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Chapter 1: Your Baby’s Head

Q: Our baby’s soft spot on the top of her head sometimes bulges out. Should we worry?

A: It’s not unusual for a baby’s soft spots to bulge when he or she is lying down, crying, or vomiting; but when the baby is picked up and calmed down, the bulging should disappear. If your baby has a soft spot that always bulges, it may be a warning sign of several serious conditions. For example, a bulging soft spot can signal an excess intake of vitamin A. Other signs of vitamin A excess may include drowsiness and vomiting.

A bulging fontanelle can also be a warning sign of increased pressure in the baby’s brain from infections such as meningitis, encephalitis, or even Lyme disease. Or it may signal an endocrine, metabolic, or cardiovascular disorder; a brain tumor; or hydrocephalus, which is more commonly called “water on the brain”. Although a baby with these conditions is likely to have other more serious signs, it’s still important to report a bulging soft spot to your baby’s doctor as soon as possible.

An infant’s soft spots (fontanelles)
should feel firm and very slightly
curved inward. When a baby is at
rest, you may feel a noticeable
pulsation when touching the soft
spot on top of his or her head.

Chapter 2: Your Baby’s Hair and Scalp
Q: Our 3- month- old has a hunk of hair missing. What could have caused this and will her hair eventually grow?

A: Hair that’s missing from the back or side of a baby’s head may be a telltale sign of friction or pressure alopecia. This is a benign condition in which hair falls out because of repeated rubbing against objects such as a playpen mattress or car seat padding. And when babies are put in one position for prolonged periods, it can place pressure on their heads, leading to a paucity of hair. Indeed, if your daughter’s hair is missing from the back of her head, it can be a healthy sign that she’s sleeping in the safest position for most babies— on her back. The back of her head may also look a bit flattened. Babies and toddlers who are head bangers can also end up with these types of bald spots. In cases of friction- and pressure- related bald patches, when the rubbing, pressure, or banging stops, the hair will usually grow back.

While it’s perfectly normal for
babies to lose their first hair
shortly after birth, hair loss
after they turn about 6 months
of age is not. Be sure to bring
it to the attention of your baby’s


Chapter 3: Your Baby’s Eyes
Q: One of my daughter’s pupils is bigger than the other. Why is that and should I be concerned?

A: Having different- sized pupils, medically known as anisocoria, is an often benign, surprisingly common inherited trait. In fact, 1 in 5 people have one pupil that’s smaller than the other, and most are born that way. When mismatched pupils are present at birth, they are usually nothing to worry about, especially if there are no other unusual signs. Anisocoria can also occur anytime after birth, usually as the result of an eye infection or injury. In these cases, the child should be carefully evaluated for other problems.

Different- sized pupils along with two different- colored eyes and/or a droopy eyelid may be a sign of congenital Horner’s syndrome, which is usually a benign condition. But Horner’s can also develop at any age, usually as a result of an injury to the neck, eye, facial nerves, spinal cord, or brain.

Children should be tested for color
blindness as early as possible. Since
many toys and preschool activities
are color dependent, teachers should
be alerted if a child is color- blind.
Otherwise they may mistakenly think
that the child has a language or other
problem. Early detection is also important
for safety. A child who is color- blind may
not be able to tell the difference between
red and green traffic lights..

Chapter 4: Your Baby’s Ears
Q: Our baby was a preemie. We’re thankful he’s very healthy, but I’ve heard that premature babies often have hearing problems. Should we worry?

A: Babies who are born prematurely, as well as low- birth- weight babies (less than 3½ pounds), are indeed at increased risk for having a hearing problem. In fact, any baby—whether full- term or premature—who was in neonatal intensive care, had a respiratory problem that required breathing machines, or had a blood transfusion is at increased risk of developing hearing problems.

In a test of more than 200 noise-
producing toys, only 10 fell within
acceptable noise levels set by the
U.S. Occupational Safety and Health
Administration. All the others could
place children at risk for hearing

Chapter 5: Your Baby’s Nose
Q: When our infant daughter breathes, her nostrils widen. Is this normal?

A: Nasal flaring is not only normal but actually necessary for newborns; it helps infants breathe when breast- feeding. However, when a baby is not nursing and his or her nostrils persistently flare, it can signal a breathing problem. This can result from any number of conditions, including nasal or airway obstruction, asthma, croup, or pneumonia.

• At birth, a baby’s sense of
smell is about 10,000 time
more accurate than his or her
sense of taste.
• Newborns can even recognize
their mothers by their odor.


Chapter 6: Your Baby’s Mouth
Q: I can hear my toddler grinding his teeth at night. I know that adults often do this when they’re tense. Why would a child do this?

A: Some children do indeed grind their teeth, medically called bruxism. One in every 3 children will grind their teeth at some point during childhood. In some children, it can be a warning sign of a misalignment of the top and bottom teeth, which can cause children to move their teeth back
and forth. Teeth grinding may also signal an imbalance in ear pressure, in which case the jaw movement may help relieve the discomfort. And as with adults, bruxism in children can be a sign of tension, anger, or fear.

Most children, like adults, grind their teeth when they are sleeping at night, a time when it can be very grating on their parents’ ears. In fact, the grinding can be so intense that parents have said they can hear the noise from another room. Bruxism is more common in children who have other nighttime and sleep problems, called parasomnias, such as bed- wetting, muscle cramps, and sleep talking. Regardless of the cause, teeth guards are sometimes recommended to help cut down the grinding. Guards are particularly good at preventing permanent damage to permanent teeth.

“Adam and Eve had many
advantages, but the principal
one was that they escaped
—Mark Twain, Pudd’nhead
Wilson, 1894


Chapter 7: Your Baby’s Torso and Limbs
Q: Our adopted daughter just started walking. Her feet turn inward and she trips a lot. Should we be concerned?

A: Toddlers often walk with their feet turned inward— medically called intoeing (aka pigeon toes). In most cases, this is the normal result of having spent 9 months in the fetal position. Whether present at birth or developed later, intoeing is typically a painless, benign condition. However, it may cause children like your daughter to have an increased tendency to trip and fall. The good news is that most children with this condition will soon learn to walk without tripping and will totally outgrow intoeing in a few years. Most pigeon- toed children don’t need any treatment because their feet will ultimately straighten out. In rare cases, however, intoeing may affect one foot more than the other, or the condition may worsen. If either of these things happens, further medical evaluation is needed. Physical therapy or other treatment may be necessary, but surgery is rarely required.

In parts of Europe and the United
States, during the 18th century,
swaddled babies were often hung
from hooks on household walls or
from trees in the field while their
busy mothers or caregivers were
working. This problematic practice
purportedly kept the infants safe
from household hazards and wild

Chapter 8: Your Baby’s Skin
Q: The skin around our 18- month- old son’s groin is red and peeling. We thought it was diaper rash, but now it’s around his neck. Could it be something else?

A: Distinguishing between the many common rashes that show up on babies can be difficult (particularly those that appear on the baby’s bottom). A rash in the skin folds—such as the
groin, neck, or underarms, and even between the toes and fingers—may be a condition called intertrigo. It’s a type of skin inflammation (dermatitis) that occurs when skin chafes against skin, particularly when the skin is hot and sweaty. Other signs that a rash may be intertrigo are if it’s a
burnt- red color and it looks the same on both sides of a skin crease. Chubby babies are more likely to get this skin condition because their extra rolls of skin are ideal breeding grounds for bacteria.

Because a baby’s skin is very delicate, intertrigo, like other types of diaper rash, can cause it to become red and irritated. As a result, babies with this condition are very prone to developing yeast, bacterial, or (in rare cases) viral infections. If there’s no infection, simple measures such as keeping the skin clean and dry should help.

Just one blistering sunburn in child-
hood doubles the risk of the deadliest
skin cancer, melanoma, later in life.
To reduce the risk of skin cancer,
all babies and toddlers should avoid
exposure to direct sunlight. This is
especially important for those with
moles and/or fair skin.

Chapter 9: Your Baby’s Genitals
Q: While babysitting for our 6- month- old grandson, my husband and I noticed that his scrotum was very large. It doesn’t seem to bother him— or our daughter, who says it’s nothing to worry about. What could be causing this swelling? Should we be worried?

A: A swollen scrotum may be a sign of a hydrocele, which forms when the fluid- filled sac that surrounds the testes during their normal descent from the abdomen into the scrotum doesn’t drain properly or when fluid builds up in the scrotum. Many boys—although how many is unclear—are born with hydroceles. In some babies, this condition may not be noticed for several months. In general, hydroceles, which can affect one or both testicles, are benign and painless. Many doctors describe the scrotum of a baby with a hydrocele as having the feel of a “water balloon.” Other signs may include a scrotum that fluctuates in size or one that has a bluish tint.

Most hydroceles disappear on their own before the baby’s first birthday. But if a hydrocele causes discomfort or disfigurement, or is so large that it’s in danger of impairing the blood supply to the testicle, it may need to be surgically repaired.

In 17th- and 18th- century Europe,
not only were babies rarely bathed,
but their urine-soaked clothes were
rarely changed. When they were, they
were dried unwashed before a fire.
Urine was believed to be a disinfectant
that was especially useful for a baby’s


Chapter 10: Your Baby’s Body Wastes
Q: I heard that if a baby has greenpoop, it’s a sign of an infection. Is that true?

Green stools, like orange ones, may be a perfectly benign sign. Breast- fed babies often have greenish stools, as do babies who eat an abundance of green vegetables, which are naturally rich in chlorophyll (the green pigment found in plants). Lime- flavored gelatin and beverages can also turn a baby’s stools green. And green stools can be a telltale sign that a baby has been given iron supplements, certain antibiotics, or laxatives. When the stools come out quickly (as in diarrhea), they will often be green. Indeed, green stools can be a warning sign of a gastrointestinal infection. Once the infection is treated (either on its own or through medication),
the green color will likely clear up too.

A recent study in Germany found that
babies who are taken into chlorinated
public pools during the first year of life
are at increased risk for diarrhea. The
researchers believe that this is because
babies have immature lungs and immune
systems, making them vulnerable to pool