Newborn Warning Signs: When Not to Wait

Signs That Mean Come In Now

The World Health Organization lists the danger signs in young babies that mean a baby needs to be assessed in hospital straight away. If your baby has any one of these, come to Limi Children's Hospital now, day or night. If you cannot get here quickly, go to the nearest emergency department. Have someone else drive if you can, so you can watch your baby, and call 0813 408 5400 on the way so the team can prepare.

Signs That Mean See a Doctor Today

Feeding Less

A healthy newborn feeds 8 to 12 times in 24 hours and wakes for most feeds. From about day five, a baby getting enough milk has at least six heavy wet nappies a day and passes yellow, seedy stools. Fewer wet nappies, dark urine, or a baby you have to keep waking and who falls asleep at the breast within a minute or two are signs that feeding is not going well. It can be a latch problem or the first sign of illness. Either way, a doctor needs to see your baby today.

Jaundice That Is Spreading

Many newborns turn a little yellow from day two or three, and it fades by two weeks. Press gently on the skin of the forehead, chest and then the legs in daylight: if the skin looks yellow as your finger lifts, the jaundice has reached that level. Yellow that spreads below the tummy button needs a blood test the same day. Yellow on the palms or soles, or a yellow baby who is very sleepy or not feeding, needs to come in now. Read the full guide to newborn jaundice.

The Cord Looks Infected

A drying cord stump can look a little moist and may bleed a drop or two when it falls off. Redness that spreads more than a finger-width onto the skin of the tummy, swelling, pus or a foul smell are signs of infection, which can spread quickly in a newborn. Keep the cord clean and dry. Put nothing on it unless a health worker has given you chlorhexidine for it — see caring for your newborn.

Sticky Eyes

A little crusting at the corner of the eye is common and clears with cooled boiled water. Eyes that are red, swollen and producing yellow or green discharge in the first two weeks need to be examined, because some eye infections picked up at birth can damage sight if they are not treated.

What Is Normal in a Newborn

These things worry almost every family and are almost always fine:

• Irregular breathing. Newborns breathe fast, then slow, and may pause for up to 10 seconds while asleep. Pauses of 20 seconds or more, or pauses with colour change, are not normal.
• Sneezing, hiccups and snuffly noises. Newborn noses are small; sneezing is how they clear them.
• Weight loss in week one. Babies can lose up to a tenth of their birth weight in the first days and are usually back to it by 10 to 14 days.
• Milk spots and newborn rash. Tiny white spots on the nose and a blotchy red rash that moves around the body are harmless and clear on their own.
• Startling. Sudden flinging out of the arms at a noise or movement is a normal reflex. A fit looks different: repeated rhythmic jerking that does not stop when you hold the limb.
• Crossed eyes now and then. Common until three to four months; eyes that are always turned need checking.
• Swollen breasts or a small bleed in girls. These are caused by the mother's hormones and settle in a week or two.

Taking a Newborn's Temperature

Touch is not reliable in a newborn — a baby can feel warm to your hand and have a normal temperature, or feel normal and have a fever. Buy a digital thermometer before the baby comes home. It costs little.

1. Use a digital thermometer under the arm. Mercury thermometers are unsafe if they break. Forehead strips are not accurate enough for newborns.
2. Place the tip in the middle of the armpit. Hold the arm gently against the side so the tip touches skin, not clothing.
3. Wait for the beep, then read it. A normal temperature under the arm is roughly 36.5 to 37.5 °C.
4. If it is high, undress the baby by one layer and check again after 15 minutes. Over-wrapping can raise the reading. If it is still 38 °C or more, come in. If the baby seems unwell, do not wait to check again — come in now.

If your baby feels cold, or reads below 36.5 °C, warm them skin to skin against your chest with a cloth over both of you. A newborn below 35.5 °C, or one who does not warm up, needs to come in.

Counting a Newborn's Breaths

Watch the tummy rise and fall while the baby is calm or asleep, and count for a full minute — breathing in newborns is too irregular to count for 15 seconds and multiply. 60 breaths or more in a minute is fast breathing and needs to be seen. Our breathing counter counts the minute for you and tells you what the number means for your baby's age.

While you count, look at the chest just below the ribs. If the skin sucks in with each breath, or the nostrils flare, or the baby grunts at the end of each breath, the baby is working hard to breathe.

Remedies to Avoid in the First Weeks

Relatives, neighbours and chemists give well-meant advice. Some of it can make a newborn seriously ill. In the first six months, a baby needs nothing but breast milk, or formula if a health worker has advised it.

On the Way to Hospital

• Keep the baby warm, ideally skin to skin on an adult's chest with a wrapper over both of you, strapped safely.
• Have someone else drive so one adult can watch the baby's breathing and colour.
• Keep offering the breast if the baby is awake and willing, unless they are vomiting everything.
• Bring the antenatal and birth records, the child health card, and any medicine the baby has been given, including herbal ones.
• If the baby stops breathing or goes blue, stimulate them by rubbing the back and soles of the feet. If they do not start breathing, start baby CPR if you know how (see CPR), and get help from anyone nearby.

Limi Children's Hospital assesses sick babies day and night and has a neonatal intensive care unit (NICU). Call 0813 408 5400 as you set off so the team is ready for you.

Questions Parents Ask