Common Questions About Newborns—Part I

Heading home with a newborn raises lots of questions and worries in new parents. Here are answers to some of the most common questions I get asked in my office.

My 3-week-old is stuffy all the time and sneezes a lot. Isn’t he too young to have a cold?

Although your 2-week-old is not too young to have a cold, the chances are he doesn’t. Babies have to breathe through their noses for the first few months of life. Their nasal passages are small, however, which explains the “stuffy” sound you hear. Sneezing occurs because of dust and other particles in the air that simply trigger the baby’s sneezing reflex. If your baby gets a real cold, he will have a runny nose just like everyone else.

This morning I saw some blood coming from my 5-day-old’s vagina. Should I worry?

Baby girls commonly have a small amount of whitish discharge from their vagina. In some cases, this discharge turns bright red—it happens because the baby is shedding the lining of her uterus just like women do when they have their periods. This is usually nothing to worry about and will pass in a few days. However, if you notice a lot of blood or the baby has a discharge for more than a few days, contact your doctor.

For the first week of my son’s life, I kept finding a pink stain in his diaper. Does he have blood in his urine?

Your baby was excreting uric acid crystals in his urine. This is a common finding in the first week or two of life. Although parents often report seeing “blood” in their baby’s urine, on further questioning we find out that there is a pink or salmon-colored stain on the diaper. In fact, if the diaper is examined carefully, parents may even see tiny crystals within the matrix of the diaper material.

When I’m changing my baby, I notice tiny opalescent beads around her anus and vagina. If I rub them between my fingers, they have a slight waxy feel. What is this?

These tiny beads come from the lining of the diaper and are not dangerous. Simply wipe them away when you clean your baby with each diaper change.

My 3-week-old’s big toenails are ingrown. Is this normal?

Although this is a common observation, it is not usually due to truly ingrown nails. A newborn’s toenails have the consistency of parchment and because of intrauterine positioning, the nail may grow up against the fleshy part of the toe. The reason it isn’t usually a problem is because the nails break off when the baby moves around. (Most of the time, big toenails do not even need to be cut.) By the time your baby is about 6 months of age, his big toenails should look more “normal” to you.

When my daughter was two weeks old, her doctor said she had a umbilical granuloma. Is that something to worry about?

After the umbilical cord falls off, there is sometimes a little “goo” that remains at the base. This is not a big deal, and I usually recommend that parents clean it with a cotton swab a few times a day until it disappears. In some cases, however, parents will notice red tissue protruding from their newborn’s belly button (it looks a bit like a small raspberry). This tissue is an umbilical granuloma. Although they are not dangerous, if an umbilical granuloma isn’t treated, new skin will grow over its surface and a fleshy lump will remain. Therefore, to ensure that babies have a cute belly button, doctors usually treat granulomas with a medication to make them fall off.

My 10-day-old still has his umbilical cord. It’s gooey and smells bad. What should I do?

It is not unusual for the cord area to have an unpleasant smell a few days before it falls off. The reason for this is because the cord remnant is actually decaying, i.e., the umbilical stump does not have a blood supply and the body’s immune system is rejecting the tissue. However, if the umbilical area smells really bad or you notice redness around the baby’s belly button, you need to contact your doctor to make sure the area isn’t infected.

My son was circumcised three days ago. His penis was red at first, but now there’s some yellow pus on the head. What should we do?

Right after a newborn is circumcised, the head of the penis is bright red and has a “wet” look. Over the next few days, the head becomes drier and takes on a dull red appearance. The head returns to its normal skin color about a week after the circumcision. While the penis is healing, it is very common to see yellowish deposits on the surface of the skin. This is part of the healing process not an infection. If a penis were to become infected, the head would become much redder. In addition, redness and swelling would extend up the shaft towards the body.

If we decide not to circumcise a baby, what do we do to take care of the foreskin? When will it come back over the head?

In the old days, parents were told to pull back forcefully on the foreskin to help it separate from the head of the penis. We don’t recommend this anymore because forcefully separating the foreskin can lead to scarring which might require a circumcision to fix the problem in the future. All you need to do to take care of the foreskin is to gently clean it when you change the baby’s diaper. The foreskin’s attachment to the head of the penis will loosen up over time, and most foreskins are fully retractable once a child enters elementary school. As the foreskin starts to detach, you should pull back very gently to clean the head of the penis during bath time.

My 5-day-old just developed diarrhea. His stools used to be dark green and tarry, but last night they became green, slimy, and runny. Is this diarrhea?

The first stool that a baby has is a thick, green, gooey mess that doctors call meconium. (For the record, meconium consists of all the stuff the baby swallowed during his fetal life: skin cells, hair, and other material floating around in the amniotic fluid.) After passing a handful of these sticky poops, a baby has something we refer to as a “transition stool.” These poops are runny, green, and foamy. In fact, if your baby has one of these poops when his diaper is off, you may see it shoot two or three feet through the air! But rest assured, they are not dangerous and will fade into memory within a couple of days.

When my baby yawns, I see a white pimple on the roof of his mouth. What is this?

It’s called an Epstein’s Pearl and is nothing to worry about. The pearl is composed of mucus cells trapped under a thin membrane. It will go away in the first few weeks of life. Babies often have two variations of this lesion that you may see in other locations. If you see tiny white pimples on the face, they are referred to as milia. If you see a tiny white pimple on the gum, it’s referred to as a Bahn’s Nodule. Although milia may hang around for months, Bahn’s Nodules disappear as quickly as Eptein’s Pearls.

I’m worried that I will hurt my son’s testicles when I clean him up after a poop.

Before puberty, it does not hurt if a boy’s testicles are manipulated. Although it’s logical to be gentle, don’t worry about causing your son any pain when you clean him up after a poop.

What’s the best way to clean the whitish material that builds up between a baby girl’s outside and inside vaginal lips?

Cleaning the material that accumulates between the labia majora (outside vaginal lips) and labia minora (inside vaginal lips) bother parents as much as cleaning a little boy’s testicles. I tell parents two things in this regard: (1) they do not need to clean away the discharge at one time and (2) they can clean it away by gently wiping with a cotton washcloth in a downward direction. (I prefer washcloths to cotton balls because they have better traction.)

Will I hurt my baby’s soft spot if I rub it when I wash his hair?

The medical name for a baby’s soft spot is called the anterior fontanelle. This is an opening in the bones of the skull that allows the cranium to grow. The fontanelle is covered with a very tough membrane so you will not hurt is when washing your baby’s hair. Although we don’t recommend poking the fontanelle, you can scrub it with a brush like the rest of your baby’s scalp.

Click here to read more questions and answers about newborns.