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Skin characteristics in newborns

Definition

The appearance and texture of a newborn infant's skin goes through many changes.

See also: Changes in newborn at birth

Alternative Names

Newborn skin characteristics; Infant skin characteristics

Information

A healthy newborn at birth typically has:

• Deep red or purple skin and bluish hands and feet. The skin darkens before the infant takes his or her first breath (when they make that first vigorous cry).
• A thick, waxy substance called vernix covering the skin. This substance protects the fetus's skin from the amniotic fluid in the womb. Vernix should wash off during the baby's first bath.
• Fine, soft hair (lanugo) that may cover the scalp, forehead, cheeks, shoulders, and back. This is more common when an infant is born before the due date. The hair should disappear within the first few weeks of the baby's life.

Newborn skin will vary, depending on the length of the pregnancy. Premature infants have thin, transparent skin. The skin of a full-term infant is thicker.

By the baby's 2nd or 3rd day, the skin lightens somewhat and may become dry and flaky. The skin still tends to turn red when the infant cries. The lips, hands, and feet may turn bluish or spotted (mottled) when the baby is cold.

Other changes may include:

• Milia are tiny, pearly-white, firm raised bumps on the face. They disappear on their own.
• Mild acne that usually clears in a few weeks. This is caused by some of the mother's hormones that remain in the baby's blood.
• Erythema toxicum is a common, harmless rash that looks like little pustules on a red base. It tends to appear on the face, trunk, legs, and arms about 1 - 3 days after delivery and disappears by 1 week.

Colored birthmarks or skin markings may include:

• Congenital nevi are moles (darkly pigmented skin markings) that may be present at birth. They range in size from as small as a pea to large enough to cover an entire arm or leg, or a large portion of the back or trunk. Larger nevi carry a greater risk of becoming skin cancer. The health care provider should follow all nevi.
• Mongolian spots are blue-gray or brown spots. They can emerge on the skin of the buttocks or back, mainly in dark-skinned babies. They should fade within a year.
• Café-au-lait spots are light tan, the color of coffee with milk. They often appear at birth, or may develop within the first few years. Children who have many of these spots, or large spots, may be more likely to have a condition called neurofibromatosis.

Red birthmarks may include:

• Port-wine stains are growths that contain blood vessels (vascular growths). They are red to purplish in color. They are frequently seen on the face, but may occur on any area of the body.
• Hemangiomas are a collection of capillaries (small blood vessels) that may appear at birth or a few months later.
• Stork bites are small red patches on the baby's forehead, eyelids, back of the neck, or upper lip. They are caused by stretching of the blood vessels. They usually go away within 18 months.

References

Olsson J. The newborn. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 7.

Haslam RHA. Neurocutaneous syndromes. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 596.