Callus in a newborn baby: on the upper lip, bony

In pediatrics, a newborn is considered a baby within four weeks of birth, and in this short time, a newborn blister can appear: and not only on the lip, but also a bone blister.

Callus in a newborn on the lip - sucking pad

Many breastfeeding moms are concerned about the so-called sucking or milk callus on the lip of a newborn when breastfeeding.

Understanding the cause of its appearance on your baby's upper lip can eliminate their anxiety.

Of the more than seven dozen innate reflexes present in newborns, one of the main reflexes is the sucking reflex, and the main cause of blisters on the upper lip, sometimes in the form of a blister - repeated vigorous sucking of milk from the breast or from a bottle.

In newborn babies, the oral cavity has certain features that help the baby "get" food. Suckling during breastfeeding, as well as during feeding with adapted formula milk, occurs with the help of movements of the jaw and tongue. And it begins with the compression of the nipple (or pacifier) by the lips of the infant - due to a strong contraction of the circular muscles of the mouth (musculus orbicularis oris) located in the lips and the movement of the chewing muscles (musculus masseter) of the lower jaw, which move it in the anteroposterior plane. This compression creates the increased pressure necessary for milk suction over the nipple. The baby then dynamically squeezes milk from the breast into the mouth by squeezing the nipple with the tongue toward the hard palate.

At this time, the pressure in the mouth is lower, which is provided not only by the compression of the lips (musculus labii proprius Krause), but also by the closure of the internal nasal passages by the soft palate and lowering of the lower jaw.

In addition, the inner zone of the red border of the upper lip of newborns is larger than that of the lower lip and has a thicker and higher epithelium with papillae - villous epithelium (under which there is a layer of loose connective tissue). This causes the formation of the pars villosa at the border with the mucosal epithelium of the lip, which helps the infant to grasp and hold the nipple.

As noted by neonatologists, the development of the medial tubercle of the upper lip can occur in the fetus after 9-10 weeks of pregnancy (when it still in the womb begins to suck its thumb), and in the newborn it has the appearance of a rounded bulge up to 5 mm in size. And this bump, although it is a normal anatomical variant, is most often referred to as a callus and only rarely as a sucking pad. The callus may be permanent, but in some babies it becomes less pronounced 10-15 minutes after the end of each feeding.

It is true that intensive sucking can lead to the formation of a bulla (bubble) with serous transparent fluid on this bump, and the bubble may burst. However, healing occurs spontaneously - without treatment - due to rapid re-epithelialization.

Callus on the lip of a newborn baby discomfort does not cause him discomfort and does not require therapy: after a few months it disappears on its own.

A bone callus in a newborn is the result of a fracture

It is generally recognized: in a newborn baby bone callus appears as a result of birth trauma, first of all, a fracture of the clavicle bone, although there may be fractures of other localizations: humerus and even femur, during the healing of which a new tissue is formed - bone callus in a newborn.

Risk factors for fracture include: shoulder dystocia during vaginal delivery - making it difficult for the midwife to remove the shoulder girdle; obstructed labor; and breech presentation of the fetus (increasing the likelihood of femur fracture).

Foreign statistics state that clavicle fractures occur in approximately one out of every 50-60 newborns; other data suggest that this injury occurs in at least 3% of physiologic births.

In turn, obstetricians have noted an increased risk of shoulder dystocia (and clavicle fracture) in cases of high birth weight - fetal macrosomia (≥4500-5000 g); in cases where a vacuum or forceps is used in labor; gestational diabetes (diabetic mothers have wider shoulders, chest circumference and abdominal circumference); repeat births - shoulder dystocia of the newborn during the first delivery (recurrence rate of dystocia is estimated at almost 10%).

Therefore, it is more common for a bone callus to form after a clavicle fracture in a newborn.

When considering the pathogenesis of neonatal clavicle fracture, experts emphasize that the process of ossification (ossification) of the tubular clavicle bone (clavicula) - from the epiphyseal plate in its central part - begins in the embryo in the fifth week of intrauterine development. The medial part of the clavicle is the thinnest and the growth plate is open at birth, which means that the bone is much easier to damage.

In addition, such fractures in newborns are subperiosteal fractures, in which the periosteum is not disturbed and the bones themselves are still soft and often bend in the damaged part without pronounced deformation. Fractures of young soft bones are called green stick fractures by surgeons. In this case, the formation of subperiosteal new bone and bone callus begins within ten to ten days after the fracture.

The most common symptoms of a fracture are local swelling, reddening of the skin, hematoma formation, crying of the child when moving the ipsilateral upper extremity or lack of movement. This is called pseudoparalysis: the baby simply stops moving the arm because of the pain.

Consequences and complications of such a fracture are very rare: if the area of the injury touches the growth plate of the bone (Salter-Harris fractures), and a lintel is formed at the site of the fracture, due to which the growth of the bone is delayed, or it is curved.

Diagnosis consists of examination of the newborn by a pediatrician-neonatologist - with palpation of the clavicles, in which the presence of crunching gives reason to diagnose a clavicular fracture. The child is also checked for the presence of the Moreau reflex, and if it is unilateral (asymmetric), the diagnosis of fracture is confirmed.

In doubtful cases, instrumental diagnostics - ultrasound of the clavicle area - may be used. Clinical practice shows that in some cases the clavicle injury is so insignificant that it is diagnosed only when the bone callus begins to form in a newborn, with the appearance of a small bulge (bump) on the clavicle, which is a sign of fracture healing.

A differential diagnosis is also carried out: medical professionals may detect in a newborn a rare genetic bone disease - osteogenesis imperfecta, myotonic dystrophy or multiple joint contractures - arthrogryposis.

What treatment is needed if a newborn has a clavicle fracture? Almost all such fractures - due to the great regenerative potential of the periosteum - heal well without therapy as such. But it is necessary to minimize the pressure and movement of the child's arm on the side of the broken clavicle: immobilization is carried out by attaching a sleeve of clothing on the side of the fracture in the front part, with the baby's arm bent at the elbow, and the shoulder and forearm fixed to the torso. If the crying is severe, the doctor may prescribe an anesthetic, for more information see. - rectal pain relievers and anti-inflammatory suppositories.

It is normal for a child to start moving the arm on the side of the fracture after about two weeks.

As the researchers found, the soft callus at the fracture site is made up of cartilage and, by starting to grow on one side of the fracture, creates a force that aligns the damaged bone. The hardening of the callus promotes complete healing of the fracture, taking an average of four to five weeks.

The prevention of shoulder dystocia recommended by some clinicians is elective cesarean section for pregnant women whose newborn has a history of a clavicle fracture. But experts at the American College of Obstetricians and Gynecologists (ACOG) consider the benefit of such a preventive measure questionable.

In addition, an emergency cesarean section carries a higher risk of long bone fracture than a normal delivery.

So many experts are inclined to believe that a neonatal clavicle fracture during labor is unlikely to be preventable.

However, the prognosis for a clavicle fracture during labor is excellent, and the bone callus in a newborn after a clavicle fracture disappears within six months.