Newborn Red Flags: When to Call the Doctor, and When to Wait

Newborns sleep a lot, make strange noises, breathe irregularly and produce diapers that look like evidence from an alien crime scene. Most of that is normal.

But newborns can also get sick fast. While she recovers from the birth, it’s often your job to notice changes, make the call and get help. This page tells you when. Save it, or print our free red flags sheet for the fridge.

When to call the doctor for a newborn: call 911 now

Call 911 right away if your baby:

• Is not breathing, or is struggling for every breath.
• Has blue or gray lips, tongue or face.
• Is limp or not responding, or can’t be woken up.
• Has a seizure.

Don’t drive around hoping it improves. Call, put the phone on speaker and follow the dispatcher’s instructions.

Call the doctor right away, day or night

Call your pediatrician immediately, or go to the ER if you can’t reach them, for:

• A fever of 100.4°F (38°C) or higher, taken rectally. See the fever rule below.
• Breathing trouble: grunting with every breath, nostrils flaring, skin pulling in between the ribs, or breathing faster than 60 breaths a minute while calm.
• Green vomit, or forceful vomiting again and again. Green vomit can mean a blocked intestine.
• Not feeding, or far fewer wet diapers than usual.
• Very hard to wake, or much floppier than usual.
• High-pitched crying that won’t stop.
• Yellow skin or eyes that are spreading or getting worse.
• Redness, pus or a bad smell around the umbilical cord, especially with fever or poor feeding.
• Purple or blood-red spots that don’t fade when you press on them.

If your gut says something is wrong, call. Pediatricians would much rather answer a question that turns out to be nothing than see a sick baby hours too late.

Newborn symptoms that can wait until morning

Call during office hours, or the nurse line if your practice has one, for things like:

• A mild rash or dry skin, without fever, in a baby who’s otherwise feeding and acting normally.
• A blocked nose, if the baby is still feeding well.
• Spit-up that’s bothering you, but the baby is gaining weight and having enough wet diapers.
• Questions about feeding, sleep or a new product that seems to irritate their skin.

The difference: a baby who’s feeding, waking up and peeing normally usually isn’t in danger. A baby who stops doing any of those is a reason to call now.

Is this normal? Newborn things that look scary but aren’t

Usually normal in the first weeks:

• Sneezing and hiccups, a lot. They’re clearing their nose and practicing their diaphragm.
• Noisy breathing and snorting while asleep. Tiny noses, lots of mucus.
• Startling and jerky arm movements. That’s a reflex, not a seizure. A seizure usually looks rhythmic and doesn’t stop when you hold the limb.
• Hands and feet that look a bit blue, while the lips and face stay pink.
• Spit-up after feeds, as long as the baby is growing.
• Weird poop colors: black and sticky at first, then green, then mustard yellow with “seeds” for breastfed babies. Welcome to parenthood. Very bright red, white or chalky gray poop is a reason to call.
• Some weight loss in the first days, regained by about two weeks.

Newborn breathing weird: what’s normal?

Newborns breathe irregularly. They can breathe fast, then slow, then pause for a few seconds before carrying on. Short pauses of under 10 seconds are common and usually fade by about one month.

Call the doctor if pauses last longer than 10 seconds. Call 911 if a pause comes with a color change to blue or gray, limpness, or the baby is hard to wake.

How to count: watch the belly rise for 30 seconds and double it. More than 60 breaths a minute while calm is too fast.

Newborn fever: the temperature rule

In a baby 3 months or younger, a rectal temperature of 100.4°F (38°C) or higher means you call the pediatrician immediately, even if the baby seems fine otherwise. Can’t reach them? Go to the ER.

• Use a digital thermometer, rectally. It’s the most accurate way at this age. A hand on the forehead doesn’t count. Ask the nurse to show you before you leave the hospital.
• Don’t give fever medicine before a doctor has seen the baby, unless they tell you to.
• Too cold counts too. A baby who stays cold after being dressed and warmed normally needs a call to the doctor.

First night home with a newborn: what to expect

Expect to check if they’re breathing roughly every four minutes. That’s normal too.

Things to know for the first nights:

• Feeds every 2 to 3 hours, day and night, about 8 to 12 times in 24 hours.
• Wet diapers go up each day. After the first 4 to 5 days, expect at least 5 to 6 wet diapers a day. Fewer, dark urine or no urine for 8 hours is a reason to call.
• Always on their back, in their own bassinet, with nothing else in it.

Your job: keep a simple log of feeds, diapers and any temperatures. A notepad or an app works. It’s the first thing the doctor will ask about, and at 3 a.m. nobody remembers.

And save these numbers in your phone today: your pediatrician, the after-hours nurse line, the hospital, and Poison Control at 1-800-222-1222.

Don’t forget her recovery either. Our guide on what to watch for in her first six weeks covers the warning signs for mom.

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General information, not medical advice. This page doesn’t list every symptom. If something feels wrong, call your pediatrician or 911.

Sources: AAP: Fever and Your Baby, AAP: Newborn reflexes and behavior, AAP: Baby’s first days, bowel movements and urination, AAP: How often and how much should your baby eat?.