Key takeaways: Most newborn “surprises” are normal and fade within days to weeks: a molded head, puffy eyes, milia, peeling skin, birthmarks, and blue hands and feet. Yellow skin spreading downward, blue lips, or a rash with fever need prompt attention.
Newborns rarely look like the babies in diaper ads. They’ve just squeezed through a birth canal or been lifted out during surgery after months floating in fluid. Many of the features that surprise parents are completely normal and temporary. Here’s a head-to-toe guide.
The Head
- Molding (cone head): During a vaginal birth, the skull bones overlap slightly to fit through the birth canal. The head may look long or pointed. It usually rounds out within a few days. Babies born by cesarean often have rounder heads.
- Caput succedaneum: a soft, puffy swelling on the scalp from pressure during birth. It crosses the skull’s seams and fades within a few days.
- Cephalohematoma: a firmer bump, usually on one side, caused by bleeding under the outer covering of a skull bone. It doesn’t cross the seams and can take weeks to months to go away. It can increase jaundice, so your doctor will monitor bilirubin.
- Soft spots (fontanelles): two soft areas on the top and back of the head. It’s safe to touch and wash them. The back one usually closes by 2 months, the front one between about 12 and 18 months. A soft spot that bulges when your baby is calm and upright, or looks sunken, needs a call.
The Face and Eyes
- Puffy eyelids: from birth pressure and fluid. They improve over a few days.
- Small red spots in the whites of the eyes (subconjunctival hemorrhages): broken blood vessels from birth pressure. They’re painless and fade in 1 to 3 weeks.
- Eye color: many babies are born with blue or gray eyes that may change over the first year.
- Crossed eyes: occasional crossing is common in the first months. Constant crossing, or crossing after about 4 months, should be checked.
- Flattened nose or asymmetric face from position in the womb usually improves.
The Skin
- Milia: tiny white bumps on the nose, cheeks, and chin. They’re blocked oil glands and disappear on their own in a few weeks. Don’t squeeze them.
- Erythema toxicum: a blotchy red rash with small yellow-white centers that often appears in the first days and comes and goes. Despite the name, it’s harmless and fades within a week or two.
- Peeling, dry skin: especially in babies born after their due date. It doesn’t need treatment.
- Vernix: a white, creamy coating that moisturizes the skin. It can be left to absorb.
- Lanugo: fine, soft hair on the shoulders, back, and ears, especially in premature babies. It falls out over a few weeks.
- Acrocyanosis: bluish hands and feet in the first day or two, caused by immature circulation. Blue color around the lips, tongue, or face is different and needs immediate attention.
- Mottling: a lacy, purplish pattern on the skin when a baby is cool. It should improve with warmth.
Birthmarks
- Stork bites and angel kisses (salmon patches): flat pink or red marks on the back of the neck, eyelids, or forehead. They often fade over the first years.
- Congenital dermal melanocytosis (once called “Mongolian spots”): flat blue-gray patches, often on the lower back and buttocks, common in babies with darker skin. They aren’t bruises and usually fade in childhood. Make sure they’re documented at a checkup.
- Infantile hemangiomas: “strawberry” marks that may not be visible at birth but appear and grow in the first weeks. Most shrink over years. Those near the eyes, lips, nose, diaper area, or that grow quickly should be seen early; treatment works best when started early.
The Body
- Swollen breasts: both boys and girls can have breast buds, and even a little milky discharge, from the birthing parent’s hormones. Don’t squeeze them. They go away in weeks.
- Genitals: may look swollen. Girls may have white discharge or a little blood-tinged discharge in the first week or two. Boys may have fluid around the testicles (hydrocele), which usually resolves in months.
- Legs and feet: bowed legs and feet turned in from position in the womb are common. Feet that can’t be gently moved into a normal position should be checked.
Normal Newborn Behaviors
- Irregular breathing with brief pauses (under 20 seconds).
- Sneezing (to clear the nose) and hiccups.
- Grunting and squeaking during sleep.
- Jittery chin or hands, especially when crying.
- Startling at loud sounds or sudden movements.
Call your baby’s doctor if you notice: yellow skin spreading to the belly or legs; a rash with fever; a bulging or sunken soft spot; a birthmark growing quickly or near the eye or lips; jitteriness that doesn’t stop when you hold the limb; or swelling that is getting worse. Call 911 for blue or gray lips or face, breathing pauses of 20 seconds or more, or a baby who can’t be woken.
The Bottom Line
Most of the things that make newborns look “funny” are signs of a recent birth and fade on their own. When in doubt, take a photo and ask at your baby’s first checkup.
My book From First Breath to First Birthday has a full head-to-toe guide to normal newborn findings.
Sources
- Altmann TR, Hill DL, eds. Caring for Your Baby and Young Child: Birth to Age 5. 7th ed. American Academy of Pediatrics; 2019.
- Lewis ML. A comprehensive newborn exam: part I. General, head and neck, cardiopulmonary. Am Fam Physician. 2014;90(5):289-296.
- Lewis ML. A comprehensive newborn exam: part II. Skin, trunk, extremities, neurologic. Am Fam Physician. 2014;90(5):297-302.
- Krowchuk DP, Frieden IJ, Mancini AJ, et al; Subcommittee on the Management of Infantile Hemangiomas. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019;143(1):e20183475.
- Association of Women’s Health, Obstetric and Neonatal Nurses. Neonatal Skin Care: Evidence-Based Clinical Practice Guideline. 4th ed. AWHONN; 2018.
- Kemper AR, Newman TB, Slaughter JL, et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2022;150(3):e2022058859.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
