What to Expect the First Year (34 page)
Read What to Expect the First Year Online
Authors: Heidi Murkoff
“I've just noticed a raised, bright red blotch on my daughter's tummy. Is this a birthmark? Will it ever go away?”
They come in all shapes, sizes, textures, and colors, and they don't always show up at birth (sometimes making their appearance in the first few weeks of life), but birthmarks are practically standard issue for newbornsâwith more than 80 percent of infants sporting at least one. And though some birthmarks will last a lifetime, others will fade fast, and still others will fade over time. Sometimes, a mark will grow a bit before it begins regressing.
How long will a birthmark stick around? When will it start to fade or shrink? That's hard to predict. One thing is for sure: Even a birthmark that's destined to disappear won't vanish overnight. In fact, it will likely fade or shrink so gradually, the changes may be hard for you to notice at all. For that reason, many doctors document birthmark changes by photographing and measuring the mark periodically. If your baby's doctor doesn't, you can do so to keep track (or just for a memento).
Birthmarks usually fit into one of the following categories:
Strawberry hemangioma.
This soft, raised, strawberry red birthmark, as small as a freckle or as large as a coaster, is composed of immature veins and capillaries that broke away from the circulatory system during fetal development. It may be visible at birth but typically appears suddenly during the first few weeks of life, and is so common that one out of ten babies will probably have one. Strawberry birthmarks grow for a while but eventually start to fade to a pearly gray and almost always finally disappear completely, sometime between ages 5 and 10. Occasionally a strawberry mark may bleed, either spontaneously or because it was scratched or bumped. If that happens, just apply pressure to stem the flow of blood.
Strawberry birthmarks are often best left untreated (even if you're eager for your baby's mark to disappear) unless they continue to grow, repeatedly bleed or become infected, or interfere with a function, such as vision. Treatment (from compression and massage to steroids, surgery, laser therapy, cryotherapy, injections, or oral medications) can sometimes lead to more complications than a more conservative let-it-resolve-on-its-own approach.
Much less common are cavernous (or venous) hemangiomasâonly one or two out of every hundred babies has this kind. Often combined with the strawberry type, these birthmarks tend to be deeper and larger, and are light to deep blue in color. They regress more slowly and less completely than strawberry hemangiomas, and are more likely to require treatment (but usually not until a child is older).
Salmon patch,
or nevus simplex (“stork bites”). These salmon-colored patches can appear on the forehead, the upper eyelids, and around the nose and mouth, but are most often seen at the nape of the neck (where the fabled stork carries the baby, thus the nickname “stork bites”). They invariably become lighter during the first 2 years of life, becoming noticeable only when a little one cries or exerts herself. Since more than 95 percent of the lesions on the face fade completely, these cause less concern cosmetically than other birthmarks. Those on the neck that don't fade will eventually be covered by baby's hair as it grows in.
Port-wine stain, or nevus flammeus.
These purplish red birthmarks, which may appear anywhere on the body, are composed of dilated mature capillaries. They are normally present at birth as flat or barely elevated pink or reddish purple lesions. Though they may change color slightly, they don't fade appreciably over time and can be considered permanent, though treatment with a pulse-dyed laser anytime from infancy through adulthood can improve appearance.
Café au lait spots.
These flat patches on the skin, which can range in color from tan (coffee with a lot of milk) to light brown (coffee with a touch of milk), can turn up anywhere on the body. They are quite common, apparent either at birth or during the first few years of life, and don't disappear. If your child has a large number of café au lait spots (six or more), point this out to her doctor.
Mongolian spots.
Blue to slate gray, resembling bruises, Mongolian spots may turn up on the buttocks or back, and sometimes the legs and shoulders, of nine out of ten children with African, Asian, or Indian ancestry. These blotchy patches, which can be quite large, are also fairly common in infants of Mediterranean ancestry but are rare in blond-haired, blue-eyed infants. Though most often present at birth and gone within the first year, occasionally they don't appear until later and/or persist into adulthood.
Congenital pigmented nevi.
These moles vary in color from light brown to blackish and may be hairy. Small ones are very common. Larger ones, “giant pigmented nevi,” are rare but carry a greater potential for becoming malignant later in life. It is usually recommended that large moles, and suspicious smaller ones, be removed (after a baby is 6 months old), if removal can be accomplished easily, and that those not removed be monitored carefully by a dermatologist.
It's hard to believe that a newborn baby will ever have any business to take care of (besides eating, sleeping, crying, and growing). But there are two very important documents that your baby will need periodically throughout life, and both should be registered for now.
One is a birth certificate, which will be needed as proof of birth and citizenship when (and all of these will come sooner than you think) registering for school and applying for a driver's license, passport, marriage license (yes, marriage license!), or Social Security benefits. Usually, the registering of your baby's birth is handled by the hospital, and you receive official notification when the record of the birth is filed. If you don't receive such notification and a copy of the birth certificate within a couple of months, check with the hospital, the local health department, or the state health department to see what's holding it up. (If you gave birth at home, you or your midwife will have to register for the document.) When you do receive the birth certificate, examine it carefully to be sure it's accurateâmistakes are sometimes made. If there are errors, or if you hadn't quite settled on a name for your baby before leaving the hospital and need to add it, call the health department for instructions on how to make the necessary corrections or additions. Once you have a correct birth certificate, make a few copies and file them in a safe place.
The second document that your baby will need is a Social Security card. Though it isn't likely your newborn is going to start holding down a job anytime soon, you'll need the number for other reasons, such as setting up a bank account, investing those cash gifts, obtaining medical coverage, even purchasing U.S. savings bonds. The main reason to get a Social Security number, however, is to claim your baby as a dependent on your income tax return. And, if you bank baby's savings in your own name and Social Security number rather than his or her own, you'll have to pay taxes on the interest at your rate rather than the baby's lower one.
Application for a Social Security number can be made during the birth certificate application process in the hospital. You can simply check a box on the birth certificate information form if you want a Social Security number assigned to your child. The hospital forwards this information to the Social Security Administration, which then assigns the Social Security number and issues the card directly to you. The parent's signature on the birth registration form and the check in the box indicating the parent wants a Social Security number for the child constitute a valid application for one.
Or, you can apply for a Social Security number for your baby at your local Social Security office in person or by mail (you can print out a form at
ssa.gov/ssnumber/ss5.htm
), submitting a copy of the birth certificate (see, you need it already), plus proof of your own identity, such as a driver's license or passport, plus the Social Security numbers of both parents. If you decide your baby doesn't need a Social Security number now, keep in mind that the law requires one by age 5. Social Security numbers are available free of charge, so never pay anyone for getting a card or number.
“There are red blotches with white centers on my baby's face and body. Are these anything to worry about?”
They may not be pretty, but they're nothing to worry about, eitherâjust another one of the many surprisingly unsightly skin eruptions newborns can develop (so much for baby-smooth skin, right?). These are actually pretty common, too, and though they come with a scary name (erythema toxicum) and an even scarier appearance (blotchy, irregularly shaped reddened areas with pale centers, sort of like a collection of angry insect bites), these blemishes are, happily, harmless and short-lived. They will vanish within several weeks without treatment. Avoid the temptation to scrub them.
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“When my baby was crying, I noticed a few little white bumps on her gums. Could she be getting teeth?”
Don't alert the social media yet. While a baby very occasionally will sprout a couple of bottom central incisors six months or so before schedule, little white bumps on the gums are much more likely to be tiny fluid-filled papules, or cysts. These harmless cysts are common in newborns and will soon disappear, leaving gums clear in plenty of time for that first toothless grin.
Some babies may also have yellowish white spots on the roofs of their mouths at birth. Like the cysts, they're fairly common and completely innocuous. Dubbed “Epstein's pearls,” these spots will disappear without treatment.
“I was shocked to find that my baby was born with two front teeth. The doctor says he'll have to have them pulled. Why?”
Every once in a while, a newborn arrives on the scene with a tooth or two. And though these tiny pearly whites may be cute as can beâand fun to show off on Instagramâthey may need to be removed if they're not well anchored in the gums, to keep baby from choking on or swallowing them. Such extra-early teeth may be preteeth, or extra teeth, which, once removed, will be replaced by primary teeth at the usual time. But more often they are primary teeth, and if they must be extracted, temporary dentures (which would be fitted once the rest of the primary teeth come in) may be needed to stand in for the missing teeth until their secondary successors come in.
“My baby has thick patches of white on the inside of his cheeks. I thought it was spit-up milk, but when I tried to brush it away, his mouth started to bleed.”
Sounds like there's a fungus among youâor, more accurately, between you. Though the fungus infection known as thrush is causing problems in your baby's mouth, it probably started in your birth canal as a yeast infection and that's where your baby picked it up. The fungus, called candida albicans, is an organism that normally hangs out in the mouth and vagina and is typically kept in check by other microorganisms. But if you get sick, start using antibiotics, or experience hormonal changes (such as in pregnancy), the balance can be upset, allowing the fungus to grow and cause symptoms of infection.
Since thrush is usually picked up at birth, it's most common in newborns and babies under 2 months. Older babies can also develop thrush if they've been taking antibiotics, have a depressed immune system, or the yeast continues to be passed back and forth between mom and baby during breastfeeding.
How can you tell if your baby has thrush? Look for those trademark elevated white patches, which appear like curds of cottage cheese on the inside of a baby's cheeks, and sometimes on the gums, tongue, roof of the mouth, and even the back of the throat, and touch gently with a gauze-covered finger. If it's thrush, the white patch won't come off very easily, and if it does, you'll find a raw, red patch underneath. Fussiness during feeding or when sucking on a pacifier (baby starts to suck, then turns away in pain) could be another sign of thrush, though some babies don't seem to be uncomfortable with it at all.
If you suspect thrush, contact the doctor, who will likely prescribe an antifungal medication (such as Nystatin), which is applied topically to the inside of the mouth and tongue (be sure to get it on all the white patches in your baby's mouth) multiple times a day for 10 days. In a tough case, Diflucan, which is an oral medication given by dropper, may be prescribed. Some babies with thrush also develop a yeast infection in the diaper region, characterized by an angry red rash. It can be treated with a different prescription antifungal medication specifically for that area.
Are you breastfeeding? Then chances are your baby isn't the only one that yucky yeast is feasting on. Yeast infections are passed back from baby's mouth to mama's nipple (and then back and forth again if both members of the breastfeeding team aren't treated). Symptoms of nipple thrush include extreme soreness and burning, along with a pink, shiny, itchy, flaky, and/or crusty appearance. There may also be sharp shooting pains in the breast during or after feeds.
If you suspect you might have nipple thrush (whether or not you see thrush in your baby's mouth), contact the doctor. Breastfeeding doesn't have to be interrupted if one or both of you have been diagnosed with thrush, but the condition can make feeding excruciating for youâanother reason why prompt treatment for both of you is needed. You'll likely be prescribed an antifungal cream that you'll apply to your nipples. If it's practical (for example, if you have the privacy and cooperative weather), you can also try exposing your nipples to sunlight for a few minutes each day, since yeast hates the sun. Probiotics may help speed recovery and keep yeast at bay, and they're safe to take while you're breastfeeding. There are also infant probiotics that the doctor may prescribe for your baby.