During the first weeks after birth, newborns may have certain physical conditions that could cause concern to parents. As part of the Your Newborn’s First Day Series, this health watch article will highlight and explain the basic concepts behind situations that generally occur during the newborn period. Also, it will offer you advice on when it would be appropriate to consult your pediatrician. If you are ever doubtful about your baby’s appearance or behavior, do not hesitate to call your doctor so they can reassure you everything is going well.


Abdominal Distension

It is usual for your baby’s belly to stick out, especially if they just had a large feeding. However, between meals, their belly should feel soft.  Consult the pediatrician if: your baby’s belly appears swollen and stiff and your baby is vomiting or had their last bowel movement more than one to two days ago. While these problems are generally caused by excessive gas or constipation, it is important to rule out more serious intestinal problems.  


Blue Baby

It is usually normal for babies’ hands and feet to appear mildly blue or purple-ish. If this is a reaction to cold, their hands and feet should turn back to their usual color as soon as the baby is in a warmer environment. You might notice that, at times, your newborn’s face, tongue, and lips will turn a little blue when they are crying intensively. Once your baby ceases crying, their skin tone should go back to normal. Consult your pediatrician if: you notice your baby has persistent blue skin coloring. This is a medical emergency, and immediate assistance is required. It is an alarm sign that the baby’s heart or lungs are not correctly functioning, and they might not be getting enough oxygen.



During your baby’s initial feedings, they may cough and spit, especially if they drink too fast. It could also be related to how quickly or strongly the breast milk comes down the mother’s breast. Once your baby gets used to feedings, the cough should cease. Consult your pediatrician if: your baby persistently gags or coughs during feedings since these could be signing more important lung or digestive tract issues.



All newborns cry. Sometimes, it may appear like they are doing it for no apparent reason. After you have made sure to feed and burp your baby, if you have kept them warm and with a clean, dry diaper, then the last thing to do would be to comfort them in your arms, talk or sing until they stop crying. You must know you cannot spoil a newborn by giving them too much attention. Another approach would be to wrap your baby comfortably in a blanket. Consult your pediatrician if: after you have become used to your baby’s pattern of crying, you notice something strange or unusual. For instance, if the sound is distinctive or if it persists for longer than expected.


Lethargy and Sleepiness

Your baby will spend most of their first days and weeks sleeping. This is completely healthy as long as they wake up every few hours to eat well, and if they seem happy and appear alert for a couple of moments every day. Consult your pediatrician if: your baby is rarely alert, does not wake up asking to be fed, seems to be too tired, or is not showing interest in eating. You should pay even more attention to these situations if they arise as sudden changes in your newborn’s behavior. 


Respiratory Distress

It takes a couple of hours after birth for a baby to regularize its breathing patterns. After that time, they should not show any difficulties in breathing. If you notice your baby has an unusual breathing pattern, it could probably be due to nasal passages’ blockage. An over-the-counter solution for this would be applying some saline drops followed by suctioning the mucus with the help of a bulb syringe. Consult your pediatrician immediately if your baby shows any of the following:

  • Fast breathing (more than 60 breaths in one minute)
  • Retractions – when the muscle between the ribs are sucked inward when the baby breathes so that their ribs stick out 
  • Persistent blue skin coloring
  • Nasal flaring
  • Grunting while breathing


Umbilical Cord

Your baby’s umbilical cord stump should dry and eventually fall off around the third week after birth. You should keep it clean and dry during this process. It is not necessary to use alcohol; a quick submersion bath is enough. Another precaution is holding the baby’s diaper folded below the cord to prevent urine from soaking it. It is normal to see a couple of drops of blood around the stump when the stump falls off. You should contact your doctor immediately if you notice any of the following:

  • Foul-smelling yellow discharge from the cord
  • Red skin around the base of the cord
  • Crying when you touch the cord or the areas right next to it
  • Actively bleeding from the cord
  • The cord persists and does not fall off after three weeks


Estefanía Henríquez Luthje, MD

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