From erratic breathing to twitching in sleep, some worrisome baby symptoms are totally normal. Here, an emergency room pediatrician discusses when you should actually give the doctor a call.


Have you ever made a frantic call to your pediatrician only to find out that a worrisome symptom wasn't a problem at all? There's no reason to be embarrassed! 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.

Baby Crying Mother Console
Credit: Konstantin Tronin/Shutterstock

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—like 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. If you're ever in doubt about your child's health, though, you should always seek medical advice. It's always better to be safe than sorry!

1. Baby Twitching in Sleep

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, 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 Baby Twitching in Sleep

A key indicator of a true seizure is abnormal eye movement along with body movements. If you see these scary symptoms—or if your baby has trouble breathing, turns blue, or the seizure lasts longer than five minutes—immediately go to the ER.

2. Stuffy Nose and Abnormal Breathing

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; a mother passes it to her baby in utero and while breastfeeding. (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, 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.

3. Noticeable Breasts in a Boy

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 maternal estrogen falls in the baby, the milk-producing hormone prolactin temporarily increases and can cause breast growth.

In fact, at least 50 percent of healthy newborn boys and girls 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 pediatrician to determine whether there's an infection. Also, while breast-tissue development is extremely common in newborns and during puberty (even in boys), this could indicate a hormonal problem if it happens at other times.

4. Bloody Spit-Up

One anxious 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 almost never worrisome in a baby who is acting normally. It's either swallowed from the mother's sore nipples or due to a small tear in the esophagus caused by forceful 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.

5. 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.)

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 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.

6. Mildly Erratic Breathing in Babies

A grandmother who was babysitting called an ambulance after her 3-week-old granddaughter paused repeatedly 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. Babies normally breathe faster than older children because their lungs are small relative to the size of their body. 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

If your baby ever has a blue or gray color around her mouth, or seems to be struggling to breathe, contact your doctor immediately.

7. 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 Sharpe 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.

When to Worry About Baby Constipation

Talk to your 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.

Originally published in the January 2014 issue of Parents magazine.

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