Everyone knows that children love to fool us. But sometimes, when kids appear healthier than they really are, they unintentionally fool us and put their health at risk. Keep these five seemingly innocent symptoms in mind when you’re with your grandchildren and be ready to step in and help them get medical attention:
1. A sleepy newborn is nothing to celebrate.
With few exceptions, a sleepy newborn is reason for worry, not relief. Of course, most babies are somewhat sleepy in the first forty-eight hours after birth—they are on “good behavior” while still in the hospital, learning to eat and then sleeping happily.
This changes when they get home. Before settling into a healthy pattern of eating and sleeping at a few weeks of age, babies are hungry most of the time and often somewhat scrappy. Depending on a number of factors, including their birth weight, babies should squawk for feedings every two to four hours, before they sleep.
A brand-new baby who comes into a pediatrician’s office at two days, or even two weeks old and who is reported to be sleeping through the night—or for any stretches longer than four hours—is raising a red flag. A complacent newborn  is always a cause for alarm.
2. Watch out for lost milestones.
It’s not uncommon for children to “lose” recently-achieved milestones during times of stress, like moving, changing day-care situations, or having a new sibling enter the family. But persistent regression demands medical attention. For example, if you have a grandchild who had started walking but has reverted to crawling; who had started talking but has gone back to babbling; or who had started tying shoes but suddenly can’t, make sure the child sees a pediatrician. Perhaps family stress will be the explanation. Or perhaps—as was the case with one patient of mine, who lost the ability to open his Christmas gifts—there’s a problem as serious as a brain tumor. Better to be safe than sorry, so make sure the parents consult their pediatrician.
3. Breathing fast without exercising is worrisome.
Parents of a rapidly breathing child often do not realize what’s wrong or how serious the problem is. Frequently, they will call a pediatrician and say that their baby is not eating well, unaware that the reason is that the baby is breathing faster than usual—too fast to eat effectively. Even children old enough to talk may not notice immediately that they have to interrupt their sentences to breathe, or that it seems harder than usual to eat and drink. A number of illnesses—most commonly, infections or asthma—can cause rapid breathing while a child is at rest, and families should seek medical attention. If a child’s lips or nail beds become dusky or bluish, call a doctor immediately.
4. When a rash spreads rapidly, react quickly.
There is one medical emergency that is rare thankfully, but which demands alert attention from parents, grandparents, and pediatricians: meningococcemia. A rapidly moving bacterial infection, meningococcemia affects toddlers (and kids in college as well) and is often rapidly fatal.
The primary means of diagnosis is identifying a telltale rash unlike any other in medicine. The rash is reddish-purple and will not disappear if you press briefly on the skin. Also, the lesions can initially be tiny (pinpoint) but then rapidly progress to sizes larger than a quarter. Over the course of hours, the rash will move from a single spot to cover most of the body. Be aware: Not all pinpoint, reddish-purplish rashes represent meningococcemia. But if you are at all suspicious that it’s what a child has, call the family pediatrician immediately.
5. Failure to gain weight is not cute.
Children grow. They should grow, and they need to grow. This may sound like an obvious point, but it’s easy to forget when you see a child every day. The rate of your grandchildren’s growth will vary depending on their ages, but no matter how old children are, they should be growing. In the practice of pediatrics, except in cases of obesity management or acute illness, weight loss, or “failure to thrive,” requires evaluation.
Originally published on Grandparents