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Ankyloglossia 4% of newborns. Many babies with this condition can breastfeed

without difficulty. In more severe cases, can prevent tongue

protrusion and/or cause a V-shaped fissure in the tip of the tongue, especially with crying.

A frenotomy may be indicated when a tight frenulum makes latching on difficult.

Outcome of speech in infants identified at birth is controversial.

Common Chest Findings

Supernumerary Nipple (Polythelia)

Found along the mammary line.

They may be single or multiple, unilateral or bilateral.

It is an insignificant finding.

Breast Hypertrophy

Due to effects of maternal estrogen.

Lasts < 1 week.

No clinical concern.

White discharge referred to as “witch’s milk” may be present.

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Skin Tag

The nipple area is a common location for small skin tags.

They are typically very small.

Do not need to be removed.

Case 6

You are seeing a patient for the first time at his 2 week well child visit. The mother asks you if the bulge coming from his chest is normal…

Prominent Xiphoid

Does not represent an abnormality.

Frequently observed finding in newborns.

With time, this becomes less noticeable.

Common Abdominal Findings

Wharton’s Jelly Cyst

Also known as a “false cyst” of the cord.

It is a fluid-filled sac that can be related to a swelling of the Wharton's jelly.

Up to 20% of infants with this condition have associated anomalies.

Case 6

The mother of a newborn is concerned about a bulge in the baby’s abdomen every time he cries or has a bowel movement. What should you tell her?

Diastasis Recti

Vertical bulge down the midline of the abdomen.

Seen in many newborns when intra-abdominal pressure increases.

Caused by a relative weakness of the fascia between the two rectus abdominus muscles.

Disappears with time.

Umbilical Hernia Due to incomplete closure of the fascia of the

umbilical ring.

More common in African Americans and LBW infants.

Usually close spontaneously by age 3 (most common by age 1).

Surgical correction needed if incarceration occurs or if hernia very large and persists past age 3.

Are the following abnormal?

Case 7

As you are examining a newborn at his 2 week well child check, you notice drainage coming from the umbilicus. The umbilical stump fell off several minutes prior to your exam. What do you tell the mother?

A spot of blood or a slight amount of moist, yellow material is normal after cord separation.

Any bleeding or discharge that persists should be evaluated.

Common GU Findings

Penile Pearl

“Pearls” may be found in different locations in the newborn.

Also known as Epstein pearls in the mouth.

The tip of the foreskin is common location. Small, firm, white nodule that contains

keratin. Spontaneous exfoliation and resolution. Not a contraindication for circumcision.

Hydrocele

Fluid filled sac in the tunica vaginalis of the testis or along the spermatic cord.

Resolve spontaneously.

Normal Female Genitalia

White vaginal discharge as well as bloody discharge is normal in the newborn period.

Due to maternal androgens. Also seen is vermix along the

interior surface of the labia majora. No special cleaning is needed.

Common Extremity Findings

Sucking Blister

Blister created by the infant sucking on his extremity while in utero.

Solitary lesion that occur only in areas accessible to the infant’s mouth.

Resolve spontaneously.

Postaxial Polydactyly Next to 5th digit of hand or toe. The most common variety. The extra digit may seem almost fully formed or may be

attached only by a thin fleshy stalk. Typically an isolated finding. Common as a dominant trait in individuals of African

descent. Managed by tying off with silk suture or transection of

small skin tag. If involving bone, soft tissues, and tendons, referral to a

hand surgeon is necessary.

Preaxial Polydactyly

Next to 1st digit of hand or foot. Less common. Likely to be related to an underlying

medical condition. Surgical correction is generally

delayed for several months to lessen the risk of general anesthesia.

Clinodactyly

Slight medial incurvation of the fifth digit is a normal newborn finding.

Often inherited as a familial trait.

The absence of other physical findings confirms that it is benign and isolated.

Positional Deformity (Positional Calcaneovalgus) of the Foot

Due to in utero positioning. Common foot deformity, especially in first-

born. Hyperdorsiflexion of the foot with the

abduction of the forefoot. The foot can easily be brought back to a

neutral position. Resolves spontaneously, if not casting is

indicated. PT that involves stretching and range of motion

exercises can help speed progress.

Metatarsus Adductus Most common congenital foot deformity. Medial deviation (adduction) of the

forefoot while hindfoot in normal position. Forms a “C” shape. More common in first-born. Most common cause of in-toeing in infant. 90% of cases resolve without intervention. Tx: casting by 8 mo of age.

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Talipes Equinovarus (Clubfoot)

Bony deformity. Characterized by the foot being excessively plantar

flexed, with the forefoot swung medially and the sole facing inward.

Orthopedic referral. Positional clubfoot is due to intrauterine crowding or

breech position. - Not a true club foot. - Normal foot that has been held in a deformed position in utero.- Easily corrects to a normal position with manipulation.

Breech Position

The legs have a tendency to remain in breech position for several days.

Spontaneous resolution. High risk for developmental

dysplasia of the hip (DDH).

Lumbo-Sacral Hair

Present in many newborns, especially those with increased skin pigmentation.

Entirely normal.

Not a marker for underlying spinal dysraphism.

Sacral Dimple Common finding.

Most are "simple dimples" and require no further evaluation. - Located within 2.5 cm of the anus- Has a base that can be visualized- Not associated with other abnormalities on exam:

hemangiomas, upraised lesions (i.e., masses, tails, and hairy patches), multiple cutaneous lesions.

If the base can’t be seen = coccygeal pits (benign, no imaging needed).

Sacral Skin Tag

Potential indicator of spinal dysraphism.

In some cases, the skin tag may be a residual tail.

Ultrasound recommended.