Is Something Wrong?

• Table Of Contents
• Feeding Your Baby
  • Breastfeeding vs. Bottle Feeding
  • Suggested Diet
• Bottle Feeding
• Breastfeeding
  • Start & End Breastfeeding
  • General Feeding Techniques
  • The Sleepy Baby
  • Storage of Breast Milk
• Common Breastfeeding Issues
  • Management of Sore Nipples
  • Other Breastfeeding Issues
• Diapering
  • Diaper Rash & Skin Care
  • Urination & Bowel Movements
• Is Something Wrong?
  • Normal Physical Characteristics
  • Signs & Symptoms of Illness
  • Taking a Temperature
  • When to Call
• Safety
  • Bulb Syringe Use
  • Car Seats
  • Shaken Baby Syndrome
• Other Care Issues
  • Bathing
  • Umbilical Cord Care
  • Circumcision
  • Sleep Patterns & Positioning
  • Newborn Screening Tests
• Recommended Immunization Schedule

"Normal" Physical Characteristics

As a new parent, we know that you are concerned about both the health and the appearance of your new baby. Some things about your baby's appearance may seem unusual to you but they are actually quite normal. Here are some common newborn physical features and conditions you may wonder about:

Birthmarks

Your baby may have birthmarks on different parts of the body. Dark-skinned babies frequently have dark blue or purple, bruise-like spots over their buttocks and sometimes their hack, arms and legs. Light-skinned babies may have small, pale pink or red spots around their eyelids and at the back of the neck. These birthmarks usually disappear within one to four years.

Pressure marks

Sometimes forceps must be used during the delivery to help the baby pass through the birth canal. This instrument may cause red pressure marks on your baby's cheek, head or jaw. These marks will usually start to disappear within a few days.

Fontanel (FON-ta-NELL)

You will probably notice a soft spot on the top of the baby's head. This is called the fontanel. The fontanel allows the skull bones to overlap slightly during birth, making it easier for the baby to pass through the narrow birth canal. The soft spot will gradually disappear over the next year or two as the skull bones grow together after allowing for growth of the brain. In the meantime, it is OK to wash and brush your baby's hair over the soft spot.

Bruising

Some babies have a collection of blood under their scalp that may grow larger over the neat few days after birth. This is a result of bruising that occurs during delivery and may take several weeks or months to go away.

Eyes

Your baby will open his or her eyes very soon after birth. Medication is placed in the eyes to prevent infection. The eyes may look puffy but this should go away after a few days. Eye color in newborns is usually grayish blue in light-skinned babies and grayish brown or brown in dark-skinned babies. You will not be able to tell the final eye color for six to 12 months. It is normal for the eyes to move in a jerky and uneven manner during the first couple of months. Even now, however, your baby can see shadows and outlines and will soon begin to respond to your face.

Breathing

You may notice that your baby breathes faster than you do. A baby's breathing is usually irregular or uneven, and occasionally a baby may even appear to stop breathing for a few seconds or appear to gasp on occasion. All of this is normal for your new baby.

Breasts

Both boy and girl babies may have some swelling of their breasts in the first few weeks of life due to mother's hormones. The breasts may be tender initially, but the swelling and tenderness will go away by itself.

Genitals

If you have a girl you may notice that the labia, the folds in the front of the vagina, look swollen. There may also be a white mucous discharge or bloody discharge from the vagina for a few days.

In boys the scrotum, the sac holding the testicles, may be either swollen and drooping down or it may appear small if the testicles are not completely down in the sac. In dark-skinned babies, the scrotum is likely to be deeply pigmented.

Smega, a cheese-like skin secretion, may be present in either the folds of the vagina or the foreskin of the penis.

All of these characteristics are normal and are due to hormonal effects from the mother's pregnancy. You do not need to do anything other than keep your baby's genitals dean.

Rash

It is common for babies to develop a red, blotchy rash with whitish bumps on their face and body. This rash may come and go for several weeks, but there is usually nothing you need to do for it.

Another common rash that your baby may develop on the forehead that may also be accompanied by flakes in the eyebrows or on the scalp is called seborrhea. You may have heard it referred to as cradle cap in the scalp. The cause of this condition is the baby's oily scalp. Don't add oil to your baby's scalp or face, it's just not needed. Your baby does not need oil or lotion applied to the skin, especially the head and face. Also, do not use soap on your baby's face for a while.

Occasionally babies develop rashes that require treatment by a health care provider. If your baby develops any rash that you are uncertain of or that seems to cause discomfort to your baby, call for an appointment to have your baby examined.

The "cone head"

Have no fear, this is a temporary look! This shape is common in vaginally delivered babies. The molding of the head is due to baby's soft cranial bones, which are designed to conform to the shape of the mother's pelvis during the trip down the birth canal. Within the first week of life, the head should be beginning to round out.

Cradle Cap

During the first few weeks of life, you may notice some yellowish crusty patches on your baby's scalp. This is a time in your baby's life when his scalp will be secreting increased amounts of oil because of extra hormonal stimulation. This oil can accumulate and dry in patches over the scalp. It doesn't bother the baby ... only the parents. When you wash your baby's hair, massage the scalp to promote circulation and remove oils and dry skin. A soft toothbrush or baby hairbrush will be fine to use. It will gradually resolve by itself. Some people may recommend that you put baby oil on your baby's head to soften the crusts. Did you ever try washing oil out of your hair? It's not easy! Just use regular baby shampoo or any shampoo or soap that is mild and has no deodorants.

Sneezing

Is your baby catching a cold? No, all babies sneeze a lot. This is the way that they clean the air that they breathe. Many babies will accumulate mucus in their nose, which may cause them to sneeze, or for you to hear sniffles and noises when they breathe. If this occurs, you may try using a few drops of an infant saline solution and cleaning the nose out with the bulb syringe.

Mongolian Spots

Not a bruise! These are bluish-black colored areas, which are normally seen on the lower back and buttocks of black, oriental, and dark-skinned babies. They will often fade during the first to second year of life.

New babies can:

• Smile in response to being talked to or played with.
• Watch objects and follows them with their eyes for a short time when they are about eight inches away.
• Respond to sounds.
• Lift and turn the head from side to side.

If there is anything about your baby's appearance that you do not understand, please, do not hesitate to ask the health care provider who sees your baby for Well Baby Check-ups. If a concern arises between check-ups, call the Nurse Advice Line at (254)553-3695 or call the Patient Appointment System at 288-8888 to make an appointment to be seen by a health care provider.

Signs and Symptoms, of Illness

• Rapid respiratory rate (more than 60 breaths per min.)
• Bluish discoloration of lips, gums, or face at any time.
• Yellow skin color (observed in sunlit room).
• Two missed feedings (in a 24 hour period) in the first 6 weeks.
• Three stools in 1 hour, or more than 10 stools in one day.
• Less than 5 - 6 wet diapers per day after 36 hours of age.
• Throwing up (projectile/forceful) two times in one day.
• Temperature higher than. 100.4 degrees or less than 97 degrees.
• Limpness, unresponsiveness.
• Irritability especially associated with poor feeding.
• Bloody stools.
• Distended abdomen.
• Sunken or bulging fontanels.

Taking A Temperature

New parents often become overly concerned when their baby has a fever. Fever is a symptom that shows that the body is fighting disease or infection. If your baby has a temperature of 100.4 degrees or more and less than 3 months old, you should change the environment of the baby. By this I mean, maybe you have too many clothes on the baby or have the baby too swaddled. Un-swaddle the baby and take the temperature again in 20 minutes. If the temperature is still above 100.4, go the emergency room or call the clinic for a same day appointment. Make sure you talk to a healthcare provider.

We recommend that you take axillary temperatures. A rectal thermometer could damage your baby's delicate rectal area. To obtain a temperature reading of you baby, first, shake down the thermometer so the mercury is less than 96 degrees; then, place the thermometer tip in the center of the baby's armpit and hold the baby's arm down by his side and hold in place for 5 min. To comfort your infant while you are taking a temperature, hold him/her in your arms. A normal range is from 97.7 to 99.5 degrees. You may use a rectal thermometer under your baby's arm. It will work just as well and may even be safer as the tip is less likely to break from pressure if you push your baby's arm too tight against it. (A rectal thermometer has a round silver bulb on the end. An oral thermometer has a long skinny silver bulb on the end.)

There are several types of thermometers on the market and you will need to decide which best suits your needs and your budget.

• Glass Mercury Thermometers: These ate less expensive and widely available. They are, however, more fragile, harder to read, and must be timed.
• Digital Thermometers: These are easy-to-read and beep when ready. The problem is that they are more expensive, but a digital thermometer is preferred.
• Fever Strips: These are easy to use and require less cooperation from uncomfortable or very young children. The drawback is that they are less accurate than thermometers and can only be used once.

When to call a health care provider

A physician should evaluate any infant under two (2) months old that develops a fever of more than 99.4 degrees F under the arm. If you need to make an appointment call the Patient Appointment System at 288-8888 for a Same Day Sick Call appointment. Call by 0700 hours on the day that you need the baby seen. After duty hours take your infant to the Emergency Room. You may also call the Nurse Advice Line at (254)553-3695 24 hours a day for advice on minor acute illnesses or to ask questions between Well Baby Checkups.

Call the clinic if you answer "yes" to any of the following questions:

• Does your child have a temperature of 104 F or higher? (Remember, a temperature taken under the arm or by the mouth usually registers lower than a rectal temperature. You should call the clinic if you are concerned about these temperatures.)
• Is the child pale or limp?
• Has your child been crying for 3 hours and just won't quit?
• Does your child have a strange cry that is not normal (a high pitched cry)?
• Is your child's body shaking, twitching, or jerking?

When calling the pediatrician or nurse practitioner to discuss an illness, you should prepare ahead by writing down the information about the illness to avoid forgetting something. Also, be prepared to write down instructions. Below you will find a sample of the information you should have when you call:

1. Infant's name and age
2. Describe the illness or problem
   1. When did it start?
   2. How often does it occur? (Reporting the number of times a baby vomits or passes a stool gives the pediatrician or nurse practitioner a better idea of the problem.)
   3. How does this compare with the baby's normal patterns?
   4. What does it look like? Describe the rash; describe the color and consistency of the stools.
3. Describe any fever.
   1. How high is it?
   2. Was it taken by axillary or rectal method?
   3. How long has the fever been present?
   4. Has it been higher than it is now?
4. Describe other signs of illness.
   1. Are there changes in eating behavior?
   2. Have sleep patterns changed?
5. Describe the baby's behavior.
   1. Does the infant seem sick?
   2. Is the infant irritable, lethargic, acting differently from normal?
6. Describe what has been done so far to treat the condition and the results.
7. Discuss other relevant information.
   1. Is there a similar illness in family members?
   2. Was the infant treated recently for a similar or different illness?
   3. Does the infant take any other medications?