Newborn warning signs: when to call a doctor now

Go to hospital now

Call 108 or go to the nearest hospital immediately if your baby: is breathing fast, grunting, or drawing in beneath the ribs; has blue or grey lips, tongue or face; is floppy, unresponsive or very difficult to wake; has a fit; has a temperature of 38C or above at under three months; is not feeding at all; or has a rash that does not fade when pressed with a glass.

Also go immediately for: a bulging or sunken soft spot; persistent vomiting that is green, or vomit containing blood; blood in the stool in an unwell baby; a swollen, hard or tender abdomen; a firm painful lump in the groin or scrotum that cannot be pushed back; or any injury or fall.

And for a baby who has stopped passing urine, has no tears when crying, has a dry mouth and sunken eyes, or is much sleepier than usual — these are signs of dehydration and in a newborn they move quickly.

Do not give paracetamol and wait. Do not wait for the clinic to open. A newborn can go from mildly unwell to seriously unwell in hours, and hospital staff would far rather see a well baby than a late one.

If you cannot travel quickly, call 108 for an ambulance rather than arranging transport yourself.

Why fever under three months is different

Any temperature of 38C or higher in a baby under three months is treated as an emergency, whatever else is going on and however well the baby otherwise seems.

A newborn's immune system cannot contain infection the way an older child's can, and serious bacterial infection can present with nothing but a temperature. They are usually admitted and investigated rather than sent home with advice.

A low temperature matters too. A newborn who is unusually cold — below about 36C — and difficult to warm can also be seriously unwell, and this is the sign most often missed.

Measure under the arm with a digital thermometer. Do not use forehead strips for a newborn.

Do not sponge a baby with cold water or alcohol, and do not give any medicine to a newborn without medical advice.

See a doctor today

Yellow skin or eyes appearing in the first 24 hours of life, deepening after the first week, spreading to the palms and soles, or with a baby who is sleepy and feeding poorly. Jaundice is common and mostly harmless, and these particular versions are not.

Fewer wet nappies than expected, no stool for an unusually long stretch in a newborn, or poor weight gain.

Feeding that has become difficult: falling asleep at every feed, taking much longer, or refusing.

Redness, swelling, pus or a foul smell at the umbilical stump, or redness spreading into the skin of the abdomen.

Persistent forceful vomiting after feeds, particularly if it is getting worse and the baby seems hungry afterwards.

Any rash with fever, blisters, or a baby who seems unwell with it.

And trust the general feeling. 'Something is different about my baby today' is a legitimate reason to be seen, and it is one experienced paediatricians take seriously.

When to see a doctor

Everything above. In addition, keep the following ready so you can describe it clearly on the phone: the baby's age in days or weeks, whether they were premature, temperature and how it was taken, how many feeds and wet nappies in the last 24 hours, when the problem started, and what has changed.

Take the immunisation card and any discharge summary with you.

If you are told to wait and you remain worried, go back or go elsewhere. Persisting is reasonable and sometimes necessary.

This article is general information, not medical advice, and has not been reviewed by a paediatrician. It is no substitute for personal medical advice. For any decision about your baby's health, please consult your doctor.

Frequently asked questions

Q: My baby feels warm but seems fine. — Measure it. Any reading of 38C or above under three months means hospital, regardless of how well they seem.

Q: Is it normal for a newborn to sneeze and hiccup a lot? — Yes, both are normal and neither is a warning sign on its own. Fast or laboured breathing is different.

Q: I feel like I am overreacting. — Newborn medicine is built around parents coming in. Nobody is annoyed by a well baby; they are worried by a late one.

Q: What if it is the middle of the night? — Go. Paediatric emergency departments are staffed overnight and this is precisely what they are for.