If your baby is not feeling well?

Signs and symptoms of illness: what they mean and what should be done if they occur?

The symptom usually is a manifestation of a disorder that has its cause and its localization in the body. Vomiting, constipation, pain, elevated body temperature, cough, runny nose etc. are common symptoms in infants and children. Their occurrence and development worries the parents.

How to behave, what to do, when to seek medical attention?

The pain

It is a common symptom. The smaller the child is, the more difficult it is to localize the pain. The most common causes for pain in infants are:


It occurs in most of the children, including in premature babies. It is typical for the first 3-4 months, more common in males. Usually, the pain is accompanied by crying, writhing the legs to the abdomen, reddening of the face, passing wind. The restlessness is more commonly increased in the afternoon and evening hours.

How to relieve the pains?

  • Make the baby burp after every meals.
  • Put it on its abdomen in your lap or on your chest. Gently massage its abdomen clockwise with warm hand.
  • Warm napkin or diaper on the abdomen will also calm the baby.
  • Warm bath + warm blanket.
  • Physical exercise type „cycling“ with the legs will help passing the gas.
  • Taking the baby out (in suitable weather).
  • Chamomile, dill, anise tea.

Seek your doctor for examination that will rule out other reasons for crying and restlessness of the baby. He will also prescribe and recommend you medicines (most frequently in the form of drops) for colic relief in infants.

Pains while passing stool

Usually they are due to constipation. It can be false or genuine.

„False constipation“

It occurs when the infant does not receive adequate quantity of milk/infant formula. In these cases, the baby passes scanty quantity of stools, once in several (2-3) days. Weight gain is inadequate or stops. You should consult your doctor and make sure how often the baby should be fed, what quantity and type of food should be given. There are cases in which the child gains weight well and still it has „false constipation“. Usually, this is due to more sluggish bowel movement. If the baby is fed with infant formula, your doctor will decide whether a switch to another type of milk would be necessary.

„Genuine constipation“

When the child does not pass spontaneously stool for more than 72 hours. Often the baby becomes restless, wails, strains, the face reddens, it may even refuse food. The stools are hard.

Seek medical attention after you have tried:

  • to increase fluid intake – glucose or boiled water.
  • to massage the abdomen with baby oil several times a day and make exercises type „cycling“ with the legs.

If there is no result, consult your doctor and he will suggest medicinal, dietetic or any other solution to the problem.

Pain in the groins

In premature children unilateral or bilateral inguinal hernias occur more often. They may reach large dimensions, especially while the baby is crying and straining. In case of incarceration the child becomes highly restless; the crying is constant because it is in pain. What should you do? Do not try any „adjustment-reposition“. Seek urgent medical consultation. It is appropriate to consult a paeditric surgeon who will assess the need of emergency or elective surgical correction. If no surgical intervention is required, he will advise you what to watch, what to avoid and what to do.


Vomiting as a symptom is common in premature babies and newborns and infants born on term. In most of  the cases it is due to anatomic and functional transient immaturity of the gastrointestinal tract and is not a morbid syndrome. Therefore, after each meal the baby should be made to burp and usually, along with the air, a small quantity of milk also comes out. When the quantity of the regurgitated (burped) breast- or infant formula is bigger and the vomitings are more frequent, this may be due to a wider stomach opening.


  • In these cases, hold your child upright and slightly bent forward, in order to make it burp repeatedly after each meal.
  • Put it in bed laying aside, its head and the upper part of the body raised. You may raise a bit the bed mattress. This will prevent the risk of aspiration (milk getting in the airways) and acute breathing disorder.

Your neonatologist and/or your GP will advise you when vomiting is normal, acceptable and will tell you the criteria to lead you (calm baby, gaining adequately weight, number of diapers with urine and stools per day etc.)

When vomiting is unusual?

When the number of vomitings is higher than usually. When the regurgitated breast milk/infant formula is abundant, more than half of the ingested milk, comes out like a fountain, has unchanged or curdled appearance. The child is restless, crying, cannot be calmed down or on the contrary – it sleeps unusually long, it is difficult to awake, shows no signs of hunger etc. In these cases do not defer your call to your GP or a doctor on duty for examination. No matter which part of the day it is.

Acute diarrheas

The normal stools of breast-fed babies are: soft, golden yellow, with slightly sour odour, frequency up to 6-8 times a day. After the 2nd month the frequency decreases. The stools of a bottle-fed baby are: thicker, with sharper odour, less frequent, coloured from yellow to gray-green (depending on the type of the milk).

When there is diarrhea?

Passing stools more frequent than usual, stools are soft, watery, with changed odour, may have admixtures (blood, mucus). Acute diarrheas are more common in infants and in early childhood. The breast-fed babies fall ill more rarely. Diarrhea is due to viruses, bacteria or faults in diet. The premature children are considerably more vulnerable, especially to rotavirus infection. Usually, diarrhea is accompanied also with vomiting, restlessness, crying or limpness, prolonged sleep, temperature increase, food denial etc. In smaller babies there is a risk of dehydration and worsening of the condition, which occurs more rapidly and earlier in comparison with older children.

What shall I do?

Count the number of stool passings so far. Pay attention to the quantity, consistency, colour, odour, presence of unusual admixtures such as blood and mucus. Keep at least one diaper with stools to show to the doctor. Measure the temperature of the baby. After each change of diaper smear baby cream on the buttocks because there is a risk of reddening and sores. If you breast-feed the baby proceed to do it at shorter intervals. The breast milk is not contraindicated in case of diarrhea. It has a pain-relieving action as well. Give also more fluids to the baby – boiled water or glucose 5%. Call your GP or a doctor on duty. After examination, he will decide whether to hospitalize the child or leave it at home for treatment.

The baby has temperature

The increased body temperature is often the first and even the only symptom of a number of diseases; it troubles the child, worries the parents and make them seek paediatric help.

Which temperature is normal and when it is elevated?

The normal body temperature is between 36.5°C in the morning and 37.2°C in the evening. Elevated body temperature is over 37°C upon axillary measurement (in the armpit) and over 37.8°C upon rectal (in the anus) or buccal (in the mouth) measurement.

How to measure the temperature?

Nowadays, for temperature measurement electronic, digital thermometers are mostly used that show the temperature within a short time. Rectal measurement (in the anus) is the most precise one. Smear vaseline or baby oil on the thermometer tip. The baby should be in supine position, you grip the ankles and hold the legs upwards with one hand, and with the other hand you gently insert the thermometer tip in the anus about 1 cm deep. Make sure the tip would not to go out. Shortly thereafter, a sound is heard signaling that the temperature is measured. Important! The temperature measured rectally is by 0.5°C higher than that measured in the armpit or in the groin fold. When measuring in the armpit, the thermometer tip should be put in the middle of the pit and the arm should be well pressed to the body. The temperature may be measured also in the ear by a special thermometer as well as in other ways.

How many times a day should I measure the temperature and when?

Temperature measurement is not necessary if there is no reason or doubt for fever (elevated temperature). In the course of a disease it should be measured at least twice daily – between 7-8 h in the morning and 16-17 h in the afternoon. Additional measurements are made if you belief that the child’s temperature is raised or after medicine intake etc., in order to assess the intensity of temperature drop.

How shall I know that the child has temperature?

The febrile baby is usually restless, crying and difficult to calm, the skin of the head and the body feels warm, and is red, and the skin of the limbs (hands and feet) feels cool. The baby may drink fluids thirstily or refuse to drink. In other cases, the skin becomes pale, the breathing is speeded and heavier, the baby is drowsy and difficult to awake. If you have any doubt, measure the temperature.

What to do?

First, measure the temperature – rectally or in the armpit. In order to be sure, do it again or use another thermometer. The thermometer should be in good working order – check for low batteries etc. If you have experience from a previous child, you may give syrup to the baby in case of elevated temperature. It should correspond to the baby’s age, should be within shelf life, unopened or recently opened and should be correctly stored. Read the dose for your baby in the leaflet. Suppositories are also suitable for use in infants for decrease of temperature. If the temperature is high and remains 39.5-40°C, call your doctor. Before he comes, start with wet wraps. Partial wet wraps – dip diapers in lukewarm water (18-20°C) and wrap the limbs. Put a napkin dipped in cold water on the forehead. If the temperature persists or keeps increasing, start with overall wet wrapping. Wrap the body and the limbs with a dipped in lukewarm water and wrung out diaper and cover with a blanket. When the diaper is warm, wet it again and repeat the procedure until the temperature drops to 38°C.

Should I take the child to the doctor in case of a single temperature elevation?

Call your GP and inform him about the temperature elevation – how many times you measured it, how high it was, are there any other accompanying symptoms, how the child feels, what is its condition.

Temperature in case of teething

Teething is a physiological process. Sometimes it is associated with gum itching, softer stools, restlessness and possible temperature elevation up to and rarely above 38°C. It is appropriate to seek medical attention, in order to rule out other reasons for the abovementioned symptoms. How shall I help the baby? Give it a suitable rubber toy to rub its gums. Increase fluid intake because of the temperature. Ask your GP for suitable medicines to facilitate your baby’s teething.

Runny nose

The infant is breathing mainly through the nose. In case of a „snorting“ nose, in the presence of nasal secretion, the baby’s breast-feeding and breathing is impeded. Prior to breast-feeding, drop 1-2 drops of saline in each nostril. Put the baby in supine position and fix the head. Raise a bit the tip of the nose, place the dropper near to the nostril without inserting it in the nose opening, so that you do not injure the nose mucosa in case of an abrupt head movement. After dropping, the baby will start sneezing. Thus the secretions will be removed. Swab gently both nostrils with a swab with a restrictor. Proceed with breast-feeding. Consult your GP, if the secretions are more abundant, watery and transparent in the beginning, and then thicken and colour. After examination, he will prescribe you drops, nasal ointments or anything else suitable for the child’s age and condition.

Secretion from the eyes

In case of eye secretion, it is important to pay attention to the thickness, the quantity and colour of the secretion. If the secretion is clear and watery, drop 1-2 drops of saline in both eyes. In order to do that, put the child in supine position, the head slightly drawn backwards. Draw gently the lower lid, drop from a distance, not touching the eye. The secretion is always swabbed from the outside inwards. In case of purulent (yellow, yellow-green coloured) eye secretion examination and treatment by a doctor is warranted.


It is caused by fungi. It is more common in premature children. It develops in case of failure to observe the hygiene requirements, prolonged antibiotic treatment. Small white coatings (resembling milk left-overs) are formed on the oral mucosa. If the disease progresses, dense white coatings on the tongue and the cheeks are seen. It causes pain and difficulties in feeding. In order to prevent its development, boiling (sterilization) of all objects that are put into the child’s mouth – comforters, feeding-bottles, toys etc - is necessary. Seek advice from your GP regarding the medicinal treatment.

In the course of the baby’s raising, you and your doctor are „partners“. Ask questions about things that are not clear to you, about anything you did not understand or about something that bothers you. If you are not satisfied, you have the right to seek second opinion. Find telephone numbers, business time, time for call, nights and holydays – localization and telephone of the consulting room on duty.

When to call the doctor?

In the beginning it is better to call more often than necessary rather than not call when you had to. Before you call put your thoughts in order.

Specific and important symptoms, reason for calling

High temperature, fast and loud breathing, writhing, pain, unusual vomiting, diarrhea, rashes.

The information that you will provide to the doctor is of vital significance:

  1. What exactly the worrying symptoms are?
  2. When did they occur?
  3. How often do they occur?
  4. Other symptoms, what kind?
  5. What are the vital indices of the baby: temperature, paleness, difficult breathing?
  6. What did you do and to what effect?
  7. Do you give any medicines and what kind?

Welcome to  "All About Premature Babies" website.
This is a project of "Our premature babies" Foundation based in Bulgaria. The book is a result of a team’s hardwork that includes doctors, psychologists, breastfeeding consultants and premature babies parents. The common information about premature babies which you can find here will help you understand better the situation you've been facing.
Please keep in mind that some of the information related to the neonatal intensive care units is prevalent only in Bulgaria.

We hope that this website and the book are going to help you to be more informed, calm and confident. We wish you and your baby best of luck and health.

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