Great Expectations: Baby’s First Year

It’s inevitable that your baby or toddler will get sick at some point. Most common illnesses are caused by invisible bacteria and viruses transmitted from one person to another. In most cases, your baby’s illness has been passed along by other children and adults through sneezing, coughing, kissing, or hand contact. In rare cases, signs of sickness can indicate something more serious than everyday germs, but usually it just means your baby’s caught a common bug.

Anytime you suspect your baby is coming down with an illness, it’s important to contact your baby’s health-care provider. Your baby’s body is just learning how to fight infectious diseases, and the battle may be much more challenging for her than when she’s older and her defenses are stronger. Sometimes, too, more serious illness may first mimic an oncoming cold but then quickly worsen.

To keep your baby from catching something, keep sick children and adults away from your baby. Keep your own hands scrupulously clean, and if you already have a cold or other communicable illness, be especially careful to keep your hands away from your baby’s eyes, nose and mouth.

A baby’s symptoms may take hours or days to develop after germs have been passed on. Symptoms of oncoming illness can vary from demanding to nurse more often than usual or refusing to eat; a fever; crankiness or excessive sluggishness; and vomiting or diarrhea.

You reach down to touch your baby or put your lips to her forehead and discover she’s burning up with a fever. Most parents have heard from their own parents or through the grapevine that a fever is dangerous. But in today’s world, a fever doesn’t usually signal a dangerous or life-threatening illness. In fact, a fever isn’t an illness but simply a symptom—a sign that your baby’s body is trying to ward off a virus or bacteria.

It’s often hard to know if your baby has abdominal pain. Sometimes the pain can appear to be originating from your baby’s belly because her abdomen seems hard and she might slap her knees against it, but the pain may actually be coming from somewhere else in her body. When pain comes from a different place than where it hurts, it’s called referred pain. For example, a baby may scream because she is suffering from an inner-ear infection, but parents will swear the pain is coming from the baby’s abdomen and not her ears.

WARNING! Smoking and Your Baby’s Health

Don’t smoke around your baby—not even in the same house or in the car. Exposure to cigarette smoke has been linked to numerous baby illnesses: a higher risk of crib death (SIDS), ear infections, pneumonia, bronchitis, allergies, and growth retardation.

Abdominal pain can be caused by trapped gas—and your baby won’t be comfortable until she passes it—but it can also be a sign of illness, such as getting a stomach virus, an allergy to a substance in formula or breastmilk, a urinary tract infection, or pneumonia (a cold that has traveled down into the baby’s lung). Less commonly, abdominal pain may be caused by constipation in formula-fed babies (breastfed babies are rarely, if ever, constipated). Exploring tots may also get into medicines or chemicals that can cause them abdominal pain when ingested. If your baby draws her knees up to her chest and she also appears pale and sweaty, she may have an obstruction in her intestines, such as an intussusception. If your baby is suffering from persistent abdominal pain, take her to the doctor to find its cause.

As with fevers, diarrhea can be the body’s way of trying to cleanse itself from an illness, or it can be caused by irritation and inflammation in the baby’s digestive system.

Diarrhea is dangerous for babies during the first four months of life. It can be brought on by an illness, a change in formula or vitamins, and taking antibiotics. (Breastfed babies’ stools are naturally loose and custardy in texture.) True diarrhea is signaled by a baby having more stools than usual that are liquid and sometimes foul-smelling. Inside your baby’s diaper you may also see solid stools sitting on the top layer of the diaper, with a ring of staining indicating where the semiliquid part of the diarrhea has soaked in.

The risk of diarrhea is that it will quickly deplete your baby’s fluid stores, and that can quickly lead to dehydration—a serious threat to young infants. A dehydrated baby may be sluggish and harder to rouse, may have a dry mouth, sunken eyes, loose, wrinkled skin, and may go for hours without wetting a diaper. A good rule of thumb is that babies should wet at least 3 to 4 diapers in 24 hours. (For more about dehydration, see Warning! in this chapter.)

A bout with diarrhea can lead to flecks of blood in the stool, but with bottle-fed babies, it can also be a sign of an allergic reaction to the proteins or other substances found in the formula. Other signs of an allergic reaction include clear mucous discharge from the nose, skin rashes, vomiting, frequent colds, and poor weight gain. In some cases, health-care providers may suggest switching a baby to a less-allergic formula mixture.

WARNING! Dehydration Dangers

Dehydration is serious in young babies and can even lead to death. It happens when fluid is lost because of vomiting and/or diarrhea or when the baby goes on a nursing strike because she’s ill or has trouble breathing while nursing because her nose is stopped up. Serious dehydration signs include dry mouth, sunken eyes, wrinkled skin that doesn’t spring back when you squeeze it between your thumb and forefinger, sluggishness, and scant or deep yellow urine (not related to vitamins). Contact your baby’s doctor immediately if these symptoms appear, since only a few hours can make a difference.

Almost all babies spit up. You can count all of those white spots going down your clothes as a mark of parenthood. Spit-ups usually happen several times a day, and usually after nursing or drinking formula. It’s caused by the baby’s immature swallowing and throat actions and is more of a laundry than a medical problem. Although it may appear that your baby is losing lots of milk with spit-ups, it probably is only a teaspoonful or less.

Vomiting is more violent than spitting up. Projectile vomiting is when a baby spits fluid out and away from her body. It may happen when a baby catches a virus that affects her digestive system (intestinal virus), and it’s usually accompanied by diarrhea, particularly in bottle-fed babies. With an exploring tot, poisoning from something the baby has ingested, such as household chemicals or an adult’s medication, should also be suspected.

Vomiting becomes a more serious symptom if it progressively worsens, if the baby is losing weight or not gaining it, and if the vomit is tinged with bile, which causes it to be green or yellow. Other serious symptoms: The baby appears to be in pain and cries when she’s not vomiting, and the baby gags and coughs during feedings. A nursing baby may have blood in her vomit, which is usually caused by ingesting blood from a mother’s bleeding nipples. Bloody vomit may also indicate a tear in a small blood-vessel at the end of the baby’s throat, caused by the force of vomiting. Neither of these occurrences are typically of serious concern, but it is best to see your baby’s doctor unless you are sure you have bleeding nipples.

Like children and adults, babies have different temperatures at different times during the day, and some babies’ temperatures are naturally lower or higher than other babies’ temperatures. When you purchase your thermometer, take a few readings while your baby’s well and write the temperatures down on masking tape stuck on the inside of the medicine cabinet. That way you’ll know what’s normal and what’s not. Always jot down what date and time you’re taking your sick baby’s temperature and the reading. Usually the smaller markings are in tenths, so a temperature might be 99.2 (spoken as “ninety-nine point two”), or 99.6.

The heat generated with a fever is useful. It helps to boost your baby’s immune system, and it slows the spread of viruses and bacteria inside her body. Discovering your baby has a fever is no reason to panic. In fact, sometimes babies can spike much higher fevers than older children or adults. When temperatures rise quickly, some babies may even have a febrile seizure (see in this chapter), a convulsion that causes twitching and jerking, usually with no lasting harm done.

Most often the cause of a fever is an infection of some kind, such as a bacterial or viral invasion that will take its course over the process of days and then gradually disappear. A long crying spell, being exposed to hot weather, sunburn, and certain immunizations, such as DTaP and MMR, can also cause your baby’s temperature to rise.

How serious a fever is depends on the age of the baby. If she’s younger than three months, a temperature above 100.4° F (38° C) should be reported to your baby’s health-care provider, because a fever may signify a serious illness or disease. (It probably does not, but it’s better to be safe than sorry.) If your baby is three to six months old, call your pediatrician for anything above 101° F (38.3° C). If your baby is older than six months, your doctor may tell you to not call, or to try to control the fever unless the temperature rises above 103° F (39.4° C).

While doctors once advised parents to try to control a temperature right away, the latest thinking is that fevers serve a purpose and may work to fight infection. So, ask your provider at what point you should administer medication (usually acetaminophen) to try to bring your baby’s temperature down. Also, let your doctor know about any other symptoms: A rash, nausea, vomiting, or breathing problems accompanying a fever should be reported right away.

If your baby is under three months of age, your pediatrician will probably ask you to take your baby’s temperature rectally in order to get the most accurate reading. Most physicians now recommend that parents use a digital thermometer rather than the old-fashioned glass versions, which contain toxic mercury that could be released if they break.

Although taking your baby’s temperature by sticking a thermometer up her bum may sound painful, your baby will hardly notice what you’re doing. Plus, your baby’s ear canal may be too small for an ear thermometer, and placing a thermometer in your baby’s mouth could damage delicate tissues, especially if your baby balks or clamps down with her jaws.

• Clean the thermometer. Follow the manufacturer’s instructions for cleaning the tip of the thermometer.

• Coat with a lubricant. Rub petroleum jelly around the first inch of the thermometer.

• Position your baby. Hold the baby facedown on your lap, or lay her down faceup as though you were about to change her diaper. Your baby will be used to this position. The thermometer may stimulate her bowels, so keep a diaper under her just in case.

• Insert the thermometer. If you’re taking a reading with your baby facedown, spread her buttocks and gently glide the sensor tip ½ an inch into her anus. If you’re taking her temperature using the diapering position, rise your baby’s legs with one hand and bend her knees toward her chest. Find the anus and insert the tip of the thermometer in ½ an inch.

• Readings. Make a note of the date, time, and temperature. While a normal temperature is between 97.6° F and 99° F, a temperature reading of greater than 100.4° F is considered a fever. If you’re taking a reading on a restless squirmer, the challenge will be keeping your baby still enough to get a reading. Try having dad make funny faces, or dangle a toy to distract her. After the thermometer beeps, write down the temperature and clean the thermometer thoroughly. If your baby is older than three months, consider using an ear thermometer or a digital thermometer under the baby’s armpit, instead. Ear thermometers are quick and easy: Insert them gently into the ear canal, and a reading should be almost instantaneous. The downside is that they tend to be more expensive. For an axillary (armpit) reading, place the tip under your baby’s arm as high as it will go under her armpit. Press the button and hold her arm down until the thermometer beeps.

Measuring Your Baby’s Temperature

When your baby is coming down with a fever, her coloring may be off—either paler than usual, or she may be red-faced and sweaty. Having a modern-day digital thermometer for reading your baby’s underarm, ear canal, or rectal temperature can be very quick and handy, because if you call your baby’s health-care provider, you will often be asked if the baby has a temperature.

Knowing how to take your baby’s temperature is an important skill to learn. It will help you in communicating with your baby’s doctor about your baby’s fever. Whether your baby has a high or low temperature will help the doctor make important decisions about how serious your baby’s illness is, and whether he or she needs to see your baby.

There are four possible places to take temperatures, each depending upon the type of thermometer that you use: in the anus (rectal temperature), under the arm (axillary temperature), in the mouth (oral temperature), and in the ear. Oral temperature taking is NOT recommended for babies since it’s nearly impossible to keep the thermometer in place, and the baby’s delicate mouth tissues could be injured in the effort.

Interpreting Thermometer Numbers

A temperature taken in the armpit is typically one to two degrees less than a rectal, oral, or ear temperature reading. A normal armpit temperature is 95.6° F to 97° F. A temperature higiher than 98° F in the armpit may be a fever, and a rectal temperature should be taken to confirm this. Note that the armpit method isn’t considered as accurate as an anal reading, so be sure to tell your pediatrician which method you used; if your baby has a high armpit reading, you may be asked to take a rectal reading.

During an illness, babies and toddlers can suddenly spike a high fever that would seem very dangerous for adults, and some babies may even go into a convulsion called a febrile seizure when a fever rapidly rises over 101° F, so take care not to overdress a sick baby. (For more on febrile seizures, see in this chapter.)

Your doctor may recommend that you give a dose of a fever-reducing medication, such as acetaminophen Tylenol^® for babies. Aspirin is usually not recommended for babies and young children with flu-like symptoms of illness because the use of salicylates like aspirin during a viral illness appears to be statistically linked to the incidence of a rare but serious affliction called Reye’s syndrome (see in 8. Parent’s Dictionary).

If your baby is older than three months, your baby’s doctor may suggest that you simply wait to see if your baby seems to become more ill. She may be more concerned about any other symptoms that your baby has in addition to the fever. Is your baby developing a rash? Does your baby seem sluggish or limp? Is she refusing to nurse? Does her cry sound weak or high pitched?

Does she seem to be in pain? Does the back of her throat seem red and inflamed? Does she have diarrhea in the form of frequent, loose, wet stools sometimes accompanied by flecks of blood? If so, for how long? How many diapers has your baby wet in the past day? (Scant urination is a sign of dehydration, not enough fluid in the body.) Has your baby’s breathing changed?

Taking your baby’s temperature over and over can be uncomfortable and invasive for her, and old-fashioned remedies such as wiping your baby down with a cool washcloth or giving her an alcohol bath don’t really help. They simply make your baby shiver and feel more uncomfortable. To keep your baby hydrated, it’s important to nurse her frequently (and drink a lot of water, juice, and yogurt smoothies yourself).

Types of Thermometers

TYPE OF THERMOMETER	DESCRIPTION	HOW IT WORKS	PROS AND CONS	HOW ADMINISTERED
Digital	A wand containing a watch-type battery with a probe on one end and a small readout screen on the other.	Quickly displays the baby’s temperature with a beep to signal that it’s finished.	Works rapidly; is easy to read; and signals when it’s done. More expensive than glass. Has to be turned on and off. Battery may fade over time.	For rectal use, lubricate the tip according to the manufacturer’s instructions. Turn on the thermometer and wait for the “ready” beep. Insert the thermometer an inch into the baby’s anus, or place it under the folds of skin at your baby’s armpit while her arm is down.
Ear	A few body movements.	Her eyes may be tightly closed or creased and partially open. Her brow will be furrowed, and she may have a crease above her nose.	Requires no lubrication. Rapid readouts are considered as accurate as glass thermometers. May not fit a young baby’s ear. Battery may fade over time. Poor record of accuracy.	Turn the thermometer on and wait for the “ready” beep. Insert the thermometer into your baby’s ear according to the manufacturer’s instructions. Remove and read when the “done” signal sounds.
Glass	A slender glass rod containing mercury with a bulb tip for use in the baby’s anus, or a longer, thinner tip designed for use orally.	Mercury in a core inside of the thermometer that rises and stays at a specific level to signify the baby’s temperature.	Inexpensive and accurate. A risk of breakage that could result in glass cuts or mercury poisoning. May give inaccurate reading if not shaken down.	Not recommended for use with babies or children.
Temperature strip and pacifier thermometer	A plastic shield the size of an adhesive band-age, with dots that change color to show a temperature; or a pacifier that gives a digital temperature reading.	Works quickly when strip is placed on a baby’s fore-head or pacifier in baby’s mouth.	Inexpensive and disposable. Poor record of accuracy.	Not recommended for use with babies or children because they can give an inaccurate reading.
Temporal artery thermometer	Hand-held, battery-operated device.	Measures a baby’s temperature from the skin of her forehead.	More accurate than an ear thermometer and equally as accurate as a rectal reading, without being invasive. Expensive (around $50). Sensitive to temperature fluctuations, which can make readings inacurate.	The unit is turned on and gently moved across the baby’s forehead. A digital window shows the temperature reading.

Measuring your baby’s medicine doses accurately is very important. There are a variety of devices and tactics for getting medicine into your baby. If your baby has a fever or is vomiting, your baby’s physician may recommend that the medicine be administered as a suppository that you insert into your baby’s rectum. Most baby medications come in liquid form and have a dropper inside with tiny lines for measuring doses. There are also medicine spoons and tiny medicine cups with dose markings. The most accurate way to measure baby medicine and make sure it doesn’t get spit out is to use a medicine syringe. Draw the medicine up to the correct marking, then squeeze out the medication at the back of your baby’s tongue.

There are more than 60 antibiotics approved for use in pediatrics, so if your baby has an infection, you may well walk out of the hospital or doctor’s office with a prescription for something you’ve never heard of.

Antibiotics given to infants are usually in liquid form, so make sure you have a good, easy-to-clean medicine dropper. Amoxicillin is the oldest and most-prescribed for ear infections or strep throat, and is commonly used to treat acute middle-ear infections, but there are also other widely prescribed names and brands.

Common Over-the-Counter Painkillers and Fever Reducers for Babies

NAME	EFFECTS	POTENTIAL SIDE EFFECTS	CAUTIONS
Acetaminophen (Tylenol ^® and others)	Relieves pain and helps to reduce fever.	None.	Do not administer to your baby or child unless instructed by a doctor. Can be fatal if overdosed. Never administer it to a baby who is dehydrated or has been vomiting.
Ibuprofen (Infants’ Advil ^® , Infants’ Motrin ^® , PediaCare Fever ^® , and others, in liquid drop form	Relieves pain, reduces fever, reduces inflammation.	Upset stomach, heartburn. Affects blood-clotting ability.	Do not administer to babies and children unless instructed by your baby’s doctor. Do not give to babies under 6 months of age.
Aspirin (Bayer ^® and other brands)	Relieves pain, reduces fever, reduces inflammation.	Stomach upset, heartburn, nausea, vomiting, increased chance of bleeding, some babies may be allergic	NOT recommended for babies and children unless instructed by a physician. Has been associated with *Reye’s syndrome, a rare, but potentially* life-threatening illness. (See in 8. Parent’s Dictionary.)

Basic Baby Medical Supplies

These products are easy to find in a pharmacy and will help you when your baby gets sick:

• Oral medication syringe. The most accurate way to measure and administer your baby’s medication is with an oral syringe that allows you to suck the medication into the barrel and then squirt it deeply into your baby’s mouth.

• Nose drops. Plain saline nose drops or sprays can be helpful for unclogging a stuffy nose.

• A nose bulb (bulb syringe). It has a bulb on one end shaped like a bicycle horn and a rounded suction tip on the other and is used to suction out a baby’s nose mucous.

• Thermometer. A digital, battery-operated thermometer for taking underarm, ear, or rectal temperature when your baby has a fever.

• Fever medication. Baby acetaminophen (e.g. Tylenol^®) for treating your baby’s fever in concentrated drops. Ask your doctor’s permission first before administering it. You should also create a card for writing down the date, time, and how much of the medication you’ve given your baby so you can share that over the telephone with your doctor.

• Lubrication. Petroleum jelly for lubricating the thermometer if your doctor wants a rectal reading.

Whatever the prescription, it’s important to limit the use of antibiotics only to a diagnosed bacterial infection, because excessive antibiotic use can contribute to the rise of antibiotic-resistant strains of bacteria. A recent Canadian study also suggested that giving antibiotics to babies younger than six months old may increase their risk of developing asthma . But if your baby does have a serious bacterial infection, antibiotics can be a (literal) lifesaver.

You may be able to help your baby’s immune system ward off harmful bacteria by breastfeeding exclusively for at least the first six months, and then when your baby’s ready for solids, making sure her diet contains probiotics—active cultures of beneficial bacteria naturally found in breastmilk, but also available through small servings of yogurt, buttermilk, miso, and kefir. Babies should not be given whole cow’s milk until they’re at least one year of age.

WARNING! Baby Medicine Dangers

When it comes to giving your baby medicine, always seek your doctor’s guidance about what to give, how often to give it, and when to stop. And always read the dosing instructions on the bottle or package insert carefully before you start. Measure doses in bright light and with great care to ensure you never exceed the exact dosage recommended by your doctor based on your baby’s age and size. Never give your baby any drug without your doctor’s prior approval and directions, including those available in drugstores or labeled “for children” that are used to treat fevers, coughs, teething pain, or rashes. Your baby’s body has immature systems for processing chemicals. Sometimes the difference between the right dose and the wrong may be only one tiny line on a dropper, and overdosing can be measured in minutes rather than hours.