Bringing a new baby home is exciting and sometimes stressful. You want to do what’s best for your baby but how are you supposed to know what that is? What’s normal and what’s an emergency? As a pediatrician and a mom, I can tell you that a strong relationship with your child’s doctor will provide the answers and support you need to raise a healthy baby.
To help you get started on the path to success, I'm going to share the major concerns with newborns (babies up to 3 months old) that should cause you to seek immediate medical care.
If the baby’s temperature measured in the rectum is 100.4 degrees or higher, the baby has a fever. For the first 3 months of your baby’s life, take temperatures in the rectum, not in the ear, mouth, or under the armpit. Rectal temperatures provide the most accurate measurement.
Fever in newborns is an emergency, as it may be due to a serious condition such as bacterial meningitis or sepsis, a bloodstream infection. Both can be life-threatening if they aren’t treated right away.
If your baby has a fever, call your doctor. Be sure to write down the baby’s temperature and the exact time you took it before calling the physician. Your provider will need that information to make decisions about how to care for the baby.
If your baby is breathing more than 60 breaths per minute, having pauses in breathing, or has a bluish tint to her skin, lips, and nails, it could be a heart or lung condition.
If your baby is taking more than 60 breaths per minute or turning blue around the mouth, call 911 immediately.
Call your doctor if the baby has other concerning breathing symptoms such as:
- Flaring of the nostrils
- Chest retractions (sucking in the skin above the collarbone, between the ribs, or below the ribs)
- Consistently fast breathing
- Heavy, noisy breathing (audible wheezes, whistling sounds, or crackly sounds during inhalation and exhalation)
It’s normal for a newborn to spit up small amounts of milk within an hour after being fed, but if the flow is particularly forceful and happens more than two or three times in a day, call your doctor. For infants, vomiting could indicate an infection, gastroesophageal reflux disease, or, in rare cases, a problem with the stomach muscles.
Call your doctor immediately if the baby has projectile (forceful) vomiting and/or the vomit is bloody or green colored.
Marked by yellowish skin or eyes, jaundice usually develops between the second and fourth day after birth. Most hospitals check your newborn for jaundice before she goes home, but it can develop in babies anytime during the first week of life. You can check for jaundice by pressing gently on your infant’s forehead -- if the skin looks yellow, she may have a mild case.
Your pediatrician will check for jaundice during the first office visit, 2-3 days after the baby leaves the hospital. If you notice signs of yellowing in your baby before the doctor’s appointment, call his/her office immediately.
Too Much or Too Deep Sleep
While everyone wants a baby to sleep well, there can be such a thing as too much sleep or sleep that is too deep. It’s true that most newborns can sleep pretty much through anything but if your baby is sleeping more than usual or won’t wake up, it's a concern. Call the doctor if your baby won’t wake up after you’ve undressed her or prodded him a bit.
What Goes in Should Come Out
Not eating, not peeing, and concerning bowel movements are all related to digestion and very important to monitor. What goes in to the baby (breast milk/formula) should come back out of the baby in a wet or dirty diaper.
A healthy newborn has 6 to 8 wet diapers in 24 hours after day 4 of life. If the baby has fewer than that, he or she may be dehydrated.
Dehydration in a newborn is very serious. Signs that your baby is not getting enough fluids include:
- Fewer than three wet diapers per day
- Acting excessively sleepy or lethargic
- Dry mouth and lips
Other signs include sunken eyes and a sunken fontanel (the soft spot on your baby’s head), and no tears when crying.
Diarrhea can also lead to dehydration. Diarrhea in a newborn is often difficult to notice, especially in breastfed babies, because infants have frequent, soft stools. If you notice more frequent bowel movements (for example, several while eating) or very watery ones, it could be diarrhea. Call your pediatrician if it goes on for 6-8 diaper changes.
Some babies don’t have many wet or dirty diapers to monitor because they won’t eat. If your newborn refuses several feedings in a row or seems to be eating less than usual, check with your doctor.
Overall, my best advice as a mom and a doctor is to trust your instincts. You know your baby better than anyone and if you’re worried, the doctor needs to know. Call the office! It’s always best to err on the side of caution, especially when it comes to newborns. Pediatricians’ offices are used to calls from anxious parents and I promise we aren’t judging your ability to provide care. We want to help ease your worries or give you some helpful things to try. We are in this together, both working toward the ultimate goal of raising a happy, healthy child.