Babies can get sick quickly in the first month of life. It is our job to keep them safe. In this module, we are going to discuss some ways to identify a baby who may be sick and needs to see a medical professional right away. This is going to be a whirlwind tour because there are so many ways that baby can tell you that he or she is sick. So, hold on to your seats. I can't go into a lot of depth on every topic, but I will give you some basic skills to keep babies safe. The good news is that if you have experience with babies and know what normal babies do and how they behave, it will be easier to identify abnormal babies who should be seen quickly. Let's start off with some symptoms or signs that would indicate that a baby should be seen in the hospital immediately. In some ways, this is the easier place to start because all of these kids need to be seen immediately by the pediatrician in the hospital. There are no other choices. First of all, listen to the baby's caregivers, who are usually the parents. If they tell you something is wrong, listen. They know their baby and should be taken seriously. You may not always be looking at the baby right away. In other words, your initial contact with a family maybe over the phone. Concerning things that a caregiver may say include, but are not limited to fever, which we define as a temperature of a 100.4 or greater, cyanosis which is blueness of the skin, poor feeding, shaking or convulsions, or a baby who is weak, usually described as floppy or has a weak cry or moaning. If a caregiver tells you these things over the phone, have them go to a hospital emergency room immediately. Be careful in deciding how quickly they need to go and how they need to get there. In other words, do they need an ambulance? What about a fever? The first thing to do is to make sure that you or the caregiver, if you are on the phone, has measured the temperature accurately. The best way to do this is to take the temperature in the rectum with an appropriate thermometer. It only needs to be inserted one-half to one inch. Don't go any further than that or you risk causing trauma. The other way to take a temperature is under the arm, but this may give you a falsely low reading. Many experts recommend adding one degree to this temperature to give a more accurate assessment of the baby's core temperature. In other words, if the axillary underarm temperature is 99.6, the baby's core temperature would be estimated to be 100.6, and the baby should be considered to have a fever. Remember, a fever itself will not cause the baby harm, but it can be a sign of a serious illness such as bacteria in the blood, urine, or spinal fluid, and the baby must be seen immediately if the temperature is above 100.4. Let's move on to concerning things when you can see the baby. You can tell so much just by looking at a baby before you have even touched the baby. If a baby looks sick, you should start your exam immediately and try to gather verbal information while doing your exam. What does a sick baby look like? A sick baby may have low tone or look floppy. A sick baby may also have color change of the skin. For example, a baby may have a blue color to their skin which we call cyanosis. A mild blue color of the baby's hands or feet or around her lips can be normal and is usually caused by the baby being a little cold. We call blue hands or feet acrocyanosis. We call blueness around the mouth circumoral cyanosis. Be sure not to confuse acrocyanosis or circumoral cyanosis with blueness anywhere else on the body which is not normal. In particular, be careful not to confuse blueness around the lips with blueness of the lips. Blueness of the lips, tongue or anywhere in the mouth is abnormal and needs evaluation by a medical professional immediately. Continuing with our visual assessment. When you are looking at a baby, if you notice paleness of the skin, this would also need to be evaluated right away. Pallor means the baby appears pale in color, perhaps with a grayish tone. This may be due to poor blood circulation to the skin, possibly due to low blood pressure. Other things that you may see without even touching the baby involved the breathing. If a baby looks like she is struggling to breathe, you should start your exam and start thinking of ways to help support and treat the baby, such as giving the baby supplemental oxygen. What does a baby who is struggling to breathe look like? Good question. It is normal for babies to breathe at a rate of 30-60 breaths per minute. If they're breathing slower or faster than this, it is abnormal. In addition, a baby who is struggling to breathe may have nasal flaring or retractions. Nasal flaring is when a baby opens the nares of her nose even wider to improve the flow of air into the nasal passages. Retractions are when the baby uses extra muscles to breathe because it has extra hard to breathe. Retractions can be seen visually by seeing the skin pull in beneath the rib cage in between the ribs above the clavicular bone or above the sternum. All of these signs mean that a baby is struggling to breathe. You should start your exam immediately and intervene to support the baby's breathing. You've done so much of your assessment already and all you have done is looked at the baby. You haven't even touched or listened. Let's talk next about listening because it is what you will do simultaneously with looking when you see the baby. I'm not even talking about using a stethoscope yet. When you first encounter a baby, you may hear things that will have you concerned about the baby's well-being. First of all, a week cry or moaning in a newborn baby is worrisome. If a baby is making noise while she is breathing in, she may have stridor which would indicate that something is partially blocking her upper airway. You may also hear wheezing which is a sign of lower airway obstruction. If either of these signs is present, you should check the baby's oxygen saturation level and start supplemental oxygen if necessary. Oxygen saturation below 90 percent is abnormal and needs to be corrected. Great job using your eyes and ears to keep baby safe. In this next video, we will review some things to look out for when you actually touch the baby.
