Given the reality that newborns and young babies have very few ways to communicate their needs, how can parents sort out when to worry? My advice to parents centers around the normal states (i.e., the infant job description) that babies all have when they are healthy:
- They eat and gain weight
- They make urine and bowel movements
- They are usually easily consoled
- Early on their native color is pink
- When awake they have good muscle tone and move spontaneously
- They have a normal body temperature
So in the early newborn period, if a baby departs from one of these states, then that should signify concern for a parent and a visit to your health care provider.
What to Watch For Warning Signs Parents Should Never Ignore
A baby who doesn’t want to feed – The brain grows about 180% in the first year of life and its nutritional requirements cause a feeding frenzy in all babies. If your infant suddenly refuses to feed, or dramatically drinks less, this should be brought immediately to your health care provider’s attention.
- Babies who don’t want to feed and lose weight are particularly concerning
- Babies who feed a lot and yet lose weight also may be at risk for malabsorption, genetic disease, or organ failure.
An acute reduction in urination, especially in a baby with vomiting or diarrhea sends up a red flag for potential dehydration. Conversely, a baby with vomiting/dehydration who is soaking diaper after diaper with urine may also have a problem. Babies naturally may reduce bowel movements to as few as 1/week by the first 1-2 months of life. If your baby’s belly is soft, appetite is good, and stool produced is soft, there is no issue. However, if there is any abdominal distension/distress/pain or recurrent vomiting associated with a drop-off of stool, consider this an urgent sign.
An inconsolable baby – A baby that cries periodically but can be consoled by feeding, changing, cuddling and rocking is a typical baby. However if baby is crying 24/7, grimacing, arching away from breast or bottle, and has no moments of contentment, this is a sign that baby is asking for help.
Pallor (a pale baby) – For the first 2 months of life, babies are pink from the donation of extra maternal blood cells from the placenta and umbilical cord. A natural anemia (physiologic nadir) occurs at about 2 months of age, kick starting the baby’s bone marrow to start its own production. If very early on baby is pale, sweaty, clammy, and especially inactive/less active, this may be a warning sign of heart disease or anemia, and worthy of a visit to your health care provider.
Prolonged jaundice – Most babies will retain a little of the red blood cell breakdown pigment called bilirubin in the first week or two of life, until their newborn livers start to recycle more efficiently. Jaundice head to toe lasting longer than a week, especially if accompanied by a baby who is feeding poorly or becoming less active/interactive is a cause for real worry. Often some jaundice may persist due to the effects of an unknown factor in breast milk, and be benign. However, if jaundice persists into the second month of life your doctor may want to reassess your baby’s bilirubin and make sure it isn’t stemming from liver or metabolic disease.
Vomiting – The great majority of babies have some element of reflux of milk from their tummies causing pretty frequent spitting up. Those babies who spit up but are happy, content and gaining weight at a good rate are of no concern and eventually will outgrow this condition. However a small percentage of babies who spit up may fail to gain weight, be unhappy a lot of the time, arch, grimace and act as if in pain. Your doctor may diagnose GERD (gastroesophageal reflux disease) and may prescribe antacid for your baby. Amongst spitty babies are a small subset who do so because of a metabolic disease or malabsorption – these babies tend to be inactive, irritable and struggle also to gain weight. Also concerning is a young baby who projectile vomits each and every time fed – this could signify a blockage or obstruction at any point along the GI tract and should be considered an emergency.
Fever – Fever (100.5 F, or greater, taken rectally) should be taken very seriously in a young infant, especially those under 3 months of age. Fever is usually a sign of infection or inflammation, and given the immature state of a baby’s immune system, a bacterial infection can become a very serious threat in a short period of time. The good news is that most fevers stem from viral infections, but those children identified to be suspect for bacterial infection often need rapid and expert evaluation and treatment.