16. Variations of the Normal Newborn
that Parents May Note
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
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.
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.
1) An infant's eyes may normally
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.
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