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16. Variations of the Normal Newborn that Parents May Note

a. Skin

1) The normal skin color at birth skin may be purplish red. Within the next few days, skin becomes the typical pink. Mottling (red streaking) may appear if the infant is cold. A pink color at rest may become red when the baby cries. Flaking of the skin may occur.   2) Jaundice in the newborn   (a) One-third to one-half of all newborns develop jaundice in the first week.   (b) Causes: Increased destruction of red blood cells no longer needed after birth and immaturity of the liver.   (c) Jaundice is most readily seen on the face and brow. It may also be seen in the whites of the eyes.   (d) Press your finger down on the skin of the cheek, brow, and chest. Note the color of the skin as you lift finger immediately. This may allow the yellow hue to become more visible.   (e) If a yellow color is noted, your physician/practitioner should be made aware of the condition.   (f) III effects are rare, but jaundice may cause sleepiness and lack of interest in feeding.   3) Milia are tiny oil cysts, appearing as white, pinhead-sized spots, mainly on and around the nose.   4) Forceps marks are bruised areas on the face. These will disappear within a few days, and problems are rare.   5) Newborn rash may occur, where small areas (I to 2 cm) of redness may appear, resembling flea bites. The center may contain a small, raised, yellowish spot. The infant is not ill and treatment is rarely necessary. b. Head 1) Moulding is the way in which the bones of the head have changed during birth to allow the baby to fit through the passageway. The baby may have a "conehead" appearance. The head will return to its normal shape within a few days. 2) Mothers should be aware of any problems of the head and face and be instructed in care by their physician/practitioner. c. Eyes
1) An infant's eyes may normally appear "cross-eyed."
2) Hemorrhages (blood spots in the white part of the eye) occur during birth and are temporary and nothing to worry about.   3) A chemical irritation of the eye (red and swollen) may occur from the use of an antibiotic in the eyes (eyedrops or ointment) at birth. This irritation should clear up in 2 to 5 days. d. Birthmarks: There is usually no special care for birthmarks, but parents should be aware of the most common birthmarks. 1) A port wine stain is a red/purple discoloration of the skin. The condition will have been noted by the physician/practitioner.   2) A stork beak mark consists of pale pink spots usually seen in the back of the neck and the eyelids.   3) A strawberry mark is a roundish raised mark of bright or dark red. It will have a rough surface.   4) Mongolian spots are dark blue or purple spots, irregular and bruiselike, seen mostly in the area right above the infant's buttocks. These are seen mostly in African American infants. e. Mouth 1) The normal newborn mouth has smooth, pink skin covering the lip surface. The inside of the cheeks, gums, and tongue should appear pink in color. Some infants' lips will develop crusts known as "sucking calluses" that will eventually be shed.   2) Thrush is seen as white or gray-white patches in the mouth or around the lips. Wipe very gently to determine that this is not milk. Wiping off thrush itself will cause the area to be left raw and bleeding. Notify the client of the suspicion of thrush so that the physician/practitioner may be consulted. f. Extremities (arms and legs) 1) The extremities should be pinkish in color and may become mottled (lines of reddish color) or purplish when the infant is cold. Warm the baby and report to the client if color in the extremities remains purple after 15 minutes of warming.   2) Some infants may be born with problems of the hips that require special care. This should be noted in Homemaker's Plan of Care along with the client's instructions.   3) Extra fingers and toes may be seen in some infants. Note in the Homemaker's Plan of Care along with the client's instructions.
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