Changes in Behavior and Appearance that are Cause for Concern

by Audrey Paul, MD, PhD, FACEP , Karen Goodman, MD, and Catherine Verow, MS, CCLS

Babies grow and change rapidly, especially in the newborn period. Many changes are positive; some, however, can be a sign that your baby is not feeling well and needs medical attention. The following symptoms are causes for concern and a sign that you need to seek immediate medical attention.

Crying Changes:

While it may be hard to tell if your baby is crying from colic, a baby who has changed from his/her normal behavior and is inconsolable despite usual attempts to soothe, may be sick.

Color Changes:

Changes in your baby’s skin color can be a sign that something is not quite right. Specific changes to be wary of include:

  • Turning blue, especially around the lips or face
  • Yellow, pale or mottled skin (or any other changes from your baby’s normal skin tone)
  • Rapidly spreading rash

Tone Changes:

Infants are not known for their superior muscle tone. But you know how your baby normally feels, the strength of their grip, and how they support themselves. Be aware if this changes:

  • Feels unusually limp or weak, different than “normal”

Sleeping Pattern Changes:

Changes that might indicate a problem with your newborn include:

  • Sleeping much more than usual
  • Acting less alert
  • Having difficulty waking your baby ( baby is not arousable)

Breathing Changes:

Changes in breathing patterns, including the following, are especially concerning:

  • Slow breathing
  • Rapid breathing
  • Irregular breathing pattern (different from normal pattern)
  • Nostrils flaring
  • Belly or ribs moving unusually with breathing – breathing seems labored
  • Not breathing

Feeding Changes:

A baby’s feeding pattern may change over the first month for a number of reasons. He or she becomes more alert. Mom’s breast milk may become more available. The baby may be able to drink more during feeding and, therefore, may be able to go longer between feeds. Changes to be concerned about include:

  • Sudden difficulty in baby’s sucking at the breast or bottle
  • Loss of appetite, skipping feedings without increasing amounts during other feedings
  • Slower feeding (baby takes much longer than usual to finish the same amount of milk/formula)
  • Sweating or sudden difficulty in breathing during feeds (when this cannot be attributed to a stuffed nose or being overdressed)
  • Vomiting (especially if projectile or green!)

Movement Changes:

Certain unusual & repetitive movements may indicate your baby is having a seizure. These may include:

  • eye blinking
  • repetitive lip smacking (not sucking)
  • jerking of one side or arm or leg

Conclusion: If your baby exhibits any changes or symptoms that appear severe or life threatening, go to the closest ER immediately. If your newborn does not appear to be in immediate distress, but something still does not feel right to you trust your instincts! Call your pediatrician. An ER visit may or may not be necessary, or your pediatrician may recommend that you go to a pediatric ER. When speaking to your pediatrician, ask if your ER is staffed with pediatric emergency medicine physicians 24/7, since pediatric emergency physicians are often more comfortable managing pediatric emergencies especially in newborns.

Ultimately, you are your baby’s best advocate, and you know your baby best. If you have any questions trust your instincts and always call your pediatrician. In an emergency, if you do go directly to the ER, you should contact your pediatrician. Your pediatrician can be helpful not only medically (by providing information to the hospital staff) but also emotionally. Your doctor knows you and your baby and can help you deal with a stressful situation.

Remember, newborns show symptoms and signs of illness differently than older children, so staying attuned of and being aware of the best expertise and being prepared for the places to go for any potential newborn emergency can be life saving The preceding information is intended to empower and inform your decisions. Its development was funded in part of a generous grant from R Baby Foundation.

The R Baby Foundation seeks to save the lives of newborn babies by educating parents, supporting research, and providing emergency room equipment and training to medical professionals.

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