Newborn babies can sometimes look a little, well, strange at first. They have spent an average of 12 hours squeezing through the birth canal!
This means that their head can often be pointy, their eyes are still adjusting and many of their features will be squashed and swollen. Don't be alarmed, your baby has worked hard coming into the world and will take some time to adjust.
The head of newborn babies
The soft spots on your baby's skull, known as fontanelles, allow the head to compress enough to fit through the birth canal. There are two: the rear fontanelle, that will close up in around 4 months, and the front one, that will need more time: it will close between 9 months and 18 months after birth.
The skin of newborn babies
Newborn skin varies in appearance depending on how many weeks pregnant you were when your baby was born. Premature babies have thin skin and may be covered with lanugo, a fine, downy hair. Full-term and late babies will have only a few traces of vernix in the folds of their skin. Late newborn babies can also be a bit wrinkly and have very little, if any, lanugo. Birthmarks are common in newborns. About half of all babies are born with milia, white dots that look like very small pimples on their faces. These disappear in time. You can read further on baby skin care to protect your little one's skin.
The hair of newborn babies
A newborns’ hair doesn't have much bearing on what your child's hair will eventually turn out like. It is not news that blondes turn into brunettes lots of times, and very dark-haired newborn babies can grow up to be blondes! Lots of newborn babies are completely bald when they are born, so you have to wait to know his actual hair colour.
The eyes of newborn babies
Most Caucasian newborn babies are born with dark blue eyes and their true eye colour – brown, green, hazel or blue – may not be seen for a few months. Babies of African or Asian origin usually have dark grey or brown eyes at birth, their dark eyes turning brown or black after a while. Mixed race newborn babies can have different eye colours.
Hospital tests for newborn babies
After birth, newborn babies will have several tests and examinations to check that they are healthy and that all is well. Below is an outline of what your midwife and doctor will be looking for when they carry out the tests:
- Apgar score: This is one of the first things tested and is done by watching your baby's colour, breathing and behaviour, activity and posture. The test is done for one minute then again five minutes later. This will tell your midwife whether your baby has any immediate problems that need medical support. If your baby does need some help, your midwife will help him by clearing out his airways, sometimes giving him oxygen.
- Measurements: About an hour after the birth, after you've had a cuddle with your baby, your midwife will also weigh your baby and measure the circumference of his head. The doctor or health visitor will provide the baby's red book with all these measurements added in.
And after, a full newborn examination
This is carried out within 72 hours of your baby's birth and is done by either your paediatrician, a trained midwife or GP. Newborn babies’ parents will be able to ask all the questions they need, since they will be present during the examination.
Be sure to mention any childhood problems common in your family to your practitioner – although he may ask you about it himself. The examination takes a head-to-toe look at your baby to check for any problems or conditions.
: The doctor or midwife will look at the shape of your baby's head. Because your baby squeezed through the birth canal, a squashed head is a very common feature in newborn babies. This should right itself within 48 hours.
Sometimes when a birth requires extra help, with ventouse or forceps, there's a risk of bruises appearing on his head or skull bone (cephalhaematoma). But these should go on their own with time.
- Ears and eyes
: The doctor or midwife will shine a light from an ophthalmoscope in your baby's eyes to look for a red reflex (his is the same as the red-eye effect from flash photography). If a red reflex is shown, cataracts are ruled out.
Your baby may have a hearing test shortly after birth called an automated otoacoustic emission (AOAE) test. This can be carried out either in the hospital, a community clinic, or at home, and only takes a few minutes. It won't hurt your baby at all.
- Mouth: To check that the roof of his mouth is complete and his sucking reflex is working your doctor or midwife will put a finger in your baby's mouth. She could find some conditions, like cleft pallet, that is a gap in the palate. This is a condition present in one in every 700 babies in the UK, and it requires surgery. Another possible condition would be tongue-tie, when the baby’s tongue remains more anchored to the bottom of his mouth. Your baby may be checked for this but often, your medical practitioner or midwife will only decide to do this if there is a persistent problem with your baby breastfeeding.
: In the first few days, your baby may experience some heart murmurs as his pattern of circulation undergoes a major change once he is born. The doctor or midwife will listen to your baby's heart with a stethoscope to exclude any extra sounds or heart murmurs.
When your baby is in the womb, the two sides of his heart beat together. The moment his first breath is taken, the two sides begin to work separately. This means your baby's heart is working hard and may be enlarged but will settle down with time. Rest assured that heart murmurs often disappear on their own.
: The doctor or midwife will listen to your baby's breathing pattern and lung function with a stethoscope. If they manage to hear an even air entry into the lungs clearly, it means that everything is fine.
: Because newborn babies are exposed to the mum’s hormones before birth, their genitals may appear swollen and darker in colour. Baby girls may have a clear, white, or sometimes slightly bloody discharge from their vagina for the first few weeks due to these hormones. For boys, the scrotum is checked and the penis will be checked to ensure the opening is at the tip of the penis, and not on the underside. These hormones may also cause your baby to have slightly enlarged breasts, regardless of your baby's sex.
The doctor or midwife will check your baby's bottom to ensure the opening is normal. You will probably be asked if your baby has had a wee or passed a dark coloured poo (meconium).
: Your baby's skin will be checked for birthmarks such as stork marks (reddish or purple V-shaped marks), Mongolian spots (bluish patches of darker pigment) or strawberry marks (raised red areas).
- Hands and feet
: The doctor or midwife will check your baby's extremities, and he will count his fingers and toes and check them for webbing.
They will also check the baby’s palms to see if the palmar creases are there. 10% of the people have one palmar crease and 5% have it on both hands. Single palmar creases are sometimes associated with Down Syndrome. But do not worry: it is unlikely your baby would have Down syndrome, since there would also be other physical signs.
To check for clubfoot or talipes, where the front half of the foot turns in and down the examiner will check the resting position of your baby's feet. Though if he has talipes, you may already be aware of it due to an utrasound.
: It is quite common for newborn babies to have a sacral dimple, a dimple at the base of the spine. Most of the times it won’t be an issue. Occasionally, a deep sacral dimple may cause problems with the lower part of your baby's spinal cord and affect nerve function in this area.
If your baby has a deep sacral dimple, they will will check for other symptoms, like leg weakness, incontinence and cold and blue feet.
: To check the stability of his hip joints, your baby's hips will be gently moved. By opening his legs wide, and then bending and unbending them, the doctor or midwife will be able to detect any instability.
- Reflexes : Sucking, rooting and grasping are reflexes your baby is born with. The doctor or midwife will check these reflexes by monitoring him. If they are concerned or can't see the reflex, they will try to make the baby show it by testing the Moro reflex. They will let his head fall a little so he'll respond by flinging out both arms with his fingers spread and legs outstretched. The baby could cry as a result, but don’t worry!
What tests come after the full examination?
The majority of tests performed in newborn babies don't show any problems. For those that do, the issue will often resolve itself in time and without treatment. If there are concerns, further tests may be needed. If there are problems, identifying them earlier is very beneficial. Your doctor or midwife should give you information about the problem and answer any questions you may have.
The next routine test your baby will have is a heel-prick test around five days to eight days after the birth. Your midwife will carry out this test by taking a tiny amount of blood from your baby's heel. This blood sample will be tested for phenylketonuria (PKU), cystic fibrosis, MCADD, sickle cell disease and thyroid deficiency, among others.
Newborn babies may cry a little when the blood is taken, but they will recover very quickly. At 6-8 weeks your baby will have a postnatal check with your doctor. If you have any worries about your baby before then, you can always call so your midwife or doctor can check again and reassure you.