Scalp Hair Characteristics in the Newborn Infant

Susan A. Furdon, RNC, MS, NNP; David A. Clark, MD

Disclosures

Adv Neonatal Care. 2003;3(6) 

In This Article

Scalp Hair Examination

A focused evaluation of scalp hair should be part of every newborn physical assessment. Although typically completed in the delivery room, it may be useful to re-evaluate the infant after the initial bath, when vernix and blood have been removed. Table 1 provides the common terminology that is used to describe hair.

Note the color of the infant's hair; it should be concordant racially with the parents.[4,7]  Table 2 compares common racial hair characteristics. Hair color should be fairly uniform, but may include a mixture of colors depending on the relative amounts of vellus and terminal hair. This can give the appearance of the hair being frosted and is a normal finding. Random patches of white hair are familial or sporadic and are inconsequential[7] (Fig 3). Be alert for diffuse or localized areas of hypopigmentation.

Hypopigmented hair localized to the occipital area. Random patches of hypopigmented hair are inconsequential. Photograph courtesy of David Clark, MD.

Assess the quantity and distribution of hair; specifically look for areas of diffuse or localized absence or abundance. Normal hair patterns vary widely. In infants, localized absence of hair can be insignificant. Hair in the occipital region enters the telogen phase after birth, so occipital hair loss around 8 weeks of age is common.[4]

Observe and palpate the hair's texture to determine if it is coarse or fine. Typically, newborns have relatively fine hair. Most of the conditions associated with abnormal textures are not obvious in the newborn period.[7] In older infants or children, ask the parents about changes in their child's hair texture over time; these changes should be noted and may have clinical significance.

Inspect the scalp for hair growth patterns. Observe distribution patterns, including the position of and number of hair whorls. The usual location of the parietal hair whorl is several centimeters anterior to the posterior fontanel. Hair whorl locations are described in relation to the midline. Location varies:[3]

  • 56% are located left of the midline

  • 30% are located right of the midline

  • 14% at midline.

This is probably related to the slightly larger left side of the brain.[3] The typical hair whorl in 95% of Caucasian infants is a single parietal hair whorl; 80% of these rotate clockwise. Double parietal hair whorls (Fig 4) are a normal variant in 5% of individuals.[3] Ten percent of African American infants with short, curly hair have a parietal hair whorl.[2,13] Observe the slope of the hair follicle. In the newborn period, unruly hair that sticks out straight despite attempts at grooming is normal (Fig 5).

Note double hair whorl. Multiple hair whorls may indicate abnormal brain growth. Photograph courtesy of David Clark, MD.

Unruly hair after the newborn period may indicate poor brain growth. In this term infant, unruly hair is normal. Photograph courtesy of David Clark, MD.

Examine the forehead hair patterning; many variations are normal. Infants with underlying brain abnormalities may have abnormal hair patterning, such as a striking frontal upsweep or multiple parietal whorls.[2] Over the frontal region, hair tends to arc outward laterally. In about 7% of the general population, the parietal hair and the frontal hair converge creating an anterior upsweep of the hair commonly referred to as a cowlick.[2] Cowlicks are often normal. The V-shaped downward projection of scalp hair, known as a widow's peak, is often a familial characteristic and can be normal. Assess the spacing of the infant's eyes, looking for hypertelorism, an associated finding.

Observe the infant's anterior and posterior hair margins for a distinct demarcated hairline. The anterior hairline is lower in newborns than older children. This feature is most prominent in newborns from racial groups with profuse hair growth. Although the normal position of the anterior hairline can be variable, there should be a separation between the hairline and the eyebrows (Fig 6). Normally, posterior hairline hair roots are located above the neck crease.

Anterior hairlines that extend to the forehead are normal. This anterior upsweep is termed a cowlick. Photograph courtesy of David Clark, MD.

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