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Is this normal in my 38 day old baby after bcg inj at birth

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BCG vaccine injection site reaction timeline papule ulcer scab normal newborn weeks

Based on what I can see in the photo, this looks like a normal BCG vaccination reaction.
What's in the picture: a small (roughly 5-8 mm) raised bump on the shoulder/upper arm with a crusted/scabbed center and mild surrounding redness. This is exactly the expected local reaction at a BCG injection site.
Why this is normal (per Park's Textbook of Preventive & Social Medicine, Red Book 2021, and WHO guidance):
  • BCG is usually given at birth (or around day 28 in some countries), and the local skin reaction typically doesn't appear immediately.
  • A papule (small bump) develops starting 2 weeks or more after the injection.
  • It grows over the next few weeks and often ulcerates in the center, then crusts over - which is what your photo shows.
  • The crust eventually falls off, and the area heals spontaneously within 6-12 weeks, leaving a small permanent scar 4-8 mm across.
  • Mild redness/induration around the papule is part of this normal process.
At 38 days old, this timeline lines up well with a typical BCG reaction progressing through its papule -> ulcer -> crust stage.
When it would NOT be normal - see a doctor if:
  • The reaction appeared within 24-48 hours instead of after ~2 weeks (this could suggest a different problem, not a normal delayed BCG response)
  • There is spreading redness, significant swelling, or the area feels hot/very tender (signs of secondary bacterial infection)
  • Pus is actively draining in large amounts or there's a foul smell
  • The lump under the arm (axilla) on the same side becomes larger than about 1 cm, hard, or the skin over it turns red/breaks down (this can indicate BCG lymphadenitis, a recognized but uncommon complication)
  • The ulcer is still open, oozing, and unhealed beyond 12 weeks
  • Your baby has fever, is unwell, feeding poorly, or lethargic
  • There are similar bumps or sores appearing elsewhere on the body (not just the injection site)
General care tips:
  • Leave it open to air as much as possible; don't apply creams, powders, or plasters/bandages unless it's actively weeping (then a loose, sterile gauze is fine).
  • Don't squeeze or pick at it - let it heal and scar on its own.
  • Normal bathing is fine.
If your baby is otherwise well, feeding normally, and there's no significant swelling in the armpit, this is very likely just the expected healing stage of the BCG scar. If you're unsure or notice any of the warning signs above, it's reasonable to have your pediatrician or the vaccination clinic take a quick look, especially since photos alone can't fully substitute for an in-person exam.
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