Health Watch for Young Babies (Birth to 3 months)

Before discharge from hospital, your newborn baby should have been examined by a doctor to make sure that he/she is healthy enough to go home. After registering with our Maternal & Child Health Centre, a routine examination will be arranged for your baby. The aims of these early examinations are to identify any congenital abnormalities or other significant neonatal conditions that may require further medical attention, and to record the current state of health of your baby for future reference. However, not all health problems, including congenital ones, are detectable through these early examinations and some may only be apparent later on. Although this is not common, young babies (especially newborn) can become ill and may deteriorate quite quickly. It is therefore important that you know when to seek medical advice promptly.

The following are indicators of serious illness in babies that parents should take note of and act appropriately:

Lethargy and Sleepiness

Newborn babies spend most of their time sleeping. However, your baby should wake up every few hours, feed well and look contented and alert when awake. You should be particularly cautious if there is a sudden change from his/her usual pattern—this may be a sign of a serious illness. If he/she appears too tired or sleepy, is rarely alert and cannot be woken up for feeding, you should bring your baby to the doctor.

Breathing Difficulty

Newborn babies usually take a few hours to settle to a normal pattern of breathing at about 20-40 breaths per minute. The breathing is usually most regular while he is sleeping. Occasionally when awake he may breathe rapidly for a very short period of time and then return to the normal pattern.

You should bring your baby to the doctor if you notice that he/she:

  • Is persistently breathing very fast, say more than sixty breaths per minute when he/she is less than two months old or more than fifty breaths per minute when he/she is 2-3 months old
  • Looks effortful to breathe and is unable to suck
  • Shows flaring of his nostrils when breathing in
  • Has dusky or bluish discoloration of the skin and lips

Circulation problem

Sometimes the hands and feet of newborn babies may appear blue when exposed to the cold environment but should turn pink as soon as they warm up. Occasionally his face, tongue and lips may turn a little blue when holding his breath momentarily while crying hard. You do not need to worry as long as the colour of these areas quickly return to normal once he/she calms down. However, if your baby becomes pale suddenly and persistently or turns blue all over, there may be problems with his heart or lungs. Immediate medical attention is needed.

Hydration condition

Babies can become dehydrated easily and quickly. You must make sure your baby has adequate intake of fluid, especially when vomiting and diarrhoea are occurring. Calculate the volume of milk taken over the past 24 hours and compare with his/her usual intake, which is about 10-22 oz (300-660ml) daily in the first month. If you are breastfeeding your baby, take note of the frequency and duration of active suckling and compare with his/her usual feeding pattern. If you are not sure whether your baby is feeding adequately, you should seek advice from the birthing hospital or any MCHC. You may monitor the fluid intake by observing your baby's urination. If your baby passed noticeably less urine over 24 hours, eg. less than 6 well-soaked nappies in young babies by the end of the first week, he/she may be at risk of dehydration. You should bring your baby to the doctor.

Distended Abdomen

Most babies have their abdomen somewhat distended especially after a large feed, but it should feel soft between feeds especially when the baby is sleeping. If his/her abdomen feels persistently swollen and firm and at the same time has not passed stool or flatus for one day or more, or is vomiting repeatedly, you should bring him to the doctor as it may signal a more serious problem with his bowel.


Whenever your baby appears unusually cranky or warm, take his/her temperature. Taking armpit temperature is a safer choice and especially advised for babies under 3 months old. If armpit temperature is higher than 37.3 °C / 99.1 °F or tympanic temperature is higher than 38 °C / 100.4 °F, you should bring him/her to a doctor as it may signal an infection. Early medical attention is necessary as young babies' conditions can deteriorate very quickly.

See your doctors immediately if your baby

  • Appears pale, drowsy and hot
  • Is lethargic or cries excessively
  • Vomits green or blood stained fluid
  • Will not feed at all or dramatic change in appetite
  • Has convulsion
  • Persistently breathing very fast or effortful to breathe
  • Stops breathing for 15 seconds or more
(Content revised 08/2013)