Five Red Flags in the Newborn Period

Regardless of your level of preparation, former parenting experience, or level of education, something about the first few weeks at home with a new baby serves as an almighty equalizer. New parents of every age and background have found themselves texting friends and family for their opinions, or frantically googling “is X normal for a newborn?” It’s basically the first unwritten milestone you’re going to encounter—practically a new-parent right of passage.  Let’s talk about Five Red Flags in the Newborn Period.

Newborn babies have tons of idiosyncrasies, or weird “newbornisms,” as I like to call them, that can cause parents to worry, but are truly just newborns being newborns. They’re noisy breathers, their skin is prone to rashes and marks, their hands and feet are cold with a blue hue, and what is going on with these wild sleeping patterns? All of these perceived issues, the vast majority of the time, are common examples of these “newbornisms.” 

Five Red Flags in the Newborn Period

While there is a variety of well-observed, benign oddities that newborns can exhibit in their anatomy and behavior, of course there are also symptoms that newborns can demonstrate that indicate something more insidious is occurring. Knowing this, it can be helpful and important for new or expectant parents to have a clear understanding of “red flags” in their new baby that would immediately warrant a call to their child’s healthcare provider, an office visit, or a visit to the emergency room. 

  1. Your baby isn’t eating. A newborn baby who is not interested in eating always warrants immediate medical attention. Disinterest or inability to eat, particularly in the first few days of life when newborns are known for being particularly ravenous, is problematic for multiple reasons. Firstly, it can often serve as the first sign that there is an underlying, undiagnosed medical condition which will require prompt attention. Secondly, if a newborn baby isn’t eating, the lack of caloric intake will quickly cause a host of other issues that will also likely require medical attention, such as hypoglycemia. If you baby isn’t demonstrating typical hunger cues, is disinterested in latching, or is refusing a bottle: call their healthcare provider immediately, and follow their plan for further evaluation, which might include a visit to their office or the closest emergency room. 
  2. Your baby isn’t producing wet diapers. Wet diapers go hand-in-hand with your baby’s intake of milk. If there are concerns about feeding, questions about the frequency of your baby’s wet and dirty diapers will be some of the first that your child’s care provider will ask in determining an appropriate course of action. While the number of dirty (stool) diapers will vary depending on feeding methods and from baby to baby—wet diapers do not. The frequency of your child’s urination is a reliable indicator of their food intake, hydration status, and kidney function in the first weeks of life. During this time, look for the following: 1 wet diaper per day of life for the first 6 days (i.e. 1 wet diaper on day 1, 2 wet diapers on day 2, etc,) and 6-8 wet diapers each day thereafter. If your newborn is not meeting these minimums, contact their healthcare provider immediately for next steps, which may include a formal feeding assessment, weight check, blood glucose check, or ultrasound to check their kidney anatomy and function. 
  3. Your baby is lethargic. Identifying lethargy in a newborn can be tough—sleepiness is one of a normal, healthy newborn’s major characteristics. But there is a difference between sleepy and outright lethargic in a newborn, and the latter can be a major red flag. Lethargic babies are difficult to wake and often show little or no reaction to external stimuli such as cool water, attempts to jostle them awake, or a sternal rub. They may show a weak or markedly decreased cry from their baseline, and may show little to no interest in feeding. Lethargy in a newborn can be indicative of a feeding problem, a blood glucose problem, or one of several underlying conditions that may present with abnormal levels of certain compounds in a baby’s blood, which in turn can cause lethargy. If you feel your baby is lethargic, but responsive, it’s a good idea to call their healthcare provider immediately. If they are unresponsive or difficult to rouse, even with strong stimuli, it’s a reason to see emergency medical care. 
  4. There is blood in your baby’s stool. The color and texture of baby’s poop in the first week of life can run the gamut from black and tarry to yellow and watery, and it is even likely to change along this spectrum several times—but it should never, ever be bloody. Bloody stool in a baby can indicate a milk-protein allergy, an intestinal problem, or a serious infection. If you notice blood in your baby’s diaper, take a picture of it, bag it, and store it in your fridge before immediately calling your ped’s office. If there are no other concerns for your baby, they may ask to see you in their office for a follow up where they can see and evaluate the diaper in person and make follow on recommendations. If there are additional concerns or symptoms your baby is exhibiting, you may be asked to proceed to the emergency room with the diaper for an urgent evaluation. 
  5. Your baby has a fever. A true fever is defined as a rectal temperature greater than 100.4 degrees Fahrenheit, or greater than 38 degrees Celsius. A fever in a baby less than three months of age is a medical emergency. If you are able to confirm a fever with a rectal temperature at home, proceed to the nearest emergency room and call your child’s healthcare team on the way. If you are concerned they have a fever, but are unable to take a temperature at home or are using a less reliable thermometer (such as one that goes across your baby’s head or in their ear) call your pediatrics office for additional instructions. They may ask you to proceed to the emergency room regardless, or may ask you to come to their office to confirm their temperature, in the absence of other concerning signs or symptoms. 

While the above is not an all-inclusive list of reasons you may need to seek medical care for your child, it encompasses signs and symptoms of some of the most common reasons newborns might require some additional medical management, and can serve as a blueprint to let new parents know when additional action is definitely warranted. As always, remember that your child’s care provider is your partner in managing their health! You should never feel awkward, embarrassed, or silly for calling them with any additional questions or concerns you might have. 

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