Newborn Warning Signs: When to Call About Your Baby

By Igel Cudiera

Call 911 if your newborn can't be woken, has blue or gray lips or face, is struggling to breathe or grunting with each breath, or has a seizure. Call your baby's doctor right away for a fever in a baby 3 months or younger (your baby will need to be examined promptly), trouble feeding, unusual sleepiness, fewer wet diapers, or yellow skin that's deepening or spreading.

Below, newborn warning signs are grouped by what to do: call 911, go to the emergency room, or call your baby's doctor right away. The guidance comes from the American Academy of Pediatrics (AAP) and other U.S. health sources. If you're ever unsure which group a sign belongs in, call. That's what your baby's care team is there for.

Call 911 Right Away If Your Baby…

These signs need emergency help now. Call 911 first, before calling anyone else:

• Can't be woken up, or is unresponsive
• Isn't moving or is very weak
• Has bluish, purple, or gray lips, tongue, face, or skin
• Has stopped breathing, or is struggling to breathe
• Makes moaning or grunting noises with each breath
• Has rhythmic jerking of the arms and legs with a loss of responsiveness (a seizure)
• Is vomiting blood
• Seems to be having a life-threatening emergency, in your judgment

Go to the Emergency Room Now If Your Baby…

These signs need to be seen urgently, even if your baby is otherwise breathing and responsive:

• Is vomiting green fluid (bile)
• Seems floppy, or has a change in muscle tone
• Is moving less than usual
• Has a weak suck, or can't suck for very long
• Has a weak or strange-sounding cry
• Has ribs that pull in with each breath (called retractions), a sign of breathing distress

If you can't safely get your baby to the emergency room, or the signs get worse on the way, call 911.

Call Your Baby's Doctor Right Away For…

These signs need a prompt call, day or night, to your baby's pediatrician or the provider caring for your newborn. They'll tell you whether your baby needs to be seen and where.

A fever or a low temperature

A rectal temperature of 100.4°F (38°C) or higher counts as a fever. If your baby is 3 months or younger and has a fever, the AAP advises calling your pediatrician immediately, even if your baby shows no other signs of being ill, because the doctor will need to examine your baby. This isn't a wait-and-see situation. The AAP's guide to urgent care lists a fever in a baby under 3 months among the reasons to go to the emergency room right away, because young infants can get sick quickly and need prompt evaluation. If you can't reach your pediatrician quickly, go to the emergency room.

Don't give fever medicine before your baby has been seen. MedlinePlus advises contacting your child's provider first before giving any medicine to a baby 3 months or younger.

A temperature that's lower than normal can also be a warning sign in a newborn. The AAP's symptom guidance advises calling your baby's doctor right away if your baby's temperature is low and doesn't come up with warming.

Breathing and skin color

Newborns normally breathe faster than adults, so some quick breathing is expected. The AAP advises notifying your pediatrician immediately if your newborn shows any of these signs of breathing distress:

• Fast breathing, more than 60 breaths in one minute
• Retractions, where the skin between the ribs sucks in with each breath
• Flaring of the nostrils
• Grunting while breathing
• Persistent blue skin color

If your baby is struggling to breathe, grunting with each breath, or has blue or gray lips, tongue, or face, call 911. If the ribs are pulling in with each breath, go to the emergency room.

Some color changes are normal. According to the AAP, a newborn's hands and feet may look bluer than the rest of the body because they're more sensitive to cold, and they should quickly look pinker when you move the arms and legs. Your baby's mouth, lips, and tongue should always look pinkish or reddish.

Feeding, sleepiness, and alertness

Newborns sleep a lot, and that's normal. What matters is a pattern, or a change from how your baby usually is. Call your baby's doctor if:

• Your baby rarely seems alert, doesn't wake up on their own for feedings, or seems too tired or uninterested to eat
• You have to wake your baby for feeds, or they can't finish feeds
• Your baby is sleeping more than normal
• Your baby sweats during feedings
• The soft spot on top of the head looks swollen

Wet diapers and signs of dehydration

Diapers are one of the easiest ways to tell whether your baby is getting enough to drink, but the expected number changes over the first week. According to the AAP, by 5 to 7 days old a breastfed baby should have 6 or more wet diapers a day, with nearly colorless or pale yellow urine. If you're unsure what's expected for your baby's age, ask your baby's doctor.

The AAP lists these warning signs of dehydration in infants and advises notifying the pediatrician immediately if any develop:

• Fewer than six wet diapers a day
• A parched, dry mouth
• A sunken soft spot on the head
• Fewer tears when crying

The AAP's symptom guidance also advises a prompt call for no urine in more than 8 hours, dark urine, or a very dry mouth.

Jaundice (yellow skin or eyes)

According to the AAP, most babies have mild jaundice that is harmless, but in rare cases the bilirubin level can get very high. Jaundice usually shows first in the face and then moves to the chest, belly, arms, and legs as bilirubin rises. Call your baby's doctor if:

• Your baby's skin turns more yellow
• The belly, arms, or legs are yellow
• The whites of the eyes are yellow
• Your baby is hard to wake, fussy, or not feeding well

The AAP notes that any baby with jaundice in the first 24 hours after birth should have their bilirubin level checked right away. MedlinePlus describes jaundice as an emergency if the baby has a fever, has become listless, or isn't feeding well.

Vomiting

Normal spitting up isn't the same as vomiting. The AAP's symptom guidance says to call right away if a baby younger than 12 weeks vomits 2 or more times, not counting normal spitting up. Green (bile-colored) vomit means going to the emergency room, and vomiting blood means calling 911.

The umbilical cord

Call your baby's doctor if you notice signs of a cord infection:

• Foul-smelling, yellowish discharge from the cord
• Red skin around the base of the cord
• Crying when you touch the cord or the skin next to it

A few drops of blood around the time the stump falls off can be normal, but if the cord actively bleeds, call immediately. The AAP says the stump should dry and fall off by about 3 weeks; if it's still there after that, your baby should be seen.

Quick-Reference Table

How to Take Your Newborn's Temperature

The AAP says a rectal reading is the most reliable and accurate for infants, especially babies under 3 months. Avoid ear thermometers for babies under 6 months, because their ear canals are too small for an accurate reading. If you're not sure how to take a rectal temperature, ask your baby's care team to show you before you need it.

What to Have Ready When You Call

Having a few details ready can make the call quicker and more useful:

• Your baby's age in days or weeks
• The temperature, and how you took it
• When the symptom started, and whether it's getting worse
• Roughly how many feeds and wet diapers your baby has had in the past 24 hours
• Any medicine you've given

None of this should delay a call. If you think your baby is having an emergency, call 911 first.

If You're Not Sure, Call

It's normal to wonder whether something is worth a call. The AAP's advice is simple: if you aren't sure whether it's a true emergency, never hesitate to call your pediatrician's office, even if you know the office is closed. The AAP also reminds new parents to follow their instincts, which are usually spot-on. Calling about something that turns out to be normal is never a wasted call.

After a Birth Center Birth: Who to Call

If your baby was born at a birth center, it helps to know who to call before you go home.

• For an emergency: call 911 first. Don't call the birth center first to ask whether to call 911.
• For signs in the "call right away" group: call your baby's pediatrician or the provider caring for your newborn.
• For questions that aren't urgent: keep a list for your baby's next visit, or call during office hours.

Before you go home, ask your care team who to call for questions in the first days, and save those numbers in your phone. The AAP recommends that newborns have a checkup within 3 to 5 days of birth, so make sure that visit is booked.

At Birthing Center Long Island, our midwives offer newborn care at the center, including newborn exams and feeding support through your baby's first weeks at home. We also offer pediatric care for your baby at our Hewlett office. If you're still pregnant, our guide to choosing your baby's pediatrician can help you have a practice lined up before birth.

A Note From Our Midwifery Practice

Much of what newborns do is normal, even when it's new to you. Knowing the newborn warning signs isn't about expecting the worst. It's about recognizing the few things that need help quickly, so you can relax about everything else.

If something about your baby doesn't seem right, trust that feeling and call. No one on your baby's care team will mind being asked.