Bringing your baby home from the hospital is a very exciting time. But having a newborn around can be stressful for lots of reasons. One of these is concern about the new baby getting sick. How will you know? It can be hard to tell when a newborn is sick. You may not know what your baby’s normal behavior is yet. This makes it difficult to tell if your baby’s behavior is not normal. Signs of serious illness in newborns can be subtle. They aren’t always easy to spot.

It is important to be aware of what signs could mean that your newborn is sick. Their immune system is not as strong after birth, so it’s harder for them to fight off infections. And once they do get an infection, it can get worse quickly. That’s why you should know what to look for.

Path to improved health

One of the main things to look for in your newborn is if they look or act in any way that seems abnormal to you. If this happens, call your baby’s doctor right away. Some of the ways they could look or act abnormal include:

• Any symptoms of illness. These include crying more often, irritability, coughing, diarrhea, or vomiting. If your newborn vomits green (bile), call the doctor right away.
• Changes in feeding. Newborns usually eat frequently. If you have to wake your newborn to eat or they can’t finish their feedings, they could be sick.
• If your newborn has a fever, especially over 100.4 F (38 C), call the doctor.
• Low body temperature. If your baby’s temperature falls below 96.8 F (36 C), call the doctor.
• Changes in how they cry. Their cry could be weak, sound strange, or be frantic without stopping.
• Weak sucking or not being able to suck for very long
• Sweating while they eat
• Sleeping more than normal (needing to be woken up to eat, for example)
• Decreased muscle tone or floppy limbs.
• Moaning or grunting noises when they breathe.
• Decreased urination (fewer wet diapers) and dry mouth (dehydration).
• Any change in color, such as pale, bluish, or gray arms and legs

It can be hard to tell if your newborn is sick. Pay attention and watch them closely for any of these signs of illness. If you have any question at all about your newborn, call their doctor.

Things to consider

While illness is not normal for a newborn, there are some conditions that are common in the first few weeks after birth. Watch your newborn for signs of any of these conditions and call their doctor if you see symptoms.

Abdominal distension. Your baby’s abdomen (stomach) should feel soft between feedings. If it feels swollen or hard, there could be a problem. It might be gas or constipation. But if they haven’t had a bowel movement for more than a day or two, or if they are vomiting, a swollen stomach could be a sign of an intestinal problem.

Blue baby. Your newborn may show mildly blue hands and feet if they are cold. They may go a little blue around the face, tongue, or lips if they are crying hard. But if they have persistent blue coloring plus breathing or feeding difficulties, it is an emergency. It could be a sign that the heart or lungs are not working correctly. Call the doctor or go to the emergency room right away.

Coughing during feeding. Your newborn may cough or sputter a bit as they learn and adjust to a feeding routine. But if they cough or gag regularly when they are trying to eat, there could be a problem in the lungs or digestive system.

Excessive crying. Newborns cry, sometimes for no reason. If your baby won’t stop crying, make sure they are fed, burped, warm, and have a clean diaper. Then try to hold them and soothe them. You can’t “spoil” a newborn with too much attention, so don’t hesitate to pick them up when they are crying. Soon you’ll get used to your newborn’s crying patterns. But if their crying sounds different, such as shrieking, or it goes on for an unusually long time, call your doctor.

Jaundice. Many healthy newborns have a yellowish tinge to their skin. This is called jaundice. It happens when a chemical called bilirubin builds up in the baby’s blood. Mild cases of jaundice are harmless. But if the buildup gets to be too much and it isn’t treated, it can cause problems. Jaundice normally appears on the face first, followed by the chest and abdomen, and finally it spreads to the arms and legs. Sometimes the whites of the eyes can become yellowish, as well. If you notice your baby developing jaundice, call the doctor.

Respiratory distress. In most cases, if your newborn is having trouble breathing, it’s because their nasal passages are blocked. This is normally easy to remedy by using saline nasal drops and a bulb syringe to suck the mucus out. But there are other signs that could mean your baby is having serious breathing problems. These include

• Fast breathing (more than 60 breaths in one minute). Remember, though, that babies breathe faster than adults.
• This is when the stomach muscles between the ribs get sucked in with each breath, making the ribs stick out.
• Flaring of the nose.
• Grunting while breathing.
• Persistent blue coloring.

Call your newborn’s doctor right away if he or she develops any of these signs of respiratory distress.

Questions to ask your doctor

• What signs should I look for that my newborn may be sick?
• How do I know what’s normal when I just brought him or her home?
• How do I know if my baby is vomiting or just spitting up?
• My baby cries all the time. Could they have colic?

Resources

National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development: What are some of the basics of infant health?

National Institutes of Health, MedlinePlus: Common Infant and Newborn Problems

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Any time your child becomes sick or injured, it can be scary. You may not know what to do. Should you take him or her to the doctor? Do they need to go to the emergency room? Sometimes the answer is clear. For example, if your child is unconscious or is choking, you should call 911 right away. But what if they have a high fever or a rash all over their body? That’s when it can be harder to know the best thing to do.

If you have any question at all about your child’s health, call their doctor. The doctor or a nurse will be able to tell you what level of care your child needs. This could be an appointment in the doctor’s office. It could also be a trip to an urgent care clinic or to the emergency room.

Keep in mind that a trip to the emergency room can be expensive. It can cost 3 times as much to go to the emergency room as it does for a regular office visit. In addition, the wait times are longer, and it is more stressful. At the same time, you want to make sure your child gets the medical attention he or she needs when they need it. That’s why it’s important to know the best place to seek care.

Path to improved health

There are common illnesses that many children will face at one time or another. Some of these can be cared for at home. Others may need to be seen by a doctor. Still others warrant a trip to the emergency room. But how are you supposed to know how serious the symptoms are? Here are some common illnesses that may cause you concern, and how you should handle them.

High fever (for children over 3 months of age)

Fever is one of the most common reasons parents call the doctor. By definition, a fever is a temperature of 100.4° F, taken rectally. If you take your child’s temperature under their arm, add one degree to get a more accurate number. Many doctors recommend not treating a fever unless it is above 101° F. This is because a fever is one of the ways the body fights infection. If your child has a fever, that means their immune system is doing its job.

Most doctors agree that what’s most important about a fever is not the number on the thermometer, but how your child is acting. If your child has a fever of 103° F but is acting normally and taking in fluids, it’s probably not much to worry about. But if your child has a 103° F fever, is lethargic and isn’t eating or drinking, then they probably need to be seen by the doctor. Also call your child’s doctor if your child has a fever of 104° F or higher. You should also call if the fever lasts 4 or more days in a row.

Widespread rash

A rash that just occurs in one or two places is probably not a cause for concern. But if your child has a rash that covers their whole body, they may need to see a doctor. Look for a rash that covers the body with small red or purple spots. If you press on them and they don’t turn white temporarily, it could be a sign of something serious, such as meningitis. This is especially true if your child also has a fever. Take your child to the emergency room right away if they have this rash.

Another rash you should watch out for is hives on the face. Hives form as part of an allergic reaction. If they form on the face, they could also form inside the mouth or in the throat, which could block your child’s airway. If your child has hives on their face, you should go to the emergency room. If your child has hives and is having trouble breathing, call 911.

Bad headache

If your child complains of a headache, rest or over-the-counter pain relievers should take care of it. If the pain lasts for several hours or is so bad that your child can’t do regular activities like eating, playing, or watching TV, they may need to see a doctor. Call your child’s doctor and see what they say you should do.

Most headaches happen because of tight muscles in the head, not because of a problem with the brain. But they can be a sign of a serious neurological problem. If your child has a bad headache along with confusion, blurred vision, or trouble walking, go to the emergency room. Also, if your child has a headache combined with a stiff neck, fever, vomiting, or a rash, they should be seen in the emergency room. These could be signs of a serious infection such as meningitis.

Stomach bug

Stomach bugs themselves are not often something to worry about. Although they can cause distressing vomiting and diarrhea, they are usually not dangerous. But too much vomiting and diarrhea can cause your child to become dehydrated. This can be dangerous. Sometimes children can get so dehydrated that they need intravenous (IV) fluids. Signs of dehydration include:

• Decreased urination (less than 2 wet diapers in a day)
• Sticky mouth
• Crying without tears
• Sunken eyes with dark circles underneath
• Listlessness
• Pale or clammy skin
• Sunken soft spot on the head in infants

Call your doctor right away or go to the emergency room if your child is showing these signs of severe dehydration, not taking fluids, and is becoming more lethargic.

Injuries

Injuries can be frightening for parents, but they don’t always mean you have to go to the emergency room. If your child can move the body part, if the bleeding has stopped, and if the pain can be controlled with over-the-counter medicine, they are probably okay. However, if your child shows any of the following symptoms, they should see a doctor right away:

• Numbness (for example, they hurt their wrist and now they can’t feel their fingers)
• Swelling
• Severe pain
• Inability to move the body part
• The body part looks deformed

Should I take my newborn to the emergency room?

In many cases, young babies are different when it comes to illness or injury. For babies ages 2 to 3 months and younger, almost anything out of the ordinary needs to be checked out right away. This could include a fever of 100.5° F or higher, problems feeding, or a bump on the head. Be sure to call your doctor if you have any questions about the health of your newborn.

Things to consider

If you aren’t sure if your child needs emergency services, follow this guide. It can help you know what to do.

Call 911 if your child:

• Is unconscious or unresponsive
• Is choking
• Has severe difficulty breathing
• Has an injury to the neck or spine
• Is not breathing or is turning blue
• Has bleeding that can’t be stopped
• Has a severe burn
• Has a head injury and has passed out, thrown up, or is not behaving normally
• Has possible poisoning (call your nearest poison control center first)

Go to the emergency room if your child:

• Is having trouble breathing
• Is passing out or fainting
• Has a seizure that lasts 3-5 minutes or more
• Has a severe allergic reaction with swelling and trouble breathing
• Has a high fever with a headache and a stiff neck
• Is a newborn and has a fever of 100.5° F or higher
• Is suddenly hard to wake up or is confused when you wake them up
• Is suddenly not able to speak, see, walk, or move
• Has a deep wound or heavy bleeding
• Has been bitten by an animal or snake
• Has smoke inhalation
• Has nearly drowned
• Has a serious burn
• Is coughing or throwing up blood
• Has a broken bone, especially if the bone is pushing through the skin
• Has numbness, tingling or weakness in a body part near an injured bone
• Has an unusual or bad headache or chest pain
• Has had vomiting or diarrhea followed by signs of severe dehydration
• Has fallen from a significant height and is injured
• Is experiencing mental health concerns, such as a desire to harm themselves or others

Go to urgent care or call your child’s doctor for:

• Nausea, vomiting, or diarrhea that you’re concerned about
• Coughs, colds, and sore throats
• Bladder or urinary tract infections
• Minor cuts, bumps, scrapes, or burns
• Earaches or ear infections
• Sinus pain
• Skin problems
• Joint sprains or muscle strains

Any time you’re not sure what to do, call your child’s doctor. They will help guide you to the best level of care for your child.

Go with your gut

Doctors encourage parents to trust their instincts when it comes to their child. You know your child better than anyone. If your child just isn’t acting right or is sicker than you’ve seen them before, they should be checked out. You don’t want to take them to the emergency room for minor illnesses. But sometimes you may think something is seriously wrong. If you do, it’s better to get them seen by a doctor right away and find out that they are not seriously sick.

Questions to ask your doctor

• What should I do if I don’t know how serious my child’s illness is?
• How long should I wait to hear back from a doctor on call?
• Should I take my child to an urgent care clinic or to the emergency room?
• Which emergency room is best to take my child to?
• When is a situation so serious that I should call 911?

Resources

MedlinePlus: When to Use the Emergency Room – Child

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What is a urinary tract infection?

A urinary tract infection (UTI) affects the kidneys, bladder, and urethra. Infection occurs when bacteria builds in the urinary tract when waste isn’t removed or the bladder isn’t emptied. When the bladder is involved in the infection, it is called cystitis. If the kidneys are involved, it is a more serious condition called pyelonephritis.

In general, UTIs are more common in girls. They can occur more often when children are potty training. Boys who have not been circumcised by the age of 1 are at risk of UTIs as well. Kids who have vesicoureteral reflux (VUR) may get UTIs more often. VUR is a condition in which urine can flow back into the urinary tract. VUR typically is present at birth.

Path to improved health

The sooner you detect a UTI, the quicker treatment can begin. It is important to know the symptoms. Common UTI symptoms include:

• Burning feeling or pain when you urinate
• Feeling like you need to urinate more often than usual
• Feeling the urge to urinate but not being able to
• Stomach pain
• Low back pain

Your child may not be able to communicate these symptoms. You should look for the following warning signs:

• Cloudy, dark, smelly, or bloody urine
• Fever or chills
• Vomiting
• Diarrhea
• Fussiness
• Poor appetite or less active
• Going through more diapers than usual
• Wetting clothes even though they are potty trained

Contact your doctor right away if you think your child has a UTI. The doctor will review symptoms and do a physical exam. The doctor also will do a urine test (urinalysis) to confirm the diagnosis. Getting a sample of urine can be hard in young children. There are several ways a doctor can collect urine.

• Catheterized specimen urine culture: The doctor places a thin plastic tube (catheter) into the child’s bladder.
• Subrapubic urine collection: The doctor inserts a thin needle through the child’s lower stomach into their bladder. This is usually a last resort when other methods have failed.
• Urine collection bag: The doctor places a plastic bag beneath the child’s vagina or penis to collect urine. This method is the least reliable.

Based on the test result, the doctor may perform other tests to rule out conditions similar to UTIs or determine the cause.

If your child has frequent infections, your family doctor may order an ultrasound or voiding cysto-urethrogram (VCUG) before referring you to a specialist. A VCUG allows your doctor to evaluate your child’s bladder and urethra using contrast and X-rays.

Treatment for a UTI depends on the cause and your child’s age. Infants often require treatment in the hospital. This is because they need antibiotics through an IV (intravenous) or catheter. Older children can take medicine at home.

Things to consider

There are several things you can do to help prevent UTIs in children.

• Keep your child’s genital area clean. This helps prevent bacteria from forming or spreading.
• Have your child drink plenty of non-sugar-sweetened fluids, especially water.
• Teach your child not to hold it too long when they need to go to the bathroom. A backup of urine in the bladder can lead to bacteria growth.
• Teach your child to wipe from front to back when they go to the bathroom. This is especially important for girls.
• Do not dress your child in clothes that are too tight.
• Always bathe your child after swimming or being active.

When to see a doctor

Call the doctor if your child’s symptoms don’t improve or get worse with medicine. If your child gets a UTI more than once in 6 months, the doctor may want to switch treatments.

Questions to ask your doctor

• How did my child get a UTI?
• How long will my child need to take antibiotics?
• What is the risk of my child getting more UTIs in the future?
• Does treatment vary if my child gets UTIs often?
• What conditions are related to UTIs?

Resources

Urology Care Foundation: Urinary Tract Infections in Children

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Bioterrorism is the use of bacteria, viruses, or germs to purposely harm large quantities of people or communities. These “weapons” are spread through air, water, or food sources. Bioterrorism is rare and is used to threaten people, governments, and countries. In bioterrorist attacks, usually only a small number of people may be injured or affected. However, many more become afraid. They change their behavior because of their fear.

Path to improved health

There are some things you can do to prepare for a bioterrorist attack. For example, take reasonable steps to prepare, just as you would for a tornado or hurricane. It is a good idea to have enough food, water, money (cash), and supplies (including any regular medications you may need) on hand to last you 3 or 4 days. You should also keep emergency contact information at home, work, and school.

Do not take antibiotics unless your doctor tells you to. Antibiotics prevent very few illnesses. They can have serious side effects. Overuse of antibiotics can actually make certain forms of bacteria difficult to treat. Also, antibiotics may interfere with medicines you are already taking.

While toxic gasses are used in bioterrorist attacks, you do not need to buy gas masks. They are intended only for short-term use when a deadly gas is released. They are not practical for use at all times. They are effective only if properly fitted. When not used properly, the masks can be dangerous. They can result in injury or suffocation, especially in people who have heart or lung problems.

Things to consider

Certain bioterrorism “weapons” include:

Anthrax. Anthrax is an infection caused by bacteria. Anthrax most commonly occurs in cattle and sheep. It is rare in humans. It is usually seen only in people who have contact with infected animals or who work with animal products such as wool, or hides. Anthrax can be a form of bioterrorism if someone deliberately spreads the bacteria in public places.

Anthrax takes 3 forms in humans, all of which are caused by the same bacteria. The form of anthrax infection depends on how the bacteria enter the body:

• Cutaneous (skin) infection caused by touching infected animal products, contaminated soil containing anthrax bacteria or the bacteria itself. It is the most common form of anthrax.
• Gastrointestinal (stomach and intestine) infection is caused by eating undercooked meat that is contaminated with anthrax bacteria.
• Inhalation infection is caused by breathing in anthrax bacteria.

None of the forms can spread from person to person. It is caused only by direct exposure to the anthrax bacteria. Anthrax symptoms can be similar to other illnesses. Symptoms include:

• Cutaneous anthrax starts as a red area on the skin, similar to an insect or spider bite. It may itch. Over a few days, the area becomes larger. Blisters may form, followed by a deep, black scab. The area is usually painless.
• Gastrointestinal anthrax typically causes vomiting, nausea, fever, and loss of appetite. It is followed by severe stomach pain, bloody diarrhea, and vomiting with blood.
• Inhalation anthrax starts out like the flu, with a fever, sore throat, dry cough, and muscle aches. Inhalation anthrax does not cause a runny nose. The symptoms are usually mild for a few days (and may even get better). The symptoms get much worse. People who have inhalation anthrax often have stomach pain. Within a few days, they will have difficulty breathing and go into shock.

If you have symptoms, call your doctor. If he or she thinks there is a possibility your symptoms are caused by anthrax, he or she will ask about your job and any travel. This information, plus an exam and possibly some lab tests or X-rays, will help your doctor decide whether you have anthrax infection. It is unlikely that the general public is in danger of anthrax exposure.

Fortunately, anthrax can be treated with antibiotics. The treatment and its success depend on the form of anthrax. Cutaneous anthrax is the least serious form. People can sometimes recover even without treatment. Gastrointestinal and inhalation anthrax are more serious and may cause death if not treated.

Anthrax gets the most news attention. However, other agents used in bioterrorism include botulism, plague, and smallpox. Some other agents have also been studied for use as biological weapons, such as tularemia, brucellosis, Q fever, and viral hemorrhagic fevers.

Smallpox: Smallpox is thought to be another more likely agent to be used in a bioterrorist attack. Smallpox is an illness caused by the variola virus.

Smallpox can be spread from person to person, once a fever and rash have developed. If you were vaccinated before 1972, you are not still protected. It is uncertain how long the vaccine is effective. There is no specific drug to treat smallpox. However, a vaccine given even a few days after exposure may prevent death. It’s important to get prompt medical attention if you think you’ve been exposed to smallpox.

• Fever.
• Headache.
• Fatigue.
• Diarrhea.
• Vomiting.
• A specific rash.

The rash starts out as flat red spots and turns into blisters. The blisters contain clear liquid and then progresses to pus. Routine vaccination for smallpox was stopped in 1972 in the U.S. The disease had been wiped out.

Botulism: This rare but serious illness is a bacterial poison that is often distributed through food sources. It forms in the soil.

Botulism symptoms include:

• Double or blurred vision.
• Drooping eyelids.
• Slurred speech.
• Difficulty swallowing.
• Dry mouth.
• Muscle weakness.

Ebola: Ebola is a severe and often fatal virus. It spreads from an infected animal to a human and then from human to human through direct contact with a patient’s blood or secretions.

Ebola symptoms include:

• Fever.
• Headache.
• Joint and muscle aches.
• Weakness.
• Diarrhea.
• Vomiting.
• Stomach pain.
• Loss of appetite.

Plague: Plague is a bacterial infection. The bacteria are found mainly in rats and in the fleas that feed on them. There are three types of plague. However, pneumonic plague is the most common bioterrorist agent. It can spread from person to person.

Plague symptoms include:

• Fever.
• Headache.
• Weakness.
• Chest pain.
• Cough.
• Bloody mucous discharge.

Vaccines for anthrax and smallpox are not available at this time. However, smallpox vaccines have been made so that supplies are available to high risk groups if needed. Because there are some risks with the smallpox vaccine, the Centers for Disease Control and Prevention (CDC) will decide if it should be given on an individual basis. The anthrax vaccine is controlled by the U.S. Department of Defense. It is only available for military personnel at high risk of exposure in combat settings. Also, it’s available to people who work with anthrax in a laboratory setting.

Questions to ask your doctor

• How quickly do symptoms appear after exposure to anthrax or smallpox?
• If I am pregnant and exposed, can it harm my unborn baby?
• Do all military personnel receive smallpox and anthrax vaccines?

Resources

Centers for Disease Control and Prevention: Bioterrorism

National Institutes of Health, MedlinePlus: Biodefense and Bioterrorism

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