Symptoms that Worry Your Pediatrician

Always Concerning

When we answer messages from worried caregivers, there are a few things we always need to know to understand how dangerous the situation is. If these symptoms are not happening, your baby is usually safe to stay at home with supportive care from parents. If these symptoms are present, however, your child may require a trip to the emergency department for further evaluation and treatment.

1. Dehydration

  • You may read or hear about different ways you can monitor this (sunken fontanelle, not making tears, dry or cracked lips, dry mouth, dry skin). Unfortunately, interpreting these symptoms correctly is complicated and takes years of practice. For this reason, we do not recommend parents use these methods.
  • The good news is there is one easy way to know if your child is hydrated or dehydrated: count the wet diapers.
  • Regardless of how old your child is, they should pee at least every 6-8 hours.
    • If they’re sick or acting differently, make a note of the time of day you see a wet diaper.
    • To count, the diaper doesn’t have to be as soaked as it usually is.
    • Any urine that’s enough to change the color strip indicator on the front of the diaper counts as a wet diaper.
  • If your child goes longer than 8 hours without making urine, and is sick or acting differently, you should let us know right away.

2. Respiratory Distress

  • Respiratory distress is a medical term which means “working hard to breathe.” Another way to think about this is “labored breathing.”
  • The best way we’ve found to describe respiratory distress to parents is that it looks like the baby is out of breath, as though they just finished a work out.
  • Here are some examples of respiratory distress for you to compare to:
  • It is difficult to see the breathing clearly with clothes on.
    • For this reason, you should always turn on the light and take off the shirt or onesie when evaluating for respiratory distress.

3. Inconsolability

  • We define a child as inconsolable if they are crying continuously, without interruption, for 30 minutes or longer, and you’ve done everything you can think of to console them.
    • Good ways to soothe your baby include:
      • Offer Breast Milk or Formula
        • We tell our families that a baby who is crying during the first 6 months of life is always hungry until proven otherwise.
          • Regardless of how recently, or how much you fed them last time, offer more food when fussy just to make sure.
          • New parents are usually surprised at how much and how frequently their baby needs to eat.
        • If your baby is crying so hard they won’t feed at the breast, offer pumped milk or formula from a bottle.
          • If your baby vigorously eats and finishes everything in the bottle, offer more.
        • You can’t overfeed a baby, because they will stop eating when full.
        • The crying and fussiness of a hungry baby are often incorrectly blamed on other things:
          • Gas pains
          • Indigestion
          • Constipation
          • Only wants to be held
          • Hates being on his back
          • Hates the bassinet or cradle
          • A recent change in formula, mixing and matching formula brands
          • Mom’s diet (as long as the food is healthy, research has shown us this is never the case)
          • Too hot
          • Too cold
      • There's nothing wrong with using pacifiers to soothe a fussy baby, but first make sure she isn't hungry.
      • Swaddling, swaying, singing, and shushing are other classic ways to soothe your baby, after you’ve tried offering more food.
      • If your child has fever, symptoms of infection, is teething, or received vaccines in the last 72 hours, offer acetaminophen to see if this helps.
        • If your baby is older than 6 months, you can offer ibuprofen as well. Both are equally effective.
  • If your baby has been crying continuously without stopping, for at least 30 minutes in a row, and you’ve tried everything discussed here, you should let us know right away.

4. Altered Mental Status

  • Examples of altered mental status include:
    • seizure
    • does not recognize parents or surroundings
    • clearly off balance compared to normal
    • Clinically lethargic
      • Luckily, when parents say their child is lethargic, they usually mean that, compared to normal, their child has less energy, or is more clingy, fussy or tired
      • The medical definition of lethargic is an almost coma-like state. Essentially, the child responds very little or not at all, despite the caregivers best attempt to get them to do so
    • True lethargy is a sign of serious illness, and usually warrants immediate evaluation in the emergency department

5. Fever in the First 90 Days of Life