When to call the pediatrician

Almost every new parent has stood in a dark room holding a phone, thumb over the pediatrician's number, thinking: is this silly? Am I bothering them?

You are not. Pediatric offices have an after-hours line for exactly this reason, and a nurse would much rather hear from you about something small than not hear about something big.

Before the baby comes, or today if the baby is already here, save two numbers in your phone: your pediatrician's office, including the after-hours line, and Poison Control, 1-800-222-1222.

When you call, it helps to have a few things ready: your baby's age, their temperature and how you took it, when they last ate, how many wet diapers today, and when the thing that worries you started.

This list follows guidance from the American Academy of Pediatrics. It is not complete, and it does not replace your pediatrician's own instructions. If your pediatrician gave you different advice, follow theirs. And if your gut tells you something is wrong, call, even if it is not on any list.

Call 911 now

Call 911 if your baby:

• Is not breathing, or has lips, tongue or face that look blue or gray
• Is struggling to breathe: the skin between the ribs pulling in with each breath, nostrils flaring, or grunting with every breath
• Is limp, not responding, or you cannot wake them
• Has a seizure
• Is bleeding and it does not stop with pressure
• Had a fall or injury and is now unusually sleepy, vomiting, or not acting like themselves
• Swallowed something that might be poisonous and is having trouble breathing, is very sleepy, or is having a seizure. If your baby seems fine, call Poison Control right away.
• Has a fever with a rash of small purple or dark red spots that do not fade when you press on them

Call your pediatrician right away, day or night

These cannot wait until morning. Call the office or the after-hours line now. If you cannot reach anyone quickly, go to the nearest emergency room.

• Fever in a baby younger than 3 months. A temperature of 100.4°F (38°C) or higher, taken rectally. Call immediately, even if your baby seems fine. For babies this young, a rectal temperature is the most accurate, and please do not give any fever medicine unless your pediatrician tells you to.
• A temperature that is lower than normal, especially with a baby who is not feeding well or seems unwell.
• Not feeding. Refusing several feeds in a row, or too sleepy to eat.
• Signs of dehydration. Far fewer wet diapers than usual, a dry mouth, or a sunken soft spot on the top of the head.
• Vomiting that is green, bloody, or forceful and happening again and again.
• Blood in the stool, or stool that is white, pale gray or clay-colored.
• Fast breathing that does not settle, more than 60 breaths a minute while your baby is calm.
• Yellow skin or eyes that appear in the first 24 hours, seem to be spreading down to the belly or legs, or come with a very sleepy baby or poor feeding.
• Crying that will not stop and sounds different from usual, very high-pitched, or weak.
• A bulging soft spot on the top of the head when your baby is calm and upright.
• The umbilical cord or circumcision area with redness spreading onto the skin around it, pus, a bad smell, or bleeding that does not stop with gentle pressure.

Call today

These are worth a call during office hours or to the nurse line, the same day:

• Mild yellow color in a baby who is waking and feeding well, or yellow color that is still there after two weeks
• White patches inside the mouth that do not wipe off
• Sticky discharge from one or both eyes, and sooner if the eyelid is red or swollen
• A diaper rash that is not improving after a few days, or has blisters or pus
• Hard, pebble-like stools, or a baby who seems to be in pain when pooping
• Spitting up that seems to be increasing, or feeds that seem painful or uncomfortable
• A stuffy nose or mild cough in a baby who is feeding well and has no fever
• Any worry about feeding, weight gain or diapers that is keeping you up

It can wait for the next visit

These are common and usually harmless in a baby who is feeding, peeing, pooping and acting like themselves. Write them down in your phone, and bring the list. Your baby's first checkup usually happens around 3 to 5 days old, and the next one around one month.

• Hiccups and sneezing
• Baby acne, tiny white bumps on the nose, or peeling skin
• Eyes that sometimes cross in the early weeks
• Flaky, yellowish patches on the scalp, known as cradle cap
• Spit-up in a baby who is comfortable and gaining weight
• Stool color that changes between yellow, green and brown
• Swollen breasts or genitals, or a small amount of discharge in baby girls in the first weeks, from your hormones before birth
• Questions about sleep, routines, pacifiers or tummy time

If any of these comes with fever, poor feeding, or a baby who just does not seem right to you, it moves up the list.

Your body is on the list too

Most of this article is about the baby. But the person who gave birth is also recovering, and her warning signs get missed all the time, often by the mother herself, because all her attention is on someone else.

The guidance below comes from AWHONN, the nurses' association for women's and newborn health, and ACOG.

Call 911 if you have:

• Chest pain
• Trouble breathing or shortness of breath
• A seizure
• Thoughts of hurting yourself or your baby

Call your OB or midwife right away if you have:

• Bleeding that soaks through a pad in an hour or less, or blood clots the size of an egg or bigger
• An incision that is not healing, is red, or is leaking
• A red, swollen leg that is painful or warm to the touch
• A temperature of 100.4°F (38°C) or higher
• A headache that does not get better, even after medicine, or a bad headache with vision changes

If you go to the emergency room or call 911, say that you recently had a baby. It changes what they look for.

This is education, not medical care. Your pediatrician and your OB or midwife know your family and are always the right people to ask.

You are not bothering anyone by calling. Checking is part of caring for your baby, and for yourself.