Many first-time parents have never seen a newborn baby the first day after birth and may be surprised about the normal newborn appearance.
A blue/gray skin color is normal in the first few minutes after birth. The skin color changes to pink after the baby starts to cry. It is normal for a baby's hands and feet to appear slightly blue one or two days after birth. Call your baby's health care provider if you notice a blue or gray coloring anywhere on your baby's skin after you leave the hospital. African American and Hispanic babies may have lighter skin than their parents at birth. The skin color darkens in a few days.
Your baby may have a creamy yellowish-white coating called vernix on his or her skin at birth. This protects the baby before birth and will wash off after the first few baths.
Lanugo is a fine, downy hair on the face, shoulders and back of some babies. It will fall off in the first few weeks.
Milia are tiny white bumps or yellow spots across the top of the baby's nose or skin. These are caused by skin gland secretions and disappear in the first two to three weeks of life.
Swelling or puffiness, also called edema, is normal on the baby's head, face and eyes. It usually goes away in a few days. Swelling of the breasts is also common in both male and female babies, due to mother's hormones that are passed to the baby before birth. In addition, you may notice a few drops of milk leaking from your baby's breast. This, too, is normal and usually only lasts about one week.
Many newborns develop a yellowish tinge to their skin in the first few days of life. This is jaundice and is caused by a normal breakdown of old red blood cells resulting in an increased amount of bilirubin. As the bilirubin levels rise above normal, this yellowish tinge will appear first on the face, then on the chest and abdomen, and finally on the legs. Bilirubin levels in term infants usually reach their highest between days three and four. For late pre-term infants, bilirubin levels will reach their highest between days five and seven. If you are concerned that your baby is jaundiced, especially if the yellowish tinge reaches the level of the belly button, you should call the baby's health care provider. A blood test may be ordered to determine if treatment is needed.
At birth, your baby's head may appear long and/or misshapen. This is called molding and enabled the baby to fit through the birth canal. Molding is normal, and your baby's head will become round in a few days. If you had an internal monitor during labor, you may see a scab on the baby's head. This heals in a few days. If forceps or vacuum extraction were used during delivery, there may be a small amount of redness and bruising.
All babies have two soft spots, or fontanelles, on their head. These are the areas where the immature bones of the skull are still growing together. The larger opening is on the top of the head and will remain soft until after the baby's first birthday. It is normal to see it moving up and down as your baby feeds or cries. A smaller fontanelle is at the back of the head and will close by four months of age. It is okay to touch these areas gently. If either of the soft spots looks sunken or bulging, call your baby's health care provider.
It is not unusual to see swelling of the genitals (sexual organs) in newborns after birth. This is due to the mother's hormones passed to the baby before birth.
In girls, the labia or lips around the vagina may appear swollen or enlarged and will return to normal in a few days. Sometimes a drop of blood or pink tint may appear on the diaper. This is normal. A clear mucous discharge from the vagina is also normal.
In boys, the penis and scrotum may appear swollen or enlarged and will return to normal in a few days.
Routine Newborn Health Screenings
In the hospital, your baby will have the following screenings, as required by the Rhode Island Department of Health:
- Hearing – a simple, quick test as part of the nursery routine in the hospital.
- Metabolic screening – a blood test for rare metabolic disorders.
The results of these screenings are sent to your baby's health care provider, and you will be contacted if there is a problem.