Babies' Warning Signs

It's been said that babies do not come with instructions, but most parents certainly wish they did, especially when a young child is sick. As they grow, babies are exposed to infectious agents that may cause colds and other illnesses. These are a normal part of a baby's development and, thankfully, most outgrow the frequent-illness stage. Because babies cannot verbalize their feelings, however, adults must always stay alert for warning signs of illness.

A change in behavior may be one of the first signs that your baby isn’t feeling well. Although your baby's activity level, appetite, and cries will vary from day to day, even hour to hour, a distinct change in any of these areas may signal illness.

Generally, if your baby is alert and active when awake, is feeding well, and can be comforted when crying, occasional differences in these areas are normal. Talk with your baby's doctor if you’re concerned about your infant’s behavior, since changes may indicate an illness. The warning signs below will help you discern when something is amiss, and will help you know when and how to take action.

Persistent Crying or Irritability

All babies cry—this is their only way of communicating their needs to you. Depending on the type of cry, your baby may be hungry, sleepy, lonely, in need of a diaper change, or in pain. At first, you may not know how to interpret your baby’s cries, but appeasing one of these issues should usually calm your infant. If your baby is continuously fretful and fussy, cries for long periods or very suddenly, or has a cry that sounds unusual, it may be a sign of illness. Colic could also be causing your baby to cry. Colic is a benign, painful intestinal problem in infants up to 3 months old, and may cause intense crying and irritability around the same time every day.

If you notice any of these signs, examine your baby carefully to make sure there isn’t a physical problem—such as clothing that pinches, or an open, pointy diaper pin. There may be a thread or even a hair tightly wound around your baby’s finger or toe. Also, look at your infant’s abdomen for signs of swelling. Call your baby's doctor if crying lasts longer than usual or your baby has other signs of illness.

Fever

Respiratory illnesses such as colds, croup, pneumonia, ear infections, stomach bugs, urine infections, and many other bacterial and viral illnesses may all cause fever. To check for fever, take your baby's temperature rectally with a digital or glass rectal thermometer that’s mercury-free. It is the easiest and most accurate way. A 100-degree temperature or lower is considered normal, but if your baby is 3 months or younger with a temperature of 100.4 degrees or higher, call the doctor immediately. If your baby is 3 to 6 months old, call the doctor if your baby’s temperature exceeds 101 degrees. If your child is over a year old, call the doctor if the fever lasts longer than 24 to 48 hours (or if it’s accompanied by any other worrisome symptoms).

Fever in children between 6 months and 5 years of age can trigger febrile seizures (convulsions), which may last for a few minutes or may be over in seconds. They are a frightening experience but are usually harmless. Let your child's doctor know if this happens. Call for emergency help if seizures are severe, cause difficulty breathing, or last longer than a few minutes. If your child has had an uncomplicated seizure, he or she should be seen by a physician during regular office hours or in an emergency room, if you are unable to get an appointment.

Listlessness or Lethargy

You may find that your baby seems to have little or no energy, is drowsy or sluggish, or is sleeping longer than usual. He or she may be hard to wake for feedings, and won’t be alert or attentive to sounds and visual stimulation. Sometimes this develops slowly, so you won’t notice the gradual change. Lethargy may be a sign of infection or other conditions such as low blood sugar. Talk with your baby's doctor if your infant becomes lethargic or isn’t as active.

Poor Appetite

After the first day or so, most newborns are ready to eat every three to four hours and show signs of hunger by sucking on fingers or a hand, crying, and making rooting motions. If your baby refuses to eat and misses several feedings, it may be a sign of illness. You may notice that your infant is having trouble sucking at your breast or bottle, doesn’t seem to be hungry, is having problems spitting up, or is losing weight.

If a sucking problem is to blame, you’ll notice that your baby’s once strong sucking has become weaker, and that he or she isn’t eating well. This is especially common if your baby was born prematurely. If your infant has a weak suck, he or she may not pull strongly or have a good latch while breastfeeding. What’s more, you may not hear your baby swallowing or gulping during feedings, or your breasts may not feel full right before a feeding or softer afterward. If your baby is bottle-fed, a weak suck may require the bottle nipple to be "worked" or pumped to stimulate a suck. Either type of feeding, whether by breast or bottle, may take a very long time—often longer than 45 minutes.

Spitting up and dribbling milk with burps or after feedings is fairly common in newborns. This is because the sphincter muscle between the stomach and the esophagus (the tube from the mouth to stomach) is weak and immature. However, forceful or projectile vomiting, or spitting up large amounts of milk after most feedings, can indicate a problem. If your baby is formula-fed, vomiting may occur after overfeeding or because of intolerance to formula. If your baby is breastfed or formula-fed, he or she may have a physical condition that prevents normal digestion and may cause vomiting. Discolored or green-tinged vomit may mean that your infant has an intestinal obstruction.

It’s normal for your baby to lose about 10 percent of his or her birth weight in the first two to three days after birth. However, your baby should gain back this weight after 10 or 11 days. Signs your baby isn’t gaining weight may include a thin, drawn face, loose skin, and a decreased number of wet or soiled diapers. Most physicians want to see a newborn in the office at the end of the first week to check his or her weight. Lack of weight gain or continued weight loss in your baby may be a sign of illness or other conditions and needs to be treated. Talk with your baby’s doctor if your infant has any difficulties taking or digesting feedings, as serious illness could occur if left untreated.

Umbilical Cord Infection

If there is puss or red skin around the stump of your newborn's umbilical cord or an unpleasant smell, it may be infected. Discuss it with your baby’s doctor.

Diarrhea and/or Vomiting

These could signal a viral or bacterial infection of the intestine, an obstruction, or other problem. In some cases, your baby’s doctor may exam your baby's stool for bacteria, which requires treatment. Viral causes don’t require treatment and will resolve on their own in a week or so. If your baby has persistent diarrhea, this may lead to dehydration.

Irregular Stools

If your baby is breast- or bottle-fed and has very hard or very dry stools, it may be a sign that he or she needs more fluids, or may be losing too much fluid because of fever, illness, or heat. After your baby starts eating solid foods, hard stools may be caused by too many constipating foods, such as cereal or cow's milk, before your baby’s system can handle them.

Urination

Your baby should wet at least four diapers a day. If he or she shows any signs of distress while urinating, it could be a sign of infection or some other problem in the urinary tract. A salmon-colored or pinkish stain on your baby’s diaper is typically a sign of highly concentrated urine and isn’t usually a cause for concern. However, if staining persists, talk with your baby’s doctor. If there is blood in the urine or a bloody spot on a diaper, call the doctor at once. If bleeding is accompanied by abdominal pain or fever, seek medical attention immediately.

Intussusception

This rare intestinal blockage is a medical emergency that must be treated immediately. If your baby has a sudden onset of severe pain similar to severe colic with hard, distressed crying, this could be a sign of intussusception. Early on, your baby may seem fine between bouts of pain, but he or she will soon become fatigued and sluggish. Your baby may vomit and may pass bloody stool (sometimes described as "currant jelly" stool). Fever (often not present initially) may also appear, and shock may follow.

What to Do

To keep your baby as healthy as possible, breastfeed your child if possible, which will provide him or her with antibodies and enzymes that help protect against illness. If breastfeeding isn’t an option, use a commercial infant formula such as Similac or Enfamil. Don't allow smoking around your baby. Also, be sure to adhere to your baby's vaccine schedule and regular checkups. In general, call your baby’s doctor if your infant seems especially sluggish, is refusing food or drink, is vomiting (not just spitting-up), has diarrhea, or has a fever. Remember, if you’re worried, there’s probably a good reason even if you don’t recognize it, so don’t hesitate to call your baby’s doctor.

Self-Care Steps for Baby/Warning Signs

• If your baby seems distressed, hold and console him or her as much as possible.

• Keep your infant away from children who are sick, especially those with infectious diseases such as respiratory syncytial virus (RSV), stomach “flu,” influenza and other respiratory infections, cold sores (HSV1) and other obvious infectious diseases.

• Prevent family members who are sick from sharing food or drink with your baby, and from handling your baby and his or her toys.