Warning Signs
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 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. The immune system is immature and infection can progress rapidly. Do not wait for other symptoms.
Difficulty breathing
Rapid breathing (>60 breaths/min), noisy breathing (grunting, wheezing, crowing), skin sucking inward between the ribs or at the base of the neck with each breath, blue or pale colour around lips or fingertips.
Seizures
Any jerking, stiffening, eye-rolling, lip-smacking, or rhythmic repetitive movements. Febrile seizures are rare under 6 months but any seizure-like event needs immediate assessment.
Limpness or unresponsiveness
Baby is unusually floppy, cannot be roused, or does not respond to stimulation. This is a medical emergency.
Bile-stained (green) vomiting
Green vomit in a newborn suggests intestinal obstruction - An emergency requiring surgery. Not to be confused with normal posseting (white/clear milk spit-up).
Inconsolable crying for more than 2–3 hours
Especially if accompanied by drawing up of legs, pallor, or episodes of suddenly going quiet - May indicate intussusception or other abdominal emergency.
Significant head injury
Any fall from a height, shaking, or head injury in a newborn - Seek immediate assessment even if baby appears fine.
Call Your Doctor Today
Jaundice spreading below the chest after day 5
Some jaundice is normal in the first week. But if yellow colouration spreads to the belly, legs, or arms after day 5 - Or appears in the first 24 hours of life - Have bilirubin levels checked that day.
Fewer than 6 wet nappies in 24 hours (after day 5)
A well-hydrated baby produces frequent pale yellow wet nappies. Concentrated orange or brick-red crystals may appear in first 48 hours - Normal then. After day 5, fewer than 6 wet nappies suggests insufficient intake.
Not feeding for 4+ hours (in the first weeks)
A newborn who skips feeds or shows no interest in feeding needs assessment - This can indicate illness, jaundice, or low blood sugar.
Blood in stool or vomit
Small streaks of blood in stool can occur from a small anal fissure or (in breastfed babies) swallowed maternal blood - But any blood warrants a same-day call.
Umbilical cord stump: redness, swelling, pus, or foul odour
The stump should dry quietly. Redness spreading more than 1–2 cm beyond the base, pus, or bad smell suggests omphalitis (cord infection) - Needs antibiotics.
Persistent vomiting after every feed
Occasional spit-up is normal. Forceful vomiting after every feed in a boy aged 2–8 weeks may indicate pyloric stenosis. Persistent vomiting in any baby warrants assessment.
Eye discharge worsening or eye very red
Mild sticky eyes in week 1 are common (blocked tear duct). Increasing yellow/green discharge, significant redness, or swelling around the eye needs same-day review.
BCG vaccine site: very large or spreading redness
The BCG site should form a small nodule, then ulcerate slightly, then heal. A very large, weeping, or spreading reaction may need review.
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, act on it. Singapore's polyclinic nurses and paediatricians would rather see a healthy baby than miss a sick one.
The single most important rule: In a baby under 3 months, any fever ≥38°C is an emergency. Do not treat with paracetamol and wait. Go to A&E.
Continue the Newborn Guide: