Newborn

11 Common Conditions in Newborns

From American Academy of Pediatrics:

Some physical conditions are common during the first couple of weeks after birth. If you notice any of the following in your baby, contact your pediatrician.​​

Abdominal distension

Most babies’ bellies normally stick out, especially after a large feeding. Between feedings, however, they should feel soft. If your child’s abdomen feels swollen and hard, and if she has not had a bowel movement for more than one or two days or is vomiting, call your pediatrician. Most likely the problem is due to gas or constipation, but it also could signal a more serious intestinal problem.

Birth injuries

Babies can be injured during birth, especially if labor is long or difficult, or when babies are very large. While newborns recover quickly from some of these injuries, others persist. Occasionally a broken collarbone occurs, which will heal quickly. After a few weeks a small lump may form at the fracture site, but don’t be alarmed; this is a sign that new bone is forming to mend the injury, and it will soon be as good as new.

Muscle weakness is another common birth injury during labor, caused by pressure or stretching of the nerves attached to the muscles. These muscles, usually weakened on one side of the face or one shoulder or arm, generally re­turn to normal after several weeks. In the meantime, ask your pediatrician to show you how to nurse and hold the baby to promote healing.

Blue baby

Babies may have mildly blue or purple hands and feet, which is usually normal. If their hands and feet turn slightly blue from cold, they should return to pink as soon as they are warm. Occasionally the face, tongue, and lips may turn a little blue when the newborn is crying hard, but once she is calm, her color should quickly return to normal. However, persistently blue skin coloring is a sign the heart or lungs are not operating properly. and the baby is not getting enough oxygen in the blood. Immediate medical attention is essential.

Unusual bowel movements

Meconium. After birth, the staff will watch for your baby’s first urination and bowel movement to make sure she has no problem with these important tasks. It may be delayed twenty-four hours or more. The first bowel movement or two will be black or dark green and very slimy. It is meconium, a substance that fills the infant’s intestines before she is born. If your baby does not pass meconium in the first forty-eight hours, further evaluation is required to make sure that no problems exist in the lower bowel.

Blood in stool. On occasion, newborns have a little blood in their bowel movements. If it occurs during the first few days, it usually means the infant has a little crack in the anus from stooling. This is generally harmless, but even so, let your pediatrician know about any signs of blood to confirm the reason, since there are other causes that require further evaluation and treatment.

Coughing

If the baby drinks very fast, she may cough and sputter; but this type of coughing should stop as soon as her feeding routine becomes familiar. This may also be related to how strongly or fast a breastfeeding mom’s milk comes down. If she coughs persistently or routinely gags during feedings, consult the pediatrician. These symptoms could indicate an underlying problem in the lungs or digestive tract.

Excessive crying

All newborns cry, often for no apparent reason. If you’ve made sure that your baby is fed, burped, warm, and dressed in a clean diaper, the best tactic is probably to hold her and talk or sing to her until she stops. You cannot spoil a baby this age by giving her too much attention. If this doesn’t work, wrap her snugly in a blanket or try some other ways that may help calm your baby.

You’ll become accustomed to your baby’s patterns of crying. If it ever sounds peculiar—such as shrieks of pain—or if it persists for an unusual length of time, it could mean a medical problem. Call the pediatrician and ask for advice.

Forceps marks

When forceps are used during delivery, they can leave red marks or even superficial scrapes on a newborn’s face and head. These generally disappear within a few days. Sometimes a firm, flat lump develops in one of these areas because of minor damage to the tissue under the skin, but this, too, will usually go away within two months.

​Jaundice 

Many normal, healthy newborns have a yellowish tinge to their skin, which is known as jaundice. It is caused by a buildup of bilirubin in the child’s blood. Mild jaundice is harmless. However, if the bilirubin level continues to rise and is not treated, it can lead to brain injury. Jaundice tends to be more common in breastfed newborns, most often in those not nursing well; breastfeeding mothers should nurse at least eight to twelve times per day, which will produce enough milk and keep bilirubin levels low.

Jaundice first appears on the face, then the chest and abdomen, and finally the arms and legs in some instances. The whites of the eyes may also be yellow. Most hospitals now routinely screen newborns for jaundice twenty-four hours after birth using a painless handheld light meter. If the pediatrician suspects jaundice may be present—based on skin color as well as the baby’s age and other factors—she may order a skin or blood test to definitively diagnose the condition. If jaundice develops before the baby is twenty-four hours old, a bil­irubin test is always needed to make an accurate diagnosis. If you notice a sudden increase in jaundice when your baby is at home, contact your pediatri­cian.

Lethargy & sleepiness

Every newborn spends most of her time sleeping. As long as she wakes every few hours, eats well, seems content, and is alert part of the day, it’s perfectly normal to sleep the rest of the time. But if she’s rarely alert, does not wake up on her own for feedings, or seems too tired or uninterested to eat, you should consult your pediatrician. This lethargy—especially if it’s a sudden change in her usual pattern—may be a symptom of a serious illness.

Respiratory distress

It may take your baby a few hours after birth to form a normal breathing pattern, but then she should have no further difficulties. If she seems to be breathing in an unusual manner, it is most often due to blocked nasal passages. Using saline nasal drops, followed by suctioning the mucus from the nose with a bulb syringe, may fix the problem; both are available over the counter.

However, if your newborn shows any of the following warning signs, no­tify your pediatrician immediately:

• Fast breathing (more than sixty breaths in one minute), although keep in mind that babies normally breathe more rapidly than adults
• Retractions (sucking in the muscles between the ribs with each breath, so that her ribs stick out)
• Flaring of her nose
• Grunting while breathing
• Persistent blue skin coloring

Umbilical cord problems

Umbilical stump bleeding. As you’re caring for your baby’s umbilical cord, you may notice a few drops of blood on the diaper around the time the stump falls off. This is normal. But if the cord actively bleeds, call your baby’s doctor immediately. If the stump becomes infected, it will require medical treatment. Although cord infections are uncommon, you should contact your doctor if you notice any of the following:

• Foul-smelling yellowish discharge from the cord
• Red skin around the base of the cord
• Crying when you touch the cord or the skin next to it

Umbilical granuloma. Sometimes instead of completely drying, the cord will form a granuloma or a small, reddened mass of scar tissue that stays on the belly button after the umbilical cord has fallen off. This granuloma will drain a light-yellowish fluid. This condition will usually go away in about a week, but if not, your pediatrician may need to burn off (cauterize) the granulomatous tissue.

Umbilical hernia. If your baby’s umbilical cord area seems to push outward when she cries, she may have an umbilical hernia—a small hole in the muscular part of the abdominal wall that allows the tissue to bulge out when there is increased abdominal pressure (i.e., crying). This is not a serious condition, and it usually heals by itself in the first twelve to eighteen months. (For unknown reasons it often takes longer to heal in African American babies.) In the unlikely event it doesn’t heal by three to five years of age, the hole may need surgery. Don’t put tape or a coin on the navel. It will not help the hernia, and it may cause a skin rash.

Food Allergy Reactions

From American Academy of Pediatrics:

How do I know if my child has a food allergy?

A food allergy happens when the body reacts against harmless proteins found in foods. The reaction usually happens shortly after a food is eaten. Food allergy reactions can vary from mild to severe. Because there are many things that can be confused with food allergies, it is important for parents to know the difference.

Symptoms of A Food Allergy

• Skin problems
  • Hives (red spots that look like mosquito bites)
  • Itchy skin rashes (eczema, also called atopic dermatitis)
  • Swelling
  • Breathing problems
  • Sneezing
  • Wheezing
  • Throat tightness
• Stomach symptoms
  • Nausea
  • Vomiting
  • Diarrhea
  • Circulation symptoms
  • Pale skin
  • Light-headedness
  • Loss of consciousness

If several areas of the body are affected, the reaction may be severe or even life-threatening. This type of allergic reaction is called anaphylaxis and requires immediate medical attention.

Not A Food Allergy

Food can cause many illnesses that are sometimes confused with food allergies. The following are not food allergies:

• Food poisoning—Can cause diarrhea or vomiting, but is usually caused by bacteria in spoiled food or undercooked food.
• Drug effects—Certain ingredients, such as caffeine in soda or candy, can make your child shaky or restless.
• Skin irritation—Can often be caused by acids found in such foods as orange juice or tomato products.
• Diarrhea—Can occur in small children from too much sugar, such as from fruit juices.

Some food-related illnesses are called intolerance, or a food sensitivity, rather than an allergy because the immune system is not causing the problem. Lactose intolerance is an example of a food intolerance that is often confused with a food allergy. Lactose intolerance is when a person has trouble digesting milk sugar, called lactose, leading to stomachaches, bloating, and loose stools.

Sometimes reactions to the chemicals added to foods, such as dyes or preservatives, are mistaken for a food allergy. However, while some people may be sensitive to certain food additives, it is rare to be allergic to them.

Foods That Can Cause Food Allergies

Any food could cause a food allergy, but most food allergies are caused by the following:

• Cow milk
• Eggs
• Peanuts
• Soy
• Wheat
• Nuts from trees (such as walnuts, pistachios, pecans, cashews)
• Fish (such as tuna, salmon, cod)
• Shellfish (such as shrimp, lobster)
• Peanuts, nuts, and seafood are the most common causes of severe reactions. Allergies also occur to other foods such as meats, fruits, vegetables, grains, and seeds such as sesame.

The good news is that food allergies are often outgrown during early childhood. It is estimated that 80% to 90% of egg, milk, wheat, and soy allergies go away by age 5 years. Some allergies are more persistent. For example, 1 in 5 young children will outgrow a peanut allergy and fewer will outgrow allergies to nuts or seafood. Your pediatrician or allergist can perform tests to track your child’s food allergies and watch to see if they are going away.

Inclined Sleepers and Other Baby Registry Items to Avoid

From American Academy Pediatrics:

Having a baby is an incredibly exciting time! Many parents set up baby registries for items that they believe their baby will need. However, it’s important to know that some popular products are unnecessary and can actually be dangerous for infants. Examples include inclined sleepers, positioners, and crib bumpers.

Each year, about 3,400 infants in the United States die unexpectedly during sleep. This can happen from accidental suffocation, sudden infant death syndrome (SIDS), or unknown causes.

To help prevent these deaths, the American Academy of Pediatrics recommends that all infants should sleep on flat and firm surfaces. Babies should sleep by themselves, without any bumpers, soft bedding, pillows, or stuffed toys. Crib bumpers and inclined infant sleeper products can cause a baby to suffocate. We also advise against using products that are for infant bedsharing with parents.

New safety standards on the way

A safe sleep environment is so important that the U.S. Consumer Product Safety Commission (CPSC) approved a federal safety standard for infant sleep products in June 2021. Starting in mid-2022, this standard will help get rid of potentially dangerous baby sleep products such as inclined sleepers, in-bed sleepers, loungers, and travel/compact sleepers. These products will have to meet the same CPSC standards that are already in place for cribs, bassinets, play yards, and bedside sleepers.

Here’s why these and other dangerous infant sleep products should stay off your registry and out of your home.

Inclined sleepers and positioners

These are sometimes called baby nests, docks, pods, loungers, rockers, or nappers. Infant positioners and inclined sleepers have been popular items on baby registry lists for years. But until mid-2022, these products are not regulated and have no safety standards.

The CPSC says that sleep products that incline more than 10 degrees are not safe. Soft and plush sleep surfaces are also dangerous. Inclined sleepers allow babies to sleep at a 30-degree angle. Infants placed in these products may fall asleep in a chin-to-chest position, which can restrict their airway. They can also roll out of the devices and become trapped under them. Inclined sleepers have been tied to at least 94 deaths.

With sleep positioners, babies can suffocate after rolling onto their stomachs since they can’t lift their heads. The soft padding can make it difficult to breathe if a baby’s face presses against it.

Crib bumpers

Crib bumpers were long considered staples of nursery décor. They were originally intended to cushion babies from the crib slats. Crib bumpers are dangerous because of the risk of suffocation, entrapment, and strangulation. Plus, older babies may use the bumpers to stand on and climb out of the crib, creating a fall risk. Crib bumpers have been linked to at least 83 infant deaths in the past 30 years.

In addition to traditional padded bumpers, stores now sell mesh bumpers and vertical crib liners. But even these can get loose and become a strangulation risk. Babies can also get trapped between them and the crib mattress.

There is no evidence that crib bumpers—of any kind—prevent injury in young infants.

Cribs today are regulated by the CPSC and have updated safety standards. The slats are closer together to prevent your baby’s head from getting stuck. This means that bumpers are not only dangerous, but unnecessary. Maybe you’re concerned about your child’s leg getting stuck between crib slats. If so, use a wearable blanket or sleeping sack that’s the right size for your baby.

Why are these products still sold?

Unfortunately, the new regulations don’t take effect until mid-2022, meaning that inclined sleepers and positioners will still be available. As for crib bumpers, the CPSC plans to review federal safety standards for them later this year. We continue to urge the CPSC to ban all these dangerous infant sleep-related products.

A bill that would prohibit crib bumpers was introduced in Congress in 2021 too. Known as the Safe Cribs Act, this bill would make it illegal to sell, distribute, manufacture, or import crib bumpers. The bill’s sponsors are concerned that parents will keep buying these products, not realizing that they’re potentially hazardous.

Some stores, online retailers, cities, and states, have already stopped selling or have banned inclined sleepers and crib bumpers. Some companies have also issued voluntary recalls of these products.

Remember

Even in areas where these dangerous products are banned, they can still turn up at secondhand stores or garage sales. It’s important to check the CPSC website to see if products have been recalled before using them. Also, make sure anyone who watches your child knows about recalled and unsafe products.

It’s also important to keep in mind that your baby should only sleep in products that are designed to be safe sleep spaces, like cribs, bassinets, and portable play yards. Other products like swings, reclined seats, bouncers, and other sitting or positioning devices are not safe for sleep. If your baby falls asleep in one of these, move her to a safe sleep space right away.

If you have any questions about safe sleep products for your baby, talk with your pediatrician.

More information

• How to Keep Your Sleeping Baby Safe: AAP Policy Explained
• Help Your Baby Sleep Safely So You Can Sleep Soundly
• Ask the Pediatrician: What is the safes t sleep solution for my baby with reflux?  
• Safe Sleep: Charlie’s Story

Colic Relief Tips for Parents

From American Academy Pediatrics:

Does your infant have a regular fussy period each day when it seems you can do nothing to comfort her?

This is quite common, particularly between 6:00 p.m. and midnight—just when you, too, are feeling tired from the day’s trials and tribulations. These periods of crankiness may feel like torture, especially if you have other demanding children or work to do, but fortunately they don’t last long. The length of this fussing usually peaks at about three hours a day by six weeks and then declines to one or two hours a day by three to four months. As long as the baby calms within a few hours and is relatively peaceful the rest of the day, there’s no reason for alarm.

If the crying does not stop, but intensifies and persists throughout the day or night, it may be caused by colic. About one-fifth of all babies develop colic, usually between the second and fourth weeks. They cry inconsolably, often screaming, extending or pulling up their legs, and passing gas. Their stomachs may be enlarged or distended with gas. The crying spells can occur around the clock, although they often become worse in the early evening.

What Causes Colic?

Unfortunately, there is no definite explanation for why this happens. Most often, colic means simply that the child is unusually sensitive to stimulation or cannot “self-console” or regulate his nervous system. (Also known as an immature nervous system.) As she matures, this inability to self-console—marked by constant crying—will improve. Generally this “colicky crying” will stop by three to four months, but it can last until six months of age. Sometimes, in breastfeeding babies, colic is a sign of sensitivity to a food in the mother’s diet. The discomfort is caused only rarely by sensitivity to milk protein in formula. Colicky behavior also may signal a medical problem, such as a hernia or some type of illness.

Although You Simply May Have to Wait It Out, Several Things Might Be Worth Trying:

• First, of course, consult your pediatrician to make sure that the crying is not related to any serious medical condition that may require treatment.Then ask him which of the following would be most helpful.
• If you’re nursing, you can try to eliminate milk products, caffeine, onions, cabbage, and any other potentially irritating foods from your own diet.
• If you’re feeding formula to your baby, talk with your pediatrician about a protein hydrolysate formula. If food sensitivity is causing the discomfort, the colic should decrease within a few days of these changes.
• Do not overfeed your baby, which could make her uncomfortable. In general, try to wait at least two to two and a half hours from the start of one feeding to the start of the next one.
• Walk your baby in a baby carrier to soothe her. The motion and body contact will reassure her, even if her discomfort persists.
• Rock her, run the vacuum in the next room, or place her where she can hear the clothes dryer, a fan or a white-noise machine. Steady rhythmic motion and a calming sound may help her fall asleep. However, be sure to never place your child on top of the washer/dryer.
• Introduce a pacifier. While some breastfed babies will actively refuse it, it will provide instant relief for others.
• Lay your baby tummy-down across your knees and gently rub her back. The pressure against her belly may help comfort her.
• Swaddle her in a large, thin blanket so that she feels secure and warm. 

When you’re feeling tense and anxious, have a family member or a friend look after the baby—and get out of the house. Even an hour or two away will help you maintain a positive attitude. No matter how impatient or angry you become, a baby should never be shaken. Shaking an infant hard can cause blindness, brain damage, or even death. Let your own doctor know if you are depressed or are having trouble dealing with your emotions, as she can recommend ways to help.

Probiotics in Infant Formula

From American Academy Pediatrics:

Probiotics” (meaning “for life”) is a word you may see when shopping for infant formula and supplements. Some formulas are fortified with these probiotics, which are types of live bacteria. Doctors may also recommend probiotic drops or powders for breastfed infants. These are “good” or “friendly” bacteria already present at high levels in the digestive system of breastfed babies.

In formula-fed babies, probiotics in formulas promote a balance of bacteria in your baby’s intestines, and offset the growth of “unfriendly” organisms that could cause infections and inflammation.

Increasingly, parents can find probiotic supplements outside of formula, including for breastfed infants. Research on the benefits of probiotics is ongoing, with some pediatricians embracing their use for infants delivered by C-section or those whose mothers are given antibiotics during labor.

Possible health benefits of probiotics

The most common types of probiotics are strains of bifidobacteria and lactobacilli. Some research has shown these probiotics may prevent or treat disorders such as infectious diarrhea​ and atopic dermatitis (eczema) in children. Other possible health benefits are being studied as well, including the possibility of reduced risk of food-related allergies and asthma, prevention of urinary tract infections, and relief of symptoms of infant colic​.

More research is needed

With many of these health conditions, the evidence confirming any positive effects of probiotic use is limited and more research is needed. At this time, benefits appear to occur only as long as probiotics are being taken. Once your baby stops consuming probiotic-fortified formula, intestinal bacteria levels return to previous levels. This is different from in breastfed infants, where the bacteria in the gut resulting from breastfeeding​ are more resilient and set the stage for healthier outcomes. 

Remember

Before giving your child infant formula fortified with probiotics, discuss the issue with your pediatrician

More information

• Choosing a Formula
• Probiotics and Prebiotics in Pediatrics (AAP Clinical Report)