BabyCroc
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Baby handbook

When to call the pediatrician

Health4 min read

Fever cutoffs by age, breathing and dehydration signs, and which symptoms should not wait until morning.

You will call the pediatrician more in the first year than feels reasonable, and most of those calls are the right use of the phone. The harder skill is knowing which symptoms are urgent, which can wait until the office opens, and which are ordinary newborn behavior. This is a map, not a diagnosis. If you are staring at your baby and thinking “this is wrong,” call. A clinician would rather hear from you early.

Fever, by age

How you take the temperature matters. In a baby under 3 months, a rectal temperature is the one clinicians trust for decisions. Forehead and ear thermometers are convenient later and less exact early. Do not add a degree to “correct” a reading. Report the number and the method.

Age Temperature that should not wait
Under 3 months 100.4°F (38.0°C) or higher, rectal. Call now, including overnight, or go to emergency care if you cannot reach the clinician.
3 to 6 months Around 101°F (38.3°C) or higher, or any fever if your baby is unusually irritable, lethargic, or not feeding.
Over 6 months Around 103°F (39.4°C) or higher, a fever that lasts more than a day or two, or any fever in a baby who looks ill, is hard to console, or will not drink.

Fever is a number plus a baby. A 6-month-old with 101°F who is smiling and drinking is a different call from a 6-month-old with 101°F who is limp. Teething does not explain a true fever. Neither does “they feel warm.” Measure, then call if the table says to.

Breathing

Call emergency services for:

  • Blue, gray, or very pale lips or tongue
  • Skin pulling in between the ribs or at the base of the throat with each breath
  • Grunting, flaring nostrils, or a belly that is working hard to breathe
  • Pauses in breathing
  • A baby who cannot cry or make sound, which can be choking

A stuffy nose that is noisy but with easy breathing, pink lips, and a baby who pauses to feed, can usually wait for office hours, with saline and suction as your clinician has shown you. Trust the work of breathing more than the volume of the snort.

Dehydration, vomiting, and diapers

Young babies have very little reserve. Call the same day, and sooner if your baby is under 3 months, for:

  • Fewer than half the usual wet diapers, or no wet diaper for 6 to 8 hours after the newborn period
  • A dry mouth, no tears in a baby old enough to have them, or a sunken soft spot
  • Repeated vomiting, especially green or bloody vomit, or vomiting that keeps every feed down from staying down
  • Diarrhea that is frequent and watery, particularly with fewer wets
  • Stool that is white, gray, or chalky, or black after the first few days of life

Spit-up that is effortless, in a baby who is smiling and soaking diapers, is a laundry problem. Vomiting that shoots across the room, over and over, is a medical problem. The difference is force, frequency, and whether your baby is still hydrated.

Other reasons to call now

Do not wait until morning for a seizure, a baby who is very hard to wake, a bulging fontanelle, inconsolable crying that is new and different, a purple rash that does not blanch when you press a glass on it, or bleeding that will not stop. Any fever in a baby under 3 months is on this list too.

Call the same day for an umbilical cord or circumcision site that looks red and spreading, a jaundice color that is moving down the body or appearing after the first week, blood in the stool that is more than a speck, or a fall onto the head. Also call if your baby is not feeding, not just feeding a little less.

What can usually wait until morning

A single extra-fussy evening with a normal temperature, a mild rash that blanches and does not include fever, a short-lived spit-up, and a night of frequent waking in a baby who is otherwise themselves can wait for the office line. Write down the temperature, the time, the number of wet diapers, and what you have already tried. That note makes the morning call shorter and better.

Trust the after-hours nurse line your pediatrician gave you. It exists for the 10 p.m. question. If you are told to go in, go in. If you are told to watch two specific things and call back if they change, watch those two things and do call back. “Wait and see” is a plan with a checkpoint, not a dismissal.

A short list to keep on the fridge

  • Under 3 months plus 100.4°F rectal: call now.
  • Hard breathing, blue color, seizure, or a baby you cannot wake: emergency care.
  • Not peeing, repeated vomiting, or white stools: call the same day, sooner if your baby looks ill.
  • You are unsure, and it is nighttime: use the after-hours line rather than searching.

Bring your log if you go in. Temperatures, feeds, and diapers from the last day answer questions you will be too tired to reconstruct in a waiting room.

Sources

This guide is general information for families, not medical advice, and it is not a substitute for your pediatrician.

This Baby handbook page is general information, not medical advice. When in doubt, call your pediatrician.