Newborn babies are somewhat different from older children as they often have subtle signs and symptoms of illness rather than florid usual symptoms observed in older children. These differences are due to combination of factors such as their physiological immaturity of systems, relatively limited capacity to mount an attack on germs particularly in small and pre-term babies, increased heat losses from their body surfaces and few nutritional and metabolic limitations. Early recognition of a newborn with sickness thus becomes important, as it could become vital factor for appropriate management and a good outcome.

What to look out for ?

*Jaundice: Most healthy newborns develop a yellow tinge over their body in their first few days due to the immaturity of liver. However if the yellow ness appears on the first day of life itself or it involves palms or soles, consult your doctor immediately. This could be observed by pressing and blanching the baby's sole for a few seconds with your thumb and looking out for the return of color, whether it is pink or yellow.

*Poor Activity and Lethargy: Newborns keep their eyes closed for most of the times but become arousable with gentle stimulation. If a baby who was crying lustily before develops a weak cry, difficulty in feeding or becomes listless needs medical attention. Such a baby may be small or premature, or has an infection, or may be too cold. Remember that irritability in newborn is rather infrequent as compared to sluggish activity.

*Breathing Difficulty: Rapid and fast breathing usually more than 60/minute, deep movements of lower chest and upper abdomen,grunting sounds with breathing, and blue color of lips and tongue are all danger signals heralding sickness in a newborn.You can count the baby's breathing rate when he or she is resting and quiet and not while crying or immediately after feeding the baby.

*Hypothermia: Hypothermia or low body temperature is a risk for newborn in any climate whether it is in tropics or in cold hilly areas. To find out whether the baby is feeling cold or not, touch the sole of foot with the back of your hand and then touch the tummy. If the sole feels colder, then the baby may be having low body temperature,medically defined as hypothermia. This increases the baby's risk to develop cold injury and also increases baby's energy needs. Remember that small and prematurely born babies are more likely to feel cold rather than have fever, which is not as commonly seen in newborns as in older babies.

*Delayed passage of stool and urine: Newborns should pass their first stool (meconium) and urine within first 24 and 48 hours of birth respectively. Healthy newborns may pass upto 8 to 12 stools per day, even with the passage of wind or after feeds. This pattern is normal and is not a cause for worry if the baby feeds well, is active and gaining weight normally.

*Vomiting: Most babies bring out a little amount of curdled milk after feeding once in a while. This occurs as the air swallowed with breast milk is expelled out of stomach along with the ingested milk. However if the vomiting is persistent, forceful, greenish yellow or brownish,please seek medical help.

*Excessive weight loss: Normal newborns can lose upto 8 to 10% of their birth weight initially and regain it 7 to 10 days of life. If they lose excessive weight or take too long to regain it, it may indicate either the baby is sick or not getting enough milk.

Severe illnesses often produce subtle signs in newborns and may sometimes be overlooked initially. Parents are the best observers to keep a watchful eye on their newborns to detect any deviation in their behaviour and seek medical help early.