When should I take my sick baby to the Doctor?

By Dr Ben – a paediatrician working in Cape Town.

This is an age-old question asked by new Moms and Dads alike. When is it ok to “watch and wait” for your child to “get better” and when must we rush off to the Doctor or hospital?

Infants, and particularly those in the first three months of life are very vulnerable. This is because their immune systems are still relatively immature. They will have received some passive immunity from their moms before birth and via breast milk, but they have not yet been exposed to many bugs (viruses and bacteria) and have therefore not built up much immunity of their own yet. In addition, they have not yet received all of their vaccinations, again making them more vulnerable to severe infection. What makes it most tricky is that the very young cannot tell you what’s wrong.

So, what are warning signs and are there any reliable indicators of severe infection in babies 3 months or younger? And when is your little one telling you that he or she is in trouble?

Here are some of the symptoms in an infant under 3 months that needs immediate assessment by a health care professional:

  • A high fever of ≥38◦C in an ill infant is indicative of significant infection that should be checked out by your health care practitioner. It is prudent to try and break a fever with an oral or rectal dose of paracetamol. The usual oral dose is 15 milligrams per kg every six to eight hours.
  • In addition to high fevers, any baby who looks unusually ill, is irritable or lethargic even after fever reducing medications needs to be checked out. This symptom may be a sign of a serious illness such as meningitis.
  • A low temperature like a high temperature can also be a sign of severe infection.
  • A baby who is inconsolable needs medical assessment.
  • Poor feeding in a child who usually feeds well must be assessed by your local Doctor or nursing sister. This may be non-specific sign of severe bacterial or viral illness.
  • Stiff neck.
  • Severe pain.
  • Any baby with persistent or excessive coughing or difficulty breathing or fast breathing or making unusual noises during breathing or difficulty swallowing and excessive drooling must be assessed as soon as possible. These symptoms may be indicative of a lower or upper respiratory tract infection.
  • Diarrhoea and or vomiting in the infant under three months should be assessed by your health care professional.
  • Signs of dehydration, these include a dry mouth and making less wet nappies than normal.
  • Pain or irritability on urination may be indicative of a urinary tract infection and most often requires antibiotics in order to protect the kidneys from scarring that is sometimes caused by urinary infections.
  • Any seizure or abnormal movements must be immediately assessed by your local GP or Paediatrician.
  • An unexplained
  • The baby who fails to gain weight adequately needs assessment. It is normal for a breastfed newborn to lose 10% of his or her birthweight in the first few days of life, thereafter there must be weight gain. Weight gain over time can be plotted and monitored in the infants Road to Health Chart.

It is always prudent to err on the side of caution with infants and particularly those under 3 months, and if you are unsure consult your GP or paediatrician.

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