Callus in a newborn child: on the upper lip, bone

In pediatrics, a child is considered a newborn within four weeks from the moment of his birth, and during this short time a corn may appear in a newborn: and not only on the lip, but also on the bone.

Corn on the lip of a newborn - a sucking pad

Many nursing mothers are concerned about the so-called sucking or milk callus on the lip of a newborn during breastfeeding.

Understanding the reason for its appearance on the upper lip of the baby can eliminate their anxiety.

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

In newborn babies, the oral cavity has some features that help the baby "get" food for himself. Sucking during breastfeeding, as well as when feeding with adapted milk mixtures, occurs with the help of movements of the jaw and tongue. And it begins with the compression of the nipple (or nipple) by the lips of the baby - due to the strong contraction of the circular muscle of the mouth (musculus orbicularis oris) located in the lips and the movement of the masticatory muscles (musculus masseter) of the lower jaw, which move it in the anteroposterior plane. This compression creates the increased pressure over the nipple necessary to suck the milk. Further, the child dynamically squeezes milk from the breast into the oral cavity, squeezing the nipple with the tongue towards the hard palate.

At this time, the pressure in the mouth is lower, which is ensured not only by compressing the lips (the muscle that compresses them works - musculus labii proprius Krause), but also by closing the internal nasal passages with the soft palate and lowering the lower jaw.

In addition, the inner zone of the red border of the upper lip of newborns is larger than the lower one, 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 pars villosa at the border with the mucous epithelium of the lip, which helps the baby to capture and hold the nipple.

As neonatologists note, the development of the medial tubercle of the upper lip can occur in the fetus after the 9-10th week of pregnancy (when he begins to suck his thumb while still in the womb), and in the newborn it looks like a rounded bulge up to 5 mm in size. And this tubercle, although it is a normal anatomical variant, is most often called a corn and only occasionally a sucking pad. The callus may be permanent, but in some babies it becomes less pronounced 10-15 minutes after the completion of each feeding.

True, intensive sucking can lead to the formation of a bulla (bubble) on this tubercle with a serous transparent liquid, and the bubble may burst. But healing occurs spontaneously - without treatment - due to rapid re-epithelialization.

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

Bone callus in a newborn is the result of a fracture

It is generally accepted: in a newborn, a callus appears due  to birth injuries , primarily a fracture of the clavicle, although fractures of other localization are possible: the humerus and even the femur, during the healing of which a new tissue is formed - the callus in the newborn.

At the same time, risk factors for fractures include: shoulder dystocia during vaginal delivery - difficulty in removing the shoulder girdle by the midwife; complicated childbirth; breech presentation of the fetus (increasing the likelihood of a fracture of the femur).

Foreign statistics state that fractures of the clavicle occur in approximately one newborn out of every 50-60; according to other data, such an injury is observed in at least 3% of physiological births.

In turn, obstetricians note an increased risk of shoulder dystocia (and fracture of the collarbone) with a large body weight of the child - fetal macrosomia (≥4500-5000 g); in cases of using a vacuum or forceps in childbirth; with gestational diabetes (in diabetic mothers, children have wider shoulders, chest and abdomen circumference); with repeated births - dystocia of the shoulder of the newborn during the first birth (the frequency of recurrence of dystocia is estimated at almost 10%).

Therefore, most often a callus is formed after a fracture of the clavicle in a newborn.

Considering the pathogenesis of neonatal  clavicle fracture , experts focus on the fact that the process of ossification (ossification) of the tubular clavicle (clavicula) - from the epiphyseal plate in its central part - begins in the embryo at the fifth week of intrauterine development. At the same time, the medial part of the clavicle is the thinnest, and the growth plate is open at the time of birth, that is, the bone is much easier to damage.

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

Most often, the symptoms of a fracture are manifested by local swelling, redness of the skin, the formation of a hematoma, the crying of a child when the ipsilateral upper limb moves or the absence of its movements. This is called pseudo-paralysis: it's just that the baby stops moving his arm because of the pain.

The consequences and complications of such a fracture develop very rarely: if the area of damage touches the growth plate of the bone (Salter-Harris fractures), and a bridge is formed at the fracture site, due to which the growth of the bone is delayed, or it is bent.

Diagnosis consists of an examination of the newborn by a pediatric neonatologist - with palpation of the clavicles, in which the presence of crackling gives reason to diagnose a clavicular fracture. Also, the presence of the Moro reflex is checked in the child, and if it is unilateral (asymmetric), then the diagnosis of the fracture is confirmed.

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

Differential diagnostics is also carried out: doctors can identify a rare genetic bone disease in a newborn -  osteogenesis imperfecta , myotonic dystrophy or multiple articular 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 hand from the side of the broken collarbone: immobilization is carried out by attaching a sleeve of clothing from the side of the fracture in the front, while the baby’s arm will be bent at the elbow, and the shoulder and forearm are fixed to the body. With severe crying, the doctor may prescribe an anesthetic, for details see -  Rectal painkillers and anti-inflammatory suppositories .

Normally, the child begins to move 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 of cartilage and, starting to grow on one side of the fracture, creates a force that aligns the damaged bone. Hardening of the callus contributes to the complete healing of the fracture, which takes an average of four to five weeks.

Prevention of shoulder dystocia, recommended by some clinicians, is a planned caesarean section of pregnant women in whom a newborn has suffered a clavicle fracture in the anamnesis of childbirth. But experts from the American College of Obstetricians and Gynecologists (ACOG) consider the benefit of such a preventive measure questionable.

In addition, an emergency caesarean section carries a higher risk of fracture of long bones than a conventional delivery.

So many experts are inclined to think that it is hardly possible to prevent a neonatal clavicle fracture during childbirth.

However, the prognosis for a clavicle fracture during childbirth is excellent, and a newborn's callus disappears within six months after a clavicle fracture.