the birth canal.

Your baby’s face might look a little askew, as if he’d been in a fight or slid down a slippery slide on his face. His nose may be flat, and his chin a little out of place. He may have some bruises on his face. The skin over his brow may be wrinkled and loose, and his eyes may be swollen and bloodshot. As with his misshapen head, this is due to the exertion of birth. A misshapen head may take a little longer but should be normal-looking in a few days.
His eyes will appear blue or be dark. However, his true eye color won’t be evident until he’s about 6 months old.

The two soft spots on the top of his head are called fontanels. One is close to the crown; you’ll be able to see and feel his pulse there. The other is above his brow on his forehead. These spots decrease in size as his bones grow together. It’s OK to touch them gently; they’re covered with a thick, protective membrane.

You may also notice the crown of baby’s head is lumpy, swollen and/or discolored. This is called a caput and results from his head pushing against his mother’s cervix and the birth canal. The caput quickly disappears; it will look better every hour and often appears normal by the time you go home in a few days.

If he has hair, you may be surprised by the color. This hair is usually temporary. His real hair (the permanent kind) will begin to grow soon, although some babies don’t get permanent hair until they’re close to a year old (or older!).

You may notice a few blisters in your baby’s mouth. Check his thumbs and fingers for any thickened or callused areas. Most babies suck their thumbs or fingers in utero; your baby probably did, too. Your baby may have a nursing tubercle on his upper lip, which stiffens the lip and makes grasping your nipple or a bottle nipple easier for him. If his chin quivers or his legs and arms seem shaky, it just means that more electrical impulses are being sent to muscles than are necessary, which results in these movements. This is normal, and movements decrease over the next few months.

Baby’s Skin

Next you may examine the skin on his body. Most babies are covered with a thick, white, waxy coating when they’re born, called vernix. Vernix protected baby’s skin while he was in the uterus. When he’s cleaned up, you may be able to see the veins through his skin, which is still thin. His hands and feet may peel. He may have birthmarks.

A Caucasian baby’s skin color can range from purplish to pinkish gray. The pigmentation of babies of color may not be evident for hours or even a few days after birth. Many are born with light skin that darkens. If baby’s a little blue in color, it may be caused by mucus in his air passages. Most mucus is suctioned out, and he coughs out the rest.

His skin may appear yellow- or orange-tinged by the second or third day—about half of all newborns experience jaundice. The color is caused by the inability of baby’s liver to remove breakdown products of blood cells, and the buildup causes the skin to look yellowish or orangish. A mild case of jaundice goes away in about a week or 10 days: It may last slightly longer if your baby breastfeeds.

Delivery marks. Delivery marks occur in almost every delivery. They can occur while the baby is in the uterus, during the descent through the birth canal and during delivery. The use of forceps or a vacuum extractor to assist with delivery may increase the chance of delivery marks. Marks can vary, from a misshapen head (nothing to worry about; it will change rapidly after birth) or a flattened ear or nose, to bumps and bruises. Forceps may leave marks on the side of the head, in front of the ears. A vacuum extractor may leave a mark on the back or crown of the head. These marks fade within a few hours to a few days. Lotion may be helpful in some situations.

Call the doctor if any of the marks get bigger or if they don’t fade within the first few days. If they become warm to the touch, or hard, let your doctor know.

Birthmarks. A baby may show many types of marks after birth. These include salmon patches, stork bites, hemangiomas, strawberry marks, Mongolian spots, cafe au lait spots, port-wine stains, spider veins (nevi) and pigmented nevi (beauty marks). All are discolorations or marks on the skin.

• Salmon patches, also called stork bites, are pinkish areas usually found on the head or face caused by blood vessels in the skin. Some are temporary; some are permanent.
• Hemangiomas, also called strawberry marks, are fairly common birthmarks. About one in 10 babies has them. They are often red or pinkish and may not appear until a few weeks after birth; most disappear by age 10.
• Mongolian spots are flat, blue-colored marks, which look like bruises, found on the back and buttocks. They are seen most often in dark-skinned and Asian babies. These spots are not a sign of disease and should fade by age 3, but they may never disappear completely.
• Cafe aulait spots are usually tan to light brown in color, can be seen anywhere on the body and are usually permanent.
• Port-wine stains are purple to red in color and often permanent. They may fade somewhat, or they may be removed by laser surgery when baby is older.
• Spider nevi are dilated blood vessels that look like a spider web; they usually fade by 1 or 2 years of age.
• Moles or pigmented nevi come in several colors, from light brown to black.

Keep an eye on any birthmarks your child has. Call the doctor if a birthmark grows or changes color. If a mark is close to the eye or on baby’s face, your pediatrician will check it If baby has six or more cafe au lait spots on his body, have them checked by your doctor. If port-wine stains appear on any part of the face, they should be checked regularly. The doctor should check moles that bleed, change color or get bigger.

In most instances, birthmarks are watched to see if they fade or go away on their own. Laser surgery is used in many instances to remove birthmarks and moles. Other treatments may be possible in specific cases.

It’s interesting to note as you examine your baby that his skin is the most developed sensory organ he has right now. He’ll love it when you gently rub and stroke him.

Examining Other Parts of His Body

Baby’s hands and feet are so small they may amaze you. He’ll probably hold his hands in tight fists. His fingernails may be paper-thin; don’t be surprised if they already need trimming! Often his legs are drawn up against his tummy—this is called the fetal position. If you gently pull them out, his legs may appear short. And when you let them go, it’s almost as if they were on rubber bands—they pull right up again against his body. His feet have only a heel bone at this time. The cartilage that makes up the rest of his foot will become bone later. His peanut-shaped feet may turn inward.

His tummy may be prominent. This isn’t fat; it’s caused by a lack of muscle tone. This disappears as he becomes more mobile in the next few months.

Your baby’s genitals may appear swollen and enlarged; this can happen with either sex. A girl may have a vaginal discharge. See the discussion in Week 1. Don’t worry—this is normal and will clear up in a few days. The mother’s hormones crossing the placenta causes these symptoms.

In a few cases, a baby may experience a bone break, fracture or a dislocation during delivery. These conditions heal well, with no lasting result, and are usually treated with bandaging. If your baby experiences any of these problems, use great care when lifting him. Dressing must be done carefully; bathing may have to wait awhile.

Your baby’s heel is usually pricked for a blood sample, so it may look sore or inflamed. His hips may seem loose-jointed and crack when they move. This is normal and caused by hormones from his mother. Your pediatrician will examine your baby for signs of a dislocated hip, which can be treated.

If you notice a hard lump between baby’s ribs, it’s a bone called the xiphoid process. Soon it will be covered with muscle and fat as baby develops, so don’t be concerned about it. Your baby may also have a hollow vertical area running down his tummy. This is caused by the two muscle bundles on either side of the abdomen—they haven’t grown together yet but will as baby grows older.

Baby’s bowels. Even though you probably never imagined it, you will be concerned about your baby’s bowels. It doesn’t only mean changing diapers; your baby’s stools can be an indication of health.

Your baby’s first bowel movement is called meconium. It consists of cellular material and other substances from his digestive tract as it developed in the womb and looks yellow-green, brown or like black tar. Your baby must get rid of this material in the 48 hours after birth before normal digestion can begin. If he doesn’t, you doctor may be concerned about intestinal obstruction.

Once your baby passes the meconium, his stools will be yellow-green and look like birdseed. If you breastfeed your baby, his stools will look different than a baby’s who is fed formula.

Baby’s Senses

It may seem incredible, but soon after birth, a baby can recognize his mother’s voice and her scent. Before your baby is born, he is already sensitive to sounds, light and temperature. His senses develop quickly once outside the womb. As we’ve already mentioned, he can hear, see, feel and taste when he is born. Let’s examine what his senses are like at this time.

Taste. Your baby is born with a desire for sweet things, which is suited to the flavor of formula or breast milk. His taste for bitter, salty and sour develops later. At this time, he can distinguish bitter and sour tastes.

Hearing. Baby’s hearing is not fully developed at birth. Parts of the ear are immature, so your baby can’t hear the range of sounds you can. Low-frequency sounds can be heard by baby at birth, including the human voice. Studies have shown that babies prefer the sound of the human voice to any other sound. To help baby develop his hearing, speak to him often in a slow, exaggerated voice. You’ll both enjoy the interaction, and you’ll help him develop his hearing.

Sense of smell. Researchers believe that your baby’s sense of smell is well developed at birth. Within hours of birth, a breastfeeding baby will use his nose to find his mother’s nipple. Amazingly, your baby’s sense of smell may be developed in utero— certain food flavors and odors, such as garlic, cross the placenta to the baby. If you love garlic and onion flavors, baby may already be familiar with them! If you breastfeed, exposure continues because flavors pass into your breast milk.
Your baby will learn about some smells as he grows. He will learn which smells are “good,” such as those associated with foods, and which smells are unpleasant.

Touch. A baby is sensitive to touch from birth; his skin is the largest organ of his body. It doesn’t take long for him to become familiar with the touch of those close to him. Your touch will soothe him or stimulate him.

It’s important to know how to touch your baby. A baby likes a firm touch. It makes him feel secure. He also likes to be stroked and massaged—that’s why we include different massage techniques in the first 6 weeks of discussions. Massaging your baby has benefits for him and you. Studies show that babies who are massaged for 10 to 15 minutes before bedtime or napping may sleep better and be less irritable.

Sight. Eyes may be quite developed by birth and capable of seeing many things. However, the baby’s brain isn’t as fully developed, so he doesn’t see as well as an adult. That’s one reason you’ll have to hold an object very close to baby for him to see it, about 8 to 12 inches away. He can distinguish light from dark and prefers black-and-white patterns. If you move an object farther away from him, his eyes may cross. He can’t focus both eyes on the same thing just yet.

Vision and hearing tests. Today, many hospitals and physicians are testing a baby’s hearing and vision before he leaves the hospital. A baby’s eyes are usually tested shortly after birth for eye disease and proper function, especially if there is a family history of problems. If a problem is discovered, your baby may need to see an ear, nose and throat specialist (ENT) or an ophthalmologist.

Hearing is tested by recording electrical brain activity in response to various sounds or by listening for an echo in the inner ear. If your baby has a hearing loss, it could affect the way his speech develops.

Baby Tests

Immediately and again shortly after birth, your baby will be subjected to a variety of tests to assess his health and to provide his physician with information about any potential problems. The chart on page xxx shows the major tests your baby may be given.

Baby Functioning after Birth

Parents frequently exult, “It’s over!” after a baby’s birth, when in reality it has just begun. Baby’s functioning after birth includes his first attempts at breathing, coughing fluid from the lungs, sneezing, movement of legs and arms, and often passage of urine or a bowel movement.

With those first breaths, your baby goes from being totally dependent on blood flow from the placenta to using his own lungs and airways to breathe. The blood flow in the heart changes—blood that was diverted from the lungs directly to the body before birth now flows through the chambers of the heart into the lungs, then into the body.

New parents are often concerned about baby’s color. “Are babies always so blue?” they ask. The answer is, “Yes,” but the baby soon turns pink. Hands and feet are the last areas to turn pink.

Following delivery, baby is often quiet but is soon crying and moving. The nurses weigh, measure and evaluate your baby in the moments after birth. During this time, he becomes more alert.

Your baby will exhibit several reflexes. The grasping reflex causes baby’s hand to become a fist when his fingers or palm are touched. When you touch or rub his cheek, his mouth will open and he will make a sucking motion; this is the rooting reflex. The baby will throw his arms and legs out, then quickly draw them in when startled. This is the Moro reflex.

Baby’s Birth Weight

“How much does he weigh?” is one of the first questions new parents ask. What a baby weighs is influenced by many factors, including your health during pregnancy, medications, smoking, nutrition, diet, length of the pregnancy (early or late) and the size of your partner. The average weight at term is 7 pounds, 2 ounces, but this can vary widely. In addition to weight, other measurements are made, including length (average is between 18 and 22 inches), head circumference and abdomen circumference.

Baby’s weight may fall a little in the days following delivery. Most babies lose a few ounces and many become shorter if the birth was vaginal and the head was pointed.

Baby’s Care in the Hospital

Your baby’s pediatrician will visit him in the hospital, and any follow-up care will be arranged. The pediatrician will examine the baby, perform a circumcision, if you request it, and get acquainted with you and your partner. The pediatrician will establish a schedule of follow-up visits in his or her office. Be sure you know how to contact the pediatrician or the pediatrician’s office if you have any problems.

Circumcision

Circumcision is the surgical removal of the foreskin on the penis of a baby boy. It is usually performed in the hospital or the doctor’s office by a pediatrician, obstetrician or family doctor within a few days of delivery. If circumcision is part of your religious ritual, it is performed by someone in your religion who is trained to do it, and it is done outside the hospital in a religious ceremony.

The decision to circumcise your son should be made by you as a couple. If you have questions, discuss them with your pediatrician. A surgical consent is required before a circumcision is performed, so you can ask questions about the procedure. Local anesthesia is used, and the procedure takes about 5 minutes. See the discussion in Week 1 for care after circumcision.

Dislocated Hips

Dislocation of a baby’s hip(s) occurs more often in baby girls and in babies delivered in the breech position. About one in 60 newborns is affected; 85% of these are girls.

When your baby is examined by the pediatrician in the hospital, his hips are checked to see that the upper leg bone (femur) fits in the hip socket (pelvic bone). A “hip click” (a clicking sound) may be heard when the legs are pulled apart. Skin folds on the buttocks may not be symmetrical or one leg may appear shorter than the other. If left uncorrected, he may have a limp when he begins to walk.

Today, surgery is rarely required to correct the problem. Splints are usually used for a few months, sometimes called pillow or diaper splints. They keep the hips widely separated. It’s like wearing three or four diapers at one time. In some cases, plaster splints (like a cast) or braces are used. In most cases, the problem is corrected before the end of the first year.