Every new parent has stood over a sleeping baby and wondered if they are breathing. Watched them make a strange face and felt a spike of alarm. Googled something at 2am that sent them into a spiral they did not need.
Most of what worries new parents in the newborn stage is normal. Deeply, reassuringly, textbook normal. But some things are not — and knowing the difference between the two is one of the most practically useful things a new parent can have.
This guide gives you that. The real red flags that warrant immediate attention. The things that look alarming but are not. And the middle ground — symptoms worth monitoring and mentioning at your next appointment, without a 3am emergency room visit.
Why Newborns Look and Act Strange
Newborns are fresh out of a completely different environment. They have spent nine months in a warm, fluid-filled, dark, constantly moving space — and they have arrived in a world of gravity, air, light, sound, and temperature variation. Their bodies are still adjusting.
Many things that look concerning in a newborn are simply the residue of that transition — temporary, self-resolving, and completely expected by your care provider even when nobody mentioned them to you in advance.
The Canadian Paediatric Society maintains current, evidence-based guidance on newborn health that is worth bookmarking. When something worries you and you are not sure whether it warrants a call, it is a reliable first reference.
Immediate Red Flags: Go to Emergency Now
These symptoms in a newborn under three months require immediate emergency care. Do not wait for a callback. Do not monitor overnight. Go now.
Fever Above 38°C
A rectal temperature above 38°C in a baby under three months is a medical emergency. Full stop.
Newborns have immature immune systems and very limited ability to fight infection. What presents as a mild illness in an older child or adult can escalate rapidly and severely in a young baby. Fever in this age group requires immediate assessment to rule out serious bacterial infection — meningitis, sepsis, urinary tract infection, and pneumonia all present with fever in newborns.
Take a rectal temperature — it is the most accurate method for babies. If it reads 38°C or above, go to the emergency department. Do not give fever-reducing medication first. Do not wait to see if it comes down.
Difficulty Breathing
Newborns breathe faster than adults — typically 40 to 60 breaths per minute, compared to 12 to 20 for an adult. This is normal. What is not normal:
- Nostrils flaring with each breath
- The skin between or below the ribs pulling inward with each breath — called retractions
- A grunting sound with each exhale
- Breathing rate consistently above 60 breaths per minute
- Blue or grey colouring around the mouth or fingernails — called cyanosis
- Pauses in breathing lasting longer than 20 seconds
Any of these symptoms require emergency attention immediately.
Unresponsiveness or Extreme Limpness
A baby who cannot be roused, who is floppy when held, who does not respond to handling or sound, or who seems profoundly different from their usual self requires emergency assessment. This level of lethargy in a newborn is not tiredness — it is a warning sign.
Seizures
Seizures in newborns can look different from seizures in older children. Watch for:
- Rhythmic jerking of one or more limbs
- Stiffening of the body
- Repetitive facial movements — eye deviation, lip smacking, chewing
- A sudden change in muscle tone — either going very stiff or very floppy
If you observe these, call 911.
Persistent Vomiting
Spitting up is normal. Vomiting — forceful, projectile, or persistent — is not. A baby who vomits after every feed, who vomits forcefully across the room, or who cannot keep any feed down requires assessment. Pyloric stenosis — a narrowing of the outlet between the stomach and small intestine — typically presents between two and eight weeks with progressively worsening projectile vomiting and requires surgical correction.
No Wet Diapers
After day four, a healthy baby should produce six or more wet diapers in 24 hours. A baby producing fewer than this — or none at all for eight or more hours — is not getting enough fluid and may be becoming dehydrated. This warrants same-day contact with your care provider at minimum, and emergency care if your baby is also showing signs of lethargy or sunken fontanelle.
Things That Look Alarming But Are Usually Normal
Jaundice
Yellowing of the skin and whites of the eyes in the first few days after birth is extremely common — it affects approximately 60 percent of full-term newborns. It is caused by a buildup of bilirubin, a byproduct of the normal breakdown of fetal red blood cells after birth.
Physiological jaundice — the normal kind — typically appears on day two or three, peaks around day four or five, and resolves within two weeks in full-term babies.
What warrants attention:
- Jaundice appearing within the first 24 hours of birth — this is not physiological and requires immediate assessment
- Jaundice that is deepening rather than fading after day five
- Jaundice persisting beyond two weeks in a full-term baby
- A baby who is jaundiced and also very sleepy, feeding poorly, or difficult to rouse
Your care provider will check bilirubin levels if jaundice appears significant. Most cases resolve with adequate feeding — frequent feeds help the body process and excrete bilirubin. Some cases require phototherapy, which is safe and effective.
Noisy Breathing and Snuffling
Newborns are obligate nose breathers — they breathe through their nose, not their mouth. Their nasal passages are tiny. Even a small amount of mucus causes audible congestion that sounds alarming.
Snuffling, snorting, and occasional noisy breathing are almost universally present in the newborn stage and do not indicate illness. A baby who is feeding well, gaining weight, and not showing signs of breathing difficulty — no retractions, no cyanosis, breathing rate under 60 — is fine.
A bulb syringe or nasal aspirator can clear the nostrils before feeds if congestion is interfering. Saline drops loosen mucus and make clearing easier.
Hiccups
Newborns hiccup constantly. It is caused by an immature diaphragm responding to stimulation from feeding and is completely harmless. Most babies are entirely unbothered by hiccups even when their parents are not.
Nothing needs to be done. They resolve on their own.
Skin Changes
Newborn skin is going through a significant transition and looks accordingly:
- Peeling and flaking — especially on the hands, feet, and ankles — is normal in the first two weeks. It is the outer layer of skin adjusting to air after months in amniotic fluid. No treatment needed.
- Milia — tiny white spots across the nose and cheeks — are blocked sebaceous glands and resolve on their own within weeks. Do not squeeze them.
- Erythema toxicum — a blotchy red rash with small white or yellow centres that appears in the first few days and moves around the body. It sounds alarming and looks dramatic. It is completely benign and resolves without treatment within a week.
- Mongolian spots — flat, blue-grey patches most commonly on the lower back and buttocks, more common in babies with darker skin tones. They are benign and gradually fade over several years. Your care provider will note them in the records to prevent any future confusion.
- Stork bites and angel kisses — flat pink or red birthmarks on the back of the neck, eyelids, or forehead. Most fade significantly in the first year.
The Startle Reflex
The Moro reflex — where a baby suddenly flings their arms out and then pulls them back in, often accompanied by a brief cry — is present from birth and is a sign of a healthy nervous system. It is triggered by sudden movement, sound, or the sensation of falling.
It is startling to witness, especially in the middle of the night. It is not a sign that your baby is frightened, unwell, or in pain. Swaddling dampens the reflex and helps babies sleep through it.
Crossed Eyes and Wandering Gaze
Newborn eye muscles are weak and uncoordinated. Eyes that cross, drift, or seem to move independently in the first weeks are normal. Binocular vision — the ability to use both eyes together — takes several months to develop.
By three to four months, eyes should be tracking together consistently. Persistent crossing or misalignment after this point warrants a check with your care provider. Before three months, intermittent crossing is expected.
Soft Spot Pulsing
The fontanelle — the soft spot on top of your baby’s head — pulses with your baby’s heartbeat. You can often see it moving. This is normal and reflects the normal pressure changes associated with circulation.
What is not normal: a fontanelle that is bulging and tense when your baby is calm and upright — this can indicate increased pressure in the skull and warrants immediate assessment. A sunken fontanelle is a sign of dehydration.
Baby Acne
A breakout of small red or white pimples across the cheeks, nose, and forehead typically appears around two to four weeks and can look quite dramatic. It is caused by maternal hormones still circulating in the baby’s system and resolves without treatment within a few weeks.
Do not apply acne products, adult skincare, or any treatment. Wash gently with water and leave it alone.
The Middle Ground: Monitor and Mention
These symptoms are worth noting and raising at your next scheduled appointment — or calling your care provider about during business hours if they are persistent or worsening. They do not typically require emergency care.
- Persistent nasal congestion that is interfering with feeding
- Nappy rash that is not resolving with standard barrier cream after three days, or that has the characteristic appearance of a yeast infection — bright red with raised edges and satellite spots
- Umbilical cord stump that is not drying out, has discharge with an odour, or has redness spreading onto the surrounding skin
- Feeding difficulties — consistent pain during breastfeeding, a baby who seems hungry after every feed, or slow weight gain
- Excessive crying — more than three hours per day, more than three days per week — may indicate colic, reflux, or another underlying issue worth investigating
- Persistent yellow skin beyond two weeks in a full-term baby
- One eye consistently tearing more than the other — may indicate a blocked tear duct, which is common and usually resolves by twelve months but is worth noting
Reflux and Colic: Two Things Worth Understanding
Reflux
Gastroesophageal reflux — where stomach contents come back up into the oesophagus — is extremely common in infants because the muscle at the top of the stomach is immature and does not close reliably. Most babies have some degree of reflux.
Signs of reflux:
- Frequent spitting up, sometimes in large volumes
- Arching the back during or after feeds
- Apparent discomfort or crying during or after feeding
- Feeding refusal
Most infant reflux is called silent reflux when it does not result in visible spitting up — the contents come up and are swallowed again. This can make it harder to identify.
Mild reflux typically improves on its own as the muscle matures — usually by six months. Strategies that help include smaller, more frequent feeds, keeping baby upright for 20 to 30 minutes after feeding, and ensuring a good latch to reduce air intake.
If reflux is causing significant discomfort, poor weight gain, or feeding refusal, discuss it with your care provider. Medication is available and effective when warranted.
Colic
Colic is defined as crying for more than three hours per day, more than three days per week, for more than three weeks in an otherwise healthy baby. It typically appears around two to three weeks, peaks around six weeks, and resolves by three to four months.
The cause is not fully understood. It is not caused by bad parenting, dietary failure, or anything you did or did not do. It is a real and exhausting experience for both baby and parent and it does end.
Strategies that sometimes help: white noise, motion, the five S’s approach developed by Dr. Harvey Karp — swaddle, side or stomach position while held, shush, swing, suck. No single approach works for every baby. Survival mode is an appropriate response to colic.
If you are struggling, our Mental Load of New Motherhood guide addresses the reality of what relentless infant care does to a parent — and what support actually looks like.
The Rule for Calling Your Care Provider
When in doubt, call. Your midwife, public health nurse, and family doctor expect to hear from new parents with questions. You are not wasting their time. You are not being anxious. You are doing your job.
The threshold for calling should be low. The threshold for going to the emergency department should be based on the red flags above — not on whether you feel like you have enough reason.
Health Canada’s postpartum and infant care resources provide additional guidance on newborn health in the early weeks. Your provincial health line — 811 in most Canadian provinces — also connects you with a registered nurse around the clock for non-emergency guidance.
You Know Your Baby
Here is the thing about all of this information: the most important diagnostic tool available to you is your own knowledge of your baby.
You spend more time observing your baby than anyone else does. You know their baseline. You know what normal looks and sounds and feels like for them specifically. When something feels different — not alarming, not dramatic, just different — that instinct is worth paying attention to.
Trust it enough to make the call.
→ Read our Basics of Baby Care guide — feeding, sleep, bathing and soothing for first-time moms.
→ Read our Newborn Essentials guide — everything you need for the first three months, by stage.
→ Read our Mental Load of New Motherhood guide — the invisible labour of new parenthood and how to get through it.
→ Shop the Cradle Song Co collection — curated essentials for pregnancy, postpartum, and baby’s first year.
