Seven serious symptoms in babies and toddlers

Posted on 12 August 2016

For new parents, determining whether a little one is really sick or just experiencing generally harmless symptoms can be a minefield. Calling your paediatrician for any hint of a sniffle is unnecessary, but there are some symptoms in infants, babies and toddlers that should never be ignored.

Dr Ruaan Stander, a paediatrician at Mediclinic Worcester, explains when to consult a doctor in the following seven situations:

1. Fever
Determining if your little one has a fever varies according to where it’s measured:
•    Armpit: above 37.2°C
•    Ear (eardrum): above 37.5°C
•    Forehead: above 38°C

If your baby or toddler does have fever, call your doctor if:
•    you have recently travelled to a malaria-risk area.
•    your baby or child has a predisposing chronic medical condition with a risk of recurrent or serious infections – for example, a primary immunodeficiency; a secondary immunodeficiency due to chemotherapy, the prolonged use of corticosteroids or HIV infection; vesico-ureteric reflux with a history of recurrent kidney infections; the presence of an indwelling medical device like a central venous catheter, ventriculo-peritoneal shunt or urinary tract stent.
•    your baby is less than three months old.
•    Baby has a very high fever: armpit above 39.4°C, or ear (eardrum) and forehead above 40°C.
•    the fever lasts longer than three days.
•    the fever is associated with an epileptic seizure or a new skin rash.
•    Baby has a non-blanching skin rash (when it doesn’t fade after briefly pressing on or rubbing over the rash area).

2. Headache
Consult your doctor if there is a background of recent head trauma or contact with a case of meningitis, and also if the headache is:
•    in a child younger than three years.
•    sudden and severe.
•    not responding to medication.
•    localised to the back of the head.
•    localised in the same area with each headache episode.
•    progressive in nature.
•    showing a change in the severity, frequency or quality from before.
•    increasing with coughing or straining.
•    waking the child up at night or presents on awakening in the morning.
•    occurring more than once a month.
•    associated with: fever, neck stiffness or neck pain; sensitivity to light; recurrent vomiting; confusion, irritability, change in behaviour or personality; a change in vision, double vision, a new-onset squint; a new onset of slurred speech, loss of balance or unsteadiness; an abnormal walking pattern; weakness of an arm, leg or one side of the face, or deterioration in dexterity; the occurrence of an epileptic seizure; a non-blanching rash.

3. Breathing problems
If your baby appears to be having trouble breathing, call your doctor if:
•    your baby stopped breathing, requiring some form of stimulation or resuscitation to recover.
•    your child is breathing too fast: above 50 times per minute in babies and infants and above 40 times per minute in toddlers.
•    there are abnormal breath sounds, like an audible sound on taking in a breath (stridor) or an audible whistling noise when breathing out (wheezing).
•    there are any of the following signs indicating that breathing has become hard work and your little one may eventually tire:
– your baby struggles to finish the usual volume of a feed
– the presence of chest wall in-drawing (the soft tissue above the collar bones, between the ribs or below the ribcage sink into the chest during breathing)
– use of the neck and/or abdominal muscles to breathe
– a blue hue to lips, tongue or nails.

4. Excessive crying
Babies do cry to communicate their needs, but consult your doctor if:
•    your baby, infant or toddler is inconsolable and has cried for more than two hours.
•    you’ve used substances of abuse during your pregnancy.
•    the crying might be related to an injury or fall.
•    there are localising signs of a possible source of pain – for example an unexplained bruise, not moving an arm or leg, fiddling with an ear, a bulge in the groin area, the passage of hard stools, diarrhea or a testicular swelling.
•    there are symptoms of a systemic illness or infection: fever, rash, not drinking or feeding well, being less active than usual or not responding in the usual way.
•    there are any of these danger signs: vomiting, bulging or sunken fontanel (the soft area on top of a baby’s head), signs of dehydration (dry mouth, being thirsty, absence of tears when crying, sunken eyes, no urine/wet diapers for 4-6 hours), a distended tummy, bloody bowel movements.

5. Vomiting
Babies frequently burp up a posset of milk after feeds, but call your doctor in the case of:
•    Bile (yellow-green) or blood-tinged (red or brown) vomit
•    Forceful vomiting in a newborn
•    An infant not drinking or not holding down anything for more than a few hours
•    Accompanying diarrhoea, which poses the risk of rapid dehydration
•    Presence of dehydration – the signs of dehydration are: dry mouth, being thirsty, absence of tears when crying, sunken eyes, no urine/wet diapers for 4-6 hours
•    Vomiting more than twice in 24 hours
•    Continued vomiting despite the use of an anti-emetic (a medicine used for vomiting and nausea)
•    Severe tummy pain
•    A distended tummy
•    Bloody bowel movements
•    A fever higher than 39°C
•    Headache

6. Bowel function
Constipation occurs when bowel movements occur less frequently than normal despite a good intake of food and/or if stools are hard, large and/or difficult or painful to pass.

When are bowel movements too few?
When there is a significant decrease from the usual bowel movement frequency (for example usually having 1 to 2 bowel movements per day and then skipping two days despite a good intake of food).

Newborn babies pass approximately 4 soft/liquid stools per day in the first week of life, with breastfed babies passing more in comparison to formula-fed babies. Young infants below three months of age usually pass 2 to 3 stools per day.

The frequency of bowel movements in breastfed babies has a wide range of normality – from having a bowel movement shortly after each feed to having one (large) bowel movement every seven days. An infant with the latter infrequent normal pattern should be distinguished from the infant who is not getting enough milk: the former shows good weight gain despite the infrequent bowel movements. Formula-fed babies shouldn’t go more than three days without a bowel movement. Toddlers should have 1 to 2 bowel movements per day, depending on intake.

If your baby or toddler is constipated, consult your doctor in case of:
•    Severe tummy pain
•    A distended tummy
•    Vomiting
•    In an infant less than four months of age: no bowel movement within 48 hours of    his/her normal pattern or the presence of hard stools
•    Poor appetite and/or losing weight
•    Presence of blood in the bowel movement
•    Having repeated episodes of constipation
•    No stool passed within 24 hours of starting laxative treatment

When does my infant, baby or toddler have diarrhoea?
When there is a significant increase from the usual bowel movement frequency, associated with a change in the character of the bowel movement to a liquid consistency.

Consult a doctor when your baby or toddler has diarrhoea in the presence of any of the following:
•    If Baby is not drinking for more than a few hours or is vomiting as well
•    If your little one shows signs of dehydration: dry mouth, being thirsty, absence of tears when crying, sunken eyes, no urine/wet diapers for 4-6 hours
•    Blood-containing bowel movements
•    Severe tummy pain

7. Bladder function
Too much
Always see a doctor if your baby or toddler is wetting too much, as it could be a sign of a bladder infection, diabetes or a problem with the bladder or control of the bladder.

Too little
Also always see a doctor if you suspect your baby or toddler is wetting too little. This could be a sign of poor fluid intake, fluid retention (heart or kidney disease) or fluid loss with impending dehydration. It may also be due to voluntary or involuntary retention of urine.