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.

Crying

Babies cry for many reasons, including hunger or thirst, but if they are inconsolable or their cries are sudden or sound particularly unusual, it may be a sign of illness. Colic in infants up to 3 months old also causes periods of intense crying and general irritability, usually around the same time every day.

Fever

Respiratory illnesses such as colds, croup or pneumonia, ear infections, stomach bugs, urine infections, and many other bacterial and viral illnesses may all cause fever. To check for fever, take a baby's temperature rectally with a digital or glass rectal thermometer. It is the easiest and most accurate way. (In an attempt to remove mercury from the environment, mercury thermometers should no longer  be used. ) A rectal reading of 100 degrees F or less is considered normal. If a child is 3 months or younger with a rectal temperature of 100.4 degrees F or higher, call the child's health care provider immediately. Call the provider if a child between 3 months and 6 months has a fever of 101 degrees F or higher. For young children over a year old, call the provider if a fever persists for more than 24 to 48 hours (or if fever is accompanied by any other worrisome symptoms).

Fever in children between 6 months and 5 years can trigger febrile seizures (convulsions), which may last for a few minutes or may be over in seconds. They are usually harmless, but inform the child's health care provider. Call for emergency help if seizures are severe, cause difficulty breathing, or last over 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.

Abnormal Sleep

Newborns spend most of their time sleeping, but if a baby is rarely alert or does not wake up as expected for feedings, consult the child's health care provider.

Poor Appetite

If a baby refuses to eat and misses several feedings, it may be a sign of illness.

Umbilical Cord Infection

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

Diarrhea and/or Vomiting

These could signal a viral or bacterial infection of the intestine an obstruction or other problem. In some cases, the child's health care provider may exam the baby's stool for bacteria, which requires treatment. Viral causes require no treatment and will resolve on their own in a week or so. Persistent diarrhea may lead to dehydration.

Irregular Stools

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

Urination

Babies should wet at least four diapers a day. If a baby 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 a diaper is typically a sign of highly concentrated urine and usually no cause for concern, but if staining persists, talk to a health care provider. If there is blood in the urine or a bloody spot on a diaper, call a health care provider 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 a 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, the infant may seem fine between bouts of pain, but soon becomes fatigued and lethargic. The baby may vomit and may pass bloody stool (sometimes described as "currant jelly" stool). Fever (often not present initially) may appear. Shock may follow.

What to Do

To keep your baby as healthy as possible, breast-feed your child if possible, which will provide him or her with antibodies and enzymes that help protect against illness or use a commercial infant formula such as Similac or Enfamil. Don't allow smoking around a baby. Adhere to a baby's vaccine schedule and regular checkups. In general, call your child's health care provider if the baby seems especially sluggish, is refusing food or drink, is vomiting (not just spitting-up) or has diarrhea, or has a fever. Remember, if you’re worried there probably is a good reason even if you don’t recognize it. This is a time to talk to the baby’s doctor or other available healthcare worker.

Self-care Steps for Baby/Warning Signs

• If the baby seems distressed, hold the infant 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 the baby, and from handling the baby and his or her toys.