When you take your newborn home from the hospital, no one gives you a rulebook about how to care for them. What if they get sick -- will you see the signs? How will you know whether they need to see a doctor when they can’t tell you what’s wrong?
Take a breath. Once you know what to check, you’ll feel more ready about when to make that call.
“Infancy is an especially vulnerable time of life, as infants’ immune systems are still maturing,” says David L. Hill, MD, a pediatrician in Wilmington, NC. “Especially before they have had all their vaccines, they may have a harder time fighting off some infections than older children.”
Babies and toddlers need a doctor’s care for certain problems that can be treated at home in older children, says Alfred Sacchetti, MD, spokesperson for the American College of Emergency Physicians.
If your baby or toddler has these symptoms, see a doctor right away:
Babies shouldn’t get fevers in the first 3 months. If your infant has a rectal temperature of 100.4 F or higher, visit the doctor or ER.
“It’s not because the fever itself is dangerous but because in newborns, a fever can be the only sign of a serious bacterial infection,” Hill says.
Once your baby passes the 3-month mark, you can wait a day before calling the doctor.
“A fever that lasts over 24 hours and does not come with cold symptoms should be evaluated,” Hill says.
The way your baby or toddler acts should help you decide whether to go to the doctor.
“The height of the fever doesn’t play into it -- it’s the appearance of the child,” Sacchetti says. “The way they respond to you. The way they look. The way they act. The child that normally can’t wait to go outside and play is just laying on the couch, moans, and rolls over -- that’s a huge change in behavior.”
Newborns often get jaundice, which can turn the skin or eyes yellow. This happens because newborns’ livers don’t always work at full speed, so they can’t break down a substance in the blood called bilirubin.
In most cases, jaundice is mild and goes away on its own. Doctors check for it before you bring your little one home from the hospital, and a few days later at your baby’s first checkup. Beyond that, if you notice that your baby’s skin or eyes look yellow, bring them back to the doctor.
“It’s very hard to tell, just looking at a child, whether the jaundice is normal or a level that needs to be treated,” Hill says.
In some cases, extra feedings help end jaundice. Other times, your baby needs to be exposed to special lights to help remove bilirubin from the blood.
3. A Certain Rash
Most rashes fade for a moment when you press on them with your finger. If your baby or toddler has tiny red dots on their chest, back, arms, or legs that don’t fade when you press on them, go to the doctor or ER right away.
“This type of rash can indicate a serious infection like meningitis or a disease of the blood vessels,” Hill says.
A rash that won’t fade that appears on your child’s face or neck is less of a worry if your child has been coughing or vomiting, but you may want to see a doctor anyway.
“When they coughed or vomited, they broke blood vessels in the skin,” Sacchetti says.
4. Vomiting or Diarrhea
If your baby or toddler vomits or has diarrhea, bring them to the doctor or ER sooner than you’d bring an older child. A key warning sign is dry diapers: If they aren’t peeing, they're likely dehydrated.
“An older child is going to be able to tolerate a day or so of pretty bad diarrhea, but an infant can get dehydrated in under 12 hours with severe diarrhea,” Sacchetti says.
See a doctor for strange-looking vomit or diarrhea.
“Seek care for blood or bile in the vomit,” Hill says. “For diarrhea, seek care if there is blood or mucus in the stool.”
5. Breathing Problems
Babies who have trouble breathing often inhale and exhale very quickly, and a spot in the middle of the chest sinks in.
“If you can see the space between his ribs being pulled in with every breath, that’s a reason to go and get medical help at the emergency department,” Sacchetti says.
If your child can’t stop coughing, take them to their doctor or the ER, in case they have asthma or they inhaled an object.
“Not everybody who has asthma wheezes -- some of them cough,” Sacchetti says. In a toddler, it may be because of an object that they breathed in.
Babies can’t let you know whether they have headaches, but toddlers can.
“Toddlers may hold their heads repeatedly or use their words to indicate pain,” Hill says. “Headache is a rare complaint in toddlers and should definitely be investigated.”
Some research suggests that migraines may be linked to colic. But it could be something else entirely. For instance, “it could be sinus infection,” Sacchetti says.
7. Nonstop Crying
If your baby or toddler cries all day and you can’t comfort them, call your doctor first to get advice or find out if you need to come in. If you can’t reach your doctor, you can go to the ER.
“Inconsolable crying is always a symptom that deserves rapid evaluation,” Hill says. Causes range from a hair wrapped around the toe to bowel problems.
Once you know the reason, you’ll be that much closer to resolving it.