Infant Medical Issues

Immunizations

Immunizations

According to the National Association of Children’s Hospitals and Related Institutions, only 60% of all children four and under have received a proper immunization series. Your child’s immunity to a number of diseases can be built up with the immunizations your child will receive at the well-baby visits. The World Health Organization has estimated that in one year alone, world-wide immunizations will save the lives of over 2 million children.

Below you will find a chart outlining the specified ages at which you should have your baby immunized. Also, below the chart you will find links to the specific vaccinations. By following these links you will learn about the vaccination schedule, possible side-effects, when your baby should not have the vaccination, signs of allergic reactions, and signs & symptoms of the actual disease.

Signs of Illness

Colds are infections in the upper respiratory system of your baby. Within your baby’s first two years of life, he/she will have approximately six to eight colds. These colds are caused by a virus. Unfortunately, science still has not come up a cure for the common cold. Thankfully, a viral infection is something that the body can usually fight off on its own.

Treating a cold, just means controlling the symptoms of a cold: fever, cough, runny nose, etc. You can control these symptoms, but remember, you are not killing the cold virus. Since medication can cause serious side effects in babies, most physicians prefer to make a baby comfortable with as few medicines as possible. Getting over a cold just takes time.

Is my baby sick?

It is often hard to tell when a young baby is sick. With a newborn, you are just learning to recognize the patterns of your baby’s behavior, and the baby is just beginning to develop a range of cries and facial expressions. Temperature can serve as an important guide during this early age. If your baby is less than 1 month old, call your physician if the baby has a temperature above 100.5°F. Do not give any medication to a baby this young unless you talk to your doctor.

As the baby gets older, how a baby is acting becomes a much better guide of how serious an illness might be. After 2 months, parents are very aware of how their baby usually behaves, the baby’s immune system is better developed, and the baby has developed a much fuller range of behavior. For example, imagine two babies, each with a 101°F degree temperature.

One baby is playing and is alert.
The other baby seems out of it, doesn’t want to eat, doesn’t want to play, and in fact is difficult to wake up.

In this case, forget about the temperature. How the second baby is acting is much more concerning and would need to be seen or discussed with a doctor.

Symptoms of Colds:

Ear Infection
Coughing
Sore Throat
Fever

Ear Infections

Your baby’s estachian tube is short, wide, and set more evenly with the throat than your own. These characteristics allow germs to travel more easily from the throat into the ears. As your baby grows, the tube will lengthen and angel in a way that will make it harder for germs to travel from the throat to the ears. During an ear infection, fluid (the same fluid you see in your baby’s nose) builds up behind the ear drums. This causes pressure within your baby’s ears, and most often will cause your baby to become irritable. The fluid accumulates and causes a significant amount of pressure and pain for your baby, especially when he/she is lying down.

During the first year, an infant may have at least 2-3 ear infections. Don’t be alarmed if they occur beyond the first year of life. Ear Infections are common and usually follow upper respiratory tract infections.

Signs to look for:

unwillingness to lie flat
crying and screaming
thick and colored nasal secretions
fluid draining from the ears
fluid draining from the eyes
ear tugging
fever
cold symtoms
fussiness
ear pain

Treatments to use before seeing your doctor include:

giving Tylenol or acetaminophen
placing a heating pad or warm cloth over the ear
heating vegetable or olive oil just slightly and using an eye-dropper to place it inside your little one’s ears; massage the outer canal of the ear after putting in the drops
place your baby on the side of the good ear to let them sleep
drain excess fluids from your baby’s nose by giving them a steam bath

If you think your child has an ear infection, call your physician. If you do see your physician, he/she might prescribe an antibiotic. If an antibiotic is prescribed for your little one, be sure to see your physician again in 2 to 3 weeks later to make sure the infection has healed. Remember, antibiotics do not work right away. It might take a day or so before you see improvement in your child.

Steps to take to prevent ear infections:

breastfeed your baby
reduce your baby’s exposure to such things as cigarette smoke, dust particles, animal dandruff, etc…
reduce your baby’s exposure to other sick babies
when feeding your baby, be sure that he/she is positioned so the head and body are position at a 45 degree angle
keep nose clear of fluid

Sore Throats

Sore-Throats

Most children less than 2 years will have throat infections secondary to irritation in the back of the throat from nasal mucous dripping. Such infections usually respond to the treatments given for colds.

Strep throat most often occurs in children greater than age two.

If your child has: high fever, or swollen glands

… he or she needs to be seen by your doctor.

Children with possible strep throat should have a throat culture done. If he or she turns out to have strep, an antibiotic will be started. The majority of throat infections, though, are viral illnesses that only require symptomatic relief. This includes:

warm salt water gargles,
throat lozenges, or
sprays

Coughing

Most upper and lower respiratory tract infections come with a cough. A cough is a reflexive spasm in response to an irritation or infection of the respiratory system. If your baby is coughing this an indication of a nose or airway irritation.

Coughing, at times, can serve a useful purpose. Coughing can keep the secretions from settling into the lungs which can cause pneumonia. A child with a cough, who otherwise appears fairly well, is fine. But if the cough is present and other signs are present, you need to contact your physician.

What to look for:

difficulty breathing
high fever
chest pain
an ill appearing child
lasts longer than 1 week
any signs of choking

How to treat a cough:

give plenty of fluids to soothe the throat use medication only if your physician recommends it, certain things in some cough syrups can give worse side effects to your baby elevating the head of your baby’s crib may also help

PPD (TB Test)

Tuberculosis is a disease caused by acid fast bacilli that causes pulmonary symptoms like cough, chest congestion with fever and lymphadenopathy. Currently, the PPD (mantoux test) is used to test for tuberculosis.

This test is administered intradermally (under the skin) for children only in high risk areas of T.B. Routine yearly testing for T.B. in low or no risk areas is NOT done. Children in high risk areas will be tested every two years.

TB Test

Croup

Coughing Croup is a barking cough or labored breathing caused by inflammation and constriction, or narrowing of the airway. Croup is ususally caused by a virus. Attacks of croup can come on very suddenly, and most certainly need immediate attention.

Treatment for your baby with croup:

try giving your baby a steam bath to help open his/her constricted airway
give acetaminophin
give plenty of clear liquids

Contact your physician immediately if you notice:

your baby turning blue and/or drooling perfusely
your baby has difficulty breathing
your baby cannot cry or vocalize any sounds

Fever

What Is A Fever?

Is my baby sick?

It is often hard to tell when a baby is sick. With a newborn, you are just learning to recognize the patterns of your baby’s behavior, and the baby is just beginning to develop a range of cries and facial expressions. Temperature can serve as an important guide during this early age. Below 2 months of age, you should contact a doctor if your baby has a temperature above 100.4

As the baby gets older, how a baby is acting becomes a much better guide of how serious an illness might be. Usually by 3 months of age, parents are very aware of how their baby usually behaves, and the baby has developed a much fuller range of behavior. For example, imagine two babies, each with a 101°F degree temperature.

One baby is playing and is alert.
The other baby seems out of it, doesn’t want to eat, doesn’t want to play, and in fact is difficult to wake up.

In this case, forget about the temperature. How the second baby is acting is much more concerning and would need to be seen or discussed with a doctor.

Virus vs. Bacteria: “What’s the big deal? Just give my child some medicine so they can get better.”

Common colds are caused by virsues. Unfortunately, there is no cure for the common cold. For the most part, viruses have to run their course. Medicine can help shorten the course of certain viruses, like chicken pox, but there are no treatments to cure most viruses. However, there are medications that kill bacterias. Antibiotic treatments can kill bacteria infections and shorten the course of your baby’s illness.

In general, fevers that follow a few days of runny noses or feeling blah, are signs of viruses. Fever and cold symptoms that occur quickly are more likely caused by viral infections. Fevers that are the highest are often caused by minor viral illnesses (104°F – 105°F). But these are just general patterns, since bacterial infections can also cause high temperatures. High fevers usually will not harm your baby unless they reach 107°F. More importantly, you need to be aware of the way your baby is acting. Many other physical signs, besides fevers, may be more important in deciding what illness a baby might have.

Signs of Illness:

Taking A Temperature?

Taking-A-Temperature

How do I take my baby’s temperature?

A baby’s usual body temperature can vary from 97°F to 100°F. Each baby is different in relation to their normal body temperatures; meaning what is normal for one baby can be abnormal for other babies. Your baby’s normal body temperatures can also fluctuate throughout the day. Temperatures can be taken in three different ways for babies: 1) orally (by mouth) 2) axillary (under armpit) 3) rectally (baby’s bottom).

For children under the age of four, you should take either a axillary or rectal temperature. Oral temperatures are complicated to take because children under the age of four tend to squirm, cry, or toss their heads making it almost impossible to get an accurate reading. Rectal temperatures are the most accurate temperatures for babies.

Oral Glass Thermometer: a glass thermometer with a long, thin end to be placed into the mouth or under the armpit. Inexpenisve, but almost impossible to use in children under the age of four.
Rectal Glass Thermometer: a glass thermometer with a short, stubby end for safe and easy insertion into the baby’s bottom. Very accurate and inexpensive.
Digital-display Thermometer: a plastic thermometer with a digital screen and a long, thin end to be placed into the mouth or under the armpit. Quick, easy, accurate, and inexpensive.
Temperature Strips: a plastic strip with a thermometer scale to be placed on the forhead. Inexpensive, yet not very accurate.

Kiss-and-Guess Method: by kissing your baby’s forehead you can sometimes decide whether or not your baby has a fever. Not a very accurate method.

Thermoscan:

a electronic thermometer device that registers your baby’s temperature after being aimed into your baby’s ear. Accurate, but also very expensive.

Treating A Fever

How do I lower my baby’s temperature?

Step 1:

Give your baby fever-reducing medication, such as acetaminophen. Ibuprofen, should only be given under your physician’s direction.

infants less than a year old can be given the liquid form by dropper
toddlers between one and two years old can take the syrups or sprinkle powders
children over two years can take the chewable tablets
suppositories can be given when vomiting persists

**Always read directions before giving any medications!!

Step 2:

Dress your baby in clothing based on the actual temperature. Do not follow old wives tales that say to sweat fevers out. Your baby needs to let the excess heat within his/her body out, and one way to do that is to dress them appropriately.

Step 3:

Remember to give plenty of fluids. Your baby can possibly become dehydrated rather quickly due to the sweating and rapid breathing caused by a fever.

Step 4:

Feed your baby throughout the day. Your baby will probably not want to eat a lot if he/she isn’t feeling well, so try to feed him/her little amounts throughout the day.

Step 5:

If your baby’s temperature is above 104°F, you can sit your baby in a lukewarm bath. Only allow the water to touch the waist and below. Try sponging your baby with the water for as long as your baby can stand it or about twenty minutes. (Give the fever-reducing medication before placing your baby in the bath)

if your baby continues to cry, try taking a lukewarm bath or shower with your baby or place some water toys around your baby to try and divert their attention away from the fever

**Do not use rubbing alcohol on your baby to lower their temperature for any reason; alcohol can be harmful to the baby’s lungs and skin.

Contacting A Physician

When should I contact my baby’s physician?

Call the doctor if……….your baby is less than three months old and his/her fever has persisted for more than eight hours.
Call the doctor if……….your baby is listless (out of it), refuses to eat, is pale in color, or is continuously vomiting.
Call the doctor if……….your baby becomes increasingly worse with his/her symptoms.
Call the doctor if……….your baby has obvious signs of illness, for example if any of the following symptoms are associated with a fever:

ear pain
severe coughing
sore or red throat
painful urination
diarrhea
prolonged crying

What will the physician ask me when I call him/her about my baby’s condition?

Below you’ll find a list of possible questions your baby’s physician will probably ask you when you contact him/her.

Did the fever begin gradually or did it spike very quickly?
Has the fever followed any kind of pattern, such as highs and lows for certain periods?
What are the other symptoms associated with your baby’s fever?
Is the illness getting increasingly worse, increasingly better, or staying the same?
How do you feel as a parent about the changes in your baby’s conditions?

Febrile Seizures

What is a febrile seizure and what do I do if my baby should have one?

Febrile seizures occur when temperatures shoot up very quickly; the medical term for this is ‘spike.’ Younger infants are more susceptible to febrile seisures because their brain’s are much more immature and usually cannot handle a rapid rise in temperature. Seizures can be as simple as a twitching lip, a shaking arm or leg, or a vacant stare or seizures can be as violent as convulsive shaking all over, completly pale skin, and rolling eyes. Febrile seizures can occur with or without warning signs. Most last only 10 to 20 seconds, usually not enough to harm your baby. If your baby should turn blue during any seizure get them to a physician immediately. It is normal for your baby to fall asleep following a febrile seizure, so don’t be alarmed if this occurs.

Bowel Movements

The Scoop on Poop

As a new parent you may worry about the strange colors and textures of the substances you find in your baby’s diaper. Below you’ll find some important tidbits on bowel movements that will hopefully calm your jitters.

Breastfed Stools:

The stools of breastfed babies tend to change often and without warning. There are many variations in the color and texture of breastfed baby stools. Some breastfed babies have a bowel movement with every feeding and others once every couple days. The key to remember is every baby is different and as far as what kind of stool will present itself after each breast-feeding…the diaper will only tell!

Bloody Stools:

If blood is passed in your baby’s stool, note the color. If the blood is bright red, then the blood is more than likely from a small tear in the anus. But if the blood is a dark red, this could mean that the blood is form an area higher up in your baby’s intestinal tract, and you should contact your physician.

Formula Stools:

Certain formulas can cause bottlefed babies to have greenish stools. Normal baby stools range in color from bright yellow to a dark green. Contact your physician if your baby has frequent (more than five per day) , wet, foul-smelling, greenish stools.

Jaundice

Sometimes newborns develop a condition called jaundice. Jaundice refers to a yellowing of your baby’s skin and eyeballs often appearing on the third or fourth day after birth and usually only lasting approximately a week. This is relatively a normal condition and is not a concern to worry yourself about. Since your baby’s liver is rather immature just after birth, it has a harder time breaking down old red blood cells and this causes the yellowish coloring (bilirubin) to appear on the skin and around the eyeballs.

Sometimes a blood level of bilirubin will be checked if your baby has jaundice. If the bilirubin reaches really high levels then it can cause brain damage. To keep the bilirubin levels low, your physician may prescribe phototherapy lamps. These lamps surround a baby’s crib and helps change the bilirubin into a non-toxic form of bilirubin that won’t harm your baby.

If you have questions about your baby’s jaundice, be sure to discuss them with your physician. If you are at home and your baby’s jaundice is lasting longer than one week’s time, contact your physician.

Dehydration

Dehydration

Dehydration is a condition in which there is not enough fluid within your baby’s body. Common causes of dehydration are:

Diarrhea
Vomiting
Fever
excessive sweating
excessive urinating

Treament:

Prevent dehydration by giving adequate fluids: you might want to consider giving your baby commercial electrolyte mixes, like: Lytren, Pedialyte, Infalyte, or Ricelyte.
Provide adequate calories in an easy digestible form. For example, children with diarrhea may not digest fluids with lots of sugar in it very well. The injured lining of their intestines can’t absorb the complex sugar molecules.

Call your physician if you notice that because of being sick, your baby:

cannot keep any types of fluids in his/her system
has a dry mouth and tongue
cries without tears
has very few or no wet diapers
has a faster heart rate (Many other things can also cause faster heart rates, including fever and crying)
has weight loss anywhere between 5-10%
has dark, concentrated urine
has sunken eyes
has dry, pale or wrinkled skin
has a sunken in soft spot on his/her head
is a diabetic and is dehydrated

See your physician if dehydration has effected how your baby acts:

not wanting to eat
difficult to wake-up
lethargic (out of it) or really cranky
is excessively tired or irritable

Vomiting

Vomiting is a condition in which your baby forcefully expells food or liquids from the stomach through the nose and/or mouth. Vomiting is a common childhood illness that usually results from a viral intestinal flu. Vomiting can cause your baby to become dehydrated if not monitored carefully.

Treatment for vomiting:

prevent dehydration by giving adequate clear fluids (do not give your baby chicken broth)
provide adequate calories in an easy digestible form; this will help the intestines to recover from the illness

1 Hour after vomiting

Vomiting is best treated by giving nothing by mouth for at least one hour and then slowly starting with clear fluids. The clear fluids give the intestines a chance to rest and heal and also replace salt and water losses. The following are a list of proper clear liquids:

Jello water
diluted Kool-Aid
pedialyte
ricelyte
flat ginger ale
weak tea
Do not give straight water or broth!

You should start with 1-2 tsp. every 10-15 minutes for 1-2 hours. If no vomiting has occurred, then increase the amounts gradually to 1-2 ounces every 20 minutes.
24 Hours after vomiting

After 24 hours, your child needs to be supplemented with more calories to promote healing of the intestinal lining. If your child is already on solids, you can give your child a “BRAT” diet. The “BRAT” diet consists of:

bananas
rice cereal
applesauce
toast

For infants, you may want to dilute the formula to 1/2 strength (1/2 water, 1/2 formula) for part of the day, and then advance to regular strength the other half of the day. You may use your usual formula but you may be advised to change to a soybase (i.e. Isomil or Prosobee) only during the illness.

* This stage increases the number of stools each day. This is due to the increase of calories and is of no significance. It may take 1-2 weeks for a normal stool to pass.

3-4 Days after vomiting

If after 3-4 days the stools are decreasing and the vomiting has subsided, advance your child to a regular diet of bland foods. These include:

chicken noodle soup
rice noodles
mashed potatoes
plain yogurt
chicken, or lean meats

Milk and your child’s usual diet are the last things to add to the diet, because it may be difficult to digest these products.
Be sure to call your physician if your little one:

vomits persistently beyond 12 hours for infants, or 24 hours for older children
has both vomiting and diarrhea simultaneously
has a stiff neck
is lethargic (lazy, drowsy, tired)
has a headache
has signs of dehydration, and/or abdominal pain
has difficulty breathing
vomits a substance that is yellow or green more than three times
does not urinate for over 8 hours
is unable to keep any clear fluids in his/her system
has sunken eyes, absent tears, and/or increased irritability

Diarrhea

Diarrhea is a condition in which your baby will have frequent loose, water stools that range form yellowish to light brown to green in color. and often times are explosive. Diarrhea is very foul smelling, and often times it is explosive. If enough water is lost, your baby will become dehydrated. Diarrhea in your baby can be caused by a number of things, such as: infections, colds, food allergies, and sometimes antibiotics. A common infection in infants is gastroenteritis, which usually causes a significant amount of diarrhea, which if not monitored carefully can also lead to dehydration.
Contact your physician if the following signs are present:

your baby has diarrhea occur more than once every 2 hours for more than 12 hours
your baby has a fever of 102.5°F or higher and last for more than 24 hours
your baby has blood present in his/her diarrhea
your baby has signs of dehydration
your baby has mild diarrhea lasting for more than two weeks
your baby refuses to eat or drink
your baby appears to be in pain due to the diarrhea

Treatment for diarrhea:

provide your baby with clear liquids, in small amounts
never use over-the-counter antidiarrheal medications for your baby, unless prescribed by your physician
if your baby develops a diaper rash due to his/her diarrhea, see Dealing with Diaper Rash

Sudden Infant Death Syndrome (SIDS)
Also known as Crib Death

This page is meant only to inform you as a parent about the facts on SIDS and merely suggest some precautionary measures. By either following or not following these steps, does not ensure that your baby will or will not die from this syndrome.

Sudden Infant Death Syndrome is defined as the sudden death of an infant under one year of age that remains unexplained after the performance of a complete postmortem investigation, including an autopsy, an examination of the scene of death, and a review of the case history. The cause of SIDS is presently unknown.

The American Academy of Pediatrics (AAP) Task Force on Infant Positioning and SIDS has developed new recommendations for the positioning of infants. These new recommendaions are based on recent research and are also a carry-over of the 1992 recommendaion to place infants in a supine postion for sleeping to reduce the risk of SIDS. Since this recommendation was introduced, the number of SIDS cases has decreased significantly. Below is a list of the recommendations suggested by the AAP Task Force on Infant Positioning and SIDS:

Infants should be place for sleep in a nonprone position. A supine position (wholly on the back) confers the lowest risk and is preferred. However, a side position also carries a significantly lower risk than a prone position. If the side position is used, caregivers should be advised to bring the dependent arm forward, to lessen the likelihood of the baby rolling into a prone position.
Soft surfaces and gas-trapping objects hould be avoided in an infant’s sleeping environment. Of particular importance, soft surfaces such as pillows or quilts should not be placed under a sleeping infant.
The current recommendation is for healthy infants only. The pediatrician should consider the relative risks and benefits. Gastroesophageal reflux and certain upper airway anomalies that predispose to airway obstruction and perhaps some other illnesses may be indications for a prone sleeping position.
The current recommendation is for infants during sleep. A certain amount of “tummy time,” while the infant is awake and observed, is recommended for developmental reasons and to help prevent flat spots on the occiput.

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

SIDS facts:

Approximately 1 out of every 5000 US babies between the ages of two and six months dies from SIDS.
95% of all SIDS deaths occur before the age of six months.
Each year in the US about 7000 babies dies from SIDS.
SIDS is the leading cause of death in children less than a year old.
SIDS is not caused by suffocation under blankets, immunizations, or choking.
SIDS is not caused by allowing your baby to sleep with you.
Check with your physician to see if your baby should be sleeping on his/her tummy

Resourceful Phone Numbers

Emergency numbers should be kept in an easy-to-reach area. Fire, 911, police, and list of special agencies are among the emergency phone number that you need to put in a place where everyone in the house can easily find them. As far as the specific emergency number for your area, you should contact your local police to find the appropriate one for your home.

All resourceful phone numbers have been placed in alphabetical order according to the first letter of the organization’s name. For example, if you’re looking for the number for the Food & Drug Administration, you simply click on the DEF hyperlink.