In this episode Dr. Carole Keim MD covers baby illnesses and red flags. A red flag is a sign something could be wrong with your baby. Dr. Keim explains abnormal temperatures, choking, diarrhea, head injuries, seizures, and more to guide you in identifying red flags and what they might mean.

Not all red flags are emergencies that require immediate attention. Some are, but some are identified as urgent, which means your baby should be seen by your doctor within the next week or two. Dr. Keim shares this list of major red flags to watch for in the hopes it helps you, and ideally saves you and your baby a trip to the ER.

This episode will cover: 

• What is a red flag?
• Urgent v. Emergent
• Abnormal Temperature - emergency
• Apnea/Cyanosis - emergency
• Aspiration/Choking - emergency
• Blood in the Diaper - urgent
• Bulging Fontanel - emergency
• Cough - emergency
• COVID/flu/RSV exposure - urgent
• Diarrhea/Vomiting - urgent
• Head injury - emergent if signs of concussion/fx, otherwise urgent
• Jaundice - urgent
• Seizure - emergency
• Umbilical Cord Infection - urgent
• Umbilical Granuloma - urgent

What is a red flag? - 00:24

A red flag is a sign that something MIGHT be wrong and you should run it by a doctor.  

Urgent vs. Emergent - 00:37

Urgent = should be seen by their doctor at the next available appointment, ideally within a week or two.

Emergent = they need to be seen that day (sometimes immediately) - go to the ER or call emergency services.  If you are traveling, look up the phone number for emergency services before you go.  It’s 911 in the US but different in other countries.

It is ALWAYS ok to call your doctor or emergency services if you are concerned!

Abnormal Temperature - emergency - 1:15

You should have a rectal or temporal artery (TA) thermometer at home.  Go buy one if you don’t have one yet.  

The rectal temperature is the most accurate in babies, since their skin doesn’t hold heat very well.  If your baby is acting strange, or feels especially warm or cool to the touch, you can check a rectal temperature.  

Underarm temps and infrared forehead temps are inaccurate after the first few days/weeks of life - they can read either too high or too low by as much as 2 degrees.  They are ok as a screening, but they are measuring surface temperature and not core temperature, so if you are concerned and want an accurate read you need to do a core temperature - either rectal or TA.

A core temperature higher than 100.4 degrees Fahrenheit (38 degrees Celsius) is considered a fever.  A rectal temperature less than 96 degrees Fahrenheit (35.5 degrees Celsius) is considered to be hypothermia.   

Babies who are less than 6 months old have immature immune systems, and an abnormal temperature (either high or low) can be a sign that they have an infection.   

Apnea/Cyanosis - emergency - 3:29 

If your baby appears to stop breathing for several seconds (apnea), or starts turning blue (cyanosis), it’s time to call a doctor.  Cyanosis is most apparent on and around the lips, fingertips, and toes.  

Aspiration/Choking - emergency - 4:10

Signs of aspiration/choking include gagging, coughing, arching the back, vomiting, and turning blue.  Call your doctor if your baby is experiencing these symptoms, or 911 if it’s severe.

Blood in the Diaper - urgent - 4:46

If you see blood in your baby’s diaper, and you think it is coming from the urine or stool (and not from pseudomenses), call the doctor.  This is urgent but not emergent.

Bulging Fontanel - emergency - 5:30

If the anterior fontanel (soft spot) seems to be higher than the rest of the skull, this is a sign that the pressure around your baby’s brain is too high.  The fontanel will often raise during crying, straining to poo, and other normal maneuvers.  That is nothing to worry about.  But when the fontanel is bulging when your baby is calm, you need to see a doctor.

Cough - emergency - 6:33

Hiccups are normal, sneezing is normal, but cough is not.  Clearing their throat after eating doesn’t count as a cough.  Any baby less than 6mo with cough needs to go to the ER - they are at risk of apnea and may need to be admitted depending on how they are doing.

OTC cough medicines are NOT to be used in children less than 6 years of age - they can cause them to stop breathing, and the safe ones (like antihistamines) just don’t work.

COVID/flu/RSV exposure - urgent - 8:47

Call your doctor or check the CDC website for current guidelines. 

Everyone in the house should wash hands often.  Anyone with cough or runny nose should wear a mask and try to stay away from baby.  If you’re breastfeeding and you have COVID/flu/RSV, keep breastfeeding!  You’re giving passive immunity to your baby that way.  Just wear a mask so you don’t cough onto the baby.   

Breastfeeding babies: mom can take Vitamin C, Vitamin D, echinacea, and zinc to pass through breastmilk to baby.

If baby develops cough or fever, go to the ER if under 6 mos, or call your doctor if over 6 mos.  

Diarrhea/Vomiting - urgent - 12:09

Babies can get dehydrated very quickly from diarrhea and/or vomiting.  Call your doctor if baby has vomiting or diarrhea 2-4x in the same day; go to the ER if it is more than 4x in a row or if baby is showing any signs of dehydration: dry lips/tongue, sunken fontanelle, irritable, lethargic.

It’s ok to rehydrate babies over 6 mos by giving water or an electrolyte solution (pedialyte, ORS) to replace losses, but only in small volumes - check with your doctor about how much is ok to give.  Remember they are on a primarily liquid diet, and giving electrolyte solution can cause them to be protein/fat/calorie depleted.  

Head injury - emergent if signs of concussion/fx, otherwise urgent - 14:22

Any time your baby falls off a surface (couch, changing table, bed, etc.) you need to call a doctor to make sure your baby did not sustain a concussion.

Signs of concussion include:

• Losing consciousness / fainting
• Vomiting
• Change in personality - persistent crying, acting strange, trouble sleeping/eating, etc.
• Pupils unequal size
• Seizure 
• Weakness of the entire body or parts of the body

If you feel skull crepitus (a crunchy sensation under the skin) or if baby’s fontanel is raised, that is an emergency.  Crepitus = skull fracture, bulging fontanel = bleeding around the brain. 

Jaundice - urgent - 18:07

If your baby’s skin and eyes appear yellow, you should call a doctor.  Most babies will have jaundice at some point, and your doctor can do a test to determine the level of bilirubin in the blood to see whether the jaundice needs treatment or not.  If the level of bilirubin is too high and is not treated, it can cause brain damage.

Seizure - emergency - 20:02

Infantile seizures may be the whole body (generalized shaking and tremors), or may only involve part of the body.  Some signs of seizures are:

• The whole body or part of the body makes repetitive jerking movements
• Sucking when there is nothing in the mouth
• Fast blinking
• Eyes deviated to the side

If you think your baby might be having a seizure, remove anything that might be in baby’s mouth, make sure your baby is not left unattended on a surface, and call an ambulance.

If you are able to take a video of the seizure, it can be very helpful for the doctors to see that!

Umbilical Cord Infection - urgent - 22:35

If the skin around the umbilical cord is red, swollen, warm to touch, and tender, these are signs of infection.  

Umbilical Granuloma - urgent - 23:42

When the umbilical cord falls off, it’s normal to have a little bit of bleeding and what looks like yellowish goo.  After the cord has fallen off, clean the area gently with a wet washcloth or a cotton ball with rubbing alcohol.  The bleeding should stop immediately, and much of the yellow goo will come off.  If the umbilicus is still bleeding, or there is too much yellowness, there may be an umbilical granuloma in there.  This can be treated easily at the doctor’s office with a chemical called silver nitrate.  The chemical cauterizes the granuloma, and the process is completely painless for your baby.

All of this information is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.  

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

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