When Should I Call the Pediatrician for My Newborn?

When Should I Call the Pediatrician About My Newborn?

By Brett Mendez, DNP, APRN, NNP‑BC • VitalStart Pediatrics, A Professional Nursing Corporation

Bringing a newborn home is exciting, but it can also be a little intimidating.

Suddenly, every sound, sneeze, feeding, diaper, and little change can make you wonder: Is this normal? Should I call someone?

As a nurse practitioner who cares for infants, I can tell you that this is one of the most common concerns I hear from new parents. Newborns do a lot of things that can look strange or concerning but are completely normal. They sneeze. They hiccup. They make surprisingly loud noises while sleeping. Their breathing can sometimes seem irregular. They may eat constantly one day and seem sleepier the next.

But newborns are also different from older babies and children. Because their immune systems are still developing and they can get sick quickly, some symptoms should never be ignored.

Here’s how I generally explain it to parents.

First: Trust Your Instincts

You know your baby better than anyone else.

One of the most important things I tell parents is that you don't need to wait until you can prove something is wrong before calling your pediatrician.

Sometimes a parent will tell me:

"I don't know exactly what's wrong. He just isn't acting like himself."

That matters.

A significant change in your baby's feeding, alertness, breathing, color, behavior, or overall appearance is worth paying attention to, even if you can't put your finger on exactly what has changed.

And please don't worry about "bothering" your pediatrician. We would much rather you call and confirm everything is okay than have you stay home worrying about something that should be evaluated.

A Fever in a Newborn Is Different

For a baby younger than 3 months, a rectal temperature of 100.4°F (38°C) or higher requires prompt medical evaluation.

This is one of the most important newborn rules for parents to remember.

Young infants may not show the same signs of infection as older children. A fever can sometimes be the first, or only sign of a potentially serious infection.

If your newborn has a temperature of 100.4°F (38°C) or higher, contact your pediatrician immediately for guidance. Depending on your baby's age and circumstances, your pediatrician may tell you to go directly to an emergency department.

Do not give acetaminophen or another fever-reducing medication to a young newborn unless a healthcare professional specifically tells you to do so.

Call If Your Baby Is Having Trouble Breathing

Newborn breathing can look a little unusual. Babies normally breathe faster than adults, and their breathing pattern can occasionally be irregular.

What we don't want to see is a baby who appears to be working hard to breathe.

Seek medical attention if you notice:

• Persistent breathing that seems unusually fast

• Grunting with breathing

• Flaring of the nostrils

• The skin pulling inward between or underneath the ribs with each breath

• Persistent pauses in breathing

• Blue, gray, or dusky coloring around the lips, tongue, or face

• A baby who cannot comfortably feed because of difficulty breathing

If your baby is struggling to breathe, becomes blue or gray, is unresponsive, or has a prolonged pause in breathing, call 911 rather than waiting for a return call from the pediatrician.

Call If Your Baby Suddenly Isn't Feeding Well

Newborns need to eat frequently, and feeding is one of the best windows we have into how a newborn is doing.

One sleepy or shorter feeding doesn't necessarily mean something is wrong. What matters more is a significant change from your baby's usual pattern.

Call your pediatrician if your newborn:

• Repeatedly refuses to feed

• Suddenly takes much less breast milk or formula than usual

• Is too sleepy to wake adequately for feedings

• Starts feeding normally but repeatedly becomes exhausted

• Frequently coughs, chokes, or has difficulty breathing during feeds

• Has repeated vomiting or cannot keep feedings down

What About Spit-Up?

Spit-up is incredibly common in newborns. A small amount of milk coming back up after feeding, especially in an otherwise comfortable baby who is eating and growing, is usually not an emergency.

Vomiting is more concerning when it is forceful or projectile, repeatedly occurs after feeds, contains blood, or is green.

Green vomit in a newborn can signal an intestinal obstruction and should be evaluated urgently.

Pay Attention to Wet Diapers

Diapers give us valuable information about whether your baby is getting enough fluid.

During the first several days after birth, the number of wet diapers normally increases as milk intake increases. By around day 4-5, many adequately hydrated newborns produce about six or more wet diapers per day.

Call your pediatrician if you notice a significant decrease in wet diapers, your baby goes an unusually long time without urinating, or poor urine output occurs along with poor feeding, excessive sleepiness, dry mouth, or other signs that concern you.

For babies in their first few days of life, your pediatrician can help you determine whether the number of wet diapers is appropriate for your baby's exact age.

Call If Your Baby Is Extremely Sleepy or Difficult to Wake

Newborns sleep…a lot. Many newborns sleep around 16 or more hours throughout a 24-hour period.

But there is a difference between a newborn who is sleeping peacefully and one who is unusually difficult to wake.

You should call if your baby:

• Is much sleepier than usual

• Cannot stay awake long enough to feed

• Has a weak cry

• Seems unusually floppy or has decreased movement

• Is difficult to wake despite stimulation

• Is significantly less responsive than usual

A newborn who is very difficult to wake or appears unresponsive needs emergency evaluation.

What About Jaundice?

A little yellow coloring of the skin or eyes is common in newborns, particularly during the first several days of life. This is called jaundice, and it occurs when bilirubin builds up in the baby's blood.

Most newborn jaundice is manageable, but bilirubin levels sometimes become too high and require treatment.

Contact your pediatrician if:

• Your baby's yellow coloring seems to be getting noticeably worse

• The yellow color spreads farther down the body

• Your baby is increasingly sleepy or difficult to feed

• Your baby is not producing enough wet or dirty diapers

• You were already instructed to have your baby's bilirubin rechecked and are having difficulty arranging follow-up

This is also why those first newborn appointments are so important. Your pediatrician is not only checking weight and feeding, they're also evaluating hydration, jaundice, and how your baby is transitioning to life at home.

Umbilical Cord Concerns

The umbilical cord stump normally dries, darkens, and eventually falls off on its own, usually within the first few weeks.

A tiny amount of blood around the time the cord separates can be normal.

Call your pediatrician if you notice:

• Increasing redness spreading onto the skin around the belly button

• Swelling or warmth

• Pus or foul-smelling drainage

• Persistent or significant bleeding

• Fever

Redness that is spreading outward from the umbilical area, particularly when accompanied by fever or a baby who appears ill, needs prompt evaluation.

What About Poop?

Newborn stool comes in an impressive variety of colors and consistencies.

During the first few days, babies pass dark, sticky meconium. The stool then transitions and may eventually become yellow, seedy, brown, tan, or green depending on whether your baby receives breast milk, formula, or both.

Call your pediatrician if you see:

• White, pale, or chalky stools

• Red or bloody stools

• Black stools after the normal meconium period has passed

• Significant diarrhea accompanied by signs of dehydration

• A swollen abdomen with vomiting or poor feeding

And remember: newborns make some spectacular noises when they poop. Grunting, turning red, and straining do not necessarily mean your baby is constipated if the stool itself remains soft.

Some Things That Look Scary but Are Often Normal

Newborns are strange little creatures, in the best possible way.

Parents frequently call about things that turn out to be completely normal newborn behaviors, including:

• Hiccups

• Sneezing

• Brief periods of irregular breathing while sleeping

• Startle reflexes

• Noisy sleeping

• Grunting while passing stool

• Peeling skin

• Mild newborn acne

• Small amounts of spit-up

• Wanting to feed very frequently, especially during periods of cluster feeding

Of course, "usually normal" does not mean you should ignore your instincts. If something seems excessive, persistent, or different from your baby's usual behavior, call.

When Should I Call 911?

Some situations should not wait for a pediatrician's office to call you back.

Call 911 or seek emergency medical care immediately if your newborn:

• Is not breathing or is having severe difficulty breathing

• Turns blue, gray, or very pale and does not quickly recover

• Is unresponsive or cannot be awakened

• Has a seizure

• Has a prolonged pause in breathing

• Appears critically ill

• Has uncontrolled bleeding

• Has another condition that you believe is immediately life-threatening

You Are Never "Bothering" Us

One of the hardest parts of having a newborn is learning what is normal for your baby.

That takes time.

You aren't expected to know the difference between every normal newborn behavior and every sign of illness the moment you leave the hospital.

So if you're sitting at home wondering:

"Is this worth calling about?"

Call.

Sometimes the answer will be, "That sounds completely normal, keep watching it."

Sometimes we'll want to see your baby in the office.

And occasionally, we'll tell you that your baby needs to be evaluated right away.

All three are perfectly appropriate outcomes of calling your pediatrician.

As healthcare providers, our job isn't only to treat your child when they're sick. It's also to help you learn your baby, answer your questions, and give you the confidence to know when something needs attention.

When it comes to a newborn, I would always rather you call than spend the night wondering whether you should have.

This article is intended for general educational purposes and does not replace individualized medical advice. If you are concerned about your newborn, contact your child's pediatric healthcare provider. For a medical emergency, call 911 or seek emergency medical care.