Understanding Your Newborn

While each baby is a unique individual there are certain characteristics and behaviors that are common to newborns. This section will describe some of the physical and behavioral traits you may notice in your baby during the first few weeks of life. PHYSICAL CHARACTERISTICS Weight and Length The average baby weighs between six and nine pounds, and is between 18 to 21 inches long. Infants may lose up to five to ten percent of their birth weight during the first week of life, due mainly to loss of extra fluid accumulated by the mother and baby as the pregnancy nears term.If the baby is approaching a ten percent weight loss we will advise you as to frequency and type of feedings to ensure proper regain of weight. Head Shape: Because of pressure before or during birth, your babys head may be temporality misshapen. Normal head shape usually returns by the end of the first week. Babies delivered by Cesarean usually dont have as much of this head molding. Soft spots: Your baby has two obvious soft spots or fontanelles. One is on the top of the head and the other is near the back of the head. Both the fontanelles are covered by a tough membrane and with normal handling care, you cant damage the soft spots when shampooing, brushing, or stroking your babys head. Eyes Color, tears, and swelling: Caucasian infants usually have grayish-blue eyes at birth. Infants of other ethnic backgrounds may have grayish-brown or brown eyes. However, an infants true eye color may not be known for several months. Tears are usually not produced in noticeable amounts with crying until your baby is one to two moths of age. Swollen and puffy eyelids or red hemorrhages on the white conjunctivae are normal after birth and result from pressure during birth. Swelling and inflammation usually go away in a few days. Eye discharge: Occasionally, a baby may have irritation from the antibiotic ointment given at birth. You may notice a small amount of yellow discharge from your babys eyes during your hospital stay. This usually clears within 24 hours. If you notice a small amount of yellow discharge form your babys lids or lashes after you get home, just gently wipe it away with a warm moist cloth or cotton ball. If the discharge is purulent (yellow or green), in large amounts and accumulates frequently, please notify us; this can be a symptom of an infection or a blocked tear duct in need of antibiotic drop therapy. Ears Newborns have a wide variety of ear sizes, shapes, and positions that are normal. At birth your babys ears may bend easily. In time, the ear will feel firmer. Ear Discharge: It is normal for a babys ears to produce wax. It is not normal for them to produce any other kind of discharge. If you think the discharge from your babys ears is not wax, please call us. Cotton swabs should not be used in your babys ears at any time; one can inadvertantly be tamping wax down into the canal deeply without realizing it. Ears can be cleaned well with the corner of a clean, damp washcloth. Just clean what you can see. Breasts Swollen breasts: During the first days after birth, it is normal for both boys and girls to have swollen breasts. This swelling is caused by hormones a baby gets from the mother during pregnancy. Occasionally a baby may produce a small amount of milk. If your baby does produce milk or have breast swelling, do not attempt to squeeze out the milk, as this might cause infection. The swelling will go down as the babys body metabolizes the mothers hormones. If the breasts are

markedly swollen, tender or reddened, please call us so that we can evacuate the child for the possibility of mastitis. Skin Color: The skin is thin and dry. You may see some veins through it. The skin is the Caucasian newborn is a pink or reddish color. As babies cry, they may become a deeper red. In the Black infant, the skin color appears as a reddish-black color that darkens as the baby gets older. In Asian babies the skin is a tea rose color. Frequently, dark bluish spots may appear on the lower portion of the back or buttocks of babies of Black, Asian, or Mediterranean descent. These are called Mongolian spots. They are caused by a temporary accumulation of pigment under the skin and they fade without treatment during preschool years. Despite the names, these spots have nothing to do with Mongolism or Downs Syndrome. In the newborn it is common for the babys hands and feet to appear bluish. This is called acrocyanosis. This is common in the first few days of life a decreases gradually. Milia: These are tiny white spots often seen on the nose and chin. They are caused by obstruction of oil or sebaceous glands. You should not squeeze these spots. They usually disappear in several weeks. Lanugo: your babys body is covered with fine downy hair. This hair is most noticeable on the back, shoulders, and ear lobes. It will fall out in time. Vernix: A white, cheese-like substance called vernix at one time covered your babys skin to protect it while in the bag or waters. Traces of it are usually found in the bodys creases. It is not necessary to scrub this off. Peeling: Most babies skin peels after birth because they have been in fluid for many months. This generalized peeling is completely normal and requires no treatment, including oils or lotions. Rashes: A temporary rash, called erythema toxicum, may occur during the first few weeks. It is small areas of redness with raised yellowish-white centers and it may resemble a flea bite or hives. This rash requires no treatment. Washing clothing with a mild detergent, such as Dreft or Ivory, omitting fabric softeners and double rinsing if necessary, will help minimize rashes. Red blotches: Many babies have reddened areas of skin on their upper eyelids and forehead. These are areas of dilated blood vessels. These areas usually fade with time (months to years) as the blood vessels contract and as the babys skin grows thicker and less transparent. Redness may reappear when your baby cries. These are often called Stork Bites or Angel Kisses and are distinct from the deeper purple Port-Wine stains which are permanent. they are areas of tangled capillaries. As the baby gets older ,these vessels contract and the visible redness fades. Diaper rash: Diaper rash is often caused by irritants in the urine or stool. To minimize diaper rashers, be sure to change your babys diaper frequently (every two to three hours during the day). Always wash the diaper area with plain water at each change. If you launder your own diapers, double rinses with one-half cup of vinegar per rinse load may help eliminate any soap and neutralize the ammonia. If your baby develops a rash in spite of these precautions, try to change diapers more frequently and expose the reddened area to the air several times a day. A diaper rash ointment (vaseline or A&D) applied to the rash area after air-drying may be helpful. Occasionally babies develop a yeast infection of the diaper area. This is usually a deep red colored rash covering a continuous area and with accentuation in the skin folds and satellite lesions at the outer edge. If you suspect this, use Lotrimin AF ointment (clotrimazole) which is available over-the-counter or call us for further guidance. Genitals- Swelling & Vaginal Discharge: The genitals of both boys and girls are usually large and swollen from hormones passed from the mother through the placenta. Girls may also have a white, mucoid, and sometimes blood-tinged vaginal discharge. As your baby metabolizes your hormones, these changes will disappear. INBORN REFLEXES

Moro (Startle): The Moro reflex is a sudden reaction to a loud noise or change in position. It appears as jerky, generalized muscular activity with a flinging out of your babys arms and legs, then bringing them back in towards the body. Rooting: When an object touches your babys cheek, your baby turns his head toward the side touched, opens his mouth and begins to suck. Sucking and Swallowing: Touching your babys lips will trigger the sucking reflex which is followed by the swallowing reflex. Gag: The gag reflex helps your baby get rid of mucus in his stomach that he swallowed during birth or to regurgitate excess milk taken at a feeding. Hiccups: Hiccups are a common occurrence. They do not bother your baby and will go away without any special treatment. Cough & Sneeze: These reflexes help your baby remove irritating substances from him nose and throat. They are not necessarily signs of a cold. Blinking: Your babys eyes will blink when they are exposed to bright light. Blinking also protects the eyes from foreign objects. Walking: When you hold your baby around the chest in an upright position with his feet touching a hard surface, he will make prancing movements with his feet. Grasping: This reflex is present in both the hands and the feet. Your baby will grasp any object put into his hands, hold it briefly and then drop it. SLEEP/WAKE STATES Deep Sleep: In this state your baby is nearly still except for an occasional startle or twitch. Breathing is regular. There are no eye movements and few facial movements. It is very difficult to arouse your baby in this state. Light Sleep: In this state your baby shows some body movement. Breathing is irregular. You can see rapid eye movements beneath the eyelids and your baby may smile or briefly fuss. This state usually comes just before awakening or you may be able to awaken your baby to feed at this time. Drowsy: In the drowsy state you babys activity level varies. The eyes may open and close occasionally and seem heavy. Breathing is also irregular in this state. Your baby may go back to sleep or awaken more. Quite Alert: When your baby is in the quiet alert state, his eyes are wide open, his breathing is regular, and he is very attentive to what is going on around him. During this time, your baby is most interested in eating and learning about his new world. Active Alert: In this state your baby becomes very active and may fuss. His breathing is again irregular and he is increasingly sensitive to stimulation or personal needs such as hunger, discomfort, fatigue, etc. At this time it is best to comfort your baby and bring him to a lower state. Crying: Crying is your babys way of telling you that he needs something or that something is bothering him. Some causes of crying include hunger, physical discomfort, fatigue, boredom, needing to be burped, being over stimulated, or needing close physical contact. As you live with your baby, you will learn to tell the difference in his cries and discover what works best to soothe him.
Copyright 2012, Clinical Pediatric Associates

BSID-II data presented in Fig. 8 are based on averaged standard scores (meanstandard deviation, sd) from the Mental Developmental Index [normed mean=10015] plus Psychomotor Developmental Index [normed mean=10015]; Bayley, 1993). These BSID scores ranged from 88 to 108 across all participants, with an overall mean of 100.2. The mean Preschool Language Scales-3, Total Language Score (PLS-3 [normed mean of 10015]; Zimmerman et al., 1992) was 112.0 (range of 90133). These preliminary growth and behavioral results are interesting in that they are generally consistent with and indicative of the relatively broad data distributions and measures of central tendency that are representative of normal/typical performance, despite the extremely comprehensive, rigorous and strict exclusion factors used for Objective-2. Although preliminary, the only measure that appears to be biased towards higher scores is the behavioral measure of language ability, where the mean of the sample (mean=112) is almost one standard deviation above the normative mean of 100, and the highest score (score=133) exceeds two standard deviations above the normed mean of 100. It is noteworthy, however, that the score of 133 is from a single, extremely verbal 2 year old, and this extreme score increased the group mean score by approximately 5 points. Overall, these preliminary growth and behavioral are quite consistent with general expectations that continuously healthy children will display good growth and behavioral development. Conclusions and contact information Objective-2 researches broad aspects of brain MRI (e.g., T1 relaxation, T2 relaxation, DTI, MRS) and behavioral (e.g., sensory-motor, cognitive, language, emotional) development of normal, healthy children from ages birth through 4-years 5-months. To our knowledge, this effort represents the first developmental MRI and behavior study that applies such a comprehensive, rigorous and strict set of biological and behavioral exclusion factors, as well as a US Census-based, demographically-balanced sample. This project also provides the first longitudinal DTI data for this age-group. A major goal of this research is to assemble a correlative brainbehavior development database that will facilitate the creation of automated, quantitative MR image analyses that can be used to generate developmentally valid brain templates and growth curves for normal, healthy infants and young children. The database can be used by clinicians and researchers to support accurate identification and definition of pathologies and abnormalities of the brains of infants and children with disease or disorders of sensory-motor, cognitive, language, behavioral, and/or emotional development. Like its sister study of children extending in age from 4-years 6-months into young adulthood (Objective-1), the stringency of screening during the subject candidacy phase of Objective-2 was designed to exclude children with medical, psychologic, and cognitive features not characteristic of healthy development. Availability of brain atlases, templates and growth curves for normal, healthy brain development will advance understanding of the normal, healthy variability range of wholeand regional brain structure during development, and will further the ability to identify relationships among measures of brain and behavioral development. Finally, knowledge of the healthy brain is imperative for identification and understanding of brain pathology that may be associated with special clinical populations, such as children with motor dysfunction, visual processing deficits, learning disabilities, or attentional problems. The overall MR database being assembled by Objective-1 and

-2 is designed to facilitate knowledge and understanding of brain development from birth into early adulthood that will serve to improve the diagnosis, treatment, and quality of care of infants, children, adolescents, and young adults with suspected brain dysfunction or abnormality. It is anticipated that portions of the Objective-1 database will be released to become available for use by clinical and research communities in the near future. Later, following the development of brain image measurement methods for the very young infants and children, portions of the Objective-2 database will also be released to the clinical and research community. Additional information about The NIH MRI Study of Normal Brain Development: Objective-2, can be obtained at the project public website (www.brain-child.org), via our protocol document (register for protocol document release via [email protected]. ca), or from project procedure documents available at www.bic. mni/mcgill.ca/nihpd_info. Acknowledgments This project is supported by the National Institute of Child Health and Human Development (Contract N01-HD02-3343), the National Institute on Drug Abuse, the National Institute of Mental Health (Contract NO1-MH9-0002), and the National Institute of Neurological Disorders and Stroke (Contracts N01-NS-9-2314, -2315, -2316, -2317, -2319 and -2320). Special thanks to the NIH contracting officers for their support. We also acknowledge the important contribution and remarkable spirit of John Haselgrove, PhD (deceased). References
Abidin, R.R., 1995. Parenting Stress Index, 3rd ed. Psychological Assessment Resources, Inc., Odessa. Achenbach, T.M., Rescorla, L.A., 2000. Manual for the ASEBA Preschool Forms and Profiles. University of Vermont Department of Psychiatry, Burlington. Ashikaga, R., Araki, Y., Ono, Y., Nishimura, Y., Ishida, O., 1999. Appearance of normal brain maturation on fluid-attenuated inversionrecovery (FLAIR) MR images. Am. J. Neuroradiol. 20, 427431. Ball Jr., W.S., 2000. Pediatric Neuroradiology. Am. J. Neuroradiol. 21, 2936. Barkovich, A.J., 1998. MR of the normal neonatal brain: assessment of deep structures. Am. J. Neuroradiol. 19, 13971403. Barkovich, A.J., 2000. Concepts of myelin and myelination in neuroradiology. Am. J. Neuroradiol. 21, 10991109. Barkovich, A.J., Kjos, B.O., Jackson Jr., D.E., Norman, D., 1988. Normal maturation of the neonatal and infant brain: MR imaging at 1.5 T. Radiology 166, 173180. Bayley, N., 1993. Bayley Scales of Infant Development, 2nd ed. The Psychological Corporation, Harcourt Brace and Company, San Antonio. Benes, F.M., Turtle, M., Khan, Y., Farol, P., 1994. Myelination of a key relay zone in the hippocampal formation occurs in the human brain during childhood, adolescence, and adulthood. Arch. Gen. Psychiatry 51, 477484. Blanton, R.E., Levitt, J.G., Thompson, P.M., Narr, K.L., Capetillo-Cunliffe, L., Nobel, A., Singerman, J.D., McCracken, J.T., Toga, A.W., 2001. Mapping cortical asymmetry and complexity patterns in normal children. Psychiatry Res. 107, 2943. Blatter, D.D., Bigler, E.D., Gale, S.D., Johnson, S.C., Anderson, C.V., Burnett, B.M., Parker, N., Kurth, S., Horn, S.D., 1995. Quantitative C.R. Almli et al. / NeuroImage 35 (2007) 308325 323