Warning Signs for Newborns

Birth is a stressful event for a newborn. Newborns must make many physiologic adaptations immediately after birth, and any number of things can occur at that time. The circulatory system changes, a new oxygen source must be utilized, and the newborn must learn to coordinate sucking and swallowing to obtain nutrition. When a newborn has trouble making the adjustment from intrauterine to extrauterine life, the warning signs are usually obvious, although some problems may not be evident for several days.

A mother, doctor and newborn in the delivery room. Credit: oceandigital/iStock/Getty Images

Breathing Difficulties

Newborns having trouble getting enough air into their lungs appear to be fighting for every breath, breathing faster than the normal newborn rate of 40 times a minute. They're cyanotic, their nostrils flare out with every breath and they grunt with each breath. Their chest and areas around the collarbone suck in when they breathe. Respiratory distress can be caused by transient tachypnea of the newborn (TTN )--a temporary respiratory problem caused by fluid in the lungs. TTN is more common in babies born by cesarean section, the Hospital for Sick Children states, because fluid doesn't get squeezed out of the chest cavity during delivery. Other breathing problems seen at birth include respiratory distress syndrome, difficulty getting air into the lungs, meconium, the first stool, aspiration, infection and congenital lung malformations.

More emergent breathing problems occur when a newborn doesn't breathe at all after birth. The infant may be pale or blue, limp and making no attempts to breathe. Supplying oxygen through an ambu bag, which delivers forced air into the lungs, may be all that's required to get a stressed-at-birth infant breathing.


Cyanosis is a blue tinge to the skin that can affect the whole body, just one side or the extremities and the area around the mouth. Cyanosis means that a newborn isn't getting enough oxygen. This can be caused by a problem with the heart or a problem with the lungs. Heart and lung problems can be congenital birth defects, or can be caused by temporary issues such as meconium aspiration or prematurity, Theodore Thompson, M.D, of the University of Minnesota Medical School states.

Floppy Muscle Tone

Normally, newborns have good muscle tone. When you pick them up, you can feel the tension in their muscles, and they pull their arms and legs up when you lay them down. Floppy babies splay out when you put them down. Their heads fall back, and their extremities hang limp. Often, floppy babies develop tone as soon as they're given oxygen, which raises their heart rate. A floppy baby can have a number of congenital diseases, infection or brain damage from prenatal or antenatal (during labor and delivery) causes, the Aukland District Health Board reports. Drugs used for pain relief during labor may also cause transient floppiness.

Irregular Heart Rate

Most newborns have a regular heartbeat of 120 to 160 beats per minute. Faster or slower heart rate at birth may be caused by poor oxygenation, which improves as soon as the baby breathes well or is given supplemental oxygen. Babies with irregular heart rates may have congenital heart problems, infection, brain damage or respiratory problems.

Poor Feeding

The ability to coordinate sucking, swallowing and breathing can be complicated for some newborns. Premature babies often are unable to coordinate suck and swallow reflexes and need supplemental tube feedings until they master this skill. Babies who feed poorly, gag or turn blue during feedings may have congenital problems such as structural problems with the gastrointestinal tract, muscle disease, heart or lung problems that tire them easily or syndromes such as Down syndrome, Medline Plus explains.

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