When leaving the hospital with a new baby, a lot of parents think, “Are they insane? Are they letting me take this person home? I can hardly remember where my keys are! What do I do with an actual person?”

There is a big difference between bringing home your first baby and when you bring home subsequent children. These days, a lot of parents haven't had much exposure to little babies, in fact, sometimes the first diaper that parents ever changed was their oldest child’s diaper.

Babies, being newborns, lack the ability to talk to communicate what they need and want, or if they are sick or in pain. This can lead to a massive and decidedly awful guessing game. So how do you, as a new parent, learn to decipher your child’s unique communication style?

What signs and symptoms require medical attention in a newborn?

Newborn babies are a category unto themselves — typical baby rules do not necessarily apply to newborns. Also, if your baby has any medical complications, such as being a preemie, err on the side of caution. If you have any uncertainty, call your child’s doctor — it’s what they are there for. Your doctor went into pediatrics knowing that babies' immune systems do not keep regular business hours.

Always call the pediatrician when:

Baby's temperature is above 100.4F

In a newborn, a fever can be a big deal. Newborns' immune systems are not well developed, so something simple can become serious quickly. Call early so your doctor can make an assessment of your child.

Baby's temperature below 96.8F

Just as high temperatures can signal trouble, low temperatures can, too.

Infant is crying inconsolably 

Babies cry, newborn babies can cry a lot — but they can also be consoled pretty easily — breastfeeding, changing diaper, and cuddling are common ways to soothe a newborn. Yes, newborn babies always want to be held — indulge this. You cannot spoil a baby, they are not lunchmeat. If you cannot console your baby, it's time to call your doctor.

Signs of dehydration in your newborn

In the first few days of life (before mother’s milk comes in) parents can expect to see one wet diaper per day of life. Typically milk comes in by day 3 or 4. After milk comes in, expect 4-6 wet diapers per day (per 24 hours). A word of caution — these days, disposable diapers are so absorbent it can be easy to miss a wet diaper. Try pouring 2-3 tablespoons of water on a clean diaper to get an idea of what a wet diaper may look or feel like; it will not be sopping wet. Babies have tiny bladders.

Baby’s urine should be pale to clear by day 3 — if it is not, call your doctor.

Dirty diapers follow the same pattern, one per day in the early days, and then once milk comes in 3-4 dirty diapers is normal. Some babies even stool every time they eat. The normal stool of a breastfed baby is seedy or runny, but this is not diarrhea. After several weeks, some infants can go a few days without stooling, this is also normal. 

If, by day four, baby’s stool is still dark or sticky, call the doctor.

Sunken fontanels on baby's head

Babies' heads have two soft spots early in life. If they are sunken, this is a sign of dehydration and necessitates a call to the doctor or emergency room visit.

Go to the Emergency Room or Call 911 when:

When your baby exhibits significant changes in behavior 

This might mean your baby is suddenly lethargic or is floppy, or otherwise not acting right. After a few days, parents begin to get an idea of their baby’s temperament. If it seems off, you should be able to tell. As trite as it sounds, mothers have instincts for a reason. Listen to them.

Baby has a seizure

While not uncommon, seizures are not normal and should be checked out by a doctor.

Change of infant's skin color

If your baby looks blue or is dusky, call 911.

Baby snoring respirations

Snoring respirations especially when coupled with wheezing, stridor, retractions, or any other indications that your baby is working hard to breath. This needs to be treated and evaluated immediately. 

Infant has suffered injury

Older babies and toddlers are pretty sturdy, but infants really can’t get into too much, so if they are hurt, get it checked out.

What does not need to be checked out urgently:

Infant has a cold

Your baby should recover normally from a cold with no complicating signs. If baby has a cold with no fever or difficulty breathing and is just listless and miserable, the best thing for him is nourishment, sleep, steam, and snuggles.

Baby spits up frequently

Babies have immature stomachs. They spit up. A baby who spits up frequently is called a happy spitter. Keep them more upright for a time after eating, burp well, and invest in burp clothes. If your baby seems uncomfortable, you can address it with your doctor, but it's typically not an emergency.

Infant has gas

In the same vein, babies have gas, but as they lack mature muscles, gas can become painful to your baby and make them upset. To help this, you can massage their tummy, burp well after eating, wear your baby, bicycle their legs, bounce gently on an exercise ball. If there seems to be a correlation between what you eat and the amount of gas your infant has, consider changing your diet and talking to a lactation consultant.

Baby is fussing

Babies can’t tell you exactly what they need — they need to cry to communicate until they can figure out how to talk, so they need to get their point across somehow. After a few days or weeks, parents will learn how to interpret different cries and respond accordingly. Address hunger cues early before your baby gets upset. Early hunger cues include rooting, sucking fists, smacking or licking lips, opening and closing mouth, pulling at clothes (when they get a little older), trying to “assume the position” (again, when they get a little older).

Your baby depends on you, and you will figure it out. It is a learning process for everyone — the baby and you. Your baby has to learn to be outside the womb, and you have to learn how to be a parent. Everyone will learn in time. 


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