Newborn Emergencies

When should I call a doctor?

We never want you to be worried at home, so if any issue is causing you concern, there is always a doctor on call for you. Specific instances in which we would like you to call would be: any temperature over 100.4 degrees Fahrenheit, increased lethargy, the baby is not arousable, less than 2 wet diapers in 24 hrs, projectile vomiting, or poor feeding. Non-urgent issues can be addressed at your well child visits or you can schedule another appointment to talk about these issues.

What is the best way to take my baby’s temperature? How often should I do it?

The most accurate way to take a baby’s temperature is rectally. The silver tip should just disappear out of sight in the rectum and then the thermometer should be held in place for about a minute. It is best to put a little Vaseline or lubricant jelly on the tip of the thermometer to ease it into the rectum. You only need to take the baby’s temperature if he or she feels warm to the touch or is not acting like himself. The temperature does not need to be taken every day. If your baby is less than one month old and has a temperature of 100.4 or greater, he or she needs to be seen by a doctor immediately.

I think my baby is congested. Do I need to give her medication?

Babies often sneeze or sound congested. It is not because they have a cold, but rather because their nasal passages are so small that there is very turbulent airflow through the nose. If the congestion is mild, intermittent, and not interfering with feedings and your baby seems comfortable,you do not need to do anything at all. For more bothersome symptoms, you can try using over the counter nasal saline drops (1 or 2 drops to each side of the nose every 4-6 hours as needed) and/or a bulb suction. If your baby has significant congestion, nasal drainage, fever or a persistent cough, you should discuss your concerns with your doctor.

My baby has a rash that looks like flea bites all over her body.

There are many newborn rashes and most of them are completely benign and will resolve on their own. If there is any rash that you notice at night, point it out to the doctor when we come for our morning rounds. The most common rash, described above as looking like “flea bites” is known as erythema toxicum neonatorum and is not an infection, is not harmful, and resolves spontaneously at about 7-10 days of age. 

Croup

Croup is a viral illness that causes fever and inflammation of the upper airway. This inflammation causes the “barky” or seal‐like cough. The swelling can also make the airway so narrow that they have noisy breathing even without coughing and this is called stridor. The cough is usually worse at nighttime and can be very scary for the family.

Children are more likely to get croup between 6 months and 3 years of age. After 3 years of age, the airway is larger, so the swelling typically does not cause any significant trouble. Like other viral respiratory illnesses, it can last for a week but typically there are just 2‐3 nights of significant coughing and the fever usually does not last for more than 72 hours.

Croup can be scary, but it is important to stay calm because the more calm your child is, the more comfortable he will be able to breath. Warm moist air can help with the stridor. Run a hot shower in the bathroom with the door closed and sit with your child for at least 10 minutes. A humidifier in the room while sleeping will also help as well. If your child does not improve and has stridor at rest (as opposed to when he is crying, agitated, or coughing), then he needs to be evaluated and may need steroids to decrease the swelling. Like other viruses, antibiotics will not make this illness better.

Please call the office immediately if your child is having any difficulty breathing. 

Cough and Cold

Children are notorious for having many colds throughout their early years and most will have at least 8‐10 colds in the first two years of life. Since these symptoms can last for up to three weeks, it may feel like they have a constant runny nose!

Colds are caused from viruses and typically peak during the fall and winter months. They are spread directly through contact with the virus such as sneezing or coughing. Cold symptoms are coughing, sneezing, fever, nasal congestion and runny nose. Most children do not need any treatment for viruses and antibiotics are used to treat bacterial infections, NOT viral infections. The best treatment is supportive care. There are many cough and cold medications that are available but these preparations are no longer recommended for children under 4 years of age.

Young infants are susceptible to colds and because they are nasal breathers, may become fussy during feeding or have some difficulty sleeping. In this case, you may need to let your child take several breaks during feeding to catch their breath. To help their breathing, you can place a few drops of nasal saline in each nostril and then suction with a nasal aspirator. The saline helps to break up the mucous and this will help their breathing. We recommend doing this prior to feeding and sleeping. Furthermore, a cool mist vaporizer in the room may help loosen nasal secretions and ensure a more comfortable sleep.

When to call the office:
• Fever that persists for more than 72 hours
•Any difficulty breathing
• Infant less than 2 months old with a fever
• If your child is lethargic or refuses to eat
• Fever that does not respond to Tylenol or Motrin