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Quick reference medical handouts used by Pediatric offices


The Newborn: When it's normal
to be abnormal!


Children, especially Infants, are unique in medicine! They may appropriately display certain signs and symptoms considered abnormal later In their lifes. In fact, not displaying some of these "abnormal" behaviors may even be abnormal In some situations. Confusing? The following examples illustrate some situations where "abnormal" signs and symptoms are clearly normal.

Jaundice in Newborns
Although clearly abnormal in adults, newborn infants develop jaundice shortly after birth. Except for jaundice in extreme ranges, this yellow color is more normally present than absent. For additional information see: Why do many newborns become jaundiced after birth? and What causes newborn jaundice?

Toxic Erythema of the Newborn
This sinister sounding rash is not only completely harmless, but seems to only occur in healthy, full term infants. This rash develops shortly after birth and consists of red blotches in a random distribution all over the infant. Most blotches have a central yellow-white pimple. The rash comes and goes and frequently changes location. It may last 2-3 weeks and spontaneously disappears. For additional information, see: The Newborn Skin

Bloody Urine
Actually, blood in the urine is always abnormal. However, infant s urine may normally contain significant amounts of uric acid. These crystals get trapped in the diaper liner and appear like red brick dust. If the "blood" in the urine has this appearance, it is probably not really blood but uric acid crystals.

Menstrual Period In a Female Infant
Several days after birth female infants frequently have vaginal bleeding lasting one or two days. Maternal hormones crossing the placenta stimulate growth in the Infant s uterine lining. This hormone stimulation is abruptly terminated at birth. This causes slough ing of the hyperdeveloped uterine lining of the baby. The result is the same withdrawal bleeding experienced by adult women, an infant menstrual period. Normal.

Breast Development in Infants
All boys and girls are born with their breasts developed. This is caused by maternal female hormone crossing the placenta and stimulating the baby s breast to grow. The closer to term the child is born, the more pronounced is the degree of breast growth. The breast stimulation peaks shortly after birth and disappears in 2-4 weeks. Normal.

Breast Milk in Female Infants
On occassion, female infants will produce a drop or so of breast milk a few days after birth. Some have called this witches milk. Once again the pregnant women s extremely active hormone factory is busily stimulating all that it can. Normal.

Sneezing
Sneezing is one way infants clear their nasal passages. If sneezing is unaccompanied by runny nose, coughing, acting ill, and not present in frequent spells, ignore this symptom. Normal.

Hiccough
This behavior usually drives parents nuts, but when doctos walk in a examining room and see an infant with hiccoughs, we are delighted. This means we will be able to do all my examination without the child crying. Infants with hiccoughs are usually in a quiet, alert state and seem curious about their surroundings (or perhaps while they are hiccoughing). Nothing needs be done about this unless the hiccoughs have been there very long and the child is tiring of its presence. A small warm feeding (preferrably breast milk) usually stops the episode. For more information, see what causes newborns to have the hicccoughs?

Vomiting/Spitting Up

Most infants spit up part of their milk feedings. Sometimes the amount regurgitated is so large that parents begin wearing rain garments. Infants that have this fountain-like trait often continue spitting until they are upright (9-12 months). When is this abnormal? In general, ifthe spitting/vomiting is associated with a happy, growing infant, if no illness (such as pneumonias, wheezing,etc. is caused by this trait, and if the child looks normal when the spitting! If vomiting is present (not pale, pasty, sick-looking), you are probably dealing with a "wet" child. For additional information to determine when vomiting might be a problem, see What is Pyloric Stenosis? and When Babies Spit up Frequently

Crossed Eyes
Most infants have occassional, short episodes of eye crossing in the first 3-4 months. Normal. Caution: if the episodes increase in length of time or severity, or if the episodes do not disappear by 4 months, an examination is necessary. Because of the infant s wide nasal bridge, a "false" turning in of the eyes seems present in some young children. Parents should check and see if light reflects symmetrically in both eyes. If it does not, a physician should examine the child. For additional information, please see: Keep an Eye on your Child's Vision and Spotting Vision Problems Early Saves Sight

Bow Legs
The combination of torque placed on the infant s legs during fetal development and the normal presence of externally rotated hip joints causes bow legs in infants. In fact this bowing is normal and persists until about 18-24 months of age. Normal. Caution: If the bowing is extreme (you can drive a freight train between theft knees when they are standing with ankles touching), if Improvement is not present by 18-24 months of age, or if pain is present, check it out.

FIat Feet
Almost all infants have flat feet. The foot arch may not develop significantly until 4-6 years. Normal. Caution:

So, when friends point out one of these abnormalities in your child, smile and say, "My child is normally abnormal."

The above weas adapted from an article written by pediatrician Harry Pellman and originally appeared in the parenting newsletter Pediatrics for Parents

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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