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Signs of Illness

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New parents spend a lot of time worrying about how they'll cope if their baby gets sick. How will they know if their baby is really ill? What will they do?

Fortunately, if you take a little time to educate yourself now on the signs of possible illness in babies, you'll feel a great deal more confident when an illness does show up. This list of symptoms will help you determine when to watch and wait, and when to call your health care provider.

Keeping your baby as healthy as possible is something you do in partnership with your health care provider. Remember, all providers want to help, and you should never hesitate to seek their professional advice or attention when concerned.

When calling your health care provider to discuss your baby's signs of illness:

    • What: Be prepared to report precisely what your baby's symptoms are.
    • How long: Report how long these symptoms have been apparent.
    • If you call after hours, you'll need to give more background to the doctor or other practitioner on call. Give your baby's age, and describe any previous conditions or health concerns.
    • Stay calm, and be as specific as you can.
    • Most of the time, the health care provider will want to know if your child has a fever, how high it is, and how long it's been elevated. Check your child's temperature before you call, unless it's a true emergency.

Young babies, particularly those under 3 months of age, have a different set of concerns for when to call the provider than those of older babies and toddlers, so we've included the following two sections: Signs of Illness in Very Young Babies, and Signs of Illness in Babies and Toddlers.

  Checklist of Serious Symptoms (in Any Child or Adult)

  Signs of Illness in Very Young Babies

  Signs of Illness in Babies and Toddlers

Checklist of Serious Symptoms (in Any Child or Adult)!

If your baby or toddler has any of these symptoms, call your provider right away, or go to the nearest emergency room. All of these symptoms require immediate attention.

    • Stiff neck.
    • Bulging fontanel — if the soft spot comes up firmly when a non-crying baby is held at a 45-degree angle.
    • Lethargy — if your baby is hard to awaken or isn't responding to you.
    • Unconscious, unarousable.
    • Fever over 105 degrees F.
    • Tender, swollen abdomen or testicles.
    • Purple spots or blotches (not bruises — except bruises around the head).
    • Won't walk.

      • Cries when touched or moved.
    • Blue lips not relieved by warming.
    • Croupy (scratchy, labored breathing) at rest.
    • Breathing over 60 breaths per minute, labored breathing, audible wheezing, or a squeak when breathing out.
    • Crying inconsolably for more than two or three hours.

Signs of Illness in Very Young Babies

Illness in an infant under 3 months of age needs special attention. The signs of illness can be subtle and confusing, and the illness can take a turn for the worse much faster than in older children. Babies are remarkably resilient, and serious illness is rare, but it's good to have some special guidelines with which to work. Below are some signs to look for:

A fever in a small infant must be taken seriously. Rectal temperatures over 100.4 degrees F are considered elevated. Don't use an ear thermometer at this age. Use a rectal or underarm thermometer.

If your baby's temperature is up, remove one layer of clothing and check his temperature again in 15 to 20 minutes. If it isn't back to normal in that time, call your health care provider. It may be nothing, or it may be a simple cold, but let your health care provider know all the same — just in case.

Be prepared to report if your baby is eating well, easy to awaken, alert, or showing any other signs of illness (see below). In a very young infant, a fever by itself is more likely to be due to over-dressing than to an illness. Also, let your health care provider know whether your baby has been exposed to any illnesses in the last week or two and whether he has any chronic health problems. Don't give him acetaminophen or ibuprofen at this age. Follow your health care provider's advice on assessment and treatment.

Low Temperature
Little babies may react to an infection with a drop in temperature. If his temperature is less than 97.4 degrees F, wrap him up and check again in 15 to 20 minutes. If your baby's temperature doesn't come up, or if it does, but not for long despite his being appropriately dressed, call your health care provider immediately. Report any other signs of illness and any exposure to illness as stated above.

Rapid Breathing
Young babies react the same way as older infants do when they have breathing problems — by breathing harder and faster. However, they run out of gas sooner, and they have a tough time keeping up with the demand for faster breathing that results from chest or heart problems. Anything over 60 breaths per minute is considered fast for a young infant. Call your health care provider if you notice rapid breathing in your very young baby. If the space between or underneath his ribs goes in with each breath, this adds to the concern. Lift up his shirt to check for this.

Poor Feeding
Every baby has a less-than-satisfactory feeding once in a while. But if your young infant has two of these in a row, and this is a real change for him, it's time to let someone check it out. If he's showing additional signs of being unwell, or if he won't wake up for a feeding, don't wait — call your health care practitioner right away. If you are breastfeeding a newborn, don't hesitate to call your health care provider if your baby is not feeding well.

Most babies spit up, and some will vomit once in a while. If your baby expels a tablespoon or more of vomit, if vomiting occurs twice in a row, or if he shows other signs of illness, call your health care practitioner. Bright yellow vomit is a serious sign that you should call right away. Vomit that shoots across the room (yes, really shoots) can be a sign of stomach blockage. Let your health care provider know.

No Urination
If a young baby goes for six hours without passing urine, or doesn't have six wet diapers in 24 hours after the first day of life, he may be getting dehydrated. Call your health care provider.

Some of the newer, highly absorbent diapers will be dry to the touch when you feel inside — they are supposed to keep the wetness away from your baby's skin. If you're worried that your infant isn't urinating, put a piece of paper towel inside the diaper for four to six hours, and check it frequently for wetness. If the paper towel stays dry, pick up the phone and call your health care provider.

Signs of Illness in Babies and Toddlers

"Acting Sick"
This is the most important observation you'll make in assessing your baby's possible illness, but unfortunately, it's also the most difficult to quantify. Telling your health care provider that your baby "just isn't acting normally" is very important information. Conversely, if you observe that your baby is acting well in spite of a fever or rash, it is less likely that he has a serious illness.

What does "not acting normally" mean? You, the parent, are in the best position to say. Here are some possible characteristics to watch for:

    • Your baby isn't smiling or playing as he normally does.
    • You can't comfort him by the usual means.
    • He seems overly clingy.
    • He is especially sleepy at times when he's normally wide-awake.
    • He is crying weakly, or seems in pain.

Describing symptoms like this will help your health care provider advise you on what action to take next. Be as specific as you can about other illness signs, but you and your health care provider will use this general observation more than anything to judge how serious an illness may be.

Your child has a fever when his temperature is over 100.4 degrees F in the rectum or 98.6 degrees F in the armpit. (Do not take temperatures orally in children under 4.) Ear temperatures should be like rectal temperature if done correctly in a baby over 3 months old.

A fever means that your child's body is fighting an infection. Fever by itself doesn't mean the child is seriously sick. A low to medium fever is part of the body's defense mechanism for the usual minor illnesses of childhood. Low-grade temperatures can be caused by overheating, or even by having a very hot drink. Very high fevers (over 105 degrees F) can cause additional medical problems by themselves and need to be lowered right away. As a general rule, fevers over 103 degrees F indicate a more serious illness than fevers under 103 degrees F, but how sick the child acts is more important than the height of the temperature.

Always check your baby's temperature if you think he is ill, and report it if you feel you need to contact your health care provider. If your baby is over 3 months old, give him acetaminophen or ibuprofen to reduce the fever or discomfort if you wish, and check the package for dosage based upon your child's age and weight. Never give a baby aspirin, however, as that can lead to Reye's Syndrome, a serious condition. Warm baths also bring down fevers in children, provided they don't get chilled and start to shake or shiver. Shivering and goose bumps mean that the body is actually increasing its temperature — just the opposite of what you want.

Don't use alcohol rubs, cool or cold baths, or compresses. These cool down small children or cause shivering that will raise their temperature.

Vomiting, or throwing up, means a forceful expulsion of the stomach contents, in contrast to spitting up a few mouthfuls of food, which babies frequently do. Sometimes children throw up mucous if they have a cough. Children swallow, not cough up, secretions that are part of a respiratory illness.

Vomiting is usually part of a flu-like viral illness, or a sensitivity to something the child ate. You should carefully observe its character and course. A bout of vomiting usually lasts 8 to 12 hours at the most. This is a more serious problem in younger children, as they get dehydrated more quickly.

Vomiting is serious and needs immediate medical attention if:

    • Your baby is also "acting sick" (see above).
    • Your baby is difficult to awaken, or seems confused when he is awake.
    • The vomit contains blood that isn't from a mouth cut or nosebleed.
    • The vomit is bright yellow or green in color.
    • Your baby's abdomen is bloated, and he seems to have abdominal pain lasting more than three hours.
    • Your baby has ingested something harmful.
    • Your baby has a head injury. Many children vomit once immediately following any kind of injury. But it's worrisome if the vomiting continues and is accompanied by sleepiness or unusual behavior.
    • Your baby shows signs of dehydration, including:
    • No urine for six to eight hours.
    • No tears when crying.
    • Dry mouth and eyes.
    • The fontanel (soft spot) at the top of the head goes in when he's lying down.


Your baby is at risk for dehydration if:

    • He is unable to keep down clear liquids, even when given in small amounts.
    • Vomiting is accompanied by watery diarrhea.
    • He refuses to drink any liquid.
    • Vomiting lasts more than eight hours in a baby under 6 months or more than 12 hours in an older infant or toddler.
    • It is also very hot outside.

What You Can Do
If your baby can't keep down liquids, try giving him a teaspoon to tablespoon of clear liquid or a prepared electrolyte solution and no more. Wait 15 minutes to give him the next sip, even if he seems able to take more. Then double the amount. A prepared electrolyte solution is best, but juice, water, and de-fizzed non-diet soda can also be used when alternated with other liquids. (De-fizz soda pop by adding sugar and stirring.)

Give just these liquids for six to eight hours, as long as your child isn't vomiting. Give bland food for another eight to 12 hours and then return to his regular diet. If you're breastfeeding, continue to nurse your baby, shifting to very frequent feedings in smaller amounts. For example, nurse on one side only and then wait 30 minutes before nursing on the other.

Although parents and grandparents fret quite a bit about the lack of bowel movements, constipation is rarely a serious problem. Treatment is really only indicated for bowel movements that are rock-hard and painful to pass. Some babies may only have bowel movements every few days, and up to four or five days would still be normal. Usually just a change in diet will relieve the problem. For infants, you can offer water after a feeding. If they are taking juices, you can give prune juice. For babies who are taking solids, you can add some extra fiber foods, such as oatmeal or barley cereal and pureed fruit or vegetables. Extra fluids should also be given. The key to more regular bowel movements is always extra fiber foods and fluid.

Breathing Trouble
Check for fast breathing after the nose has been cleared and your baby is quiet. Fast or labored usually indicates a serious chest problem and needs attention right away. If you see the space between his ribs and above the collarbone go in with each breath, it's abnormal, and you should call your health care provider right away. The normal breathing rate for babies is between 40 to 50 breaths per minute. (See the section on younger babies above.) Over 60 breaths a minute is abnormal.

Call your health care provider right away if you are worried about breathing problems. Babies have irregular breathing, but pauses longer than 10 seconds are abnormal. If your baby has bluish lips or has stopped breathing for 10 seconds or more, call 911 immediately.

Funny Sounds While Breathing
Babies make a lot of funny noises now and then. If your baby is ill and is making funny sounds, it will help your health care provider if you can describe the sound. Sometimes noisy breathing by babies and toddlers is wheezing. This will sound like a raspy squeaking when your child exhales, or breathes out. Wheezing can accompany an illness in the lungs, or be a sign of allergies. It can also be a sign of having swallowed something that is now in the windpipe. Call your provider if:

• This is the first episode of wheezing.

• Your baby is under 6 months old.

• The wheezing is getting worse.

• There's any color change in your baby.

Young infants who make a regular cooing-like sound when they breathe out are in breathing distress. They need attention right away. This symptom can take the form of a grunt with each exhalation in older children.

Noisy sounds when the baby breathes in may be part of croup, which is a viral illness that occurs when the voice box or larynx becomes infected. A croupy noise can also be a sign that something is caught in your baby's throat. If your baby is croupy at rest, even after bringing him into a steam-filled bathroom, call your health care provider. Sudden onset of this kind of breathing trouble, accompanied by high fever, drooling, and any color change, needs immediate attention.

Sometimes a baby sounds croupy when he coughs or when he is crying or upset. Lots of moisture may help, but you should know that this may be part of a five- to seven-day illness. Watch for symptoms worsening, however, or if he's croupy even when not crying, coughing, or upset.

Cough and Runny Nose
If your baby's breathing is calm without wheezing and there are no other serious symptoms, you can try some home remedies. Clear the nose if your baby seems uncomfortable. For infants, you can use a few drops of saline (salt water) to loosen the mucous before sucking it out with a bulb syringe. For toddlers, simply wiping with a gentle tissue will usually do the job.

Color Change: Red, White, Blue, or Yellow
Many newborns have bluish hands or feet because of their immature circulation system. Older babies and toddlers don't, unless they are cold, they are holding their breath, or they have a breathing or heart problem. Blue lips, hands, or feet in an older baby is not a good sign and needs immediate medical attention. Some children turn bluish when they hold their breath in a tantrum, but this goes away once they start breathing again. It's nothing to worry about. Bluish coloration may sometimes appear if a child is cold — for instance, when he has been swimming too long. He needs a towel and a hug in that case.

Paleness may be a sign of anemia or some other illness. Check the inside of your baby's mouth or the lining of his eyes; these should be a robust pinkish-red. If not, let your health care provider know at a scheduled visit, or sooner if there are other symptoms.

Redness can signal flushing associated with fever or a rash. Check your baby's temperature, and inspect his body thoroughly. He may be overheated — check his clothing and find a cool corner.

Skin that looks yellow means jaundice. This is fairly common in newborns, although you should let your health care provider know so he or she can monitor your baby. In older babies, yellow skin can be a sign of a liver problem. In contrast, an orangish-yellow color, especially on the palms and soles, means your baby is eating a lot of carrots or squash. This is nothing to worry about, but you might want to think about varying your baby's diet.

High-Pitched, Inconsolable Crying Lasting Two to Three Hours
This usually means that your baby is in pain or has a neurological problem. This cry is qualitatively different from the usual screaming that every baby does, even if he's colicky. This cry is a high-pitched screeching, and doesn't seem to let up at all.

If your baby suddenly goes very limp and is unable to hold her head up, sit up, or reach for a toy, call your health care provider right away. Such sudden symptoms can be very serious.

Persistent Diarrhea
Diarrhea, defined by frequent and watery stools, usually lasts several days to a week and responds well to time, a little extra fluid, and minor dietary changes. If diarrhea persists for five or six days, despite a modified diet and extra fluid, contact your health care provider today. Watch for signs of dehydration (see above). Blood or pus in the stool also requires a call right away (unless the blood is a small amount of bright red blood that is clearly coming from a small tear in the skin inside the anus).

Green stools or ones that are very watery and explosive have passed from the upper intestine very fast. This type of diarrhea, whether moderate or severe, is very likely to irritate the diaper area. Keep the diaper area clean and protected with petroleum jelly, applied directly or in the diaper itself. For all diarrheas, give clear liquid or a prepared electrolyte solution frequently in small amounts. Keeping your baby hydrated is the key to managing diarrhea.

The main problem caused by diarrhea is the loss of extra fluid that can cause dehydration. Here's what you can do:

    • For children with just loose, mushy stools, give a little extra water, breast milk, or formula with each feeding. If your baby is eating solids, give him foods that act as "stoppers," such as applesauce, bananas, rice, or potatoes. Avoid fruit juice.
    • If the stools are really watery, use one of the prepared electrolyte solutions in frequent (every 15 to 30 minutes), small (one tablespoon to an ounce) amounts for about 24 hours. De-fizzed soda pop or half-strength sports drink can be used if electrolyte solution isn't available. If you are breastfeeding your baby, continue to do so. If your infant starts to improve and he's eating solids, start adding those stopper foods (see above).

For toddlers with watery diarrhea:

    • Stop milk products for at least three to five days.
    • Give lots of clear fluids (popsicles count).
    • Start solids with crackers, toast, rice, bananas, applesauce, soups, plain pasta, and noodles.
    • Add meat, vegetables, and eggs slowly.
    • If the diarrhea returns, go back one step on the diet.

Don't give your child herbal teas, unless you check with your health care provider, or any over-the-counter remedies to combat diarrhea. Over the counter medications for adults or older children can be very harmful to babies or young children.

A skin rash can be the sign of an illness or simply a sign of bug bites, skin irritation, or an allergy. If your child isn't sick, there is no need for an urgent call unless your child has:

• A purplish rash of small dots or blotches

• Big red blotches that indicate hives or an allergic response that may need treatment.

In either of these circumstances, call your health care provider right away.

Severe Pain
A high-pitched scream, a completely inconsolable child, or tenderness to the touch of any body part should be taken seriously. Call your health care provider if you notice any of these signs.

Refusal to Walk in a Walking Child
When a child refuses to bear weight on his leg(s) or is suddenly limping, it could indicate joint or bone problems, and you should let your health care provider examine your child immediately. If he is too weak to stand or seems limp, he should also be seen right away. These guidelines don't apply to the child who is sick or tired and simply wants to be held. If he's walking bent over, he may have a stomach problem that needs attention right away.

Tender Tummy
This includes sudden tenderness or swelling of the abdomen or scrotum. These two are real emergencies that need urgent attention. Bring your baby to an emergency room if there is any delay in reaching your own provider.

Some children have tummy tenderness if they are constipated, but this sort of tenderness comes on slowly and is relieved when the child has a bowel movement. Make an appointment with your health care provider if this is a chronic problem or one that isn't helped by extra fluid or fiber for a toddler.

Loss of Consciousness
This needs immediate attention in all cases. Call 911 immediately. In all instances, be sure to watch the breathing and color of your child carefully. Initiate CPR if you have training.


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