00:01
Now, let's move on
to our general survey.
00:04
So just as our general survey
works in our adults,
we're going to just
take a look at the baby.
00:09
We're going to look
at every part of their skin
and just see what they look like.
00:13
One of the first things you
will notice is the baby's color.
00:17
So often when a baby's first born,
their central area will be
pink or normal color.
00:24
But you'll notice that they
may have blue hands and feet.
00:27
We call that acrocyanosis.
00:30
And acro meaning
edges or extremities,
and cyanosis, meaning blue,
so not well oxygenated.
00:37
And so this is a normal response
because in utero,
well, we don't need oxygen
going to hands and feet,
we're not going to waste that.
00:45
So when we're born,
it takes a while
for all that oxygen to get out
to our hands and feet.
00:49
It may take a few days.
00:51
And so you want to reassure
the parents
that this is a normal finding.
00:55
And they will not be Smurfs
for the rest of their life.
00:58
This is just temporary,
but it's called acrocyanosis.
01:02
Next, you want to look
at the baby's tone.
01:05
So we think about flexion.
01:06
And we talked about this
a little bit
when we discussed APGARs.
01:10
So is the baby lying sort
of like this baby is really
chilling like a villain
just everything is very loose.
01:16
Or does the baby look like this.
01:18
So you'll notice
with the term baby,
the arms are sort of
in a muscle position,
the legs are pulled up.
So this all refers to tone.
01:26
So do we have good tone?
Or do we have sort of
a flatted tone,
the way we would note
with a preterm baby
that would be expected for them.
01:36
The next thing we might notice is
something called vernix caseosa.
01:40
So if you look at this baby,
you'll notice there's this white
sort of cream cheese like substance
that's all over the baby.
01:47
And this actually comes from
sebaceous gland secretions.
01:51
And this is there
to protect the baby.
01:53
To think about maybe
when you've taken a bath
or been in the shower
a little bit too long.
01:58
And when you get out your fingertips
and your toes are all wrinkly.
02:02
Well, most babies
when they're born,
even though they're swimming
in water for months, and months,
they're not all wrinkly
on their fingers.
02:09
And that's because
they have vernix caseosa
all over them to protect the skin.
02:14
So it's sort of white,
and it's greasy.
02:18
And it's definitely protective.
02:20
And you'll find it mostly
in the creases.
02:23
So anywhere where the skin folds,
you'll find more vernix caseosa.
02:28
You do not need to remove it.
02:30
In fact, if we could collect this
and bottle it,
it would be the best
moisturizer ever.
02:36
But we don't do that.
02:37
Because I don't know,
that would just be weird.
02:39
But just to reminder,
you don't have to do
anything with it,
you can rub it in.
It's wonderful.
02:44
And the way I remember this
is it looks like a case of cheese.
02:48
So vernix case of cheese,
then you'll remember
this is what it looks like.
02:53
Now, let's talk about another
skin issue that you may see
that's completely normal.
And it's called lanugo.
02:59
So lanugo refers to that
baby fine hair.
03:02
So around 12 to 20 weeks,
you're gonna see a lot of lanugo.
03:06
So if you were able to transport
yourself inside the uterus,
you would see a baby covered
with all of this baby fur.
03:14
And this fur does
just what any fur does,
it helps to keep the baby warm.
03:19
So as the baby gets to
around 28 weeks, however,
we know that birth is
going to be coming sooner.
03:25
And so we may notice that some
of the fur begins to fall out.
03:29
So if you have a baby
that's born around 28 weeks,
they won't be completely
covered with fur,
they'll have spots that
are perhaps missing that.
03:37
Once the baby gets to term, there's
going to be lots less lanugo
or if you have a baby
that's post term,
there may not be any lanugo at all.
03:46
So remember, lanugo refers
to that baby fine hair
that's there to keep
the baby warm.
03:52
You may find it on the tops
of the ears and on the back,
sometimes even on the face.
03:57
But assure the parents that this
will all fall out eventually
and they won't have a baby
with a hairy face.
04:04
That's not what's going to happen.
04:07
Now, let's talk about some
other sort of skin changes
that you may notice with a newborn.
04:11
The first one we'll talk about
is erythema toxicum
also known as the newborn rash.
04:18
So it looks like the baby has acne.
04:21
But babies don't have acne.
So that's not what it is.
04:24
So this results from eosinophils
that are reacting
to the environment.
04:28
So before the baby's born, they're
in a wonderful protective sac.
04:32
They don't have all of these
pollutants and things in the air,
but the minute they're
exposed to the air,
their skin goes,
"Ah! What is this?"
And we get erythema toxicum.
04:42
Now, this is going to be
common on the face,
maybe on the trunk,
maybe on the legs.
04:46
But you can reassure the parents
that this is benign
meaning it's not a problem
that it happens.
04:53
It may look kind of strange,
but it is really okay
and as the baby adjust
to the external environment,
this will go away.
05:00
The next skin condition are
telangiectatic nevi,
also known as stork bites,
which is much easier to say.
05:08
But telangiectatic nevi
are caused by a collection of
immature red blood vessels.
05:14
And it's really important that you
let the parents know about this
because whenever the baby
gets upset, or the baby cries,
they may notice these
reddened areas.
05:23
And it may happen
on the back of the neck
where a stork,
"would bite the baby",
or they may notice it
on the eyelids,
or maybe on the lips.
05:32
So letting the parents know
is really helpful
in terms of anticipatory guidance.
05:37
This will disappear at about
one year of age.
05:41
Next, I want to talk to you
about melanocytosis.
05:45
Now, back in the old days, this
used to be called Mongolian spots.
05:49
But we recognize that that is not
a correct term. It's not inclusive.
05:53
And so the term that is correct,
the term you should use now
is melanocytosis.
05:59
And this refers to this
sort of darkened area
that you might notice
over the buttocks or over the legs.
06:04
Now, what's interesting
about melanocytosis
is that if you were to blanch it,
meaning you touch the skin
and sort of remove the blood flow
for just a second,
it will blanch
just like regular skin.
06:16
Because if you look closely,
this looks awfully like a bruise.
06:20
And so you might wonder,
how would you tell the difference?
Well, bruises don't blanch.
06:25
Melanocytosis does.
06:28
And why do you want to know
the difference?
Because if I saw a baby that came
into the emergency department
with something that
looked like this,
I might suspect child abuse or
some sort of trauma or accident.
06:39
So it's very important that if the
nurse notes this on an assessment
that this is charted,
because there have been
cases of parents
that are pursued by
child protective services
because of abuse,
because this has not been recorded.
06:51
So melanocytosis blanches,
bruises do not.
06:56
The next one I want to talk about
is Strawberry hemangiomas.
07:00
So it looks like a strawberry
which is why it's called that.
07:03
These will disappear
usually by the age of two or three,
but may go all the way
up to the age of 10.
07:10
So they're not permanent
but they will be noticeable.
07:12
And they can occur
anywhere on the body
but usually around
the trunk section.
07:17
And the final skin condition we'll
talk about is the Port Wine Stain.
07:21
So one of the major differences
between
the Port Wine Stain and
a strawberry hemangioma
is the fact that the
strawberry hemangioma
is going to go away.
07:29
The Port Wine Stain however,
will not.
07:31
So this baby will have
this particular mark
for the entirety of their life.
07:36
The other thing you may notice
with a port wine stain
is that it's flat
and the strawberry hemangioma
is usually raised.
07:42
So you'll see that sort of three
dimensional characteristic there
of the hemangioma.