No Need to Worry, Mom. It’s Normal.


One steady source of business in the emergency department comes from a group described as the “worried well.” Anxious new parents are frequent members of this tribe and come into the ED at all hours to point out perceived abnormalities or areas of concern in their little ones.



10 common neonatal concerns that have non-threatening explanations

One steady source of business in the emergency department comes from a group described as the “worried well.” Anxious new parents are frequent members of this tribe and come into the ED at all hours to point out perceived abnormalities or areas of concern in their little ones. To be fair, neonates can be more than a little mysterious, and even emergency physicians can pick up on odd physicial findings and begin to worry unnecessarily. To assist in your care of the “worried well,” here is a list of ten findings that can be normal in infants:

Cutis marmorata – this is the elegant Latin term for that lattice-like mottling that infants can get due to vasomotor instability. While mottling can be pathologic, it is seen in normal infants with cooling, starting in the newborn period and persisting for several months. If the baby looks well otherwise, warm them up and then come back and re-examine them. It should resolve.


Acrocyanosis – blue hands and feet, also due to vasomotor instability and also generally benign. It is usually seen when the baby gets cold and can be dramatic after they are pulled out of the bathtub. It may be seen in the first few months of life. If the baby has pink lips and tongue, it is not concerning and should disappear with warming.

Peri-oral cyanosis – the parent will come in and report that the baby turned blue around the mouth. You may even witness this yourself in the exam room. If the lips and tongue remain pink while the area around the mouth turns blue, this is fine. It is due to engorgement of a venous plexus around the mouth and is normal.

Harlequin color change – this one is dramatic. It is uncommon and is not due to disease in the heart or the vessels. The neonate appears to be divided down the middle into a pale half and a red half starting at the forehead and going to the pubis. It is due to vasomotor instability and is normal in the newborn period. Sometimes, if you lay them on the pale side, the color change will shift and the dependent side will get red and the other side will get pale.

Breast enlargement – this can occur on both male and female infants. It is due to stimulation from maternal estrogen in utero. It can persist for several months after birth. Sometimes, the breasts become engorged and drain a white liquid known as “witches milk”. This is not pathologic and will go away after 1-2 weeks.


Vaginal discharge – female infants can have a milky vaginal discharge in the first few weeks of life that can even be blood-tinged. This is from exposure to high levels of maternal estrogen prior to birth and is normal.

Hyperpigmented genitalia – this can occur in both male and female infants. It is also due to maternal estrogen effect and will fade during the first year of life.

Myoclonus – course trembling of the jaw, arms, and ankles can occur in the neonatal period, usually during a period when the infant is active. It does not persist. Twitching due to a convulsion is more likely to happen when the infant is in a resting state and may last longer.

Palpable liver – the liver edge is frequently felt in normal newborns. It can be normal up to 2 cm below the costal margin.

Palpable spleen – a spleen tip can also be felt occasionally in normal newborns.

Amy Levine, MD, is an associate professor of pediatric emergency medicine at UNC Chapel Hill.


  1. I know this is a very late comment, but parents SERIOUSLY bring neonates in for this stuff? I know we have parents with low literacy issues, who may be kids themselves, but every single Mom gets sent home with a fairly thick handout on normal neonatal “funny looking things”.

    I guess if some of them were listening to the teaching instead of texting the world during their (too short) inpatient stay, they might have picked up on some of this already. Where is Dr. Google when you really NEED him?

    • Really insensitive and ignorant remark. Grow some compassion! It’s also often better to be safe than sorry. And no im not interested in a reply.

    • Yes Pattie, because nurses know everything so every new parent also should. You are the prime example of why I have so little respect for nurses.

      • Whoa! I’m a nurse in a step down post surgical cardiac unit.. you have no idea what we go through or the knowledge we have. Though I agree pattit is being a douchebag, you need to stop with not respecting nurses. Nurses like Pattie who sign rn on a comment box is a poor example of the rest of us. BTW I just had my newborn and I had a horrible experience from my nurses.. does not make me disrespect the rest of my fellow nurses. It actually taught me how the importance of being a good nurse to my patients. I can’t believe you have little respect for nurses.. wake up and realize how hard and dedicated a real nurse is to the profession! I’m honestly shocked by your remark.

        • Excuse my grammatical errors above. As a new mom I’m running on low sleep. I’m just surprised someone would say that about a profession where most nurses put their heart and soul into a patient. Let me also add that some people aren’t ment to be nurses – if Pattie was my nurse im sure her attitude would play a huge role in her bedside manner.. and I wouldn’t want her taking care of me or a loved one. Clare I’m sorry you have had poor experiences with nurses in the past, but a passionate nurse deserves a sliver of respect. Before cardiac, I was in oncology – you don’t have a clue how much of our hearts go into our patients & their loved ones and that’s why I had to change departments – I was hurting from watching amazing ppl suffering and dying from cancer. Why do you think I’m on this site, I want reassured my baby is ok and I’m not blowing things out of proportion. I have my bsn.. but I specialize in the adult population.. not babies. I hope you can think differently of a future nurse – the one that is working a third 12 hr shift in a row – no time for lunch – the ones who get into their car and cry the whole way home after watching a patient last breath while holding their hand…

        • Thank you for being an amazing nurse. My father had a quadruple bypass a few months ago and my mother passed away years ago due to multiple myeloma. The nurses, the really great ones, they’re often what kept me going. Their love and resilience was inspiring. Thank you for all you do. Keep at it.

      • Nowadays you’re freaked out not to take them. If you don’t and something happens they’ll probably charge you with neglect and take your kids away!

        Better safe than sorry!!! That’s what the system is there for!

        • Our patient education hand out did not have any of these items listed.
          One week in and our little neonate is having peri-oral cyanosis. Had no clue what it was, but knew the lips were good and baby was acting fine. Regardless, it concerned me enough to Dr. Google it and come across this blog post.

          I’ve been in Emergency Medicine for seven years and have been NRP certified for most of it. I can only imagine what non-healthcare peeps must feel when they are exposed to this stuff for the first time.

      • The blue around the mouth had me freaked. I’m a Registered Nurse! Not illiterate, just a concerned THIRD time mom!

    • From an RN's daughter on

      Pattie, my 4 day old firstborn had both acrocyanosos and peri-oral cyanosis after falling asleep while nursing. I felt he was faling asleep too quickly and deeply as well. I called my mom, a pediatric/PICU RN and asked if I needed to worry. She said he’s probably fine, but I should call his pediatrician just on case. I called the pediatrician’s and the person in triage said stay were I am she’s sending an ambulance. We went lights and sirens to the children’s hospital and spent 4 days in the NICU. He was desaturating significantly in deep sleep. This whole time his lips themselves never turned blue, iust his hands, feet and around his mouth. In the end they determined he had central apnea and he was on O2 for 9mo. His doctor said in the future not to talk to triage and talk to her directly so we can avoid the hospitalization, however, I did not freak out and rush him to the ER, the triage nurse did.

    • Morgan jeffers on

      I spent a month in the nicu with my baby and never once was told “normal things” to expect or funny things I may see on her. Don’t be rude just because moms are nervous

    • Apparently A. Dumdum on

      Pattie cannot possibly be a nurse! Nurses are kind and generally extremely informative! They put the patient first, and typically understand that a primary caregiver only asks questions in the best interest of his or her child. How unkind! Do adoptive parents who are not invited to attend birthing classes also suffer from minimized IQs in your opinion? Perhaps Pattie should spend less time posting nasty messages online and take a class in human compassion!

    • What a supremely unhelpful comment. Can you bear the weight of responsibility of all those mother’s dissuaded from taking their baby to ED because they felt judged by your post on that troll cave you post from? Perhaps there were other things going on that had not been considered. As someone who works in healthcare I can say that the worried well is how we wish all patients to turn out to be. Unfortunately, they’re not. Can you take a moment to think about the potential consequences of your post before offering next time?

    • Patti- why are you a nurse? I am a pediatric advice nurse and I spend most of my day on the phone reassuring parents and setting up telehealth (during COVID) and answering all their concerns about COVID 19. If I was as insensitive and harsh as you I would be fired so fast.

    • I never received any kind handouts on “normal neonatal funny looking things”. They didn’t give me any info on funny looking things that might happen but that are normal.

      • I never did either . I’m not a new mom I have a 11yr old but I seem to be more anxious this time around . Like for instance my little ones feet turned white the other day and I don’t know if I should be worried . He seems perfectly fine other wise eats and sleeps smiles and baby talks a lot . He had Acrocyanosis when he was born and happened whenever he got cold .. his doctor said it’s normal . Should I be worried about Rynuads phenomenon ( I know I misspelled it ) .

    • Hannah Collins on

      I am actually a paediatric nurse and mother of 4 (oldest 18years, youngest 3 months)
      Nurses don’t know everything and we can’t expect them to. When you are a new mother regardless of how many children you have then your nursing experience goes out the window.
      My youngest son is a constant worry for me and because of the things I’ve seen in work it makes me even more paranoid.
      All I can suggest if parents have ANY concerns about their little one then ALWAYS get checked. It’s better to have a orient come in worried about nothing than one bringing in their critically ill or dead child in as they were frightened about looking foolish in front of healthcare professionals. We should support and reassure families not ridicule them Pattie!

  2. my baby is now one month old,she had an 2decho scan on her second week old when her gp heard a murmur in her heart.she told us that my bb have a hole in the middle of her her heartbthat causes pressure on her lungs.she also told us that the hole will closed on its own,and nothing is alarming.but recent i’ve noticed in bluish color at the bottom of her it possible sign of cyanosis?pls help…thanks

  3. I’m not surprised parents bring their babies in for these things. Especially if it’s their first child. It’s overwhelming to have a first baby and be inundated with information. And even if the new parents read that what they are seeing is normal, I can understand their asking their ped just for reassurance.

    I think the problem with Dr Google is that the average person doesn’t know how to tell if a source is legitimate. Pretty much no matter what is googled, you can come up with scary information as well as conflicting information.

    And isn’t it better to bring a baby in for an exam to find out it’s nothing serious than not bringing a baby, assuming it’s nothing, when it really isn’t? Should a parent with no medical training be trusted to differentiate between benign and serious conditions? For example, distinguishing acrocysnosis from general cyanosis?

    Even doctors can be wrong. My sister, now 25y, turned blue when she cried. My mom took her to the ped when she was a few days old, and the ped said she had a minor heart problem and they could see the ped cardiologist in a few days. Had my parents not refused to wait, she would have died that night. She has hypoplastic right ventricle , tricuspid and pulmonary atresia. When my own son was diagnosed with a murmur at 2 days old, our ped said it was a waste of time to see the cardiologist, despite the family history of congenital heart defects. At every well check she said the same thing, it would be a waste of time, it’s a classic PPS murmur. Finally when he was 7 months old , I was more persistent. I had found journal articles that said PPS murmurs are GONE by six months. Nearly 25 years to the day, since my sister saw the ped cardiologist for the first time (when my parents were told to immediately follow him to the hospital) , my son saw the same ped cardiologist who diagnosed mild pulmonic stenosis that needs to be monitored and may one day need to be repaired through a cath procedure. He certainly didn’t think it was a waste of time to do an echo!

    And not all these conditions in this article are included in take-home-info. My son had the harlequin color change as a newborn and the pediatrician didn’t know what it was. I only learned it was benign by asking Dr Google. I also don’t remember reading anything in the take-home pamphlets about any of the conditions in this article except mottling, breast enlargement, and vaginal discharge. And I read it all. More than once. I listened to doctors and nurses and lactation consultants without having my phone out. And I’m a veterinarian so I have a pretty good grasp of anatomy and physiology, and I know how to analyze sources for quality. And yet I still had questions about the harlequin color change and his palpable liver. After all, heart defects can cause an enlarged liver and how should I know how big a newborn human’s liver should be? I think better be safe than sorry, and see a dr for anything worrisome for peace of mind.

    Lol as a side note, as a vet, Dr Google typically causes more trouble than good. People look things up and conclude ridiculous ideas, such as that raw eggs cure parvovirus, and that Manuka Honey cures bladder cancer. I joke that I charge extra for people that consult Dr. Google. But I enjoy when people know how to analyze sources and ask intelligent questions and bring up intelligent ideas and solutions. For those that don’t know how to analyze sources, I do my best to educate them and steer them in the right direction to educate themselves. So many people get info from non-experts posting on bulletin boards and assume it’s fact. It can be frustrating for sure.

    • I couldn’t agree more with PETVET. Parents should not try to diagnose themselves what is peri-oral cyanosis or enlarged liver, because they got a leaflet at the hospital. The right thing to do is to take them to the doctor, even for reassurance.
      I find comments of the first poster offensive and unprofessional, as well as first paragraph:
      One steady source of business in the emergency department comes from a group described as the “worried well.” Anxious new parents are frequent members of this tribe and come into the ED at all hours to point out perceived abnormalities or areas of concern in their little ones.

      I recognize the type of the doctor who wrote this article. it is sad to see that a ED doctor can see a job in ER as business.
      My dad worked as pediatrician and was never bothered by concerned parents. The author of this text should probably go into “another business”

  4. Thank you!! I felt the first comment on this page was very rude! I have worked in an emergency room for 8 years and I can tell you YES people do bring their babies in for the listed above reasons but you know what… Almost everything listed will get a baby taken to a room right away! Also as a first time mom I considered taking my child to the ER for oral cyanosis. As a health care worker it’s almost more terrifying when something of this sort happens cause you know first hand what could happen next! I was also not one that was “on my phone” while being educated by hospital staff and to assume everyone that has a question about their child’s health and well being was is not fair. There is A LOT of new information thrown at new moms while in the hospital as well as trying to recover themselves!! It would be almost impossible to remember all of it. As far as the send home packet, this is the age of technology!! My phone, along with Google, is a lot closer to me than a packet of papers I sat down and piled 100 other papers on top of!!

  5. My daughter was born 2 months prematurely and shows some of these signs even now that she is almost 7 months old, especially the oral cyanosis, mottling, and muscle spasms and tremors. The first comment was extremely rude. I was not on my phone during my daughter’s delivery, the week I was hospitalized for preterm labor before she was born and was being lectured to daily by staff, nor the nearly 2 months she was in the NICU. I received notebooks filled with information about her care once she was released to go home..and hardly any of this information was included. I was never talked to about oral cyanosis, which still scares me considering she was kept in the NICU a lot due to bradycardia and low o2 saturation. My parents are RNs (dad in the ER, mom in adult ICU) and they sometimes get concerned with blueness around her mouth during slight activity. Whoever wrote that first comment needs to get off their pedestal and high-and-mighty throne because being the parent of any newborn is stressful, and having a preemie is about 100 times worse. I haven’t rushed my daughter to the ER for anything, but if I didn’t have any medical knowledge, there would be times I probably would have.

  6. I just got out of the hospital with my newborn and I found at least 50% of the nurses during our 2 day hospital stay to be rude know-it-all doctor impersonating controll freaks. The rest were mostly delightful.

    Anyway. Thanks for this article. The part about the blue around the mouth mouth thing was very helpful.

  7. Thank you for this post, it was very helpful and kept me from rushing to the doctor when my LO’s face turned blue in the tub.

    As for the comments, maybe someone could just delete that first one?
    I was not on my phone while given any instructions, I simply was not told any of these things! Is it common that these are told to new parents? I even looked through all my paperwork and found nothing about any of these!

    Don’t be rude, and don’t assume all new parents are uneducated morons. We want what’s best for our children and have no knowledge of the medical world. Would it be worse or better if we self diagnosed and came to the hospital with our own conclusions? If something is odd, then all we can do is ask a professional. Isn’t that why they are there? They can’t complain, we pay for that mansion Doc lives in and that BMW in the parking lot. They should be thanking us as we rush in for dumb stuff. Cha Ching cha Ching $$$

  8. My daughter is now 16 years old and still goes blue around the lips every time she lies flat on her back. She had had several tests and they have found that she has enlarged lungs. When she breathes in the inflated lungs are too heavy and press down on her heart. Was very scary when we first noticed it. As a new mother I was terrified.

  9. Being a first time mom and having a traumatic birthing experience and requiring our baby to be in the NICU for almost two weeks, there are things I probably missed in our preparation and discharge. My husband and I went to an all day newborn class way before the arrival of our daughter, and spent four weeks preparing for labor (even though I ended up having a c-section) in a class as well. Despite all the things we did to prepare there are still things I don’t trust myself with – and probably don’t remember half of what nurses told us due to being in a post-labor haze, with stressing about our babies outcome and being overwhelmed. Patti – please be more sensitive. Better safe than sorry for our little babes. And no, I wasn’t texting through all our classes.

  10. Should be “No Need to Worry New Parents” rather than singling out mothers. These are common concerns that all clinicians of newborns need to address with new mothers, fathers, and other caregivers.

    • Nancy Rouse, CNM DNP on

      I am appalled to read the insensitive last paragraph of this article and also Patti RN’s response. BOTH of you need to go back to school and re take Post Partum 101. Specifically the chapter on how the new mother can not soak in all the information that is thrown at her after delivery. It does not matter if it is lectured, on video, printed, or sent home in a booklet. She has gone through a very traumatic experience of labor and delivery and now must care for a newborn while her body is healing. I also hope NO ONE is teaching new parents how to palpate a liver. Why would they need this information? I’m a Certified Nurse Midwife with a Doctorate in Nursing Practice. I have over 40 years of experience delivering and examining newborns. As I sit here looking at my newborn Granddaughter with cyanosis on her upper lip I still doubt myself and wonder if she should have more testing even though her hands and feet and mouth are pink and her respiratory rate is normal… Get off of your high horses and remember why you went into this profession. We are in the business of caring.

  11. Jahnavi Jaanu on

    First time parenting is really full of anxiety, tensions, and worries. Parents get worried about each and everything. Till the baby grows at least two years old, and able to communicate their problems with patients, parents are never relaxed. For every small thing, parents get tensed that their baby is not normal and some abnormality is haunting the baby. This post helps them to relate to the issue of the baby and consoled. Thank you for the post.

  12. I was not sent home with most of this information. In fact they barley told me anything about what I might see. I never learned this in school so I am not sure where you would expect people to hear it just because you did. Some first time moms just want to make sure their baby is okay because they fear the worst case. Let me tell you the worst case almost always ends in a dead or severely hurt baby.

  13. I keep reading that the Acrocyanosis is normal. Yet day care is making a big deal out of it and notifying us every time her feet flush blue for a moment. The first time, we called the nurse line and explained that the hands and feet are flushing blue occasionally. They sent 911 to the house! I’m so confused whether or not we should be panicked every time this happens.

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