Below, every sign is sorted by how quickly it needs a response: emergency care now, a call today, a call booked this week, or a routine question for the next visit. Corrected age does not change any of these rules. A sign is a sign at any age.
This is an educational checklist, not a diagnostic tool. It cannot tell you what is wrong, and it cannot tell you that nothing is. If something here matches what you are seeing, contact your own clinician or your local emergency number. In Australia, healthdirect lists the emergency signs below as reasons to call an ambulance straight away: symptoms of serious illness in babies and children.
Emergency — seek immediate care
Do not wait for a call back, and do not wait for the next clinic slot. Take your baby to an emergency department or call your emergency number.
- Working hard to breathe: grunting, nostril flaring, chest pulling in, pauses in breathing
- Blue or grey colour around the lips or tongue
- A seizure, or unusual repetitive jerking or stiffening
- Unrousable, floppy, or very much less responsive than usual
- Fever in an infant under 3 months corrected, or any fever in a baby with a central line or shunt
- Repeated vomiting, a swollen abdomen, or blood in the stool
Working hard to breathe, or a colour change
What you may see: Grunting at the end of each breath, nostrils flaring wide, the skin sucking in between the ribs or at the neck, long pauses between breaths, or a blue or grey tinge around the lips or tongue.
Why it matters in a preterm baby: Lungs are the last organ system to finish before birth, so a baby born early starts with smaller airways and far less reserve than a term baby. Bronchopulmonary dysplasia and a recent viral illness are common in this group, and breathing that looks “a bit fast” can deteriorate within hours.
What to tell your clinician: Gestational age at birth, today's corrected age, when the work of breathing started, how feeds are going, and anything from the discharge summary about oxygen at 36 weeks or home oxygen.
A seizure, unusual jerking, or a baby who will not wake
What you may see: Repetitive jerking or stiffening, repeated odd postures or eye movements that stop on their own, or a baby who is unrousable, floppy, or clearly much less responsive than usual.
Why it matters in a preterm baby: Seizures in young infants often look subtle: a freeze, a stare, or the same limb moving over and over rather than a full convulsion. Prematurity and the brain changes that can come with it lower the threshold for these events, so an abnormal repetitive movement is never a wait-and-see sign.
What to tell your clinician: What time it started, how long each episode lasted, and a video if you can take one safely. Say explicitly that your baby was born early — it changes which scans are offered first.
Fever in a very young baby
What you may see: A temperature of 38 °C (100.4 °F) or higher in a baby under 3 months old, or any fever at all in a baby who still has a central line or a shunt.
Why it matters in a preterm baby: A young infant can have a serious bacterial infection with almost nothing else to show for it — no rash, no cough, just the temperature. Premature babies are more likely to be in that group, and infections move faster in them.
What to tell your clinician: The exact temperature and how it was taken, the age in weeks since birth, how the baby is feeding and alerting, and whether any line or shunt is still in place. The AAP's advice on calling for fever is at Fever: when to call the pediatrician.
Repeated vomiting, a swollen belly, or blood in the stool
What you may see: Vomit that keeps coming back, an abdomen that is swollen and tense, green (bile- stained) vomit, blood in a nappy, or a baby who refuses feeds with a swollen tummy.
Why it matters in a preterm baby: A preterm gut had to learn its job earlier than it should have, and babies who needed surgery for necrotising enterocolitis or for a bowel problem are at higher risk of later obstruction. Bilious vomit in any infant is an emergency.
What to tell your clinician: What the vomit looked like, how many nappies in the last 24 hours, the last few days of feeds, and any abdominal surgery in the NICU.
Call today — do not wait for the next visit
- • Loses skills they once had — at any age, this always needs a same-week call
- • Does not respond to sound, or you are worried about hearing
- • Stiffness, floppiness, or persistently using only one side of the body
- • Feeding difficulty, choking, or poor weight gain
- • Eyes that do not follow, or that consistently turn in or out after 4 months corrected
- • Any worry that will not settle — a parent's concern is clinical data
This list never gets downgraded to a routine question. CDC's Learn the Signs. Act Early. programme puts the same rule plainly: if a skill is lost, if a milestone is missed, or if you have another concern, act early and talk to your child's doctor rather than waiting for the next appointment — see CDC's developmental milestones. Going backwards is the one pattern that is never a normal part of catching up.
Book this week — a same-week call to your paediatrician
These signs rarely become emergencies overnight, but they deserve an appointment in the next few days rather than at the next scheduled check. Write down what you have seen before you call; a short written account makes the consult faster and more useful.
- Not gaining weight, or crossing downwards through growth centiles
- Feeding is taking longer and longer, with coughing or choking
- Persistently favouring one hand before 12 months corrected — early hand preference is a motor red flag, not a talent
- Stiff or arched posture, or a baby who feels floppy when picked up
- No response to your voice, or no babble by 9 months corrected
- No eye contact, or eyes that consistently turn in or out after 4 months corrected
- No pointing or showing by 18 months corrected
- Snoring with pauses, or noisy laboured breathing during sleep
Weight that is not following its own curve
What you may see: Week after week of flat weight gain, or a point where the line crosses downwards through the centiles on the chart.
Why it matters in a preterm baby: Preterm babies are judged on their own curve, plotted by corrected age, not on the shape other babies have. Read against chronological age instead, a healthy preterm baby can look growth-restricted: one study found up to 72.9% of very preterm babies were misclassified as stunted at term when chronological age was used — preterm growth assessment: the latest findings on age correction. The point of the same-week call is to sort a chart-reading problem from a real one.
What to tell your clinician: Every weight with its date, the amounts and type of feed per 24 hours, wet nappies, and any vomiting or reflux. The preemie weight gain calculator turns those numbers into an interval rate you can hand over.
Feeding that is getting harder, with coughing or choking
What you may see: Feeds that stretch longer and longer, coughing, spluttering or choking during a feed, wet nappies dropping off, or a baby who falls asleep exhausted at the breast or bottle.
Why it matters in a preterm baby: Sucking, swallowing and breathing have to be coordinated, and preterm babies learn that coordination early and often imperfectly. Late feeding difficulty is also the first clue to reflux, airway problems or neurologic concerns, so it is treated as a feeding and a development question at the same time.
What to tell your clinician: Minutes per feed, what happens in the middle of a feed, the number of wet nappies, and whether choking happens with thin fluids only. Ask about a feeding review by a speech pathologist or occupational therapist if your clinic has one.
Tone, asymmetry and early hand preference
What you may see: A posture that is always stiff or arched, a baby who feels floppy when lifted, hands that stay fisted, one side used far more than the other, or a clear preference for one hand before 12 months corrected.
Why it matters in a preterm baby: Cerebral palsy is more common after preterm birth, and the earliest sign parents notice is often handedness — a preference that should not exist yet. Australian guidance calls persistent hand preference before 12 months a red flag: early hand preference and infantile spasms. Physiotherapy started in the first year changes what the second year looks like.
What to tell your clinician: Which hand, since when, and what the other hand does during play. Bring the gestational age, any grade of intraventricular haemorrhage, and the discharge summary if you still have it.
Hearing, vision and social communication
What you may see: No response to your voice or to sounds, no babble by 9 months corrected, no eye contact, eyes turning consistently in or out after 4 months corrected, or no pointing or showing by 18 months corrected.
Why it matters in a preterm baby: Preterm babies are more likely to have a hearing difference, a vision screening history such as retinopathy of prematurity, or a squint — and each of those changes what “no babble” means. Corrected age sets a fair milestone row; it does not explain away an absent response.
What to tell your clinician: Whether the newborn hearing screen was passed, any ear infections or otoxic drugs in the NICU, the result of the last vision check, and which sounds or words your baby does respond to. Ask whether a formal screen is due at the ages the CDC milestone checklists cover.
Snoring with pauses, or laboured breathing in sleep
What you may see: Loud snoring most nights, pauses in breathing followed by a gasp, restless sleep, or breathing that looks like hard work once the baby is asleep.
Why it matters in a preterm baby: Chronic lung disease of prematurity, a small airway and enlarged adenoids can combine to obstruct sleep in a toddler who cannot describe it. The AAP lists frequent snoring as a reason to tell your paediatrician straight away: sleep apnea in children. Pauses in breathing during sleep are never part of normal catch-up.
What to tell your clinician: How many nights a week, whether you have heard an actual pause, a video recorded in the dark, and any oxygen or steroid history from the NICU. Ask whether a sleep study is appropriate.
Routine — things that are usually not a problem
- Sitting or walking “late” when the corrected age row says the child is on time
- A brief plateau during an illness, with recovery afterwards
- Being smaller than term-born peers of the same birthday, while following their own curve
- Preferring to be carried, disliking tummy time, or being sensitive to noise after a long NICU stay
These belong at the routine tier: note them and raise them at the next scheduled visit rather than calling today. The distinction that matters is the curve, not the comparison. A child who stays on their own line while being smaller than birthday peers is doing what catch-up growth looks like, and the correction applied in the corrected-age worked examples is usually enough to read that line fairly. If the line itself is falling, move the concern up a tier.
One exception cuts across this section: a skill that has been lost belongs in the call today list at every age. Plateaus recover; losses do not.
A note on trusting yourself
Parental concern is one of the strongest predictors of a genuine developmental problem in the published literature. In a study of 408 children, systematically elicited parental concerns identified 79% of the children with disabilities — close to the standard expected of a formal screening test (Glascoe, 2000). If something feels wrong and this page does not list it, that is not evidence that nothing is wrong. Call anyway. No paediatrician has ever resented being called about a NICU graduate.
What this page will not do is score your child. There is no pass mark here, no percentile of development, and no diagnosis behind any of these lists. Read the tier, act on the tier, and let the clinician do the part only a clinician can do.