My two-month-old is fussy, feeding less

Get her seen in person today — and if any of the danger signs below are showing now, call your local emergency number now and go straight to the emergency department.

A two-month-old who is fussier and feeding less than usual falls into the "not right" group for her age, where the threshold for assessment is deliberately low: serious illness in a baby this young can appear with no fever at all, and a normal temperature does not rule it out. I can't tell you from here what is causing it — that needs an examination, a temperature and a weight — and I am not going to guess at medicine, feeds or anything for her mouth. This is not a diagnosis and not a substitute for a clinician.

1. What you have already tried, and the better version of each

One thing to get right today: if the Friday feeding assessment is still on, go to it — but that is a feeding review, and a feeding slot is not the same thing as an assessment of a possibly unwell baby. So before you go, tell the nurse line or the clinic front desk exactly what has changed (fussier since when, feeding less, fewer wet nappies) and ask whether she needs an urgent medical review today as well, and where. If they cannot see her today, ask where to go today. It is Friday: doors close early, so if the answer is "book Monday", the correct door is the emergency department today, not Monday.

2. Constraints and the avoid list (until a clinician sees her)

• Nothing on the tongue: no cutting, scraping, stretching, sharp objects or online frenulum tools.
• No powders, drops, gels or herbal remedies bought online, nothing borrowed from an adult or an older child, no leftover antibiotics.
• No feeding changes before the team sees her: no switching breast and bottle, no amount changes, no dropping the nipple shield, no formula, and no water, juice or cereal (nothing before 6 months). Do not stop breastfeeding to "test" the tie.
• No medicine decision from home: at two months a fever, and any medicine at all, is a clinician's call. I am not choosing a product or an amount for her, and nothing borrowed from anyone else goes in.
• No plain water to make up for feeds — that is how a baby loses electrolytes.
• Do not force a feed to "keep up the numbers", and do not delay a feed to catch up later.
• Do not let "the nurse line said she is probably fine" be the whole plan while she is feeding less and passing less urine.

3. Red flags — when home care stops

Go now — call your local emergency number now, and go to the emergency department. Do not wait at home first.

• Hard to wake, limp or floppy, or will not feed at all.
• A cry that is weak, high-pitched or continuous.
• Fast or laboured breathing, grunting, sucking in below the ribs, or blue lips.
• Green (bile) vomit, vomit with blood, or blood in the stool.
• Fitting, staring or jerking.
• A temperature of 38 °C or above, or she feels hot, or unusually cold, or her temperature keeps changing — under 3 months, even when she looks well.
• A bulging or deeply sunken soft spot on the head.
• She is not right and you cannot explain why.

Same day — do not wait for morning, and do not wait for the next checkup.

• Markedly fewer wet nappies than her own usual.
• Feeding much less than usual.
• Not gaining weight, or losing weight.
• A sunken soft spot on the head.
• Anyone in the family says "she just isn't right". At this age that alone is enough to get her seen.

Decision tree

1. Any "go now" sign above? → call your local emergency number now and go to the emergency department. Do not wait at home first.
2. No "go now" sign, but feeding less and/or fewer wet nappies? → seen in person today, through the door in section 1. Not tomorrow.
3. Neither of those, and she is bright, feeding near her usual and wetting near her usual? → still call the nurse line today, keep the log running, and re-check every few hours. If she moves up to step 1 or 2, go up a step. And at two months, "she just isn't right" from anyone in the family is enough on its own to get her seen.

What the team will want as numbers, not impressions: wet nappies in the last 24 hours compared with her usual, feeds in the last 24 hours compared with her usual (they use "less than about half of her usual intake" as one of their history items), and every temperature reading with the time and how you took it.

While you sort out the door (the next few hours)

• Keep her warm: light clothing, a warm room, no draught. Skin-to-skin on your chest is fine for settling and warmth.
• Keep her on her usual feeding, and let her take small feeds as often as she asks for them.
• Write everything down as it happens: time, feed start and end, how the feed ended, wet nappy, stool, temperature and how you took it, and anything given to her.
• If you take a temperature, use the same place each time and note the time. No alcohol rubs, no cold baths.
• Take with you: the log, her birth weight and how many weeks early she was born, her vaccination record, anything that has been given to her, the nipple shield plus a spare, and any clinic papers or weights you already have.

Two scripts to read out

To the nurse line or the clinic front desk

"Hello — I'm the parent of a two-month-old. Since [time] she has been fussier and feeding less. In the last 24 hours she has had about [X] wet nappies and [Y] feeds, against a usual of [X] and [Y]. Her temperature is [value], taken [how, when]. She is [awake and settling / hard to wake], breathing [easy / fast], no rash, no vomiting. Does she need to be seen today, and which door — the Friday feeding slot, an urgent appointment, or the emergency department? And what exactly should bring us back, and by when?"

To whoever is with her while you are at work or at the appointment

"Call me straight away if she is hard to wake or floppy, will not feed at all, has a weak or high-pitched cry, is breathing fast or laboured or her lips look blue, vomits green or brings up blood, has blood in her stool, fits, or has a temperature of 38 °C or above or feels hot or unusually cold. If any of those happen, call the local emergency number first, then call me. Do not give her anything to eat or drink and no medicine, unless I have told you in writing."

At the visit, ask for these four

1. Please weigh her, tell me the number, and how it compares with her birth weight and her last weight.
2. Can someone watch one feed, check the latch and the nipple shield, and show me how to tell that milk is transferring?
3. Is the tongue tie the main limit on her feeding, or is latch and position the bigger issue — and what would you want to see before deciding anything?
4. What exactly should bring us back, and by when? And if she is not better overnight, who do I call in the morning?

What "going well" looks like in the next 24 hours

This is not a promise that she will be better — she may need tests or treatment. It means:

• She has been seen today by a clinician, and you have a weight number and a decision about the feeding plan.
• Today's log has the feeds, the wet nappies and any temperature written down.
• Nothing was added, cut, stretched or changed in her mouth or in her feeds.
• You have a written answer to "what should bring us back, and by when".
• You got one break, and one more person knows their job for tomorrow morning.

What I can't cover from here (no coverage): the exact emergency number and door for your town, her tongue and her feeding plan, and any medicine. The first needs your country and city; the rest need the team who examines her.

One question so I can point you to the right door and the right number: which country and city are you in? I will not give you an emergency number from memory — with that, I can name the exact number and the correct door for today.

If it would help, I can also lay the log, the danger signs and both scripts out on one printable page for you to carry today — just ask.