One of the most difficult issues for new parents, and grand-parents, is deciding if a very young infant (under 2 months of age) is sick. Some people go by “look”; others seem to have a built in radar that alerts them to when something may be wrong that at least prompts the call to the pediatrician. Pediatricians, too, develop a sixths sense with this age group. They have to because this group, above all others, deserves special attention when illness lurks.

We worry so much about this age group because these babies are quite difficult to assess. Their physical exams are not as reliable as older infants and once they look very sick, they are actually quite ill. Moreover, unlike older infants who tend to get viral illnesses, these babies tend to get bacterial illnesses that can become life-threatening quickly due to their immature immune systems. So, we tend to bring these babies into the office a great deal more than other infant age groups  if we have any concern for possible sickness. This isn’t a “wait and see” age group.

The question that has plagued us over the years, however, has been what clinical signs to focus on and what signs to counsel parents to call us about. The journal Lancet published an interesting study in the January 12, 2008 issue that received a great deal of press at the time and really helps clarify this question for both pediatricians and parents.  However, I do worry that research designed for physicians can sometimes become a burden to parents when passed on so specifically in the press so I want to discuss it a bit so you are not alarmed and understand what it means for you as a parent.

As the Reuters summary on MSNBC accurately stated, the 7 signs that an infant under 2 months of age may be very sick are:

• history of difficult feeding
• history of convulsions  (seizure)
• movement only when stimulated
• breathing rate of 60 breaths per minute or more
• severe chest in drawing
• over 37.5 degrees Celsius (99.5 degrees Fahrenheit)
• under 35.5 Celsius (95.9 degrees Fahrenheit)

Most of these are signs we will pickup on exam and they can be very, very subtle. Of all the signs on the list, the most common signs for parents to notice are feeding and temperature changes.

The study was actually designed to determine sickness in infants under a week of age but the authors noted it can be extrapolated to infants under  2 months of age depending on the clinical situation with the evaluation of a pediatrician. That is very important to keep in mind because this list may not apply to all infants and may, in fact, be of more use to pediatricians and just for very, very young infants, such as infants under a month of age.