Even the most prepared parent-to-be can be caught off guard by some of the strange (but totally normal) physical characteristics of their newborn, such as a slightly cone-shaped head or hair on their back and shoulders. And that first diaper change can be downright alarming!
But don’t worry. As pediatricians – and often parents ourselves – we’ve seen and heard it all. Together with our Ob/Gyn colleagues, we can provide new parents with the answers they need to calm their nerves and ensure their baby gets the best possible care.
Here are some of the commonly asked questions from new parents about strange-but-normal traits they notice about their babies in the first few weeks after birth.
1. Why does my baby have a conehead?
After a vaginal birth, we hear this question quite a bit, and there’s a perfectly normal explanation.
When babies are born, their skull bones are not fused together. These bones are a little like tectonic plates in the earth. They can overlap to help babies get through the narrow birth canal, and then they settle back into place.
The birthing process is not gentle, by any means. When babies exit head-first, the pressure from squeezing through a tight space molds their soft skull into a long, pointy shape. Babies who don’t have a defined point might have a bump or swelling in the back of the head that causes an irregular shape. This can look concerning, but it is simply a buildup of fluid that forms when the pressure during birth damages small blood vessels.
Your baby’s head should start to round out after about 24 hours, but it can take up to two weeks for it to settle into what is considered normal – and that is a long time to wait for new parents.
To allow the brain to grow, skull bones won’t fuse until the baby is much older, which is why you’ll notice two soft spots on their head: the posterior fontanel, located in the back of the head, and the anterior fontanel, located on top.
You can certainly touch these spots, but don’t push down on them or allow anything to hit or fall onto them. These gaps close, or harden, on their own when the bones fuse. It usually takes two or three months for the back spot to close and up to a year and a half for the top one.
Related reading: What moms should know about forceps and vacuum deliveries
2. Why doesn’t my newborn shed tears when he/she cries?
During the first five weeks, your baby’s crying will gradually increase. But you might not see tears.
Babies are usually dehydrated when they are born because they received everything they needed to stay hydrated in the womb. And because their tummies are so small, they can’t hold very much liquid. With so little fluid throughout their bodies, they can’t physically make tears for the first couple of weeks.
Some babies also have a blocked tear duct, a condition called dacryostenosis. You’ll likely see crusty discharge on the inside corner of the affected eye. To unplug the tear duct, wrap a warm washcloth around your finger and lightly massage the area in a circular motion. To follow a regular cadence, do this every time you change their diaper until the discharge disappears.
3. Why is there hair on my baby’s back and shoulders?
Some babies are born without eyebrows or eyelashes and with barely any hair on their head. Hair follicles develop at different rates, so it may take a month or two for them to grow in.
Other babies are born with a lot of hair all over their body, especially their shoulders and back. This is called lanugo; it forms within the womb to protect a baby’s skin and regulate body temperature. The excess hair typically sheds within the first week or two. If your baby was born prematurely, it might hang on a little longer.
4. Why is the first diaper change so dark and sticky?
A baby’s first stool is called meconium. It looks a little like tar and consists mostly of cells, proteins, and fats. As your baby eats more, their stool will start to become looser and lighter colored.
The transition time is different for every baby. What’s important is that they pass stool in the first 48 hours. As they start eating more, six to eight diaper changes a day is normal.
5. Is it normal for my baby to have teeth?
In rare cases (1 in 2,000-3,500), babies are born with a natal tooth. It doesn’t look like your average tooth. Natal teeth are soft, somewhat discolored, and not fully developed or functional. They’re attached to gum tissue instead of a root.
They typically fall out within a year. The only real concern is if they are really loose. We recommend parents see a pediatric dentist to ensure they’re not a choking hazard and to have them removed if they are.
6. Why is my baby losing weight?
Weight loss during the first week is another result of babies adjusting to life outside the womb, where they received all the necessary nutrients. Newborns actually exercise by eating; you’re not the only one working during breastfeeding or bottle feeding.
We don’t expect babies to return to birth weight until they’re 2 weeks old. The amount of weight lost is different for each child. Babies born by caesarean section tend to lose more weight, but as long as your baby’s weight loss stays under 10% of their birth weight, there’s nothing to worry about.
7. How can I help reshape my baby’s flat head?
After your baby’s head shape evens out, you might start to notice a flat area in the back. This is called positional plagiocephaly, a condition that affects 1 in 4 babies in the U.S. when a baby spends too much time on their back.
It’s critical for babies to sleep on their backs, but you can prevent a flat spot from becoming permanent by:
- Keeping them off their back while they’re awake. Lay them tummy down on your lap or chest and let them start lifting their head and building their neck muscles. As long as you watch them, you can also put them on the floor on their tummy.
- Alternating which way they turn their head while sleeping on their back. Sometimes they have a preference, but you can lightly adjust their head position while they’re sleeping to ensure they rest on each side relatively equally.
If the back of your baby’s head still appears flat after six months, they might need helmet therapy. This treatment uses a custom-fitted helmet to mold the skull into a rounder shape.
You don’t have to monitor your baby’s head shape on your own. UT Southwestern pediatricians check it at every visit. We schedule follow-up appointments for all babies after a few days, then two weeks, two months, four months, and six months. If we notice that flatness is becoming an issue or the skull bones are not fusing correctly, we will engage our craniofacial colleagues for proper treatment.
Related reading: 5 things to consider when choosing a pediatrician
We understand your concerns
Every baby is wonderfully different, so you can’t and won’t know everything when they’re born. My colleagues and I understand that your worries come from a place of love and care for your baby, and we are always happy to answer your questions.