What to expect from your newborn

Many parents-to-be rely on the popular book What to Expect When You’re Expecting to guide them through pregnancy. But what can you expect from your newborn after birth? Your newborn’s appearance and behaviors may surprise you at times. Find out what’s normal – and when you need to contact a pediatrician.

The first days and weeks

When you bring your baby home from the hospital, every behavior in those early days and weeks is a first. You give them their first bath. You rock them to sleep for the first time. You share your first night together at home.

During this time, you and your baby are learning about each other. Knowing what to expect can help you feel more confident as a parent and assure you have the best experience after your baby is born.

Sometimes, it’s hard to know what’s normal and what isn’t – especially if you’re a first-time parent. Here’s a list of common newborn issues that you might experience, why they happen, and when to get your pediatrician involved.

Umbilical stump

The umbilical stump is the portion of the umbilical cord that remains attached to your baby’s belly button after the cord is cut at birth. This small piece of tissue typically falls off on its own within two weeks. 

A healing umbilical stump goes through a drying and color-changing process before falling off. It may be slightly damp at first, then dry out and turn brown, gray, or even black. Your baby may also have a bloody umbilical stump just before it falls off – so don’t be alarmed if you see a few drops of blood on your baby’s diaper or clothing.

Symptoms of an infected umbilical stump include:

• Foul-smelling, yellowish discharge from the cord

• Red skin around the base of the cord

• Your baby cries when you touch the cord or the surrounding skin

A granuloma is a small reddish or brownish mass of scar tissue that stays on your baby’s belly button after the umbilical cord has fallen off. Granulomas are also very common – and thankfully, easily treatable.

Your baby’s umbilical stump should be kept clean and dry. We no longer recommend using alcohol on the umbilical stump. Instead, you can gently clean the stump with a cotton swab dipped in warm water (add mild soap if the stump is dirty), then pat it dry. Folding your baby’s diaper below the umbilical stump if there is no notch in the diaper also helps stop urine from soaking it. 

What to do after the umbilical stump falls off

Never attempt to remove the umbilical stump on your own – it should fall off naturally. After the umbilical stump is gone, continue to keep your baby’s belly button area clean and dry. You should also do sponge baths only until the area is fully healed.

Lanugo

Lanugo is a fine, soft hair that develops in the womb to help protect your baby’s skin from amniotic fluid. Most babies shed their lanugo before birth. However, some are born with it, especially premature babies.

If your newborn baby has lanugo, treatment is not necessary. Most babies naturally shed the hair within the first few days or weeks after birth.

Vernix

Vernix (also known as vernix caseosa) is a white, waxy, cheese-like substance that coats the skin of your newborn baby at birth. Vernix offers many benefits for your baby in the womb and after birth, such as: 

• Protecting your baby’s skin from amniotic fluid

• Acting as a natural moisturizer

• Regulating body temperature

Vernix usually absorbs into your baby’s skin within 24-48 hours after birth on its own. Based on recommendations from the World Health Organization and other leading sources, your hospital or birthing center may delay your baby’s first bath until the vernix can fully absorb.

Does vernix smell?

Yes, it can have a sweet or slightly sour odor due to amniotic fluid, bacteria, and other factors. But there is usually no risk of leaving vernix on your newborn after birth, despite the odor.

Bluish or purplish feet and hands

Discoloration on your newborn baby’s feet can be a startling discovery for parents. This common and usually harmless condition is called acrocyanosis.

Is acrocyanosis dangerous? Not necessarily – many newborn babies have acrocyanosis in their first few hours of life, especially if they are born prematurely or with a low birth weight. Because your baby’s circulatory system is still developing, it may prioritize blood flow to vital organs like the brain and heart instead. 

Acrocyanosis becomes less common the first week after birth, but can still occur several weeks or months later. Seek medical attention immediately if your baby has bluish or purplish areas on their lips or tongue, is breathing rapidly or seems to be grasping for breath, or has difficulty latching or sucking during feedings.

Newborn rashes and other skin issues 

Newborn skin issues happen frequently in the days and weeks after birth. Babies can develop rashes, acne, milia, cradle cap, and other conditions for a variety of reasons, including skin irritation, allergies, and infections. 

Newborn rashes

Erythema toxicum is a common newborn rash that looks like small red spots or bumps, sometimes with a tiny white or yellow center. It usually appears on your baby’s face, chest, arms, or legs within the first few days after birth. 

Erythema toxicum does not hurt or itch but can spread easily. Like most newborn rashes, erythema toxicum is not dangerous and usually goes away on its own without treatment in two weeks or less.

However, there are certain rashes could indicate an underlying medical issue. Contact a pediatrician ASAP if your baby’s rash:

• Is accompanied by a temperature of 100.4° F or higher

• Is spreading or getting worse

• Is painful or causing discomfort

• Has blisters or pus-filled bumps

• Doesn’t improve after a few weeks

Baby acne

Baby acne is a common skin condition that results in small white or red bumps on your newborn’s face or other parts of their body. Most cases of baby acne are caused by hormones passed from mother to baby prior to birth and resolve in a few weeks without treatment. 

Milia

Milia are tiny white or yellow bumps that may also appear on your newborn baby’s face, especially around their nose. About half of all healthy infants have milia when they are born.

Milia are caused by trapped dead skin cells below the surface of your baby’s skin. Like baby acne, milia are harmless and typically disappear on their own within a few weeks.

Peeling or flaking skin

Peeling or flaking skin is also normal for newborns, especially those that are born full-term. Over the first days to weeks after your baby is born, they will shed 1-2 layers of skin – mainly because the protective coating they had in the womb is no longer there. 

Most peeling or flaking skin occurs on your baby’s arms or legs, specifically their wrists or ankles. Other conditions like eczema can also cause your newborn’s skin to peel and flake from the start.

Seborrhea (Cradle cap)

Seborrhea is a skin condition that creates a rash, usually crusty, oily, or scaly patches on your baby’s scalp (cradle cap) or eyebrows. Seborrhea can also create red, dry, or greasy patches on your baby’s face or within the creases of their body. 

What causes cradle cap? It’s not poor hygiene or allergies. Seborrhea is caused by a combination of overactive oil (sebaceous) glands – the result of the mother’s hormones being passed to the baby – and a type of yeast called Malassezia that naturally lives on your baby’s skin. Seborrhea is harmless and often goes away on its own.

Treatment is usually preventive and may include washing your baby’s scalp with a fragrance-free shampoo and moisturizing with a fragrance-free moisturizer. We may also recommend dandruff shampoo and 1% hydrocortisone cream if your baby’s rash is more severe.

Soft spots

Soft spots, or fontanelles, are soft areas on your newborn baby’s head where the skull has not fully fused together yet. Despite how scary this might sound, it’s safe to gently touch your baby’s fontanelles as they continue to grow.

The two main fontanelles are the anterior fontanelle (front of the head) and the posterior fontanelle (back of the head). When do the fontanelles close? The posterior fontanelle usually closes a few months after birth, while the anterior fontanelle closes anytime between 4-26 months.

Misshapen head

Do not be alarmed if your baby has a misshapen or flat head, also known as plagiocephaly or flat head syndrome. Babies can also develop brachycephaly (a widened head shape) after sleeping or spending a lot of time on their backs.

Head shape issues often improve on their own with simple changes in positioning, such as alternating your baby’s head position during sleep, feeding, and wake times. Increasing tummy time and limiting time spent in baby equipment like car seats and swings also helps reduce the amount of pressure on the back of your baby’s head.

Bowed legs and upturned feet

Many babies are born with slightly bowed legs due to lower-extremity positioning in the uterus during the third trimester. This outward curve of the legs usually straightens naturally as your baby begins to crawl, walk, and put weight on their legs.

Subconjunctival hemorrhage

Subconjunctival hemorrhage occurs when small blood vessels in your baby’s eye burst, often from the force of vaginal delivery. You may notice a small red spot (or spots) in your baby’s eye shortly after birth.

Although it looks alarming, subconjunctival hemorrhage is generally not dangerous. This superficial bleed should heal in a month without treatment. You should see a doctor for subconjunctival hemorrhage if there are any signs of infection, your baby is in pain.

Blocked tear ducts

All newborn babies cry – but sometimes, a blocked tear duct causes additional complications. If your baby’s tear drainage system isn’t working properly, tears can pool in their eye and clog the duct, resulting in excessive wateriness.

Home remedies for a clogged tear duct include applying a warm compress to the affected eye to help soften the debris. You can also use a soft washcloth to gently massage the inner corner of the eye in the direction of your baby’s nose. Contact your pediatrician if there is any redness, swelling, or if cloudy or yellowish discharge forms in the eye.

Bumps in mouth

Tiny white or yellow bumps called Epstein pearls may appear along the gumline and on the roof of your newborn baby’s mouth. Many parents confuse them with unerupted baby teeth – but they are actually cysts filled with excess keratin that gets trapped during palate development. Keratin is the same protein that helps form your baby’s hair, skin, and nails

Epstein pearls are common and do not cause any pain or discomfort. They usually go away on their own.

Swollen genitals, eyes, and other features

Swelling after the birth process is normal and temporary for a newborn baby, especially in the genital area. The natural transfer of maternal hormones and the pressure caused by vaginal birth often results in swelling of the scrotum for boys and the labia and hymen for girls. Newborn girls may also have a reddish or pinkish vaginal discharge for the first 1-2 weeks after birth as levels of maternal estrogen begin to drop.

Higher levels of maternal estrogen during pregnancy can also cause breast swelling for newborn boys and girls, which should resolve within a few weeks after birth. Seek medical attention for any redness, warmth, discharge, or if your baby cries when their breasts are touched. 

Circumcision

If your newborn son was circumcised, the head of their penis will look shiny and red and may ooze yellowish fluid. Circumcision wounds should heal within 7-10 days. Contact your pediatrician if your baby has a thick discharge, increased swelling, fewer wet diapers, or any signs of pain.

A guide to newborn behavior

Here’s what you can expect for the first few days after birth and your first weeks at home: 

Sleeping

• Newborn babies sleep up to 16-18 hours per day, often in short stretches.

• Your baby may have a reversed sleep-wake cycle at first, sleeping during the day and waking at night.

• Maintaining your usual daytime routine can help your baby develop a normal circadian rhythm, the internal body clock that regulates the sleep-wake cycle.

• Your baby should sleep on a firm surface by themselves with no blankets, pillows, toys, bumpers, or other objects.

• Co-sleeping is not recommended due to the risk of infant death.

Feeding

• Newborn babies should be fed every 3 hours until good weight gain is established, unless instructed otherwise.

• Your baby may want to nurse or feed more frequently (8-12 times per day), sometimes only for a few minutes.

• Do not prop bottles. Babies should be held when they are fed.

• Feeding often takes practice. It’s normal for babies and parents to need time and support to get it right.

• If you need breastfeeding help, ask your pediatrician about a lactation consultation.

Frequent sneezing and nasal stuffiness

• Don’t worry, your baby doesn’t already have a cold! Newborns are nose breathers by necessity, so they sneeze often to keep their nasal passages clear.

• Seek medical care if your baby’s sneezing and stuffiness are accompanied by nasal discharge, cough, or other signs of a cold or flu.

Hiccups

• Hiccups are very common and frequent in newborn babies.

• Burping is the best way to help your baby get rid of hiccups.

• Fun fact: a mother can sometimes feel her baby hiccup in utero towards the end of the third trimester

Crying without tears

• Your baby’s tear ducts may not be fully developed at birth or for the first few weeks.

• If your baby is old enough to produce visible tears and then suddenly stops, they could be dehydrated or have a blocked tear duct.

Jerky movements 

• Your baby’s nervous system is still developing, so shaky or seemingly random movements in the arms and legs may happen often.

• Babies often twitch or move during sleep as well.

Startle reflexes

• Startle reflexes (also known as Moro reflexes) are sudden arm and leg movements that babies make in response to loud noise, vibration, cold touch, and more.

• These normal neurological signs typically stop after 4 months.

Straining or grunting while pooping 

• Newborn babies often appear to struggle during bowel movements.

• Straining or grunting doesn’t necessarily mean your baby is constipated, even when bowel movement does not occur.

• There’s no cause for concern as long as your baby’s stools are soft.

Lack of eye contact 

• It can take weeks for your baby to make sustained eye contact or track your movements.

• Your baby may also avoid eye contact if they become overwhelmed by too much stimulation.

Minimal social interaction

• Newborn babies typically don’t smile back until they are 2 months old.

• Babies primarily build social skills through bonding with their caregivers. They also learn how to respond to cues like facial expressions and physical touch.

• If you are concerned about your baby’s social development, ask your pediatrician.

The early newborn period is full of surprises – but knowing what to expect can help you become a more confident parent. Whenever you have questions, Pediatric Associates is here for you.