Symptoms in Infants: Normal vs Worrying

Normal newborn behaviors that worry parents

Common symptoms and what they can mean

Fever

Fever means a temperature of 38 °C (100.4 °F) or higher. Use a digital thermometer in the bottom (rectal) for the most accurate reading in young babies. In a baby under 3 months, fever can be the only sign of a serious infection such as a urinary infection, meningitis or neonatal sepsis, so it always needs urgent medical review. See infant fever.

Crying and fussiness

All babies cry, and crying usually peaks around 6 weeks. Colic is crying for more than 3 hours a day, 3 days a week, in a healthy baby, usually in the evening. It settles by 3 to 4 months. A sudden change in cry, high-pitched crying, or crying with fever, vomiting or poor feeding needs checking. See infant crying.

Spitting up and vomiting

Spitting up small amounts is normal in a baby who is gaining weight. Warning signs are forceful (projectile) vomiting after every feed (possible pyloric stenosis), green vomit (possible bowel blockage), blood, or vomiting with poor weight gain or dehydration.

Jaundice

Yellow skin and eyes are common in the first week as the liver matures. Jaundice in the first 24 hours, jaundice that spreads to the belly or legs, a very sleepy baby who feeds poorly, pale stools or dark urine, or jaundice lasting beyond 2 weeks (3 weeks in premature babies) needs prompt testing. See neonatal jaundice.

Breathing problems and cough

Colds are common. Bronchiolitis, usually caused by RSV, causes cough, wheezing and fast breathing in babies under 1, especially in winter. Watch for signs of working hard to breathe: grunting, flaring nostrils, sucking in between the ribs or below the breastbone, and feeding difficulties.

Rashes

Most baby rashes are harmless: baby acne, milia, heat rash, eczema, diaper rash and cradle cap. A rash that does not fade under a pressed glass, with any signs of illness, may be meningococcal disease and is an emergency.

Feeding problems and dehydration

Signs of dehydration include fewer wet diapers, dark urine, a dry mouth, no tears, a sunken soft spot and unusual sleepiness. Newborns should have at least 6 wet diapers a day after the first week. Poor feeding is a common early sign of illness in young babies.

Diarrhea and constipation

Breastfed babies' stools are often loose, yellow and seedy, and frequency varies widely. Diarrhea means a sudden increase in watery stools. Constipation is hard, pellet-like stools, not straining or infrequent soft stools.

How to check your baby

• Temperature: rectal reading for babies under 3 months is most reliable.
• Breathing: count breaths for a full minute while the baby is calm. Over 60 a minute in a newborn is fast.
• Color: check lips and tongue for blue or gray tinges.
• Feeding and diapers: count feeds and wet diapers.
• Alertness: a well baby wakes for feeds and responds to you.
• Skin: press a glass on any rash to see if it fades.

When to call the doctor

Call your pediatrician or nurse line for advice whenever you are unsure. Doctors would rather see a well baby than miss an ill one. The red flags in the triage box above, especially fever under 3 months, difficulty breathing, poor feeding and unusual sleepiness, need same-day or emergency care.

Medicine safety in babies

• Do not give any medicine to a baby under 3 months without speaking to a doctor.
• Acetaminophen (paracetamol) can be used from 2 to 3 months as advised by your doctor, and ibuprofen from 6 months, at the dose for the baby's weight.
• Never give aspirin, honey (under 12 months) or cough and cold medicines to babies.

Frequently asked questions

What symptoms in a baby are an emergency?

Call 911 if your baby has blue or gray lips, pauses in breathing, is struggling to breathe, is floppy or hard to wake, has a seizure, a rash that does not fade when pressed, or green or bloody vomit. Fever of 38 °C (100.4 °F) or more under 3 months needs urgent medical care.

Is it normal for a newborn to sneeze a lot?

Yes. Newborns sneeze often to clear their small nasal passages of mucus, milk and dust. Sneezing alone is not a sign of illness. If it comes with fever, poor feeding or breathing difficulty, see a doctor.

How do I know if my baby is sick?

Signs a baby may be ill include fever, feeding less than usual, fewer wet diapers, being unusually sleepy or irritable, fast or labored breathing, repeated vomiting and a change in color. Trust your instincts: if your baby does not seem themselves, contact your doctor.

Why does my newborn breathe irregularly when sleeping?

Newborns often have periodic breathing: fast breaths, then slower ones, then a short pause of under 10 seconds. This is normal and improves over the first months. Pauses of 20 seconds or more, or color changes, need emergency care.

When should I worry about my baby's jaundice?

Contact your doctor if jaundice appears in the first 24 hours, spreads to the belly, arms or legs, the baby is very sleepy or feeding poorly, stools are pale or urine is dark, or jaundice lasts more than 2 weeks. A simple skin or blood test measures the level.