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Identifying Babies’ Warning Signs

Do you ever wish your baby came with an instruction manual for troubleshooting the source of their behavior?

Even though your child’s doctor is always a phone call away, it is important for parents to identify and learn how to respond to signs which may indicate a problem with your baby. Warning signs may include changes in behavior, physical changes or differences in how your baby eats.

Parents are the best judge of changes in a baby's behavior. If you feel something is not right - call your physician. In general, these signs indicate a reason for you to contact your child's doctor:

Call your baby’s doctor if your infant:

  • Seems sluggish or unresponsive
  • Is refusing food or drink
  • Is vomiting
  • Has diarrhea
  • Has a fever

Watch for these changes:

Babies cannot tell you what is wrong. 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. As parents, you can watch for these types of changes to alert you that your baby may need attention. 

Behavioral Warning Signs

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 behavior may signal illness.

Here are some examples of behavioral changes and warning signs:

Crying or irritability

When babies cry, they are communicating their needs to you. Depending on the nature of the cry, your baby may be craving more food or sleep, feeling lonely, in need of a diaper change, or in actual physical pain.

Calming an irritable infant may seem impossible at first, but over time, parents get better at knowing what their children want just by the sound of their voice or cries.

If your child is continuously fretful and fussy, cries for long periods or very suddenly, has a cry that sounds unusual, contact your physician.

Colic

Colic is a benign, painful intestinal problem that could be causing your baby to cry. Colic is found in infants up to three months old and may cause intense crying and irritability. This crying and irritability usually happens around the same time each day. Colic is defined as crying which:

  • Lasts for more than 3 hours a day
  • Happens more than 3 days a week

Colic is generally not serious and babies grow out of it after 3 months. 

Diaper pain or clothing discomfort

Your infant’s irritability may be the result of a physical problem that causes pain or discomfort. Common physical problems that affect babies include:

  • Clothing that pinches
  • An open, pointy diaper pin
  • A thread or hair tightly wound around your baby’s finger or toe

Inspect your child's clothing, diaper, fingers and toes to see if anything is physically hurting your baby.

Intermittent episodes of crying / pain

If you notice that your infant has a sudden onset of severe pain with symptoms that are similar to severe colic (hard, distressed crying), he or she may have intussusception. Intussusception is a rare intestinal blockage that demands immediate medical attention.

Look for these other symptoms that are commonly associated with intussusception:

  • Fatigue, sluggish activity
  • Vomiting
  • Bloody stool / currant jelly
  • Straining or drawing knees up during crying episodes

This is a serious condition that requires you to seek immediate medical attention for your baby.

Lethargy or listlessness

Does your baby seems to have limited energy, or appear drowsy and sluggish? Warning signs of lethargy include:

  • Baby sleeping longer than usual
  • Harder to wake baby for feedings
  • Signs of inattentiveness to sounds and visual stimulation

Lethargy in babies develops slowly, which makes it hard for some parents to spot. Lethargy may be a sign of bodily infection or other conditions such as low blood sugar.

Talk to your healthcare provider if you think your infant is not as active or energetic as in the past.

Physical Warning Signs

Changes in behavior are not the only warning signs that parents need to monitor. Look for these physical warning signs as indications that your infant may have a more serious condition that requires treatment or follow-up.

Fevers in babies

Fevers are one of the most recognizable warning signs for parents to learn to identify. Fevers can be a symptom of:

  • Colds
  • Croup
  • Pneumonia
  • Ear Infections
  • Stomach Virus
  • Urinary Infections
  • Bacterial & Viral Infections

Taking your baby’s temperature

The easiest and most accurate way to take your baby’s temperature is with a digital rectal thermometer. Parents must understand that fevers can mean different things for babies at different stages of their development.

  • If your child is older than 3 months old, then a 100 degree temperature or lower is considered normal.
  • If your child is 3 months or younger with a temperature of 100.4 degrees or higher, be sure to call your child’s healthcare provider immediately.
  • A temperature of 100.4 or higher in an infant less than 29 days old is a medical emergency.

  • If your baby is 3-6 months old, call the doctor if your baby’s temperature exceeds 101 degrees.
  • If your child is over a year old, get in touch with your healthcare provider if the fever lasts longer than 24-48 hours (or if it’s accompanied by any other worrisome symptoms).

Fevers and febrile seizures

If your baby is between 6 months and 5 years old, fevers can trigger febrile seizures (convulsions), which may last for a few minutes or be over in seconds.

While febrile seizures are a frightening experience for parents and their children, they are usually harmless to the baby’s health. 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.

In the event that your child has a febrile seizure, call for emergency help as soon as possible. Seizures can become severe when they constrict your baby’s breathing or last longer than a few minutes.

Umbilical Cord Infections

Do you notice red skin or puss around the stump of your newborn’s umbilical cord?

This could be a sign the umbilical cord is actually infected. In some cases, the skin irritation will be accompanied by an unpleasant smell. If you think your infant’s umbilical cord is infected, discuss it with your baby’s doctor.

Feeding & Digestion Warning Signs

Some warning signs related to feeding and digestion are harder to identify than behavioral changes or physical warning signs. Look for these signs or symptoms the next time your baby eats.

Poor appetite

Most newborns begin eating every three to four hours after they have come home from the hospital. You will also notice your infant showing signs of hunger by sucking on his or her fingers, crying, or making rooting motions. If you notice differences, discuss them with your child's doctor.

If your child refuses to eat

If your baby refuses to eat or continually misses feedings, it may be a sign of a more serious illness.

If your baby is losing weight or having trouble sucking at your breast or bottle and doesn’t seem hungry, it may be a sign of a more serious illness.

Sucking problems

If your child is having difficulty sucking or you feel your child becoming weaker during regular feedings, it may be a warning sign.

Signs of a weak suck during regular feedings include:

  • Not being able to latch while breastfeeding
  • Not being to hear baby swallowing or gulping
  • Not being able to complete feeding in usual time
  • Spitting up

Sucking problems are especially common if your baby was born prematurely.

Your child's physician or a certified lactation consultant may help identify and correct sucking problems so your baby gets adequate nutrition.

Spitting up

Babies are born with a weak and immature sphincter muscle responsible for controlling the flow of food or liquids between the stomach and the esophagus. As a result, newborns will frequently spit up or dribble milk with burps after feedings.

  • 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.

If your child is spitting up an usually large amount of milk after feedings or experiencing forceful, projectile-like vomiting this may indicate a more serious problem. 

Diarrhea/vomiting

Diarrhea and vomiting are signs that your baby may have a bacterial infection of the intestine, an obstruction, or another problem related to their digestive system.

In the event that your infant is displaying these signs, know what to expect:

  • Your healthcare provider may request an examination of your baby’s stool for bacteria.
  • Your healthcare provider may advise no treatment at all if it is a viral infection. Viral infections typically resolve on their own in a week or so.
  • Your healthcare provider may advise you to monitor your infant’s hydration during periods of persistent diarrhea.

Weight gain

While it is normal for your baby to lose about 10% of his or her birth weight in the first 2-3 days, this weight will return after 10-11 days.

Signs your baby isn’t gaining weight may include:

  • A thin, drawn face
  • Loose skin
  • Fewer wet or soiled diapers

Your physician should check the weight of your newborn at the end of his or her first week. If you notice a lack of weight gain or continued weight loss in your infant, it may be a sign of an illness or other medical condition that demands further investigation.

Irregular stools or diarrhea

Inspect your baby’s stool for irregularities as they may be warning signs of a more serious medical condition.

If your baby has very hard or dry stools, it may be a sign of dehydration. Ensure your infant is receiving enough fluids, especially in the event of fever, illness, or heat.

Once your child is ready to start eating solid foods, constipation can be an issue for children eating heavier foods like cereal or cow’s milk before their bodies are ready to handle them.

Irregular urination

On average, your baby should wet at least four diapers over the course of a day. Look for these warning signs related to urination:

  • Is your infant showing signs of distress or discomfort while urinating? This could be a sign of an infection or problem related to the urinary tract.
  • Do you notice salmon-colored or pinkish stains on your baby’s diaper? This could be a sign of highly concentrated urine but isn’t cause for concern. If this staining is persistent, talk with your healthcare provider about investigating other underlying causes.
  • Is there blood in the urine or a bloody spot on the diaper? Any bleeding that is accompanied by abdominal pain or fever requires immediate medical attention.

Self-Care steps to keep baby healthy

Follow these care steps for making sure your baby remains as healthy as possible.

  • If your child is distressed, hold and console him or her as much as possible.
  • Keep your infant away from others who are sick, especially those with infectious diseases like respiratory syncytial virus (RSV), stomach “flu”, influenza, and other respiratory infections, cold sores (HSV1) and other obvious infectious diseases.
  • Do not allow family members who are sick to share for or drinks with your infant or from handling your baby and his or her toys.
  • Do not allow anyone to smoke around your baby.
  • Breastfeed your child if possible to provide him or her with antibodies and enzymes that help protect against illness during development.
  • Use a commercial infant formula if breastfeeding is not an option.
  • Be sure to adhere to your baby’s vaccine schedule and regular checkups.

Remember if you’re worried, there’s probably a good reason even if you do not recognize it, so don’t hesitate to call your baby’s doctor immediately.

 

Emily Bendlin, MD

Methodist Physicians Clinic - Hawthorne Court

Dr. Bendlin loves working with kids and their parents. She has always enjoyed caring for kids.  "I've always liked medicine, but more importantly I've always liked kids," Dr. Bendlin said. "During my pediatric rotation it was the 'aha' moment. It was so fun and I was so excited when I went home. I knew at that time this is it for me – pediatrics is where I’m supposed to be." According to Dr. Bendlin, "Working with kids is fun. What other ...

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