Newborn Care
The first 4 weeks: what to expect, APGAR scoring, newborn reflexes, jaundice, umbilical cord care, circumcision, and screening tests.
The First 24 Hours
What to expect immediately after birth
Newborn Appearance
- Skin may appear bluish, mottled, or covered in vernix caseosa (a waxy white coating that protected skin in utero)
- Head may be cone-shaped from passing through the birth canal (molding) -- resolves within days
- Fontanelles (soft spots): anterior fontanelle closes by 12-18 months, posterior by 2-3 months
- Lanugo (fine body hair) may be present, especially on shoulders and back -- sheds within weeks
- Milia (tiny white bumps on nose/chin) are blocked oil glands -- disappear without treatment
- Newborn acne may appear at 2-4 weeks -- hormonal, resolves on its own
- Eyes may appear swollen or puffy; cross-eyed appearance is normal until 3-4 months
- Skin peeling is normal in the first 1-2 weeks, especially in post-term babies
Newborn Reflexes
- Moro (startle) reflex: arms fling outward then curl inward when startled -- disappears by 4-6 months
- Rooting reflex: turns head toward touch on cheek, opens mouth -- helps find the breast
- Sucking reflex: automatically sucks when roof of mouth is stimulated
- Palmar grasp: grips anything placed in palm -- so strong it can support partial body weight
- Babinski reflex: toes fan outward when sole of foot is stroked -- disappears by 12-24 months
- Stepping reflex: makes walking motions when held upright with feet touching a surface
- Tonic neck (fencing) reflex: when head turns, arm on that side extends -- disappears by 5-7 months
First Hours Checklist
- Skin-to-skin contact immediately after birth -- regulates temperature, heart rate, and breathing
- First breastfeeding attempt within 1 hour (colostrum is liquid gold -- rich in antibodies)
- Apgar scores assessed at 1 and 5 minutes (heart rate, breathing, muscle tone, reflexes, color)
- Vitamin K injection to prevent bleeding disorders (VKDB)
- Erythromycin eye ointment to prevent neonatal conjunctivitis
- Hepatitis B vaccine within 24 hours of birth
- Newborn metabolic screening (heel prick) at 24-48 hours
- Hearing screening before discharge