Symptoms that Worry Your Care Team

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's impossible to evaluate the breathing with a shirt on.
    • For this reason, your child needs to be completely naked from the waist up.
      • Turn on the light
      • Take the shirt or onesie over their head and completely off the body

3. Inconsolability

  • Inconsolable is defined in the following way: Continuous, non-stop crying, without interruption, for 30 minutes or longer, and you’ve done everything you can think of to console them.
    • Any child, regardless of age, who meets this definition needs to be evaluated immediately, day or night.
    • If your child is 4 months old or younger, please make sure they're aren't still hungry, especially if they just finished feeding.
      • Remember: "You can’t overfeed a baby."
        • When they're full they stop eating, just like you and I do (or should do, in my case!).
    • 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 30 Days of Life