Newborn Care – Head and Neck

Skull Bones and Soft Spots (Fontanelle)

The bones of your newborn’s head are not completely grown or fused at birth. This is normal and allows your baby’s brain to rapidly grow, but it may seem scary for there to be soft areas of your baby’s head. These areas will slowly harden over time and the bones will fuse together.

There will be two soft spots, one toward the front of your baby’s head and one at the back. While these are completely normal, be sure to be extra careful to protect these areas of your child’s head.

These areas may seem to be sunken in, which can be a sign of dehydration. Be sure to give your newborn adequate feedings, but this may still occur, even without dehydration. If you are still worried, contact your pediatrician.

These areas may look like they are pulsating. This is normal, and is simply the blood flowing through these areas with the heart beating.

Skull molding (“cone head”)

Skull molding is a temporary condition where a newborn’s skull is misformed, usually due to passing through the birth canal during the birthing process. The bones of the skull are not fully fused at this point, so they can shift. This can also occur if you lay your baby down with the head turned to the same side every time, so it is important to change the side your baby’s head is laying on when they sleep.

Symptoms

  • Misshapen head
  • Can cause the skull to look like a cone or flat

Treatment

  • Continue to lay your newborn on their back to sleep, but alternate what side their head is lying on.

Skull molding usually goes away in a few days, but if molding does not go away with alternating head position while sleeping, persists after 6 months, or is severely misshapen, a molded helmet may be prescribed by your pediatrician to relieve pressure on the flattened areas.

Caput Succedaneum

Caput Succedaneum is a relatively common swelling on the head of a newborn, not filled with blood like in a Cephalohematoma. The bruise is usually benign, as the swelling is located within the skin.

Symptoms

  • Raised area commonly found at the top of the head
  • Soft to the touch

Treatment

  • Usually resolves on its own within a few days
  • No treatment is usually required

Caput Succedaneum is more common than a Cephalohematoma. Both are normally not serious conditions and usually resolve on their own without treatment. Your doctor can differentiate between the two conditions.

Plagiocephaly (Flat Head)

Plagiocephaly is a condition where one side or back of a baby’s head is flat. This condition occurs when a baby sleeps on the same part of the head in the first few months of life. This can also occur from your newborn spending long periods of time sleeping in car seats, strollers, and carriers.

Signs & Symptoms

  • One side of the head appears flat compared to the other
  • Back of head appears flat instead of rounded
  • Less hair on the flattened portion
  • Ear may appear shifted on the flattened side

Treatment

  • Vary what side your baby’s head lays on when they sleep.
    • Always have your baby sleep on their back
  • Practice “tummy time” while your baby is awake.
  • Limit the time you allow your baby to spend lying on their back or with their head resting against a flat surface.
  • In some circumstances, your doctor may prescribe a special helmet to help fix the flattened areas.

In many cases, a flattened head is caused by tight neck muscles, a condition known as torticollis.

Torticollis (stiff neck)

Torticollis is a condition where your baby’s neck muscles are tight, causing difficulty or pain when turning the head to one side. This condition can lead to other issues, such as a flattened head (Plagiocephaly).

Signs & Symptoms

  • Head tilted to one side
  • Favor turning head to one side over the other
    • Often will not turn to other side due to pain or inability due to the stiff muscle
  • Difficulty breastfeeding on one side

Treatment

Enlarged lymph nodes

Lymph nodes are parts of our immune system that help fight infections. Enlarged lymph nodes may be signs of an infection being present or may occur over time with recurrent infections. Lymph nodes can be found throughout the body, with common enlarged lymph nodes being in the neck, the tonsils at the back of the throat, and the adenoids at the back of the nasal cavity.

Signs & Symptoms

While most parents may not be able to tell if their baby has enlarged lymph nodes, your baby’s doctor will check by palpating these regions or viewing them (tonsils). Symptoms with enlarged lymph nodes would be associated with infection, such as fever, fatigue, and decreased feeding. If your baby’s tonsils or adenoids are enlarged, they may also have difficulty breathing or sleeping.

Treatment

Depending on what lymph nodes are swollen, different treatments may be recommended. Because most enlarged lymph nodes are caused by an infection, antibiotics may be given to fight the infection. If the swollen lymph nodes are from a different source, your doctor may recommend a different treatment or to see a specialist. In the case of some lymph nodes interfering with breathing or sleep (tonsils & adenoids), surgical removal may be suggested.

Mouth breathing

Newborns are obligate nose-breathers, meaning they normally only breathe through their nose. A newborn will normally only breathe through their mouth while crying. Mouth breathing in newborns is a sign there may be some obstruction in the upper airway and should be investigated by your doctor.

Possible causes

There are several common causes of mouth breathing in newborns:

  • One or both nostrils are blocked with mucus (boogies)
  • One or both nostrils are blocked by soft tissue or bone (choanal atresia)
  • Enlarged adenoids and/or tonsils

Concerns and possible treatments

Mouth breathing in newborns is not normal and you should contact your doctor if it does not seem to be caused by boogies. Depending on the underlying reason for increased mouth breathing, several treatment plans may occur, with surgery to correct structural blockages in the nose or upper airway.

If your baby appears to have severe difficulty breathing or their lips and skin begin to turn blue, contact your doctor or call 911 immediately.

Sleep apnea

Sleep apnea is a period where an individual stops breathing due to something obstructing their airway. In newborns, the cause of this condition is usually enlarged tonsils or adenoids. If you believe your baby has sleep apnea, you should call your pediatrician and let them know. They may suggest a specialist or a sleep study to monitor your baby.

Signs & Symptoms

While many adults can also have sleep apnea, newborns with sleep apnea usually have different causes and affect babies differently than adults.

Signs during sleep

  • Snoring
  • Pauses in breathing (rarely lasts longer than 20 seconds)
  • Restless sleep
  • Snorting, coughing, or choking while sleeping
  • Mouth breathing
  • Low oxygen level (blue lips or skin)
  • Slow heartbeat (bradycardia)

If your baby stops breathing for an extended period of time or begins turning blue, try to wake them. If you cannot wake them, call 911 immediately and check for a pulse if possible.

Signs of sleeping issues while awake

  • Decreased energy
  • Increased napping (signs also present during naps)
  • Slow growth

Treatment

Your doctor will most likely refer you to a specialist for further testing to determine the cause of sleep apnea in your baby. The most common causes of sleep apnea in babies are enlarged tonsils and/or adenoids. Many newborns will outgrow sleep apnea, but in some cases, surgically removing them may be recommended. If a different cause is found, the doctor will recommend other treatments accordingly.

https://momlovesbest.com/baby-breathing-monitors (maybe add info on breathing monitors?)

Enlarged adenoids

The adenoids are small lumps of tissue that are part of our immune system. They are similar to the tonsils and help our bodies fight infection. They are not visible by looking inside the mouth like the tonsils are. If the adenoids are enlarged, they may affect your baby’s ability to breathe through their nose, leading to increased mouth breathing and increased risk of sleep apnea.

Signs & Symptoms

  • Mouth breathing
  • Difficulty sleeping
  • Snoring
  • Sleep apnea
  • Recurrent ear and/or sinus infections

TreatmentMost babies will outgrow enlarged adenoids, so treatment is not usually required. Your doctor may recommend seeing a specialist if they are concerned. The specialist can quickly diagnose enlarged adenoids using a telescopic device or x-ray. For enlarged adenoids not related to infection, the most common intervention is to surgically remove the adenoids.

Enlarged tonsils

Tonsils are small lumps of tissue found on either side of the back of the throat. They are part of the immune system and help your baby fight off infection. These can be enlarged due to infection, which in turn may cause your baby to have problems with sleeping, breathing, and eating.

Signs & Symptoms

  • Difficulty sleeping
  • Snoring
  • Sleep apnea
  • Recurrent ear and/or sinus infections
  • Decreased feeding

Treatment

Most babies will outgrow having enlarged tonsils, so treatment is not usually required. Your doctor may recommend seeing a specialist for further testing if they have concerns. The most common treatment for enlarged tonsils not caused by an infection is surgically removing them.