Should you call the doctor or wait and see? Five symptoms in your infant you don’t want to ignore.
Any discussion of this topic needs an immediate disclaimer: the short answer is to call the doctor whenever you are worried. No list can cover every possible scenario, and most, like this one, will cover the most obvious situations. As parents, you know your child better than anyone else. Your instincts should never be ignored. If you are worried, call, regardless of how silly you feel the question is. You may end up getting a serious problem detected earlier. At the least, your concerns will be addressed and you will have learned something in the process. That stated, here are a few situations to watch out for:
Fevers are taken very seriously in young infants. If your child feels warm, is acting fussy, or seems off, take his or her temperature rectally. You should be comfortable taking a temperature this way, as it’s the most accurate way to detect a fever in a young infant, and fever can sometimes be the only sign that an infection is brewing.
Any temperature above 100.4°F or 38°C is considered too high and should be explained. If your infant has been well bundled and you suspect he is overheated, remove some of the layers, wait 20 minutes, and retake the temperature, but don’t ignore even the slightest fever in the first few months of life.
Refusing to Eat
Newborns need to eat every few hours: as often as every one and a half hours for breastfed babies and only slightly less often for bottlefed babies. During the first month of life, the interval between feeds should not be longer than four hours, day or night. An infant who seems hungry and tries to eat but then pulls away from the breast or bottle may be having trouble breathing or may be in pain during sucking. An infant who isn’t interested in eating way beyond his or her usual interval is just as worrisome. Not only is loss of appetite is an early sign of illness, but it can lead to fatigue, weakness, and dehydration. Your pediatrician should hear about either of these situations.
Diarrhea and Dehydration
Normal newborns’ stools shouldn’t be hard or formed, but should be more the consistency of mustard and can occur after every feed. Diarrhea, then, is hard to define on an absolute basis, but is considered when stools are more watery or more frequent than usual. One looser than normal stool may not mean much, but several in a row probably do. The cause is often an intestinal viral infection, but more worrisome possibilities include a bacterial infection or food intolerances.
Regardless of the cause of the diarrhea, dehydration can follow very quickly in a small child. The presence of a fever can bring about dehydration even sooner. In general, the younger the child, the faster he or she dehydrates.
Early signs of dehydration are a decrease in the frequency and quantity and a darkening of the urine. Though in an infant with watery stools, this can be hard to gauge. Other signs are a dry-appearing, “sticky” mouth and not producing any tears during crying. Parents are well advised not to wait until any signs that their child appears dry, but to call early if they think there is a risk of dehydration.
Rashes are quite common in the young infant and, fortunately, most of them are more annoying than worrisome. Heat rashes, cradle cap (seborrhea) eczema, and infantile acne are all common, but none are emergencies.
The following types of rashes do need immediate attention, however. The first is any rash that may represent a serious allergic reaction. Though not that common in very young infants, hives (pink, itchy, blotchy spots that come and go in different locations) shouldn’t be ignored, as they signal a reaction that can progress to swelling of the face, hands, mouth, or throat and may ultimately interfere with breathing.
A second type of rash that needs attention is one that doesn’t “blanch,” meaning gently pulling the skin on either side of the rash in opposite directions doesn’t make the pink, red, or bluish color of the rash disappear. This may represent leaking blood from the vessels from a serious cause.
Finally, any area of the skin that seems infected—hot, tender, swollen, with or without area of pus—regardless of whether it was preceded by another type of rash, needs to be evaluated.
True vomiting in an infant is serious, but this can be confused with regurgitation or reflux. Many infants, due to the immaturity of their digestive systems, have some degree of reflux, where recently consumed milk comes back up through the mouth or nose. Often called “spitting,” it is painless, happens without warning, and is more “gentle” than most episodes of vomiting. It should never consist of blood or bile or anything more than the milk just taken in.
Any vomiting that is forceful or that contains the green substance called bile or any blood is a potential emergency in a very young infant and needs an immediate evaluation. The same is true for any vomiting or spitting that is frequent enough to bring up a concern for dehydration.
Again I stress, when in doubt, call your doctor. Parenting is a situation of lifelong learning, and it is better not to learn the hard way when it comes to your infant’s health.