By now, it’s clear that your baby’s personal traits are unique. However, there are some general physical developments that most babies share. We hope you find the following guidelines and descriptions helpful as you watch your newborn develop over the next few weeks.

Bowel movements  |  Breasts  |  Breathing  |  Cradle cap  |  Dehydration  |  Eyes  |  Fingernails & toenails  |  Fontanels (soft spots)  |  Genitailia (female)  |  Genitalia (male)  |  Head and face  |  Jaundice  |  Lanugo  |  Milia  |  Navel & umbilical cord  |  Rashes  |  Reflexes  |  Sucking  |  Senses  |  Vernix  |  Weight

Bowel movements

The baby’s first bowel movements are made of a sticky, greenish-black material called meconium, which was in your baby’s intestines during pregnancy. If you breastfeed, the colostrum in your breast milk acts as a laxative and helps your baby move his/her bowels. Meconium stools are present for a few days following birth.

Later, it is normal for babies to have yellow-green or slightly brown-yellow stools. The number of stools per day and their texture varies from baby to baby. It also depends on whether you are breastfeeding or bottle feeding. A breastfed baby will usually have loose, seedy stools. A bottle-fed baby will have stools with a more pasty appearance. It may be normal for your baby to have one stool in 24 hours or up to one stool every 2 to 3 hours in a 24-hour period.

Your baby may be constipated if the stool is hard and dry. If a baby has diarrhea, the stool is usually mucousy, thin and watery, and may have a foul smell. As your baby grows, the bowel movements may change in amount and frequency.
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Breasts

Whether your baby is a boy or a girl, his/her breasts may be temporarily swollen due to hormones passed to the baby while in the uterus. A very small amount of thin milk may be seen at the nipples. Do not squeeze the breasts to remove this milk. It will disappear once the hormones leave your baby’s body.
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Breathing

Babies only breathe through their nose for the first few months. It is normal for a newborn to have periods of irregular breathing. Your baby may snort or even have a brief pause in breathing while sleeping. Your baby’s breathing pattern will become more regular in about a month or two.

It is also normal for your baby to sneeze often to clear his/her nose.

If your baby has trouble breathing due to a lot of mucous, follow these steps to remove the mucus from your baby’s mouth with a bulb syringe:

• Squeeze the air out of the bulb syringe away from the baby’s face.
• Gently insert the tip into one side of the baby’s mouth (pocket of cheek).
• Release the pressure and remove the mucus.
• Remove the syringe and empty the mucus by squeezing the bulb away from the baby’s face.
• Repeat in the cheek pocket on the other side of the baby’s mouth.

Follow these steps to clear the baby’s nostrils:

• Squeeze the air out of the bulb syringe away from the baby’s face.
• Gently insert the tip into the baby’s nostril.
• Release the pressure and remove the mucus.
• Remove the syringe and empty the mucus by squeezing the bulb away from the baby’s face.
• Repeat in the other nostril.

In addition to the bulb syringe, try these tips to ease your baby’s breathing:

• Raise the head of your baby’s bed.
• Use a cool mist vaporizer in your baby’s room.

Cleaning the bulb syringe:

• Clean the bulb by flushing it out with hot soapy water after each use.
• Do not wash in the dishwasher.
• Do not use the baby’s bulb syringe on other children.
• Do not insert into baby’s ears.

Using a bulb syringe.

In addition to the bulb syringe, try these tips to ease your baby's breathing:

• Raise the head of the baby's bed.
• Use a cool mist vaporizer in the baby's room.

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Cradle cap

Cradle cap is a common condition that looks like a yellowish or whitish, scaly, patchy area over part of the baby’s scalp or sometimes behind the ears. Daily washing and/or brushing may help prevent cradle cap. If your baby has cradle cap, use a baby comb, fingernail brush or soft toothbrush to gently scrub the affected area with mineral oil or baby oil. Wash all the oil off the scalp with shampoo or a mild soap when you are done. Do this each day until the cradle cap is gone.

From our Health Libary
Cradle cap illustration
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Dehydration

Dehydration happens when there is too little fluid in the body. In the first weeks of life, babies can suffer from dehydration due to prematurity or breastfeeding problems caused by breast reduction or enlargement or other breast surgeries that may interfere with breastfeeding.

Signs that your baby is dyhydrated:

• Lack of wet or dirty diapers
• Becomes more difficult to wake for feedings
• Poor sucking and/or trouble latching on to your breast
• Feeds less frequently (less than 8 times in 24 hours)
• Seems hungry after most feedings
• Dry tongue and mouth
• Greater than 10% weight loss

If you baby is dehydrated:

• Breastfeed more often. Wake your baby for feedings at least 8 to 12 times in a 24 hour period.
• If needed, increase your milk supply by pumping your breasts with a high quality, double electric breast pump.
• Call your baby's health care provider.
• Talk to a lactation (breastfeeding) specialist.

In some cases, you may need to supplement (add to) breastfeeding with bottle feeding. If so, your expressed breast milk is a better choice than formula. Supplementation is usually short term. To protect your milk supply, it is important to nurse and/or pump your breasts 8 to 12 times in 24 hours.
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Eyes

During the first few days of life, your baby’s eyes may look puffy from the birth process and the eye medication used to help prevent infection. It is common for a newborn’s eyes to have poor control and appear cross-eyed. This should lessen as the eye muscles get stronger. Newborns’ eyes usually look blue-gray or brown. In general, your baby’s permanent eye color will be visible within six to 12 months.

Call your baby’s health care provider if your baby has constant yellow or green drainage from one or both eyes.
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Fingernails & toenails

You may wish to try one of the following methods to trim your baby’s nails to prevent accidental scratching:

• File the nails with an emery board.
• Trim the nails with round-edged or stainless steel baby scissors or baby clippers. Cut straight across the nail, not in the corners.

Both of these methods may be easier to do when your baby is sleeping or busy feeding.
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Fontanels (soft spots)

At birth, there are two soft spots (fontanels) on the top of the baby’s head. The larger is diamond shaped and toward the front. The smaller is located at the back of the head. These soft spots are areas where the bones of the skull have not yet grown together. The smaller one closes within two to six months after birth. The larger one usually closes by 18 months. The fontanels have a tough membranous covering, so the scalp can be gently brushed and shampooed without harming your baby.
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Genitailia (female)

A white coating called vernix may be present between the labial folds of a female baby. This coating is normal and does not need to be washed off. A clear, mucus-like discharge (sometimes blood-streaked) may be present and is a normal result of the mother’s hormones. During bathing and diaper changes, gently clean the vaginal area by spreading the labia and wiping from front to back.
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Genitalia (male)

Most newborn boys' scrotums are swollen at birth, and will shrink to a normal size in about a week.

Care of the penis
In general, do not use premoistened towelettes, alcohol, powder or lotions when cleaning a circumcised or uncircumcised penis. These items may cause or add to irritation.

Uncircumcised
The uncircumcised penis of a newborn does not require special care.

• According to the American Academy of Pediatrics, "It is not necessary to retract any part of the foreskin in order to wash under it." Cleaning the outside is enough. Wash the penis with warm, soapy water just as you would any other part of his body.
• Do not retract (pull back) the foreskin. The foreskin and glans (area covered by the foreskin) will separate normally over time with growth and development. For some boys, the foreskin will retract while they are infants. For others, it may take as long as five years. Trying to pull back foreskin that is not yet ready to separate can create tears and scarring. It is best to let your baby’s health care provider assess if the foreskin is ready to be retracted.

Circumcised
Newborn circumcision (removal of the skin, that covers the head of the penis) is performed for religious, social and cultural reasons. The American Association of Pediatrics (AAP) states that there is no absolute medical reason for this procedure. Discuss circumcision techniques and pain management options with your baby's health care provider. If you choose to have your baby circumcised, you may wish to hold and comfort him immediately after the procedure.

After cirumcision

• After circumcision, an infant may be fussy and not interested in eating for a few hours. Cuddling him may help at this time.
• The end of the penis will appear red after the procedure and often a yellowish "crust" appears around the head of the penis. This appearance is normal and is not a sign of infection.
• Call your baby's health care provider if you notice bright-red bleeding; unusual redness or swelling; white, yellowish (pus-like) or greenish drainage with a bad smell; or if your baby does not urinate within 24 hours.

Once the circumcised penis heals, normal washing is enough.

The two most common methods for circumcision are 1)The Clamp and 2)The Plastibell.

Clamp Circumcision

• A gauze/petroleum jelly dressing is placed on the penis after the circumcision. This dressing is removed during the first diaper change or as directed by your baby’s health care provider.
• After removing the petroleum jelly dressing, new petroleum jelly is applied to the circumcision at every diaper change for the next 24 hours. For cleanliness, it is recommended that a separate jar or tube of petroleum jelly be used for the baby’s circumcision.
• During diaper changes, gently wash around the penis with a clean, warm wet cloth to remove stool or urine and pat dry. Avoid rubbing. It is normal for the first few diaper changes to show some spotting of blood.
• Secure the baby’s diaper loosely for several days to prevent uncomfortable pressure on the circumcision.

Plastibell Circumcision

• The plastic rim is left on the baby’s penis after the circumcision. The plastic rim usually drops off 5 to 8 days later. Call your baby’s health care provider if the rim has not dropped off 8 days after the circumcision or if the rim has slipped down the shaft of the penis.
• No special dressing is necessary. Do not use petroleum jelly.
• Check the circumcision for swelling.
• A dark brown or black ring encircling the plastic rim is normal. It will disappear after the rim drops off.
• You may bathe and diaper the baby normally, but do not rub or scrub the circumcised area.
• Notify your baby’s health care provider if your baby does not urinate regularly (at least six wet diapers per 24 hour period) or you have questions about the swelling.

Once the circumcised penis heals, normal washing is enough.
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Head and face

A newborn’s head is large in comparison to the rest of his body. At first, your baby’s head may not be round because passage through the narrow birth canal causes the bones of the skull to squeeze together and mold the head. The head usually returns to its normal shape within a few weeks.
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Jaundice

A small amount of jaundice, or yellow color of the skin and eyes, is common in many full-term babies. It is even more common in premature babies. If jaundice occurs, it usually appears in the first three to five days of life and disappears by the end of two weeks without treatment.

Jaundice can be harmful if the bilirubin level in the baby’s blood is too high. Extremely high levels can harm the brain and cause hearing loss.

How to check for jaundice:

• Undress your baby and place him/her on a white sheet or blanket.
• Gently press on your baby’s nose, then chest and then leg. Note if there is a yellow color to the skin when you release your finger.
• Check inside of your baby’s mouth and whites of eyes for a yellow tinge.

Call your baby’s health care provider immediately if your baby is:

• Very sleepy and does not wake up for feedings or skips two or more feedings
• Very fussy and does not eat or sleep
• Limp or floppy
• Seems still, especially arms or legs
• Screeching or has high pitched cry

Causes of jaundice
Most jaundice occurs when a baby is born with more red blood cells than needed. When the blood cells break down, they release a yellow substance called bilirubin, which is eliminated from the baby’s blood through the liver. Most newborn’s livers are not developed enough to handle this, and bilirubin builds up in the baby’s bloodstream. This causes the skin and whites of the eyes to turn yellow. Call your baby’s health care provider if you notice your a baby’s skin or the whites of the eyes turning yellow after leaving the hospital or if you have questions.

Conditions that increase the likelihood of jaundice include:

Not being fed often or long enough.

Prematurity (babies born two weeks or more before their due date)

Blood type incompatibility (When baby’s blood type is different from mother’s.)

Bruising to the baby during birth

Bilirubin is measured by taking a small blood sample or sometimes by using a special device pressed against the skin.

If the bilirubin level is slightly high, treatment may include:

Frequent breastfeedings or formula feedings (not water) to help eliminate the bilirubin.

In some cases, you may need to supplement (add to) breastfeeding. If so, your expressed breast milk is a better choice than formula. Water is not recommended. Supplementation is usually short term. To protect your milk supply, it is important to nurse and/or pump your breasts 8-12 times in a 24 hour period.

Phototherapy (exposing the baby’s skin to a special light source) to help break down the bilirubin. This may be done in the hospital, but can also be done in your home.

The best way to prevent jaundice is to follow the instructions from your baby’s health care provider about how often to feed and/or how much fluid to give your baby during the first few days of life.
More about jaundice, causes and treatment
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Lanugo

Lanugo is fine, downy hair that is most noticeable over a newborn’s back, shoulders, forehead, ears and face. It is more obvious in premature babies and will disappear during the first few weeks of life.
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Milia

Milia are pinhead-size white spots on your baby’s nose, cheeks or chin caused by blocked sweat and oil glands. They will disappear without treatment in several weeks when the glands begin functioning. Wash your baby’s face with water and a washcloth while they are present. Do not try to remove or squeeze them.
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Navel & umbilical cord

The stump of the umbilical cord, which remains temporarily attached to the navel, should be kept clean, dry and free from diaper irritation.

• Follow cord care instructions given by your baby's healthcare provider.
• If the cord becomes soiled, wash it with soap and water and dry thoroughly.
• When diapering your baby, fold the front edge of the diaper below the healing navel, so it does not irritate this area or add moisture.

The stump will usually fall off between seven and 14 days after birth, but may stay attached up to a month. There is often a pinkish discharge after the stump falls off. This is nornal and does not need treatment.

Report any excessing bleeding, unusual discharge, redness, swelling, irritation or bad odor around the navel to your baby's health care provider.
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Rashes

Baby acne
A red pimply rash known as “baby acne” may break out on your baby’s face during the third or fourth week of life. This rash seems to bother parents more than the baby. No treatment is usually necessary other than gentle washing with a mild soap and water. It is caused by the stimulation of the baby’s oil glands due to the increased hormones passed from the mother to baby at birth.

Diaper rash
Diaper rash consists of red patches with tiny pimple-like bumps that appear in areas covered by the diaper. It can be caused by urine, stool, some laundry products, too much ammonia in cloth diapers not washed well, chemicals used in some disposable diapers, or often unknown causes. Exposing the skin to air improves healing. Protective ointments are available in drug stores. Call your baby’s health care provider if a rash won’t go away.

Heat rash
This is common during warm weather and with babies who are kept overdressed or over wrapped. It appears most often in the shoulder and neck regions and looks like clusters of tiny pink blemishes. (When it begins to dry, it looks slightly tan.) The rash looks worse than it probably feels to the baby. The best treatment is to keep your baby cool and dry, and dress your baby as you dress yourself.
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Reflexes

Most of your baby’s behaviors in the early days and weeks are involuntary reflexes, such as yawning, quivering, coughing, sneezing, stretching and hiccupping. Some of these reactions help insure your baby’s survival, while others help relieve irritation.

Grasp reflex
If you touch the palm of your baby’s hand, he/she will grasp firmly. This reflex disappears soon after birth. The feet exhibit the same reaction as the hands, but in the feet the reflex continues for a longer period.

Hiccuping
Hiccupping is common in newborns and is not a cause for concern. Hiccups will stop on their own and do not require any special attention on your part.

Moro or "Startle" reflex
When a newborn is startled, he/she will initially stretch out the arms and legs and straighten the body, then curl up. This response will be less noticeable by four months of age and usually disappears by the sixth month.

Rooting reflex
Lightly stroking your baby’s cheek or lower lip will cause your baby to turn his/her head in that direction and open his/her mouth. Stroking the lower lip will be helpful with latch-on while breastfeeding. To avoid confusing your baby, don’t stroke your baby’s cheek once he/she is latched-on.

Standing & walking reflex
If a newborn is supported upright on his/her feet, the baby will stand and imitate a walking motion. These reflexes usually disappear by the second month.
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Sucking

Newborns have a strong sucking desire. Sucking is needed not only to ensure nourishment, but as a self-calming method (non-nutritive sucking).
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Senses

All five senses are functioning at birth, enabling newborns to respond to their environment in many ways.

Hearing
A baby’s hearing is well developed, even in the uterus, as is shown by the startle or Moro reflex in response to loud noises (see above). Babies are able to make out both of their parents’ voices right after birth. However, babies pay more attention to high-pitched voices, as they hear best in the higher ranges. If you have questions about your newborn’s ability to hear, please contact your baby’s health care provider.

Sight
Your baby may be fascinated by dramatic contrasts, such as black and white shapes, but will be most responsive to your face. A baby’s ability to focus at birth is about the same distance as from a baby at the breast to a mother’s face (8 to 12 inches). An application of eye ointment (as required by law) is given after birth to prevent possible eye infections. This may blur your baby’s sight for a brief period of time.

Taste and smell
There is evidence that a newborn has the ability to respond to sweet, salty, sour and bitter tastes, as well as to a variety of smells. Newborn babies have been observed to tell apart their mother’s clothing from others solely by sense of smell.

Touch
Touch is your baby’s first sensation. Most of your early contacts will involve touch as you cuddle, rock and caress your new baby. Feeding, whether by breast or bottle, is an ideal time for you to give your baby this very important, close physical contact.

Skin

• Birthmarks
  There are many types of birthmarks that may be found on various parts of your baby’s body. If your baby has any unusual marks, discuss them with your baby’s health care provider before going home. Many birthmarks will fade over time.
• Mongolian spots
  Mongolian spots are greenish-blue pigmentation seen on the lower back area, primarily in dark skinned babies. They are not painful or cause for concern and usually fade over time.
• Mottled skin/blue hands and feet
  A newborn’s skin can remain slightly see-through for several weeks and have purplish blotches, especially fair-skinned babies. It is also common for newborns to have bluish hands and feet since their circulatory system is not fully developed yet.
• Peeling skin
  During the first few weeks, your baby may have peeling or cracking of the skin, especially on the wrists, hands, ankles and feet. Overdue babies seem to peel more than babies born closer to their due date. This is normal and no treatment is necessary.
• "Stork bites"
  Occasionally, blood vessels close to the skin are visible on the back of the baby’s neck, eyelids, nose or forehead. These are called “Stork Bites.” They usually fade or disappear in several months.

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Vernix

Vernix is the white creamy substance that protected your baby’s skin before birth. It can remain in the creases of the skin for several weeks, even after bathing. There is no need to remove it as it continues to provide protection for your baby’s skin until it is completely absorbed.
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Weight

Many babies lose approximately 7 to 10 percent of their birth weight during their first days of life. Do not worry. Babies are born with fat reserves and usually regain the weight by two weeks of age. Frequent around-the-clock feedings will help prevent a major drop in weight. Initially, breastfed babies need to be fed at least 8 to 12 times and bottle-fed babies 6 to 10 times in a 24 hour period.

If you are worried about your baby's weight, contact your baby's health care provider.
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