By: Shanna McGinnis, MD
Becoming a parent is a tremendous responsibility. Your baby is dependent on you for his or her every need. Every baby is different and they do not come with a manual; however, there are a few general rules that apply. Listed below are some common concerns that may come up in the first couple months that necessitate a call to your baby’s doctor.
Fever
The most accurate way to measure a newborn’s temperature is with a digital rectal thermometer. The American Academy of Pediatrics has a helpful set of instructions, including pictures, about taking a rectal temperature on healthychildren.org. A temperature at or above 100.4° F is considered a fever and could be a sign of serious infection; the baby’s doctor should be notified immediately. Do not give any fever reducer until a physician or healthcare professional instructs you. Likewise, a low temperature, less than 97°F, can also be a sign of infection.
Poor Feeding
Breastfed newborns eat more frequently, about every 2-3 hours, than bottle fed infants, who eat about every 3-4 hours. Whether breast or bottle, babies gradually eat more and more during the first weeks of life. If a newborn is not eager to eat or difficult to arouse to eat at least every 4 hours, or if he or she is taking smaller quantities or nursing for shorter durations, you should call the baby’s doctor.
Decreased wet diapers
It is not unusual for a newborn to have 8-12 wet diapers a day. Breastfed babies may have bowel movements as often as every feeding. A decrease in wet diapers is a more urgent matter, however, than constipation. Decreased urination indicates dehydration and may be related to poor feeding. Less than 4 wet diapers in a 24-hour period for a newborn or a significant decrease from your baby’s norm is a reason to phone your baby’s doctor.
Jaundice
Yellowing of the skin, or jaundice, is a condition seen in almost all newborns to some extent. There is a substance in the bloodstream called bilirubin that is a by-product of red blood cell breakdown. Since newborns’ bodies are immature, bilirubin is not removed from the bloodstream as quickly. When this occurs, their skin turns yellow, progressing from head to toe; therefore, a baby with yellowing of his or her face, chest, and belly has a higher bilirubin level than a baby with yellowing of the face only. The whites of the eyes and gums can also be affected and is a good place to check for jaundice in darker skinned infants. Before newborns are discharged home from the hospital, a bilirubin level is checked. Make a note of how your baby’s skin, eyes, and gums look at that time so you can monitor your baby for increased yellowing of the skin. Jaundice is more common in breastfed infants, but is not usually a reason to discontinue breastfeeding. Oftentimes, the infant is not getting enough milk and may require feedings as often as every 2 hours. It is very important to notify your doctor if you feel the level is increasing. When untreated, a very high level can lead to irreversible brain damage. The treatment is usually as simple as placing the baby under a special light to help break down the bilirubin faster. This treatment can sometimes be done at home without re-hospitalization.
Breathing problems
If your baby is experiencing unusual breathing, it may be helpful to suction his or her nose with a bulb syringe. If this maneuver fails to resolve the matter, a call to the doctor may be in order. Specific concerns include flaring of the nostrils, grunting, sucking in under the rib cage or around the collarbones, or fast breathing. A fast breathing rate in a newborn is more than 60 breaths in one minute. Count for a full minute because newborns sometimes exhibit “periodic” breathing where they have pauses in breathing, for up to 10 seconds, followed by several rapid breaths. Apnea, or absence of breathing, is defined as a pause in breathing for 20 seconds or longer. This is of particular concern when a baby has accompanying skin color change (blue, ashen, or pale) or becomes limp or floppy. This is a much more significant event and warrants a 9-1-1 call, especially if the symptoms do not resolve.
This is not a comprehensive list, but represents the most common reasons a newborn’s parents should talk with the baby’s doctor. You may have noticed that many of these issues are interconnected and one problem can lead to another. For this reason, you should learn what to expect from your baby, trust your parental instincts, and if something does not seem right, do not delay – call your baby’s doctor.