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Pediatric Primary Care


Looking at Your Newborn: What's Normal

General Appearance of Newborns

In delivery room scenes on TV and in the movies, the mother-to-be, often a famous actress in full makeup and with every hair in place, "delivers" a baby after a few token grunts and groans. Seconds later, the doctor presents the glowing parents with a picture-perfect, neatly combed and scrubbed, cooing several-month-old infant.

Contrast that picture with how a baby really looks just after emerging from the womb: bluish, covered with blood and cream-cheesy glop, and looking as though the little one has just been in a fist-fight.

The fact that your newborn doesn't resemble one of those Hollywood "stand-ins" shouldn't come as a great surprise. Remember that the fetus develops immersed in fluid, folded up in an increasingly cramped space inside the uterus. The whole process usually culminates with the baby being pushed forcibly through a narrow, bone-walled birth canal, sometimes requiring the assistance of metal forceps or suction devices.

Still, it helps to remember two things:

  1. Usually, the features that may make a normal newborn look strange are temporary.
  2. In the eyes of the adoring parent, every infant looks like the perfect baby anyway.

When you first get to see, touch, and inspect your newborn may depend on the type of delivery, your condition, and the condition of your baby. Following an uncomplicated vaginal delivery, you should have the opportunity to hold your baby within minutes after the birth.


In most cases, infants seem to be in a state of quiet alertness during the first hour or so after delivery. It's a great time for you and your newborn to get acquainted and begin the bonding process. But don't despair if circumstances prevent you from meeting your infant right away. You'll have plenty of quality time together soon, and there's no scientific evidence that the delay will affect your infant's health, behavior, or relationship with you over the long run.


Primitive Reflexes


  • grasp reflex, which causes an infant to tightly close the fingers when pressure is applied to the inside of the infant's hand by a finger or other object
  • Moro reflex, or startle response, which causes an infant to suddenly throw the arms out to the sides and then quickly bring them back toward the middle of the body whenever the infant has been startled by a loud noise, bright light, strong smell, sudden movement, or other stimulus

Also, due to the immaturity of their developing nervous systems, young infants' arms, legs, and chins may tremble or shake, particularly when they're crying or agitated.

Sleeping and Breathing Patterns

In the first weeks, infants usually spend most of their time sleeping. This may be even more exaggerated during the first day or two of life in newborns whose mothers received certain types of pain medications or anesthesia during the labor or delivery.

Frequently, new parents become concerned about their newborn's breathing pattern, particularly with the increased attention that sudden infant death syndrome (SIDS) has received in recent years. But rest assured that it's normal for young infants to breathe somewhat irregularly.

When an infant is awake, his or her breathing rate may vary widely, sometimes exceeding 60 breaths per minute, particularly when the little one is excited or following a bout of crying. Newborns will also commonly have periods during which they stop breathing for about 5 to 10 seconds and then start up again on their own. This is known as periodic breathing, which is more likely to occur during sleep and is considered very normal. However, if your infant turns blue or stops breathing for longer stretches of time, it's considered an emergency and you should contact your child's doctor immediately or go to the emergency room.

Although talking won't come until much later, your newborn will produce a symphony of noises — especially high-pitched squeaks — in addition to the obligatory crying. Sneezing and hiccups also occur very frequently and don't indicate infection, allergies, or digestive problems in newborns.


Because the infant's head is usually the first part through the birth canal, it can be affected by the delivery process. The newborn's skull is made up of several separate bones that will eventually fuse together. This situation permits the large head of the infant to be squeezed through the narrow birth canal without injury to mother or baby.



Don't be alarmed if you see the fontanels bulge out when the infant cries or strains, or if they seem to move up and down in time with the baby's heartbeat. This is perfectly normal. The fontanels will eventually disappear as the skull bones close together — usually in about 12 to 18 months for the front fontanel and in about 6 months for the one in back.





A newborn's face may look quite puffy due to fluid accumulation and the rough trip through the birth canal. The infant's facial appearance often changes significantly during the first few days as the baby gets rid of the extra fluid and the trauma of delivery subsides. That's why the photos you take of your baby later on at home usually look a lot different than those "new arrival" nursery shots.









Because newborns tend to breathe through their noses and their nasal passages are narrow, small amounts of nasal fluid or mucus can cause them to breathe noisily or sound congested even when they don't have a cold or other problem. Talk with your doctor about the use of salt-water nose drops and a bulb syringe to help clear the nasal passages if necessary.









Arms and Legs




Sometimes parents are concerned about the curved appearance of their newborn's feet and legs. But if you recall the usual position of the fetus in the womb during the final months of pregnancy — hips flexed and knees bent with the legs and feet crossed tightly up against the abdomen — it's no surprise that a newborn's legs and feet tend to curve inward. You can usually move your newborn's legs and feet into a "walking" position; and this will happen naturally as the infant begins to bear weight, walk, and grow through the first 2 to 3 years of life.







The genitalia (sexual organs) of both male and female infants may appear relatively large and swollen at birth. Why? It's due to several factors, including the exposure to hormones produced by the mother and fetus, bruising and swelling of the genital tissues related to birth trauma, and the natural course of development of the genitalia.




In boys, the scrotum (the sack containing the testicles) often looks swollen. This is usually due to a hydrocele, a common collection of fluid in the scrotum of infant boys that usually disappears during the first 3 to 6 months. You should consult your doctor about swelling or bulging in your son's scrotum or groin area that persists beyond 3 to 6 months or that seems to come and go. That may indicate the presence of an inguinal hernia, which usually requires surgical treatment.












When bearing down to cry or having a bowel movement, an infant's skin temporarily may appear beet-red or bluish-purple. Red marks, scratches, bruises, and petechiae (tiny specks of blood that have leaked from small blood vessels in the skin) are all common on the face and other body parts. They're caused by the trauma of squeezing through the birth canal or by the pressure from obstetrical forceps used during the delivery. These will heal and disappear during the first week or two of life.

Fine, soft hair, called lanugo, may be present on a newborn's face, shoulders, and back. Most of this hair is usually shed in the uterus before the baby is delivered; for this reason, lanugo is more frequently seen on babies born prematurely. In any case, this hair will disappear in a few weeks.

The top layer of a newborn's skin will flake off during the first week or two. This is normal and expected and doesn't require any special skin care. Peeling skin may be present at birth in some infants, particularly those who are born past their due date.




Strawberry or capillary hemangiomas are raised red marks caused by collections of widened blood vessels in the skin. These birthmarks may appear pale at birth and then typically become red and enlarge during the first months of life. Then, they usually shrink and disappear without treatment within the first 6 years.

Port-wine stains, which are large, flat, reddish-purple birthmarks, won't disappear on their own. As the child gets older, concerns (your or the child's) about cosmetic appearance may require the attention of a dermatologist.


Common brown or black moles, known as pigmented nevi, may also be present at birth or appear or deepen in color as the child gets older. Larger moles or those with an unusual appearance should be brought to a doctor's attention because some may require removal.



Miliaria — small, raised, red bumps that often have a white or yellow "head" — is sometimes called infant acne because of its appearance. Although miliaria often occurs on the face and may be present on large areas of the body, it's a harmless condition that will go away within the first several weeks with normal skin care.

Despite the frightening sound of its medical name, erythema toxicum is also a harmless newborn rash consisting of red blotches with pale or yellowish bumps at the center, which give the rash a hive-like appearance. This rash usually blossoms during the first day or two after birth and disappears within a week.

Pustular melanosis, a rash present at birth mainly in black infants, is characterized by dark brown bumps or blisters scattered over the neck, back, arms, legs, and palms, which disappear without treatment. Also, it isn't unusual to see infants born with sucking blisters on the fingers, hands, or arms because the fetus can suck while still in the uterus.

Newborn jaundice, a yellowish discoloration of the skin and white parts of the eyes, is a common condition that normally doesn't appear until the second or third day after birth and disappears within 1 to 2 weeks. Jaundice is caused by the accumulation of bilirubin (a waste product produced by the normal breakdown of red blood cells) in the blood, skin, and other tissues due to the temporary inability of the newborn's immature liver to clear this substance from the body effectively. Although a certain degree of this is expected, if an infant becomes jaundiced earlier than expected or their bilirubin level is higher than is normal, then the doctor will follow the baby very closely.

Getting to Know Your Little One

The first days and weeks of a newborn's life are a time of great wonder and delight for most new parents. However, being responsible for such a seemingly fragile creature can be intimidating, particularly if you're unfamiliar with how a normal newborn looks and behaves.

If you feel anxious or uncertain about any aspect of caring for your infant, don't hesitate to consult your doctor, other health care professionals, or family or friends who have had experience caring for a newborn, too.

Reviewed by: Steven Dowshen, MD
Date reviewed: October 2010