A normal baby or a full-term baby is considered to be born at the end of gestation, approximately 40 weeks after normal or eutotic delivery, with no history of parental illness, problems during pregnancy or childbirth, or any alterations.
The weight and size of the child at birth are determined by the size and function of the placenta, as well as by gestational age (weeks of gestation). Subsequently, growth is conditioned not only by the amount of food the child receives and how often it is taken, but also by the inheritance received from the parents. During the first four days of life, the baby's weight decreases as excess fluid is evacuated. This loss can reach a maximum of 10%. There is no single, fixed pattern of weight gain for the newborn, but as a rule, from the fourth day onward, it begins to recover and equals that of childbirth by the tenth day. Exclusive breastfeeding minimizes weight loss and promotes recovery.
Weight gain is usually monitored by a nurse or pediatrician, weekly for the first few weeks and monthly thereafter. If parents want to control it more often, they should consider the variations caused by different scales, clothes, stools and intakes, to avoid any unnecessary worry.
The body proportions of the newborn are different from those of the older child. In comparison, they have the largest head and limbs, especially the lower ones, shorter.
Head and skull: The skull of infants and infants is made up of bone plates that allow the brain and the skull to grow. The bones are soft and grow rapidly. The edges where these plates attach are called sutures or sutures and usually close when the child is 2 to 3 years old.
Fountains: These are soft, membranous areas located on the top of the head, above the forehead (anterior fontanella) and in the neck area (posterior fontanella). The anterior fontanella is the largest, approximately 2,5 x 2,5 cm, rhomboid, and normotensive on palpation: it should not be sunken (a sign of dehydration), nor should it be pumped and perceived. a heartbeat (it's pulsating).
The posterior fontanella is triangular and is generally closed or only palpable "at the fingertips". The function of the fontanelles, in addition to adjusting the head to the birth canal, is to allow the brain to have the space it needs to develop more easily. They usually close at about 18 months of life.
Cranial modeling: It is very common in normal or eutotic delivery. It consists of a deformation of the skull due to the passage through the birth canal. It normalizes for the first few days. Injuries to forceps may appear in the areas where the blades were applied. Treatment involves applying an antiseptic to prevent infections. They will usually have scarred before discharge, otherwise the pediatrician will monitor them. Circular edema of the scalp may disappear on suction pads, which will disappear within a few days.
Hair: Almost the entire body of the newborn is coated with a thin, non-pigmented hair. Many also have it on their scalp, which will fall off in the first month. From the age of 3 months it will begin to grow again from the front to the back of the neck. Mature hair appears from the sixth month of age. Hair loss on the back of the head (occipital alopecia) is physiological, not due to friction with the pillow or crib.
Eyes: The eyes of the newborn have a correct anatomy but little functionality. They are grayish blue. Until the 6 months they do not acquire a definitive color. Tears appear from the first month of life. During the first few weeks, eye movements are rare, not conjugate, and erratic. They flicker in bright lighting. When placing a face or a striking object about 20-30 cm from the baby, we will observe how the eyes are oriented towards us and follow the lateral movements. At the end of the first month he already coordinates and fixes his gaze on what catches his eye, and is able to follow it with his eyes and head. Flashing eyes (strabismus) intermittently for the first six months. This non-constant strabismus is normal or physiological. Color perception begins to develop by the fourth month.
A common alteration in 6% of newborns is the epiphorus. It is the excessive and passive tearing caused by the obstruction of the nasolacrimal duct. Clinical signs appear a few days or weeks after birth. The child may have a bright look, continued tearing or even mucous discharge. The massage technique helps reduce clogging. This is done by pushing the tear sac from top to bottom in the direction of the mouth. In case of purulent secretion consult a pediatrician, who will evaluate the application of an antibiotic treatment. It usually heals spontaneously during the first three months of life.
A high proportion of infants may have conjunctivitis. The child has a mucous or purulent secretion. You should consult your pediatrician as they may be of viral or bacterial origin and therefore the treatment will vary depending on the cause (these are usually eye drops or ophthalmic ointments that are applied after washing the area with serum). physiological for 5-7 days).
Nas: Newborns have a blunt tip and a broad root. It is common to see dry nostrils in the nostrils of the newborn, which rarely causes discomfort. Sneezing is normal reflexes, does not mean they are cold, this is the baby's way of cleaning the nose from mucus, dust or other irritants.
Boca: In the middle of the upper lip, at the time of birth or during the first week, hypertrophy of the mucosa called "suction call" may occur. It disappears in a few weeks.
- Fountains: These are soft, membranous areas located on the top of the head, above the forehead (anterior fontanella) and in the neck area (posterior fontanella). The anterior fontanella is the largest, approximately 2,5 x 2,5 cm, rhomboid, and normotensive on palpation: it should not be sunken (a sign of dehydration), nor should it be pumped and perceived. a heartbeat (it's pulsating).
It is circular and has a broad base. The xyphoid appendix (lower end of the sternum) is clearly visible during the first weeks of life. The breathing is calm and it is normal to be regular, that is to say, after an irregular breathing period, pauses of 15 to 20 seconds in duration, without changes of coloration of the skin or mucous membranes.
Breast intumescence: In some children, there may be an increase in the size of the breast button from the third day onwards (a small lump or nodule under the nipple is noticeable when touched). It is observed in both sexes and is caused by the passage of the mother's hormones through the umbilical cord, which causes the mammary gland to develop. It reaches its maximum development during the first 2-3 weeks, but after a few days it becomes involved. It is important not to manipulate it to prevent infections. It does not need treatment.
- Head and skull: The skull of infants and infants is made up of bone plates that allow the brain and the skull to grow. The bones are soft and grow rapidly. The edges where these plates attach are called sutures or sutures and usually close when the child is 2 to 3 years old.
It consists of two arteries and a vein covered by a jelly of a yellowish white or yellowish white. From 48 hours of life begins the process of dehydration and mummification, which will cause its fall (between 7 and 15 days) and will acquire a dark brown or black coloration. Babies with jaundice or those born by cesarean section fall off the cord later.
Umbilical cord care
- Until it is detached, the cord must be kept dry and clean.
- It is advisable to dry it and leave it in the air without alcohol or other disinfectants, with diapers folded to prevent rubbing and to avoid overlapping clothes or bodysuits.
- Each time the diaper is changed, the umbilical cord must be observed. Warning signs that indicate the need to consult a pediatrician or pediatric nurse are: yellowing, odor, redness, swelling or tenderness of the skin around the base or bleeding.
- The daily bath should be avoided until it drops and heals, but if done, it should be dried thoroughly.
Possible alterations of the navel after the fall of the cord:
Omphalitis: It is a purulent, stinky secretion, with inflammation of the skin surrounding the cord, which needs antibiotic treatment. It should be differentiated from normal secretion, which has no special odor or signs of inflammation, and is normal after fall.
Umbilical hernia: In many cases, a small hernia is seen in the navel, due to the immaturity of the abdominal muscles. It becomes more apparent when the child is crying or making efforts. Sashes or a strap should not be used as they are not reduced and are uncomfortable for the child. These hernias, even the largest ones, usually close spontaneously during the first year of life.
- granuloma: Small, fleshy, reddish, pinkish, or purple, benign tumors may also appear on the navel. It does not pose a health problem and is easily eliminated by applying silver nitrate, which will be performed by the nurse at the consultation. After these applications (cauterization), the base of the navel will be dyed black. This color will disappear after a few weeks.
When born, the child is coated with a yellowish-white substance called the vernix (sebaceous spot). It is an oily mixture that contains fat and flaking cells secreted by the fetus itself. It is nourishing to the skin and reabsorbed. During the first days the flaking is common and normal, especially in the area of the folds; it is solved spontaneously, just moisturize the skin. The newborn may also have certain specificities that, despite not appearing in all cases, are normal, and therefore no treatment is necessary:
- Miliaria: These are small granules (microvesicles) with transparent contents, which break easily. They disappear spontaneously. The heat and the fact that it is excessively warm contribute to its appearance.
- Milium: Due to the immaturity of the pilosebaceous apparatus (pores where the hair is born), keratin and sebum are retained and nodules of a yellowish white or pearl appearance of 1-2 mm in diameter appear, which are located in the nose , cheeks, chin and forehead. They have no relation to lactation. They usually disappear in the first month of life, but may persist for several months. They do not cause discomfort.
- Milky crust: It is a scaly, scaly area localized on the scalp and common in newborns, although it is more common in infants 2 to 3 months of age. Oily scales also appear on the facial midline, behind the ears, and on the eyebrows. The main treatment is to wash the scalp daily with a neutral shampoo and apply oil or petroleum jelly 15-20 minutes before washing to facilitate the removal of the scab. Response to treatment is rapid, but often reappears during the first few months, and should be re-treated.
- Marmorata cutis: Due to dilation of the capillaries, the skin may have a reticulate appearance, with purple lines on the trunk and extremities. This marbled coloration may be intermittent or permanent, and is most apparent with exposure to the cold. It is a benign phenomenon that disappears during the first few months.
- Acrocyanosis: Bilateral and symmetrical cyanotic (bluish) coloration on the hands and feet. It disappears with heat and intensifies with exposure to cold. It is caused by the instability of the blood circulation, and disappears during the first weeks of life.
- Neonatal acne: 40% of newborns have a rash of reddish pimples, preferably on the cheeks, although sometimes they are also located on the forehead and chin. It is more common in boys than girls. It is solved spontaneously.
- simple nevus: In some cases, pink spots may be seen on the upper eyelid, between the nose and lip, or on the neck. They grow at the same rate as the child during the first years of life and then disappear.
- Hemangioma: Uncommon at birth. Between the second and fifth weeks a bright red or purple spot may appear, with well-defined edges. When pressed, it only partially bleaches and has a firm consistency. It can be found anywhere, but mainly on the head, neck and trunk. It grows in size for the first 6 months and then slowly engages until it disappears, in most cases, around the age of 6.
- Flame nevus: These are wine-colored vascular spots that appear on the face and extremities. Unlike others, they do not disappear.
- Mongolian stain: An irregularly shaped dark bluish-gray spot that appears almost always in the gluteal or lumbosacral region. It increases in size and becomes more apparent during the first years, and disappears almost always by the age of 4. In a few cases it persists forever.
- Neonatal jaundice: Yellowing of the skin and mucous membranes. It occurs when blood levels of a yellow pigment (bilirubin) increase. Bilirubin is the result of the degradation of another pigment, hemoglobin, which stores red blood cells and is required for tissue oxygenation. When the red blood cells are broken for any reason, hemoglobin is released and converted to bilirubin, reaches the liver and, after several transformations, is eliminated in the intestine in the form of bile, where it helps. for the digestion process.
La physiological jaundice (considered normal) newborns appear for the first 24-48 hours and disappear during the first weeks of life. It appears when the baby's body destroys the maternal blood that circulates in its vessels and begins to use its own blood to oxygenate. Hemoglobin in the maternal blood becomes bilirubin, so its level in the child's blood can increase greatly in the first days and make the skin and mucous membranes thick.
If bilirubin levels are very high in a baby's physiological jaundice, one of the most common treatments is phototherapy or exposure to visible light, either in the spectrum of blue, or in broad spectrum white light. It is used only when specifically indicated and the baby has bilirubin levels in the blood of 3-4 mg / dL (monitored during hospitalization) and has no problems in the biliary tract. Ultraviolet rays are filtered by a screen and protect the child's eyes during exposure.
After discharge, the pediatrician at the primary care center monitors the evolution of the different revisions performed to the newborn.
In order to accelerate the disappearance of the child, once it is home, it is advisable to expose it to indirect sunlight by the side of a window in a bright room.
There are other types of jaundice, severe and persistent, due to causes associated with the disease. These are situations caused by congenital biliary tract problems and require immediate pediatric evaluation, which is made in the first days of a child's life, while still in the care of newborns, to apply the necessary treatment before giving high.