Babies are tiny, fragile, helpless beings who totally depend on parents, other caregivers, and doctors for their wellbeing. If they’re not feeling well, they may fuss or cry, but they can’t tell anyone what’s bothering them. We all know the classic signs of a sick baby: fever, diarrhea, vomiting, difficulty breathing, and listlessness, among others. But not all babies with medical problems display obvious signs. In fact, many medical conditions manifest themselves with signs that can be easily overlooked or deemed too insignificant for a doctor’s attention. Some subtle signs may signify something serious while signs that look scary may be benign and nothing to worry about.
Most babies are carefully examined from head to toe by a doctor immediately after birth and at each checkup. But between those exams, it’s the people who spend the most time with them—parents, grandparents, and babysitters—who are more likely to notice something out of the ordinary. Using your five senses, you too can check a baby for signs of health or illness. Here’s how:
Look at a baby’s head, eyes, ears, nose, mouth, skin, torso, genitals, and body wastes. For example, you may notice that a baby or toddler has recently developed freckles. Medically known as ephelides, freckles are usually an inherited trait in families with blond or red hair and fair skin. But they can appear in children with dark hair and skin as well. Freckles are not present at birth. Rather, they’re the result of excess exposure to the sun and found on sun-exposed areas of the body. Therefore, lots of freckles are an important warning sign that a child has been out in the sun too much and needs to be covered up. Indeed, a child with freckles is at increased risk for skin cancer, which is on the rise in children.
Freckles shouldn’t be confused with the much larger café au lait spots, which often appear on non-sun exposed skin. More common in babies of African and Hispanic descent than in white babies, these spots are present at birth and are the color of coffee with milk, hence the name. They’re usually not noticeable until age two or three, and are usually benign. However, if a child had more than six large café au lait spots (over a half-inch in diameter), it can be a warning sign of several very rare, but serious, genetic disorders.
Listen to a baby’s breathing sounds and patterns. All babies occasionally stop breathing for a few seconds or sometimes longer, while they sleep. Premature babies and those who move around a great deal during sleep are more likely than other babies to have repeated bouts of sleep apnea, as it’s medically called. Most outgrow it. But if it continues, or happens very often, it could be a sign of obstructive sleep apnea (OSA). OSA can be caused by enlarged tonsils and adenoids, an infection, an airway obstruction, or other physical problems. Once these problems resolve, the OSA tends to improve.
Snoring is also common in infants and babies, particularly boys. Toddlers tend to snore during the deep stages of sleep and usually to outgrow it. Snoring is also fairly common in children with colds or allergies. And many babies with OSA also snore, and most outgrow both. When snoring continues, however, it can be a sign of some structural abnormality with a child’s nasal passages.
Feel a baby’s skin for lumps and bumps, fever, clamminess, or a fast or unusual heartbeat or other sensations. A baby has six soft spots (fontanelles), but only two can be normally be felt: the larger one on top of the baby’s head and the other in the back. Many parents are surprised to feel a heartbeat when they touch the one on top. This is, in fact, a healthy sign; the pulsating beats are the result of blood flowing to the baby’s brain. The pulsating is most noticeable when the baby is resting. A baby’s soft spots should also feel firm and very slight curved inward. If a fontanelle feels very sunken, it can be a sign of dehydration. If, on the other hand, the soft spot always bulges outward, it can signal a number of medical conditions ranging from a Vitamin A excess to a brain infection, in which case other more serious signs would be present.
Taste a baby’s skin for excessive saltiness when cuddling and kissing him or her. It’s not unusual for babies to sweat and taste salty. Indeed, many parents complain that their babies have sweaty heads. Because their temperature-regulating systems aren’t fully developed, babies sweat easily. And because sweat contains a lot of salt, it can taste salty. If a baby sweats occasionally, it’s usually nothing to worry about. In fact, the sweat may merely be a warning sign that the baby is overdressed or in an overheated room. However, if a baby often has salty, sweaty skin, it can signal a medical condition such as an overactive thyroid (hyperthyroidism), diabetes, asthma, and rickets. However, in all of these disorders, other, more obvious and serious signs than sweating are likely to be noticed.
If a baby’s skin always tastes salty, even when he or she is not sweating, it can be an important early warning sign of cystic fibrosis (CF), a rare, inherited disease. Other early signs include breathing difficulties and frequent diarrhea with greasy, foul-smelling stools. CF causes serious respiratory and gastrointestinal problems that may not show up until teen years or young adulthood. While CF has no cure, treatments have improved tremendously in recent years, and life expectancy has increased greatly.
Smell a baby’s body wastes. Smelling a baby’s pee and poop may be unpleasant, but it can be especially revealing. While urine that has a strong ammonia odor may mean the baby’s diaper hasn’t been changed for a while, it can also mean the baby is seriously dehydrated. Smelly urine can signal a urinary tract infection, as well.
Frequent bouts of smelly, loose stools in older babies or toddlers can signal celiac disease (intolerance to gluten) or other malabsorption disorders. If the foul-smelling feces float, are frothy, and have an oily coating, it can also be due to an overly fatty diet, or may even signal inflammatory bowel disease (IBD), a more serious condition.
As you can see, it’s important to pay attention to a baby’s body signs no matter how insignificant they seen to be. And it’s a good idea to keep a record of any you encounter, when they first appeared, and under what circumstances. Bring the record to each pediatrician visit. If you do notice a sudden suspicious or scary sign on your baby, call your doctor immediately. It’s better to be safe than sorry—your baby’s health depends on it.