What warning signs may mean a problem with a newborn?

Your newborn baby is going through many changes in getting used to life in the outside world. This adjustment almost always goes well. But there are certain warning signs you should watch for with newborns. These include:

• Not urinating (this may be hard to tell, especially with disposable diapers)

• No bowel movement for 48 hours

• Fever (see below for information about fever and children)

• Breathing fast (for example, over 60 breaths per minute) or a bluish skin coloring that doesn’t go away. Newborns normally have irregular breathing, so you need to count for a full minute. There should be no pauses longer than about 10 seconds between breaths.

• Pulling in of the ribs when taking a breath (retraction)

• Wheezing, grunting, or whistling sounds while breathing

• Odor, drainage, or bleeding from the umbilical cord

• Worsening yellowing (jaundice) of the skin on the chest, arms, or legs, or whites of the eyes

• Crying or irritability that does not get better with cuddling and comfort

• A sleepy baby who cannot be awakened enough to nurse or bottle-feed

• Signs of sickness (such as cough, diarrhea, pale skin color)

• Poor appetite or weak sucking ability

• Vomiting, especially when it is yellow or green in color

Every child is different. Trust your knowledge of your child and call your child’s healthcare provider if you see signs that are worrisome to you.

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher

• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age

• Temperature of 104°F (40°C) or higher in a child of any age

• A fever of ___________ as advised by the provider