Newborn Warning Signs: When to Call a Doctor
When to go to A&E, when to call your doctor, and what looks scary but is actually normal. Trust your gut - If something feels wrong, get it checked.
Go to A&E Immediately
Fever 38°C or above in a baby under 3 months
Any temperature at or above 38°C in a baby under 3 months is a medical emergency. Even if baby seems fine, go to KKH or NUH Children's Emergency immediately. Do not treat with paracetamol and wait at home. Do not wait for other symptoms. The immune system is immature and infection can progress very fast.
Difficulty breathing
Breathing rate above 60 breaths per minute, grunting sounds when breathing out, nostrils flaring with each breath, skin pulling in between the ribs or at the base of the throat with each breath. These are signs the baby is working hard to breathe.
Blue or grey colour around the lips or fingernails
Bluish or grey colour around the mouth or fingernails (called cyanosis) means the baby is not getting enough oxygen. This is an emergency. Call 995 or get to A&E immediately.
Unresponsive or floppy
Baby cannot be roused from sleep, is unusually limp, or does not react to noise or touch. Very floppy muscle tone that is new or worsening is a medical emergency.
Seizures
Any jerking or stiffening of the body, eyes rolling back, lip-smacking, or rhythmic repetitive movements. Any seizure-like event in a newborn needs immediate assessment.
Jaundice in the first 24 hours, or spreading below the belly button
Yellow colouring that appears within the first 24 hours of life is never normal - Go to A&E. Also go immediately if jaundice has spread to the belly, thighs, or feet (Kramer zones 4 and 5). These zones need a blood bilirubin test the same day.
No wet nappies in 12 hours, or very dark urine
No wet nappy for 12 hours or urine that is very dark yellow or orange is a sign of severe dehydration in a newborn. This needs same-day assessment.
Blood in stool or white chalky stool
Bright red blood in a nappy (not just a pinkish tinge) needs medical review the same day. White, grey, or chalky pale stool can indicate a bile duct problem and needs urgent assessment.
Bile-stained (green) vomiting
Green vomit in a newborn suggests intestinal obstruction. This is a surgical emergency. Do not confuse with normal white or clear milk spit-up.
Inconsolable crying for more than 2 to 3 hours
Especially if accompanied by drawing up of the legs, pallor, or episodes of suddenly going very quiet. This may indicate intussusception or another abdominal emergency.
Significant head injury
Any fall from a height, shaking, or head injury in a newborn needs immediate assessment, even if baby appears fine.
Call Your Doctor Today
Fever 38°C to 38.4°C in a baby 3 to 6 months old
In this age group, a temperature in this range still needs a same-day call to your doctor or polyclinic. Do not wait overnight.
Not feeding at all
If baby refuses 2 or more feeds in a row and cannot be roused to feed, call your doctor today. This can be a sign of infection, jaundice, or low blood sugar.
Jaundice spreading below the chest after day 5, or not improving by day 14
Some jaundice is normal in the first week. But if yellow colouring spreads to the belly or legs after day 5, or if it has not cleared by day 14, have bilirubin levels checked that day.
Fewer than 6 wet nappies in 24 hours (after day 5)
After day 5, a well-fed baby should produce at least 6 wet nappies per day. Before day 5, fewer wet nappies are normal as milk is coming in. Orange or brick-red crystals in the nappy in the first 48 hours are also normal. After day 5, they are not.
Umbilical cord stump looks infected
The stump should dry up and fall off in 1 to 3 weeks. Call your doctor if you see redness spreading around the base, pus, or a foul smell. This is called omphalitis and needs antibiotics.
Persistent inconsolable crying for more than 3 hours
If you cannot explain or settle the crying after 3 hours, and baby is not simply hungry, windy, or uncomfortable, call your doctor or head to a polyclinic.
Yellow or green eye discharge
Mild sticky eyes in week 1 are common (blocked tear duct). But increasing yellow or green discharge, significant redness, or swelling around the eye needs same-day review. This may be an infection.
Persistent vomiting after every feed
Occasional spit-up is normal. Forceful vomiting after every feed in a boy aged 2 to 8 weeks may indicate pyloric stenosis. Persistent vomiting in any baby needs assessment.
BCG vaccine site: very large or spreading redness
The BCG site should form a small nodule, then ulcerate slightly, then heal over several weeks. A large, weeping, or rapidly spreading reaction may need review.
Newborn Jaundice: What You Need to Know
About 60% of newborns develop jaundice in the first week of life. In most cases it is harmless and clears on its own. But it needs to be monitored carefully because high bilirubin levels can cause brain damage if left untreated.
Physiological jaundice (the normal kind)
This is the most common type. It usually appears on day 2 or 3, peaks around day 3 to 5, and clears by day 14 in most babies. It is caused by the natural breakdown of red blood cells that the baby no longer needs after birth.
Breastfeeding jaundice vs breast milk jaundice
Breastfeeding jaundice happens in the first week when a baby is not latching well and not getting enough milk. Feeding more frequently helps. This is a sign to get breastfeeding support, not to stop breastfeeding.
Breast milk jaundice is different. It happens in some breastfed babies after the first week and can persist for 2 to 3 months. It is generally harmless, but your doctor will check bilirubin levels to confirm it is not rising to a concerning level.
The Kramer rule - how far has it spread?
Jaundice starts at the face and moves downward. Doctors use a simple rule called the Kramer scale:
- Zone 1Face and forehead - common and usually mild
- Zone 2Trunk above the belly button - still often mild
- Zone 3Below the belly button and thighs - needs a bilirubin blood test
- Zone 4Knees and lower legs - needs urgent bilirubin check today
- Zone 5Feet and hands - go to A&E now
Note: Skin colour can be hard to assess in darker skin tones. Check the whites of the eyes and the palms of the hands instead.
Phototherapy (blue light treatment)
If bilirubin levels are too high, your baby will need phototherapy. This is blue-spectrum light that breaks down bilirubin through the skin. It can be done in hospital at KKH or NUH, or at home using a phototherapy blanket hired from a medical equipment provider in Singapore. Your paediatrician will advise which is appropriate based on the bilirubin level and your baby's age.
What Looks Scary but Is Normal
Sneezing constantly
Newborns sneeze to clear their nasal passages - They have no other way. Not a cold unless accompanied by fever.
Grunting and straining during a bowel motion
Normal - Newborns have not yet learned to relax their pelvic floor while pushing. This is not constipation if the stool is soft.
Hiccups many times per day
Immature diaphragm. Completely normal and not uncomfortable for babies. Often triggered by feeding.
Trembling or jitteriness when startled
The nervous system is immature - Sudden movements, loud noises, or cold can trigger a fine tremor. Normal if it stops with gentle holding.
Breathing irregularly (periodic breathing)
Newborns breathe irregularly - They may pause for 5–10 seconds, then breathe rapidly. This is normal 'periodic breathing'. Not the same as apnoea.
Crossed eyes (intermittent)
Up to 6 months, babies' eyes are still developing coordination. Intermittent crossing is normal. Constant or fixed deviation: see a GP.
Swollen breasts (in boys and girls)
Maternal oestrogen causes breast budding in both sexes. A small amount of 'witch's milk' may even be expressed. Resolves without treatment.
Milia (white dots on face)
Blocked sebaceous glands - Not acne or infection. Resolves in weeks without treatment.
Tight fists most of the time
Normal in the first 1–2 months. The grasp reflex is strong and the cortex hasn't developed enough to override it.
Noisy breathing while awake
Laryngomalacia (floppy larynx) causes a characteristic 'squeaky' or 'crowing' breath when baby is active. Usually resolves by 12–18 months. See GP to confirm if worried.
Trust Your Parental Instincts
Parents of newborns are often told not to overreact. But the reality is that you know your baby better than anyone. If something feels wrong, it probably is. Act on it.
Singapore's polyclinic nurses and paediatricians would rather see a healthy baby than miss a sick one. You will never be judged for going in to get something checked.
- •KKH Children's Emergency is open 24 hours a day, 7 days a week, and will never turn away a sick baby.
- •Do not rely on "wait and see" for babies under 3 months. In this age group, infections can get serious very quickly.
- •Call 995 (Singapore ambulance) if you are not sure your baby is safe to move.
- •The single most important rule: In a baby under 3 months, any fever of 38°C or above is an emergency. Do not give paracetamol and wait. Go to A&E immediately.
Key contacts:
- KKH Children's Emergency: 6225 5554
- NUH Children's Emergency: 6772 2002
- Singapore ambulance: 995
- HPB HealthHub helpline: 1800 223 1313
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