Originally published in The Ottawa Citizen August 14, 2001

It is 2 AM and your two week old infant’s breathing sounds raspy and congested. You also notice a strange rash on their body. First-time parents face a multitude of these anxiety provoking events. What can you do to assess if this is normal or not?

Infants prefer nose breathing. They can become fussy, uncomfortable and noisy when a few drops of mucous accumulate in their narrow nasal passages. How do you differentiate normal noise from something more ominous?

Let’s check your infant’s breathing. Remove your babyâs shirt or top. Lay them down on their back. Make sure the room is adequately lit. A well-child’s chest should smoothly rise and fall. Normal breathing (respiration) rates for newborns ranges between 22 and 30 per minute.

An infant that is in respiratory distress will have these four signs:

1) The skin between their ribs tugs inward (indrawing).

2) Their stomach area (abdomen) pops outward while their ribcage pulls inward with each breath, then the reverse happens (paradoxical breathing).

3) There is in drawing at the semi-circular notch at the top of the breast bone (sternum).

4) Their nostrils flare in order to maximize air intake.

If all these are present, go to the ER immediately.

Do they have a fever? Rectal temperatures are preferred for accuracy. The normal temperature is 38¡ C. A serious fever in newborns and infants is greater than 39.5.

Rashes in the newborn are disconcerting. It is difficult to know whether it is a serious or benign condition.

Rashes are another common concern. In the first week of life you baby may develop these red elliptical eruptions with a small white dot n the middle (find definition in derm book AFP Article) that can spread over their entire body. This rash is called Erythema toxicum neonatorum. Despite its name it is harmless and disappears after about a week.

At three weeks some will develop baby acne. Their face upper chest and back can be covered with many small pimples. The cause of this is due to the mother’s hormones that were transferred into the baby’s blood stream. The acne miliaria lasts about a month and disappears. Interestingly it can be an indicator of the severity of the acne when they become teenagers. sucking blister mongolian spots.

Vomiting is one of those signs that causes great consternation. Is my baby getting enough to eat? Most vomiting is more aptly described as regurgitation. It may appear to be their whole feeding has graced your floor or shoulder. However, as long as your infant is gaining weight and following their growth curve, they are getting enough food.

Vomiting that results in weight loss needs further investigation. This problem is uncovered early due to the frequency of well baby check ups early in an infants life.

When do you bring your infant in to see the doctor if they have a fever. If you baby is not eating like they usually do, do not hesitate to go to your doctor. If they are more irritable and do not want to feed as usual, please see your doctor. Many times fever are caused by viral infections but in the first six months of life it is important to make sure that it is not something more serious. I recommend that you ask your doctor as many questions as you think is necessary to be comfortable with your baby’s condition. The more knowledge available to you the better you capacity to determine the seriousness of an illness. Make a list of questions for your well baby visits. Many parents forget several questions they wanted to ask because they did not write them down.

The is an excellent reference for parents and physicians alike published by the Canadian Pediatrics Society entitled “Little Well Beings” It is a veritable cornucopia of information written in a succinct and readable style

• Diaper rash (rash in the diaper area) is a skin irritation caused by prolonged dampness and the interaction of urine and feces with the skin.
• Heat rash (caused by the blockage of the pores that lead to the sweat glands) is most common in very young children, but can occur at any age. With an increase in heat and humidity, the sweat glands attempt to provide sweat as they would normally, but because of the blockage, this sweat is held within the skin and forms little red bumps, or occasionally small blisters in young infants.
• Erythema toxicum can cause flat red splotches that appear in up to half of all babies. These blotches rarely appear after 5 days of age, are usually gone in 7 to 14 days, and are nothing to worry about.
• Baby acne is caused by exposure to the mother’s adult hormones. The little white dots often seen on a newborn’s nose represent an abnormal amount of normal skin oil that is a result of these hormones. Acne usually occurs between 2 and 4 weeks of age but may appear up to 4 months after birth and can last for 12 to 18 months.
• Cradle cap causes greasy, scaling, crusty patches on the scalp that appear in a baby’s first 3 months. It usually goes away by itself, but some cases may require treatment with medication.
• Prickly heat causes rash or blotches during hot weather or in a hot environme