INSERT CLINIC NAME, ADDRESS AND CONTACT …
INSERT CLINIC NAME, ADDRESS AND CONTACT INFORMATION HERE
Changes in Behavior
□ Baby suddenly becomes "floppy" with loss of muscle tone
□ Baby becomes stiff
□ Baby stops feeding normally
□ Baby cries for an abnormally long time
□ Baby is unusually cranky and irritable or unusually sleepy
Changes in Appearance
□ Any change in the baby's color, paleness or bluish color around the mouth and face
□ Redness or tenderness around the navel area
□ White patches in the mouth
Signs of Illness
□ Fever (rectal temperature of 100.4 degrees Fahrenheit)
□ One or both eyes are pink, bloodshot, have a sticky white discharge
□ Diarrhea - more than six to eight watery stools per day or any blood in the stool
□ Nose blocked by mucus so baby can't breathe while feeding
□ Vomiting for 6 hours or more
Changes in Behavior
□ Hysterical crying
□ Loss of consciousness
□ Extreme sleepiness
□ Painful or frequent urination
□ Sudden weakness or unable to move any part of the body
□ Uncontrollable shaking of body
Changes in Appearance
□ Pain, redness, or swelling of a joint that can't be explained by an injury
□ A cut or scrape that oozes pus or becomes hot, red, tender, or swollen
□ A yellow color in the whites of the eyes or in the skin, especially with pain in the abdomen and/or dark or tea-colored urine
□ A sudden rash, or sudden crop of blotches or blisters
Change in Ability to Use Senses (Such as Eyes and Ears)
□ Sudden hearing loss
□ Earache or fluid discharge from the ear
□ Sudden decrease in vision
□ Eyes are red, swollen, and watery - with or without blurred vision
□ Eyes are extremely sensitive to light, especially if accompanied by a fever, headache, or stiff neck
Change in Body Fluid - Color, Smell or Amount
□ Urine that is discolored, bloody, cloudy, or has an unusual smell
□ Discharge from the penis
□ Vaginal discharge that is thick and white, brown or discolored, or smells bad
□ Diarrhea that is streaked with blood or mucus
Other Signs of Illness
□ High fever or chills
□ Severe headache
□ Pain, heaviness, or stuffiness around the nose, eyes, or forehead
□ Nasal fluid that is discolored, bad-smelling, or bloody
□ Severe or persistent cough especially if it brings ups bloody or discolored mucus
□ Vomiting for 12 hours or more or vomiting with blood
□ Stiffness or pain in the neck, especially with fever or headache
□ Severe sore throat, especially with trouble swallowing or speaking
□ Difficulty breathing, especially with pale or bluish color of the lips or nails
□ Unusually rapid breathing
□ Intense or unusual stomach pain or swollen stomach
□ Pain in the middle or low back, especially with fever or with discomfort while urinating
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Infants from Birth to Three Months
Infants and Children of All Ages
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