Have you ever made a frantic call to a health care provider only to find out that a worrisome symptom concerning your child wasn't a problem at all? There's no reason to be embarrassed. It happens to the best of us! As an emergency-room pediatrician and a mother of two, I sympathize with the parents who call me when they want to know if their baby should visit the doctor.
Little ones can have true emergencies, of course, but you'd be surprised by how many issues aren't really dangerous. Symptoms that indicate a serious medical condition in an adult, such as shaking uncontrollably, can actually be normal in a baby. That's because an infant's physical immaturity and rapidly changing hormones make their body react in unique ways.
To help put your mind at ease, I've compiled some of the most common frightening-but-normal baby symptoms I've seen, ranging from twitching in sleep to abnormal breathing and more.
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While the information in this article is meant to be helpful and reassuring, it should not take the place of medical advice. If you are worried about a symptom concerning your child, please do not hesitate to reach out to a health care provider or seek medical assistance immediately in the event of an emergency.
Baby Twitching During Sleep
If you spot your baby twitching in their sleep, it's understandable to be worried—but rest assured, this symptom is often harmless, and the result of a baby's still-growing nervous system.
Consider this story: New parents brought their 1-week-old to their family doctor after they saw her jerk uncontrollably in her sleep. They showed the doctor a video of her spasms, and he sent them directly to a small community-hospital emergency room.
The ER doctor put the baby in the intensive care unit (ICU), but when a pediatrician visited, he diagnosed her with a harmless phenomenon called benign sleep myoclonus. It was no more dangerous than another form of myoclonus: hiccups!
What made the pediatrician so sure this baby was fine was that her seizure-like movements only occurred during sleep and stopped instantly when she was awakened. My colleague Michael Zimbric, M.D., a pediatric neurologist at Rady Children's Hospital in San Diego, explains what was going on:
“Babies have an immature nervous system, and their movements are even more uncoordinated during sleep than when they're awake. These jerking movements are not unlike those that we adults have as we drift off to sleep.”
Doctors don't know why benign sleep myoclonus occurs, but they have observed that it can be brought on by a loud noise or by touch. Studies have shown that these movements are harmless.
When To Worry About Twitching in Sleep
A key indicator of a true seizure is abnormal eye movement along with body movements. If you see these symptoms—or if your baby has trouble breathing, turns blue, purple, or gray, or the seizure lasts longer than five minutes—call 911 or immediately go to the ER.
What Your Baby's Twitching Really Means
Stuffy Nose and Abnormal Breathing
It's common for a baby to experience stuffy noses that impact their breathing, and this is sometimes the result of hormones.
A mother brought her 2-week-old girl into the ER because the baby always sounded congested. Mom had a cold, and she initially worried that she'd given it to her daughter, although the baby had no other cold symptoms. At night, her breathing became very loud, and the mom soon feared that her newborn had something worse than a cold.
It turns out that this normal form of stuffiness is caused by the hormone estrogen, which stimulates the nasal passages. Estrogen is passed to the baby in utero and while breastfeeding or chestfeeding. (You may have felt similarly stuffed up while pregnant.)
This condition generally subsides within two months, whether your baby is breastfed or formula-fed. And by 6 months, when a baby's nasal passages have doubled in size, this stuffiness is hardly noticeable, if it's there at all.
When To Worry About Stuffiness and Breathing
Go to the emergency room if your child is flaring their nostrils as they breathe (it means that this is their only way to open the passageway for air) or if their chest or tummy is pulling in. These are signs of respiratory distress.
Here are a few other signs of respiratory distress in infants and toddlers that would require immediate medical attention:
Rapid breathing, which may mean your child isn't getting enough oxygenGrunting sounds as your child exhalesSweating, especially when the skin is not warm to the touch or feels cold and clammyWheezing or whistling sounds, which may indicate restricted airwaysUrgent Care vs. ER: Where to Go for 8 Common Kid Health Emergencies
Chest Lumps
The parents of a 6-week-old boy came to the emergency room after he woke one morning with a warm red lump on his chest, directly under his right nipple. Here, too, estrogen was the cause. As the level of excess estrogen falls in a baby after birth, the milk-producing hormone prolactin temporarily increases and can cause breast growth.
In fact, at least 50% of healthy newborns experience this, often on just one side. Five percent of newborn boys will even produce a milk-like substance known as "witch's milk"—and that's exactly what happened in this case and explains why the lump grew so quickly. The enlargement usually goes away within the first month, but it can last for three months or longer.
When To Worry About Baby Chest Lumps
If the breast appears red, seems tender, or if your baby has a fever, see your child's health care provider to determine whether there's an infection. Also, while breast tissue development is extremely common in newborns and during puberty, this could indicate a hormonal problem if it happens at other times.
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Bloody Spit-Up
One worried couple brought their 5-month-old son to my emergency room when he had streaks of blood in his spit-up after breastfeeding. They feared he'd had a bad reaction to the milk or even internal bleeding.
But bloody spit-up is seldom worrisome in a baby who is otherwise acting normally. It's either from trace blood swallowed from the breastfeeding or chestfeeding parent's sore nipples or due to a small tear in the esophagus caused by forcefully spitting up. Neither condition is anything to worry about—even a small esophageal tear will heal easily.
This particular mom confirmed that she did have cracked nipples—thanks to her baby's newly erupted teeth—and they were the source of the blood.
When To Worry About Bloody Spit-Up
If your infant appears ill, vomits a large amount of blood, spits up blood after a formula feeding, or projectile vomits, see a doctor immediately.
Orange-Hued Skin
First-time parents brought their 10-month-old to my emergency room because her skin had turned orange. She'd had jaundice at birth, and the parents were told to return if her skin became yellow again. But I knew this baby wasn't jaundiced because her eyes remained white, and her skin was orange, not yellow.
This is a very common phenomenon called "carotenemia," caused by eating a lot of vegetables that are rich in beta-carotene. Babies prefer the sweet taste of carotene-rich foods like sweet potatoes and carrots, and many first foods that aren't orange are high in beta-carotene, too. (You just can't see it in veggies like spinach and broccoli because the green chlorophyll pigment covers it up.)
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Carotenemia, which doesn't affect adults, happens because of the way baby food is manufactured. The extensive cooking, mashing, and pureeing of vegetables breaks open plant fibers in a way that our teeth can't, making more carotene available to be absorbed by the baby's intestines.
So, when a baby has eaten more carotene than they need, the extra is released with sweat, and it stains the skin. In fact, the first place you'll see the orange color is where babies have the most sweat glands: the nose, the palms, and the soles of the feet.
When To Worry About Orange Baby Skin
Honestly, never. As your baby's diet changes, the orange color will fade. If you continue to serve lots of foods rich in beta-carotene, their skin will stay orange, but it's harmless.
Mildly Erratic Breathing
A grandmother who was babysitting called an ambulance after her 3-week-old granddaughter repeatedly paused while breathing. The contented, sleeping baby would breathe rapidly for about 20 seconds and then stop breathing altogether. The woman feared the baby had inherited her husband's sleep apnea.
Although this intermittent breathing can look alarming, "periodic breathing" is common in newborns. Babies normally breathe faster than older children because their lungs are small relative to the size of their bodies.
However, researchers suspect that the reason for irregular breathing is that the chemical sensors that detect carbon dioxide aren't fully developed in a newborn. This means that babies sometimes just don't know they need to breathe, and they pause until carbon dioxide levels become high enough to trigger these sensors.
When To Worry About Erratic Breathing In Babies
Look for changes in skin color that signal a lack of oxygen, such as a bluish, grayish, or purplish cast to the skin (especially around the lips and nail beds) or mucous membranes (such as the gums) or signs that your baby is struggling to breathe. These signs warrant immediate medical assistance.
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Constipation
One mom brought her 2-month-old daughter into the emergency room because the baby hadn't had a bowel movement in five days. She would grunt, turn red in the face, and her stomach would become hard, but only a bit of soft poop would come out.
It can be quite jarring to see your newborn struggle to poop, but remember that they're lying down, which makes it harder to get the stool out. “Young babies don't yet know how to control and coordinate their anal sphincter, the muscle that holds stool in the rectum,” says Rebecca Preziosi, M.D., a pediatrician at Sharp Rees-Stealy Medical Center in San Diego. “They have to push and grunt to get the stool past this muscle.”
I explained to the mom that it's fine for a baby to poop as infrequently as once a week. As the gut becomes more efficient and better at digestion, after 6 to 8 weeks, it takes longer for the body to produce a lot of poop.
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When To Worry About Baby Constipation
Talk to a doctor if your baby's poop is hard or looks like pellets (signs of constipation) or if your child doesn't poop daily during the first month of life. It can signal a rare problem with the nerves controlling the rectum.
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