How to Decide When to Bring Your Baby to the ER

What are the warning signs you should be aware of?

This article is part of a video series with Dr. Changa Kurukularatne, a specialist in infectious diseases and internal medicine; he is a father of four. Dr. Changa has worked in multiple countries from the U.S. to New Zealand and Singapore.

Dr. Linnea: And what about babies like under 12 months? Is there anything different that you would consider in this situation?

Dr. Changa: So this is a very challenging age group because an older child may be able to tell you, “This hurts,” or, “I don’t feel right,” or, “I can’t breathe properly.” So, the margin for error is very small when we’re dealing with an infant in the first 12 months of their…especially the first 3 months of life. And the thresholds are also different. We would tolerate a high fever in an older child. For instance, if my eldest, if William has a fever, well, he’s 11, my comfort level is a lot more than my youngest who’s 4 but he happens to have febrile seizures. So when he gets a fever, I’m very conscious about not letting it go too high because it may trigger a seizure.

So the other three children, I can’t even remember the last time they got any fever-reducing medicines. But with my youngest, with Terry [SP], the fever starts creeping up, I may reach for that medicine even though I would never do it for the other three. But for a very young age group, the difference is that babies are really prone to dehydration. And even with a fever that’s a lot less than what older children experience, the babies can lose a lot of body water, and that can be devastating. So, keeping track of wet nappies is very, very important.

And if parents go online, and let’s say if my baby is two months old, how many wet nappies should he or she make, you’ll to get the answer. So, keeping track of how the baby’s peeing is very important. For certain respiratory illnesses, if the baby’s respiratory system is being taxed too much, you might hear some grunting, and you’ll see the nose really flaring. And you see the muscles between the ribs, we call the intercostal muscle, just kind of going in, all of those things tell us that the baby’s really working hard to breathe. And if that continues, the baby will get too tired to breathe properly and that could be very dangerous. So if you hear this, the grunting sounds, the flaring of the nostrils, the retraction of the breathing muscles, then that’s something that warrants a visit to a doctor.

So, pain in the limb, like in an arm or leg in a young child, especially an infant. So if they’re withdrawing from certain motion, or if you notice that they’re favoring one arm over another, or not wanting to put weight on the leg, that’s something that should be looked at by a professional because they don’t have the language to kind of go into it deeper. It could be trauma, it could be, we call it, occult fracture or hidden fracture, or it could be a more serious condition. Things like meningitis, sometimes we have pain in the leg because there’s something wrong with the spinal cord. So, that’s one thing that I advise my patients to look for.

And, again, the alertness. If your baby is just sleeping all the time, you can’t really arouse the baby, that’s considered enough to take the baby to the doctors. One thing we could perhaps share with the moms and dads that you would see on the actual NICE, we call it NICE, guidelines from the U.K. health system that a general practitioner would use. But I think there’s enough in layman’s terms of what we can look for at home.

And I think it’s really good for parents to be aware of what the doctor should look for because then we are entering the collaboration because then that can open a good discussion between the parents and providers. And we could say, “Well, I know he’s fine now. But at home, he showed some of the signs. Do you think that’s important?” So this is exactly the kind of dialogue that we need.

So, what I encourage people to kind of stay within the expertise as parents or physicians, it’s always good to be aware of what’s on the other side. So, a parent looking at these guidelines, I think is a fantastic thing, but trying to interpret them too much, I would say just leave that to the experts. So, that’s a very useful thing that I would encourage people to do.

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Written by Dr. Linnea Passaler

A surgeon and mom of a three, all currently under the age of five, Dr. Linnea is MamaDoctor's founder. She believes healthy virtual spaces where people can share their honest concerns and get help from knowledgeable, trustworthy sources, change lives for the better. She is an advocate for maternal mental health and wellbeing.