General observations

Welcoming a newborn baby into the world is an exciting and sometimes challenging time for families. Understanding the basics of newborn baby health can help you enjoy this special time, and recognise what is normal, what you can expect, and when you need to seek medical attention.

Reflexes

Muscle tone

A sign of healthy muscle tone is if your newborn can move their arms and legs (they are not limp or ‘floppy’). Muscle tone is one of the key health signs your baby’s midwife will check soon after they’re born.

Irritability

Many newborns spend part of their day crying or being unsettled — this is part of normal newborn behaviour. While it can be difficult and upsetting for parents and other family members, usually there is no need for medical attention.

Features of ‘normal crying’ include a pattern that increases in the first few weeks of life, peaks at around 6 to 8 weeks and improves by around 4 months of age.

See your doctor if your baby starts crying suddenly or your baby may have an injury (for example, from head trauma, or ‘shaken baby syndrome’).

Head

Fontanelle

The fontanelles are the ‘soft spots’ on a newborn baby’s skull. They are the skin-covered gaps where the skull plates meet. There are 2 fontanelles on your baby’s skull: the anterior fontanelle is at the front of your baby’s head, and the posterior fontanelle is at the back. Your healthcare team will check your baby’s fontanelle during routine visits.

Your baby’s fontanelle should feel soft and flat. If its bulging or sunken, show your doctor or midwife since it may be a sign that your baby is unwell.

Head shape

Your baby’s head shape is influenced by their birth experience. For example, if you’ve had a vaginal birth, vacuum cup or forceps-assisted birth, your baby’s head shape might be temporarily affected. It's also common for a baby's head shape to change in the days after birth. Depending on the cause of the unusual shape, your baby's head should go back to a normal shape by around 6 weeks after birth.

If you’re concerned about your baby’s head shape, if it looks flat or uneven (asymmetrical), or if you notice that your baby only turns their head to one side when lying on their back, ask your doctor, midwife or child health nurse at your next health check.

Eyes

Your baby’s eyes should be clear and alert. Your baby’s doctor or midwife will check this during regular newborn health checks. They will also check for yellowing (which may be a sign of jaundice) or sticky discharge (a sign of infection).

Most babies are born with blue or grey eyes. This can change any time until your baby is 12 months old.

Your newborn can only focus on objects that are nearby, such as your face or their fists. As their eyes develop, they will be able to focus on objects further away.

Nose

Newborn babies’ breathe exclusively through their nose for the first 4-6 months, so it is important to keep their nasal passages clear.

Babies get colds and sniffles just like everyone else. Because babies have small airways, and are nose breathers in the early months, even a small amount of mucous can make breathing uncomfortable. It’s especially hard to suck from a breast or a bottle with a blocked nose.

Ask your child health nurse or pharmacist if a saline nasal spray will help in your situation.

Mouth

Your newborn’s mouth should look pink and moist. Babies are usually born with 20 baby teeth (also known as primary teeth). They start to come through the gums at about 6 months of age. Your baby's tongue should move freely from side to side, reach up to the roof of their mouth and extend past their lips.

You can help keep your baby’s mouth healthy with these tips:

• Clean your baby’s mouth and gums with a soft cloth.
• Don’t clean a dummy in your mouth — use fresh running water.
• Don’t let your baby fall asleep with a bottle.
• Plan a dental check-up for your baby around their 1st birthday.

Ears

You can expect your newborn to be able to hear sounds right from birth. It's normal for babies not to respond to very soft sounds in the first 2 months. This doesn't mean they have hearing problems. From around 4 months of age, you may notice that they turn their head towards sounds coming from one direction.

Sometimes, you may see wax in your baby’s ear. There is no need to remove the wax, as this happens naturally. If you notice large clumps of wax in the outer part of the ear, you can gently wipe them away, but do not use earbuds or stick anything into babies ears.

Ear infections are common in young babies. They are usually not serious and pass quickly. The 2 most common types of ear infections in children are middle ear infections (otitis media) and outer ear infections (otitis externa). Most ear infections involve the middle ear.

Neck

A healthy newborn’s neck should move freely and not have lumps or swellings. If you notice lumps or bumps, other than swollen glands, seek urgent medical attention.

Swollen glands in the neck are common in young babies. You may feel a lump in your child’s neck on one or both sides from enlarged lymph nodes. Usually, the swelling is not a sign of a serious illness, and it will pass by itself. Sometimes, if the swollen neck glands are a sign of infection, your doctor will recommend treatment.

Skin

In the first few months, your baby’s skin is thin and sensitive while it continues to develop. It is also less able to protect against bacteria, irritants and allergens that may cause irritation and common newborn rashes.

Good skin care includes avoiding soaps and cleansers not made for newborns and ensuring good sun protection. For babies less than 6 month, this means keeping them out of direct sunlight. This can help keep your baby’s skin healthy and prevent future problems.

As part of their regular well baby checks, your healthcare team will check your child’s skin for:

• warmth
• skin colour, jaundice, birthmarks
• dimples
• dryness, irritations or cradle cap
• common or serious rashes
• infection, insect or animal bites
• bruises or other conditions

Chest and breathing

Breathing rate

Healthy newborns have a normal breathing rate of between 25 and 60 breaths per minute. The rate is highly variable and depends on many things including their age and size. Newborn babies sometimes breathe in a pattern called periodic breathing.

This means they breathe normally for 5 to 10 seconds, then pause and don't breathe for a short time. This type of breathing is normal for babies. It happens more often between 2 and 4 weeks of age, and usually goes away by the time they are 6 months old. As long as your baby's skin doesn't turn blue during the pauses, there is no need to worry.

If your baby is showing the following signs, they need medical attention:

• Recessing: inward movement of the muscles between the ribs (intercostal muscles) and above the breastbone when a baby is breathing in.
• Grunting: a sound made by babies when breathing out. It may be a sign that the baby is having difficulty getting enough air.
• Stridor: a high-pitched wheezing or crowing sound when breathing in, which may be a sign of blockage of the upper airway, often due to swelling or mucus in the voice box (larynx) or windpipe (trachea).
• Coughing: coughing or choking especially after feeding. This may be a sign that the baby is having a hard time coordinating breathing and swallowing.

Stomach

At birth, your baby’s stomach is very small, and they only need a small amount of milk in the first few days. As they grow, their stomach will be able to take in larger amounts of milk.

Many new parents worry whether their baby is getting enough milk. While you can't measure how much a baby takes if they are breastfeeding, you can watch out for some reliable signs that your baby is getting enough.

Regular feeds

Every baby is different, but most babies need between 8 and 12 feeds every 24 hours in their first few weeks.

Weight gain

Your baby’s weight and growth are good indicators of their overall health and nutrition. Your baby's weight is measured regularly at their health checks using a special baby scale. All babies lose some weight in the week after birth. They usually regain this weight by 2 weeks. Most babies double their birth weight by about 4 months.

Normal poos and wees

Some babies fill their nappies (wee or poo) at or around every feed. Some, especially breastfed babies, can go for several days or even up to a week without a bowel movement (poo). Both are normal, and not generally a reason for concern.

Your baby’s wee should be light to dark yellow in colour.

During their first 6 weeks of life, both breast-fed and formula-fed babies will generally have poo that is either yellow or green. Breast-fed babies tend to have softer, runnier poo while formula-fed baby poo is a little bit firmer.

From day to day, week to week, your baby's poos will probably vary. If you notice a significant change of any kind in your baby's wee or poo, you should talk to your doctor or child health nurse.

Vomiting

Some babies bring up milk between feeds. This is known as ‘posseting’ or ‘spitting up” — it is normal and not usually a cause for concern. Vomiting often, or vomiting that seems forceful or distressing for your baby, is not normal and you should seek medical advice.

Umbilical cord care

After your baby is born, the umbilical cord is clamped and cut, leaving the umbilical stump. The stump will fall off naturally in 1 or 2 weeks. Taking care of your newborn baby’s umbilical stump helps prevent infection. Good hygiene is the best way to encourage healing — see your doctor or child health nurse if your baby’s umbilical area (‘belly button') becomes infected.

Hips

Many babies are born with hips that feel loose when moved around. This is called newborn hip laxity. It happens because the bands of tissue that connect one bone to another, called ligaments, are extra stretchy. Neonatal hip laxity usually gets better on its own over time.

Hip dysplasia (developmental dysplasia of the hip or DDH) is a more serious condition when your baby’s hip doesn’t develop normally. It needs specialist medical attention.

Feet

Babies' feet continue to grow and develop into early childhood. Their feet should appear in a normal position (not turning to much inward, outward, upward or down). They develop important muscles by kicking and wriggling. This means that their feet need to be free and active. Make sure that their foot movements aren't held back by bedding, socks or booties that are too tight.

It's important to care for your child's feet so that they stay healthy as your child grows. There is a lot you can do to help keep your baby's feet in good condition.

Resources and support

If you have any concerns about your baby, speak to your doctor, midwife or child health nurse.