If your baby gets ill

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Article Summary

To help you decide when to watch and wait, and when to call your doctor.

New parents spend a lot of time worrying about how they'll cope if their baby gets ill. 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 develop. This list of symptoms will help you determine when to watch and wait, and when to call your doctor.

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

When calling your GP 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 doctor will want to know if the 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 to call the doctor for from 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 Problems

Signs of Illness in Very Young Babies

Signs of Illness in Babies and Toddlers

Checklist of Serious Symptoms

If your baby or toddler has any of these symptoms, call your doctor straight away. All of these symptoms require immediate attention.

 Stiff neck.
 Bulging fontanelle - if the soft spot comes up firmly when the baby is held at a 45-degree angle and is otherwise quiet.
 Lethargy - if your baby is hard to awaken or isn't responding to you.
 Fever over 41 degrees C/105.8 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 at rest. Croup is noisy breathing when breathing in, a wheeze is noisy when breathing out.
 Breathing over 60 breaths per minute, laboured breathing or audible wheezing.
 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 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 to work with. Below are some signs to look for:

Fever

A fever in a small infant must be taken seriously. Rectal temperatures over 38.5 degrees C/101.3 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 doctor. It may be nothing or it may be a simple cold, but let your GP know all the same - just in case.

Be prepared to report whether 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 doctor know if your baby has been exposed to any illnesses in the last week or two, and if he has any chronic health problems. Don't give him paracetamol or ibuprofen at this age. Follow your GP's advice on assessment and treatment.

Low Temperature

Small babies may react to an infection with a drop in temperature. If his temperature is less than 37.5 degrees C/99.5 degrees F, wrap him up and check again in 15 to 20 minutes. If his temperature doesn't increase, or if it does, but not for long, despite being appropriately dressed, call your doctor 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 become exhausted more quickly and have difficulty 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 doctor 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 feed 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 take a look. If he's showing additional signs of being unwell or if he won't wake up for a feed, don't wait - call your general practitioner straight away. If you are breastfeeding a newborn, don't hesitate to call your doctor if your baby is not feeding well.

Vomiting

Most babies regurgitate (sometimes called possetting or upchucking) and some will vomit once in a while. If he expels a tablespoon or more of vomit, if vomiting occurs twice in a row or if he shows other signs of illness, call your doctor. Bright yellow vomit is a serious sign that you should phone straight away. Vomit that shoots across the room (yes, really shoots) can be a sign of stomach blockage. Let your GP know.

No Urination

If a young baby goes for six hours without passing urine or doesn't have six wet nappies in 24 hours after the first day of life, he may be getting dehydrated. Call your doctor.

Some of the newer, highly absorbent nappies 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 nappy for four to six hours and check it frequently for wetness. If the paper towel stays dry, pick up the phone and call your doctor.

Signs of Illness in Babies and Toddlers

"Acting ill"

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 GP that your baby "just isn't acting normally" is very important information. Conversely, if you observe that your baby appears to be 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 out 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 doctor advise you on what action to take next. Be as specific as you can about other signs of illness, but you and your doctor will use this general observation more than anything to judge how serious an illness may be.

Fever

Your child has a fever when his temperature is over 38.5 degrees C/101.3 degrees F in the rectum or 37.5 degrees C/99.5 degrees F in the armpit. (Do not take temperatures orally in children under 4.) Ear temperature 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 ill. A low to medium fever is part of the body's defence 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 41 degrees C/105.8 degrees F) can cause additional medical problems in themselves and need to be lowered straight away. As a general rule, fevers over 39.5 degrees C/103.1 degrees F indicate a more serious illness than fevers under 39.5 degrees C/103.1 degrees F, but how ill the child acts is more important than how high the temperature is.

Always check your baby's temperature if you think he is ill and report it to your doctor if you feel you need to contact him. If your baby is over 3 months old, give him paracetamol (Calpol) or ibuprofen to reduce the fever or discomfort if you wish and read the instructions on the packet for the dosage based on 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 cold 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

Vomiting, or throwing up, means a forceful expulsion of the stomach contents, in contrast to regurgitating 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 has eaten. 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 ill" [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 colour.
 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 a concern if the vomiting continues and is accompanied by sleepiness or unusual behaviour.
 Your baby shows signs of dehydration, including:
    No urine for six to eight hours.
    No tears when crying.
    Dry mouth and eyes.
    The fontanelle (soft spot) at the top of the head goes in when he's lying down.

Dehydration

Your baby is at risk from dehydration if:

 He is unable to keep down clear liquids, even when given in small amounts.
 Vomiting is accompanied by watery diarrhoea.
 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 flat, non-diet soft drinks can also be used when alternated with other liquids. (Make soft drinks flat 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 twelve hours and then return to his normal diet. If you're breastfeeding, continue to do so, shifting to very frequent feeds in smaller amounts. For example, breastfeed on one side only and then wait 30 minutes before breastfeeding on the other.

Constipation

Although parents and grandparents worry 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 feed. If they are having juices, you can give apple or prune juice. For babies who are on solids, you can add some extra fibre 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 fibre foods and fluid.

Breathing Trouble

Check for fast breathing after the nose has been cleared and your baby is quiet. Fast or laboured breathing usually indicates a serious chest problem and needs attention straight 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 doctor immediately. The normal breathing rate for babies is between 40 to 50 breaths per minute. (See section on younger babies above.) Over 60 breaths a minute is abnormal.

To determine your baby's breathing rate, clear his nose and watch his breathing while he is quiet. Call your GP straight 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 000 immediately.

Funny Sounds When Breathing

Babies make a lot of funny noises sometimes. If your baby is ill and is making funny sounds, it will help your doctor 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 GP if:

 This is the first episode of wheezing.
 The baby is under 6 months old.
 The wheezing is getting worse.
 There's any colour change in the baby.

Young infants who make a regular cooing-like sound when they breathe out are in breathing distress. They need attention straight away. This symptom can take the form of a grunt with each exhale 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 croup noise can also be a sign that something is caught in your baby's throat. If your baby is croupy at rest, even after taking him into a steam-filled bathroom, call your doctor. A sudden onset of this kind of breathing trouble, accompanied by high fever, dribbling and any colour 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.

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. All babies will benefit from using a humidifier, especially at night.

Colour 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 anaemia or some other illness. Check the inside of your baby's mouth or the lining of his eyes; these should be a healthy pinkish-red. If not, let your GP know at a scheduled visit or sooner if there are other symptoms.

Redness can signal flushing associated with fever or with a rash. Check your baby's temperature and examine 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 GP 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 orangeish-yellow colour means your baby is eating a lot of carrots. This is nothing to worry about, but you might want to think about varying his 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.

Limpness

If your baby suddenly goes very limp and is unable to hold his head up, sit up or reach for a toy, call your doctor straight away. Such sudden symptoms can be very serious.

Persistent Diarrhoea

Diarrhoea, defined by frequent and watery stools, usually lasts several days to a week, and responds well to time, a little extra fluid and minor changes in the diet. If diarrhoea persists for five or six days, despite a modified diet and extra fluid, contact your GP today. Watch for signs of dehydration. Blood or pus in the stool also requires a phone call straight away (unless the blood is a small amount of bright red blood that is clearly coming from a small tear in the anus).

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

The main problem caused by diarrhoea 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 feed. If your baby is eating solids, give him foods that act as "stoppers", such as apple sauce, 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. Still soft drink 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 diarrhoea:

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

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

Rash

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

 A purplish rash of small dots or blotches
 Big red blotches that indicate hives or an allergic reaction that may need treatment.

In either of these circumstances, call your doctor straight 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 GP 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 doctor examine your child immediately. If he is too weak to stand or seems limp, he should also be seen straight away. These guidelines don't apply to a child who is ill or tired and simply wants to be held. If he's walking bent over, he may have a stomach problem that needs immediate attention.

Tender Tummy

This includes sudden tenderness or swelling of the abdomen or scrotum. These two are real emergencies that need urgent attention. Take your baby to casualty if there is any delay in reaching your own GP.

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 GP if this is a chronic problem or one that isn't helped by extra fluid or fibre in the case of a toddler.

Loss of Consciousness

This needs immediate attention in all cases. Call 000 immediately. In all instances, be sure to watch the breathing and colour of your child carefully. Initiate CPR if you have training.

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illness

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