It’s scary when your baby isn’t his usual self. Find out when you need to bring him to the doctor.

As a parent, you’ll know that your baby’s health symptoms are a minefield: For instance, when is a fever too high to ignore, or why is your baby crying uncontrollably suddenly?

Indeed, most of us have problems deciding if the symptoms are serious enough to need a dash to the paediatrician, or even a quick call to your doctor.

Paediatrician Dr Wong Chin Khoon walks us through common baby symptoms, plus deets on how serious they can be.

1. How high should a fever be before you rush your baby down to the Paediatrician? Why is this important?

Your baby’s fever is a symptom and not a disease. It is also the body’s way to fight infection. Like all symptoms, fever may be due to illnesses that are minor or serious, or sometimes even life-threatening. Therefore, there is no clear-cut degree of fever that tells us that the baby is very sick or otherwise. However, some studies have shown a four-times higher risk of serious infection in babies who have a temperature above 40 deg C. It is also important to note that fever in itself does not cause brain damage. In general, the degree of the fever does not correlate with the seriousness of the illness. How your baby acts is what counts.

Bring your baby to the doctor if he:
* Is less than 3 months old (there is a 21 times higher likelihood of a serious infection (compared to older children).
* Has a temperature of 40 deg C and above.
* Feeds poorly and passes very little urine (can result in dehydration).
* Seems drowsy or lethargic (especially if the fever is not above 38 deg C). A fever may make children want to sleep more, but they should awaken easily and be able to interact with their parents.
* Has difficulty breathing or has breathes noisily.
* Develops a rash (such as red spots or small purple spots on the skin that may look like bruises).
* Has a soft spot on the head that bulges out or is sunken inwards.
* Is extremely irritable ― cries constantly and you cannot settle him;
* Becomes grey, pale or blue.
* Has a fit (seizure/convulsion).

Note that a high fever does not necessarily indicate a serious illness, and a low-grade fever does not necessarily mean that the illness is minor. If the fever doesn’t come down with fever medicine does not necessarily mean the illness is serious. Sometimes, babies who have had a minor illness develop a more serious infection later. If your baby seems to be getting sicker, return immediately to the doctor’s clinic, even if you have just left the clinic and even if your baby is taking medication. Even if it is a false alarm, it is better to return than to wait too long.

Note that a high fever does not necessarily indicate a serious illness, and a low-grade fever does not necessarily mean that the illness is minor.

2. My baby doesn’t seem to be responding when I call his name (when he used to). Should I be worried?

Every newborn in Singapore is offered a newborn hearing test soon after birth. The chance that the hearing loss is congenital is very low if the result is normal. Congenital hearing loss may be due to genetic inheritance, viral infection of the baby while in the womb, or trauma during the birth process. However, certain non-genetic or non-congenital conditions may impair the hearing. These include:

* Low birthweight.
* Severe neonatal jaundice, although with close monitoring by the paediatrician and the effectiveness of phototherapy, it has become uncommon these days.
* Use of a certain antibiotic that is toxic to the ear, especially during infancy.
* Meningitis.
* An ear infection, usually associated with a running nose and a cough.
* Trauma to the ear resulting in a perforated eardrum or damage to the inner ear.
* Ear wax.

You may want to test your baby’s hearing in a quiet room, as he can be easily distracted by bright, colourful objects or sudden brightness. This can be the reason why he does not appear to respond when you call his name. If your baby is startled by a closing door or a sudden loud noise from the television, his hearing is likely to be normal. If you are still concerned, please see your paediatrician, who will test your baby’s hearing. He may recommend an additional formal hearing test if necessary.



3. My baby has been losing weight, even though he eats normally. What could the problem be?

Weight is a product of genetics, metabolism, activity, diet, as well as the presence or absence of illness. The first step is to confirm that indeed there is a weight loss. Different weight scales (or even the same scale) may give you slight differences in readings at different times, which should not be a concern. Therefore, it is advisable that you repeat weighing him over several days and weeks, especially if your baby is otherwise well and happy.

Most babies may have static weight or slow weight gain if they are not eating well or have an mild ongoing illness. Genetically small babies tend to have slow growth rather than weight loss. Therefore, it is a concern if there is a significant weight loss over a prolonged period. Babies in the first year of life should double their birth weight at 3 or 4 months and triple their birth weight at a year. Breastfed babies tend to gain less weight in the first month but will ultimately catch up with the rest of their peers. Premature babies may also take up to 1 to 2 years to achieve the catch-up growth with their peers.

The paediatrician may assess your baby’s dietary intake and developmental milestones. If the milestones are appropriate, this is less of a worry. He can also help you plot your baby’s growth on the growth chart provided in every newborn health booklet. The trend over several months is more important and provides more information than a single reading.

Rarely, blood investigations are done to exclude nutritional deficiency, underlying organic causes (liver, kidney and thyroid disease). As every newborn in Singapore has a thyroid screening test done using the umbilical cord blood, it has become less common for thyroid hormone disorders to be the underlying cause. Do consult your doctor if you are concerned about your baby’s growth.

4. His stool looks different ― and I sometimes see blood in it. Is something wrong?

See your paediatrician if you see blood in your baby’s stool. Blood in infant stools have three common causes. These are:

* Diarrhoea (acute gastroenteritis).
* Constipation with anal fissure (tear around the anus).
* Cow’s milk protein allergy.

Acute gastroenteritis is usually due to a viral infection affecting the digestive system. If there are blood specks or tiny streaks in the stool, it can be due to the stripping of the skin in and around the anus caused by the frequent passing of very watery stool. The baby may have vomiting, fever and poor appetite. However, if the amount of blood is alarming (large blotches, well-mixed with the stools and mucous) or is associated with fever, crying or irritability, please see your paediatrician to exclude other serious causes.

Constipation can happen when you start adding solid food as part of the weaning diet.

Constipation ― passing of hard stool, usually associated with straining and sometimes with fresh blood streaks ― can happen when you start adding solid food as part of the weaning diet. This is due to the tear (anal fissures) at the anal opening during defecation. Giving small amount of water a few times a day and increasing the fibre content of the weaning food (such as fruit, fruit juices, puréed vegetables) will help.

A small percentage of babies may have cow’s milk protein allergy, which present as blood in the stool, irritability and possibly vomiting and diarrhoea. This may happen when you try to transition your baby from breastmilk to formula milk. It may even happen if the breastfeeding mum consumes a large amount of cow’s milk and the baby can receive the cow’s protein via the breastmilk. Breastfeeding mums are likely to see a resolution when they remove all dairy products from their baby’s as well as their own diet. See your paediatrician regarding this.



5. My baby can’t stop crying he’s been extremely fussy for almost a week, but has no other symptoms. Does he need to see a paediatrician?

Your baby cries for many reasons including a wet or soiled diaper, hunger, or being too hot or too cold. However, from your description, infantile colic is a likely cause of your baby’s cry. Typically, infantile colic begins at about 3 weeks of life, presenting with inconsolable crying but the baby is otherwise growing well except for small regurgitations. He has normal urine and bowel motion with a completely normal physical examination. The exact cause is still debatable but possible reasons include lactose intolerance, cow’s milk protein allergy, gastro-oesophageal reflux, poorly coordinated gut movement due to immaturity or an imbalance of probiotics. Infantile colic peaks at about 6 weeks and usually resolves by about 3 to 4 months. We should recognise the self-limiting nature of the colic. However, the following are red flags that should prompt you to bring your baby to a paediatrician:

* Projectile vomiting.
* Arching of his back during or after feeding.
* Bloody stools.
* Failure to gain weight.
* Bloated tummy.

Association with frequent respiratory symptoms (eg cough), diarrhoea or constipation, eczema or a family of atopy (asthma, eczema, sensitive nose).

6. There are unexplained bruises on his body and leg, that haven’t been caused by falling or physical hurt. Is this serious?

Possible causes include a viral-induced low platelet count (eg dengue), or blood disorders like leukaemia and haemophilia (a congenital bleeding disorder due to a deficiency in clotting factors in boys). Child abuse by a caregiver, or pinching by a jealous older sibling may also possible. A congenital birth mark, commonly known as the mongoloid blue spot, can sometimes be mistaken as a bruise. It is commonly found on the buttock, which is an unusual place for a bruise to occur.

A congenital birth mark, commonly known as the mongoloid blue spot, can sometimes be mistaken as a bruise.

It is also common for toddlers who are roaming around fearlessly and unsteadily to have bruises on their legs but not on their body. Infants who aren’t mobile yets should not have bruises, therefore you should bring your baby to the paediatrician as soon as possible.

7. My baby is usually extremely active but for the last two days, he has been lethargic and sleepy. Is something wrong?

Illnesses, dehydration or hypoglycaemia (low blood sugar) from poor feeding, fever (especially when it is high) or medications used to treat a common cold can cause the baby to be lethargic and sleepy. It is important for you to seek medical attention as soon as possible.

Photos: iStock


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