Your Baby's Appearance
Beautiful though she will seem to you, your baby may not quite match up to the newborn babies seen in glossy magazines. If you had an assisted delivery, she may still have some marks or bumps and her head may be rather elongated or even lopsided. All this is normal and will resolve in time. She will be covered in creamy-white vernix and may be streaked with blood.
On top of your baby's head, near the front, is a 'soft spot', or fontanelle, where the skull bones have not fused together. Do not worry about touching it because there is a tough layer of skin beneath it. There may be signs of swelling, which is quite normal if there has been pressure on the head during the delivery, and this will have been noted along with the results of other early tests.
Her eyes may also be puffy as a result of pressure during the birth but any severe discharge could be a sign of infection. Any birthmarks will be drawn to your attention, although it is quite usual for babies to have little pink marks, often called 'stork marks', which gradually fade. Her temperature will be checked because newborn babies can lose heat quite quickly - particularly if they are small or have a low Apgar score. Some babies have a blue area on their tummy or back, a bit like a bruise. The are called 'Mongolian spots' and are often found in babies of African, Asian, Mediterranean, Native American or Canadian origin.
Early health checks
The paediatrician will carry out a thorough series of checks within the first few days, or this may be done by your doctor if he visits you.
Head and neck: This involves checking the skull bones and fontanelle; the eyes, ears and nose; the roof of the mouth, to make sure that the palate has formed properly; and the neck for any signs of cysts.
Heart sounds and breathing: 'Innocent' heart murmurs may be heard in the first few hours as her circulatory system adjusts. If the murmur continues, her heart may be scanned before you leave hospital.
Spine: The doctor will hold your baby and run his thumb down the bones in her back (vertebrae) to check that the bones are in the right place and that there are no obvious abnormalities of the spinal cord.
Hips: The doctor will bend your baby's legs up and turn them out to check for signs of a condition called congenital dislocation of the hips (CDH). This is when the ball at the top of the thigh bone (femur) does not fit properly into the socket of the pelvis or is dislocated. Many babies have 'dicky hips' where pregnancy hormones have made the ligaments loose. This is nothing to worry about and will improve with time.
Hands, feet, arms and legs: The doctor will check the feet for signs of them turning turn in excessively (talipes). This is often related to the baby's position in the uterus and will correct itself. He will also look at the creases on your baby's palms - there are usually two. A single crease may indicate Down's syndrome, in which case further checks would be made. He will also check the tone and strength of the limbs.
Genitals and anus: Babies commonly have swollen genitals after birth and a baby girl may have some vaginal discharge for a couple of days. The doctor will check that the genitals are formed properly and that a boy's testicles are in his scrotum (not undescended). The doctor will also check with you that your baby has opened her bowels.
Reflexes: The doctor will check the baby's reflexes, which are present at birth and indicate that the central nervous system is working correctly.
Parents often ask when their baby will be checked, unaware that their baby's first check took place at 1 minute of age. This Apgar test (after the doctor who devised it) is repeated again at 5 minutes. Five categories are assessed, which are each given a score of 0,1 or 2, the total being out of 10. The categories include: Colour Parents are often surprised that babies do not immediately come out pink but are tinged with blue. However they do pink up quickly after their arrival -especially after a good cry. In non-white babies, the inside of the mouth, the whites of the eyes, the soles of the feet and the palms are examined.
Heart rate: Newborn babies should have a heart rate of over 100 beats per minute.
Breathing: This should be strong and regular, as it will be if your baby is crying.
Muscle tone: Your baby should be able to actively move her arms and legs.
Response/Reflex: Your baby should respond to stimulation, such as being dried with a towel or handled. A healthy baby will have a score of 7 or higher, whereas a baby with a score lower than 7 may need time to recover from the birth. A baby with a very low score may need medical attention.