Newborn bodies: swollen breasts, genital care and the things that alarm parents

Caused by the mother's hormones

Swollen breasts, in boys and girls both. Maternal hormones cross the placenta before birth and cause breast tissue to enlarge in the first weeks. Sometimes a little milky fluid appears. It settles on its own over weeks to a couple of months.

Do not squeeze, massage or express it. This is done in many Indian households — sometimes by a maalishwali — and it is how newborns develop breast abscesses. Leave it entirely alone.

Vaginal discharge in newborn girls: a thick white or slightly bloody discharge in the first two weeks is caused by the same withdrawal of maternal hormones. A small amount of vaginal bleeding, like a tiny period, is normal in the first week or two.

Swollen labia or a swollen scrotum in the first days, from the same hormones and from fluid, and settling within weeks.

None of the above needs treatment. All of it needs to be left alone.

Get it checked if: the breast becomes red, hot or hard, or the baby has a fever; the bleeding is heavy or continues beyond about two weeks; or there is any discharge with a foul smell.

Cleaning, without doing harm

Girls: wipe front to back, every time. Clean only the outside — do not separate the labia and clean inside, which removes protective secretions and causes irritation. Plain water and cotton wool is enough in the newborn weeks.

Boys, uncircumcised: clean the outside of the penis only. Never retract the foreskin. It is naturally attached in infancy and separates on its own, usually somewhere between two and ten years and sometimes later. Forcible retraction causes tearing, scarring and infection, and is one of the more common avoidable injuries in this area.

Boys, circumcised: follow the specific instructions given at the time, keep it clean and dry, and watch for bleeding, swelling or difficulty passing urine.

Both: change nappies frequently, let the skin air, and use a barrier cream for redness. Skip powders — talc is an inhalation risk for a baby — and skip perfumed wipes in the early weeks.

Do not apply oil, kajal, surma or any traditional preparation to the genitals.

Wash your hands before and after, and keep the nappy area separate from the cord stump while that is healing.

The things that do need a doctor

Hypospadias: the opening of the urethra is not at the tip of the penis but on the underside. It is usually identified at the newborn check and needs paediatric surgical review. Importantly, a baby with hypospadias should not be circumcised before that review, because the foreskin tissue may be needed for repair.

Undescended testes: one or both testes not felt in the scrotum. Often noted at birth, and it needs follow-up because it does not always resolve and treatment has a time window.

A swelling in the groin or scrotum that comes and goes, gets larger with crying, or cannot be pushed back. A hydrocele is common and usually resolves; a hernia needs surgical assessment, and one that becomes hard, tender or discoloured is an emergency.

Not passing urine in the first 24 hours of life, a very weak or dribbling urine stream, or a baby who seems in pain passing urine.

Any ambiguity about the appearance of the genitals, which needs prompt specialist assessment rather than reassurance.

And in girls, labial fusion, or a vaginal opening that appears absent, which needs a paediatric review.

When to see a doctor

Go to hospital immediately for: a groin or scrotal swelling that is hard, tender, red or dark and will not reduce, especially with vomiting or a distressed baby; no urine passed in the first 24 hours; or any fever of 38C or above under three months. Call 108 or go to the nearest hospital immediately if your baby: is breathing fast, grunting, or drawing in beneath the ribs; has blue or grey lips, tongue or face; is floppy, unresponsive or very difficult to wake; has a fit; has a temperature of 38C or above at under three months; is not feeding at all; or has a rash that does not fade when pressed with a glass.

See a doctor the same day for: a red, hot or hard breast swelling, or fever with it; heavy or prolonged vaginal bleeding; foul-smelling discharge; a foreskin that has been retracted and is now stuck and swollen, which is a urological emergency; or blood in the urine.

Arrange review for: hypospadias, undescended testes, a persistent hydrocele, or any concern about how the genitals look. Do not proceed with circumcision until hypospadias has been excluded.

This article is general information, not medical advice, and has not been reviewed by a paediatrician. It is no substitute for personal medical advice.

Frequently asked questions

Q: My newborn girl is bleeding from the vagina. — A small amount in the first week or two is a normal hormone withdrawal effect. Heavy or prolonged bleeding needs a doctor.

Q: Should the swollen breast be pressed to release the milk? — Absolutely not. This causes infection and abscess. Leave it entirely alone.

Q: Should I pull back my son's foreskin to clean? — No, never. It separates on its own over years. Clean the outside only.

Q: Is a hydrocele serious? — Usually not; most resolve in the first year. A swelling that changes size, will not reduce, or becomes hard and tender needs urgent review.