Below is a quick-reference guide to common baby illnesses and physical problems you may encounter during the first year. The chart lists symptoms and illnesses and gives you the page numbers for where to find more detailed descriptions in this section or in other parts of the book.
Page Locator: Common Baby Illnesses and Physical Problems
| ILLNESS | BODY PART AFFECTED | SYMPTOMS | |
| Allergic rhinitis | Nose | Itchy, reddened nose, clear nasal discharge, sneezing. | |
| Allergies | Respiratory system, digestive system, and skin. | Clear nasal discharge, breathing problems, headache, fever, diarrhea, stomach pain, vomiting, rashes. | |
| Anemia | Circulatory system | Blood test results and/or fatigue and sluggishness, and pale appearance with discoloration under the eyes. | |
| Apnea (sleep apnea) | Chest and lungs | Baby stops breathing briefly and may begin to turn blue. | |
| Asthma | Breathing passages | Fast, labored breathing, gasping sounds, chest sucks inward around the rib cage, wheezing (whistling sounds) with breathing. | |
| Autism (including Asperger’s and Rett syndromes) | Brain and nervous system | Unusual head-growth patterns, behavioral abnormalities, problems in relating to others, and developmental delays (often called “Pervasive Developmental Disorder”). | |
| Baby acne | Skin, especially on the face | A pimply, oily rash that resembles teenaged acne; it appears around 2 to 3 weeks after birth and may last 3 to 6 months. | |
| Boils | Skin, especially the diaper area | Raised, red, tender bumps on the skin that may develop white-topped blisters containing pus. | |
| Bronchiolitis | Small airways of the chest | Whistling sounds when the baby breathes in (wheezing), rapid, shallow, noisy breathing and coughing, paleness, sluggishness. | |
| Bronchitis | Large airways of the chest | Cold symptoms (see colds on Baby Illnesses A-Z), low fever, harsh cough that worsens at night, rapid breathing, paleness, sluggishness. | |
| Chicken pox (varicella) | Skin | Fever, a spreading rash resembling insect bites that often start on the trunk and spread to other parts of the body. The bumps form blisters that turn into itchy sores and scabs. | |
| Colds and | coughs Nose and throat | Watery nasal discharge that thickens and later turns yellowish. Sneezing that may later lead to coughing, fever, listlessness, and breathing problems during feeding. | |
| Conjunctivitis (“pinkeye”) | Eyes | Goopy, bloodshot-looking, teary eye(s) with reddened, swollen eyelids. | |
| Constipation | Bowel movements | Infrequent bowel movements and hard, pellet-like stools. | |
| Cradle cap (seborrhea) | Scalp, face, and other parts of the body | Greasy, scaly, or crusty dandruff-like patches that form over a rash. | |
| Croup (See also Respiratory problems) | Respiratory system | Hoarseness and a deep, honking cough, sometimes accompanied by breathing problems. | |
| Diaper rash (atopic dermatitis) (See also Thrush) | Diaper area | A number of types: red marks from diaper chafing; redness around the anus; bright red rash in diaper area folds and creases; and boil-like eruptions. | |
| Ear infection | Inner ear | Crying or screaming, plus cold symptoms, including thick nasal mucus. Could also include eye and ear drainage; pulling at ears. | |
| Eczema | Skin | Itchy skin breakouts often starting on the face, the crooks of the arms, or on the backs of the legs and knees. | |
| Febrile seizure | Nervous system | A seizure (a “fit”) brought on by a high fever. Symptoms include: losing consciousness and shaking on both sides of the body, becoming rigid, twitching in an arm or leg that can appear on only the right or the left side of the body. Most febrile seizures last a minute or two, although some can be as brief as a few seconds or as long as several minutes. | |
| Fifth disease (erythema infectiosum) | Skin | “Slapped face” appearance of a red rash on the baby’s cheeks and/or a lace-like red rash on the baby’s trunk, legs, and arms, and, rarely, a slight fever and painful joints. | |
| Gastro-esophageal reflux disease (GERD) | Throat | Frequent spitting up and regurgitating, and there may be flecks resembling coffee grounds in the vomit. Back arching and colic-like crying. | |
| German measles(See Rubella) | |||
| Heart murmur | Heart | Abnormal heart sounds detected by a stethoscope. | |
| Heat rash (“prickly heat”) | Skin | A bumpy rash made up of tiny red spots that appear on a baby’s chest, armpits, or body creases, especially during hot weather. | |
| Heatstroke | Body | Hot, dry (or sometimes moist) skin, extremely high fever, possible convulsions, and loss of consciousness. | |
| Hepatitis A | Liver | Nausea and vomiting, dark urine, tenderness over the liver (below the right ribcage). | |
| Hepatitis B | Liver | Infrequent bowel movements and hard, pellet-like stools. | |
| Hernia (See also Hydrocele) | Navel or scrotum (testicle pouch) | Umbilical hernia: bulging around the belly button when the baby cries, coughs, or strains. Inguinal hernia : swollen scrotum or labia, accompanied by tenderness and redness. | |
| Hydrocele | Scrotum | A swollen fluid sac inside a baby boy’s scrotum (the pouch that supports the testicles). | |
| Impetigo | Face or buttocks | Small red spots below the nose or on the buttocks; the spots turn into tiny blisters that rupture and become patches, which produce an oozing, sticky, honey-colored crust. | |
| Influenza (flu) | Body | Fever and clear, runny nose; possible vomiting, cough, and diarrhea. Baby looks unwell. | |
| Jaundice | Body | Yellowish discoloration of the skin and the whites of the baby’s eyes. | |
| Measles (rubeola) See also Rubella | Body | Cold-like symptoms followed by a fever, cough, bloodshot eyes and, around the fourth day, a deep red rash that starts on the face and joins together as it spreads over the rest of the body. | |
| Meningitis | Head and neck | Begins like a cold (see Pervasive Developmental Disorders (Autism and others)), flu (see Colds and coughs (See Respiratory Problems)), or an ear infection, with increasing sluggishness, drowsiness, vomiting, stiff neck, or stiffening when the legs are raised for diapering. The soft spot on the skull will bulge and the baby will appear very sick. | |
| Milia | Nose and face | Tiny white spots that appear across the baby’s nose or on the face. | |
| Mumps | Cheeks | Starts like the flu (see Colds and coughs (See Respiratory Problems)) and an upset stomach, followed 2 to 3 days later by tender, swollen glands beneath the earlobes or swollen jaws. Possible low fever. | |
| Pertussis (See Whooping Cough) | |||
| Pervasive Developmental Disorder (See Autism) | |||
| Pneumonia | Lungs | Bacterial pneumonia: high fever, chills, rapid breathing, fast heart rate, a wet cough, abdominal pain, and vomiting with the baby becoming sicker over time. Viral pneumonia: low fever, no chills, a lingering cough with symptoms that linger for 3 to 4 weeks. | |
| Respiratory problems | Nose, throat, and lungs |
Asthma Bronchiolitis Colds and coughs Croup Pertussis Pneumonia RSV Infection Strep throat Whooping cough |
|
| Roseola | Skin | Sudden onset of a high fever (may lead to febrile seizures, see Allergies) that breaks about the third day, followed by a faint pink rash (not red, as with measles) on the trunk and extremities lasting about 1 day. | |
| Rotavirus gastroenteritis | Stomach and intestines | Fever, upset stomach, watery diarrhea (loose, runny stools), and possible dehydration. | |
| RSV (respiratory synctial virus) (See also Bronchiolitis) | Nose, throat, and lungs | Begins with cold-like symptoms: runny nose, nasal congestion, a low-grade fever, decreased appetite, and general irritability. Symptoms proceed in vulnerable infants, such as preemies, to a raspy cough, rapid breathing, flared nostrils, grunting, wheezing sounds, blue coloration around the nose and mouth, and listlessness. | |
| Rubella (German measles, “three-day” measles) | Skin | Low-grade fever, slight cold, or other flu-like symptoms followed by a pinkish-red, spotted rash that develops first on the face and then spreads rapidly to the trunk and disappears after the third day. The baby will look unwell and may have swollen glands behind the ears or nape of the neck. | |
| Seborrhea (See Cradle Cap) | |||
| Skin problems and rashes | Skin |
Allergies Baby acne Boils Chicken pox Cradle cap (seborrhea) Diaper rash Eczema Fifth disease Heat rash (“prickly heat”) Impetigo Measles Milia Roseola Rubella (German measles) Sunburn Thrush |
|
| Strep throat (streptococcal pharyngitis) | Throat and tonsils | Runny nose, rising and falling fevers, irritability, loss of appetite, pale appearance, and possible sore throat (uncommon in babies under 2 years of age). | |
| Sudden infant death syndrome (SIDS) | All body functions | An otherwise healthy baby, or one that has had mild flu-like symptoms, is found not breathing and blue, usually in the crib after being put down to sleep. | |
| Sunburn | Skin | Red, hot, inflamed skin that appears within hours after overexposure to the sun. Redness may not be immediately visible. May cause blistering, headache, and vomiting. | |
| Thrush | Tongue and mouth, diaper area | Yeast infection affecting the baby’s tongue and cheeks with white, milky-colored patches that can’t be wiped off. Diaper area may also have a bright, cherry-red rash caused by the yeast. | |
| Varicella (See Chicken pox) | |||
| Whooping cough (pertussis) | Breathing passages | Common cold, followed by spastic, deep-sounding coughing spells that follow in 1 to 2 weeks. |
*See also Your Baby’s Immunization Schedule on Month 4 Doctor’s Visit.
Allergies
Sometimes the body reacts when it comes into contact with what would normally be a harmless substance; this is known as an allergy. The baby’s immune system releases histamines and other chemicals to fight what the body believes to be an invader. Symptoms of an allergic reaction may be a stuffy or runny nose, sneezing, red, itchy skin, and red, watery eyes.
While some allergic reactions happen almost immediately, others may take days to happen, making it harder to find the cause.
Your baby will be more likely to have allergic reactions if she is exposed to cigarette smoke; if you have a family history of being prone to allergic reactions such as rashes, sneezing, asthma, or eczema; if you bottle feed; or if your baby has been given antibiotics.
The substance that causes a reaction is called an allergen . The most common allergens for babies are cow’s milk substances in formula, eggs, wheat, citrus fruits, seafood, tomatoes, nuts, chocolate, and other foods. Sometimes babies will react to pollen, animal dander, house dust, feathers, and mites. Some babies may also have allergic reactions to contact with latex (a form of synthetic rubber) or to plastics found in disposable diapers. More rarely, a baby may be allergic to a substance in breastmilk, or may react to a medication such as ibuprofen (such as Infants’ Motrin®) that may cause an allergic reaction such as hives, facial swelling, wheezing, reddening of the skin, a rash or blisters.
Allergic rhinitis is swelling and inflammation of the lining of the nose that lingers instead of disappearing in a week to 10 days, as a cold would. Your baby will have trouble breathing, her nose will leak clear mucus, and she may sneeze a lot and have other symptoms such as red, swollen eyelids. Some babies may have dark circles under their eyes, called “allergic shiners,” and a puffy-looking face. And others may break out in an itchy rash, such as eczema.
Your doctor may recommend tests to help determine the cause of your baby’s reaction, or if your baby is formula-fed, your baby’s formula may be changed to see if her condition improves. If your baby has started solids, a special diet that tests for reactions may be recommended. Medications, such as antihistamines that fight the actions of histamines, may also be suggested.
WARNING! Life-Threatening Allergic Reactions
Sometimes babies and children (and adults) can have such a severe allergic reaction to a substance, a medication, or an insect bite that it becomes life threatening. Symptoms come on rapidly. Called anaphylactic shock, your baby or toddler may suddenly break out in red, itchy welts (hives) or have severe swelling of her air passages, causing them to swell and nearly close, so that breathing becomes difficult. If your baby’s throat begins to swell closed, call 911, stress the severity of the situation, or get your baby to the emergency room yourself, since every second counts. Then, ask your doctor to prescribe an emergency kit containing epinephrine, such as the Ana-Kit® or EpiPen®, and ask for instructions on how to administer it correctly for your baby’s weight and age should there be another reaction.
A pediatric allergist/ immunologist is a medical doctor trained to treat babies and children who have allergies.
Anemia
If your baby is pale and tired, she could have anemia . Other symptoms include a rapid heartbeat, irritability, loss of appetite, brittle nails, and a sore or swollen tongue. Anemia happens when a person doesn’t have enough iron to be able to produce hemoglobin, which the blood uses to carry oxygen to body tissues. It’s normal for a baby to have low iron four to eight weeks after birth, because her bone marrow is just developing the ability to make new red blood cells. But anemia is more than a temporary condition. It may occur when you’re breastfeeding and you are anemic, or if the baby is drinking low-iron infant formula. If the baby has suffered blood loss or was born prematurely, then she (or you, if you’re breast feeding) may require an additional iron supplement, usually in the form of liquid drops.
Apnea
Apnea , simply translated, means “not breathing.” It’s defined as a temporary pause or complete cessation of breathing that most often occurs in premature and low-birth-weight babies or from complications as a result of a baby being aspirated with a tube at birth. Apnea in babies is often classified as central, obstructive, or mixed.
Central apnea occurs when the infant’s central nervous system fails to send the appropriate “breathing orders” to the respiratory muscles. If your child is premature and/or diagnosed with central apnea, all of her future doctors should be informed that she had this condition.
With obstructive apnea , the brain gives the order, but the baby’s breathing problem is caused by an obstruction, such as a tight airway muscle, mucous, or spit-up. If obstructive apnea is due to something wrong with the baby’s body, then surgery or intervention may be necessary.
If your health-care provider uses this term in relation to your baby, try to find out the cause and whether it’s treatable. Infection, anemia, and hypoglycemia (low blood sugar) are treatable causes of newborn apnea. Apnea related to a trauma, like seizures, is less treatable.
If your baby has apnea, or is premature or of low birthweight, then everyone in the family who’s old enough should learn infant CPR, since time is of the essence if your baby has a respiratory arrest.
If your baby stops breathing, one person should begin CPR (see in this chapter) while another person calls 911. Ask your pediatrician whether you should also keep a tank of oxygen at home.
Apnea monitors
Sometimes babies, especially preemies, who have been known to stop breathing, are given an apnea monitor to use at home. The monitor has wire sensors that attach to your baby and set off an alarm if your baby stops breathing.
If your baby has been prescribed an apnea monitor, it must always be used whenever your baby is asleep. It’s important for babies to be close to their parents, but if you’ve been given an apnea monitor to take home from the hospital and have been told to use it, having your baby close is no substitute for a working monitor. Don’t convince yourself that “If she runs into breathing problems, I’m sure I’ll notice it.”
As an extra precaution, never let anyone smoke in the house or car with your baby. Invest in good HEPA (High Efficiency Particulate Air) Filter and/or a quality vacuum cleaner with dust filters to keep your baby’s air free of dust and other pollutants that could aggravate breathing problems.
Asthma (See Respiratory Problems)
Autism (and Asperger’s and Rett syndromes) (See Pervasive Developmental Disorders)
Boils
Boils are raised, red, tender bumps on the skin that may develop white-topped blisters containing pus. They can erupt anywhere on the skin, but in babies, they most often appear in the diaper area. It’s best to let the boils heal on their own. Don’t try to pick or squeeze the bumps, as this could cause the infection to spread and could possibly lead to scarring. If a bump seems seriously infected, your baby’s doctor may lance, or open, the boil and recommend antibiotic ointment to help with healing.
Bronchiolitis (See Respiratory Problems)
Bronchitis (See Respiratory Problems)
Chicken pox (Varicella)
Chicken pox is a highly contagious childhood disease caused by the varicella-zoster virus, a member of the herpes family. It can be very serious for young babies. If you are an adult and haven’t had chicken pox, you may catch it, too. It may be contagious one to two days before symptoms show.
Chicken pox is spread by other children, so keep your baby away from children who have been exposed to chicken pox at school or from siblings. The varicella vaccine is available, and is recommended between twelve to eighteen months of age. It is also recommended for you, if you’re not pregnant, your partner, and for your baby’s siblings if any of you have not had the disease. Chicken pox can cause serious complications in adults, so you should see your doctor if you become infected.
The early symptoms of chicken pox are sluggishness, frequent crying, and loss of appetite. Several days after exposure, a rash of flat, red, splotchy dots will erupt. It usually starts on the chest or stomach and back, then spreads to the face and scalp a day or so later. The red dots of the rash then join together to form clusters of tiny pimples, which then progress to small, delicate, clear blisters with new rash areas developing each day. The blisters form extremely itchy scabs. Recovery can take as long as two weeks.
Oatmeal baths can be very soothing to dry and itchy skin. Tie a handful of raw oatmeal in a washcloth and swish it around in your child’s bath water. Your baby’s doctor may prescribe localized creams or lotions, such as calamine lotion, to help relieve the intense itching. Filing down your baby’s nails or keeping her hands in baby mittens or using the hand flaps from gowns can help to keep the baby from scratching and infecting her sores.
Colds and coughs (See Respiratory Problems)
Conjunctivitis (“pinkeye”)
(See Eye Problems)
Constipation
Breastfed babies cannot become constipated, but it is common for them to go without bowel movements for days on end before having a big blowout. But constipation is a familiar problem for bottle-fed babies. If your baby is constipated, her stools will be hard and pellet-like, and she will appear to strain and become red-faced or fussy when trying to pass them. The hard stools when they are finally delivered may have streaks of blood from tiny broken blood vessels scratched by the stool on the way out. Sometimes constipation can be a sign of a problem more serious than the baby’s formula or diet, such as abnormalities in the baby’s intestine or a blockage. Consult your baby’s doctor if you are concerned that your child has constipation. Never give your baby an enema or a suppository unless ordered to do so by the baby’s doctor.
Croup (See Respiratory Problems)
Diaper rash (See Thrush)
Ear Infections
Next to colds, middle-ear infections ( otitis media ) are the most common cause for trips to the pediatrician during baby’s first year. As many as three out of four babies have some form of ear infections by age three.
There are two different kinds of infections: otitis media with effusion (OME), which just means there’s fluid in the middle ear, and acute otitis media (AOM), which refers to fluid in the middle ear that also comes with pain, redness, and a bulging eardrum. Children with OME will seem completely fine, and you won’t know anything’s wrong unless your pediatrician discovers the infection during a well-baby visit. But babies with AOM will be fussy, especially at night, and may have a fever and other cold-like symptoms. After a case of AOM, your baby will probably have a case of OME for several weeks afterward. Typically, an acute infection will set in a few days after a cold has started. You can’t see that the baby has the infection, but your health-care provider will be able to detect it by looking for swelling in your baby’s ear with an otoscope and by blowing air on the eardrum to see if it’s swollen (the baby will hate this, so be prepared for screaming).
If your baby has an ear infection, a painkiller such as acetaminophen may be recommended, along with a course of antibiotics that will usually come in liquid form. If the baby rejects the liquid, try mixing it in with a little breastmilk or formula, or, for an older baby, applesauce or yogurt.
In the meantime, try keeping your baby in a semi-upright position as much as possible, such as in a car seat that’s carefully supported on the sides so it can’t tip over. And apply a mildly warm, moist towel to your baby’s cheek near the ears. It will probably be recommended that you not let the baby recline for feedings (which, if you’re breastfeeding overnight, means you have to sit up to feed, too).
Usually ear infections get better after several days of treatment. If ear infections are recurrent—that is, more than three episodes in six months—and your pediatrician fears that the infections might interfere with your baby’s hearing and language development, minor surgery may be recommended. The surgery involves placing tiny tubes in the ear to help the fluid drain.
Eczema
About 10 to 20 percent of all babies have eczema, or itchy skin breakouts, before they turn one year of age. Eczema is a red rash that can appear just about anywhere on a baby’s body, but it often starts on the face, the crooks of a baby’s arms, or on the backs of the legs and knees. It can be caused by baby’s skin coming into contact with something irritating, such as new detergent, scratchy fabrics, or, most commonly, a baby’s own saliva drooling down the chin. And if your baby is nursing, it could be caused by something you’ve eaten, such as chocolate. A baby may react from a substance in formula, or even having cow’s milk spilled on her skin. Sometimes eczema will develop into bumps that make a baby miserable. Contact your baby’s pediatrician for suggested treatments, and try to limit bathing for a while, using only clear water with no soap to keep the skin from getting dried out. Emollients like Vaseline® are effective in preventing the skin from drying out.
Eye problems
Many serious eye diseases that affect babies can be diagnosed at a very early age—and the earlier an eye disorder is detected, the easier it is to fix the problem. Your pediatrician will examine your baby’s eyes at every well-child visit. Some newborns have a greater chance of having eye problems than others. Risk factors include
• Babies born prematurely (before 28 weeks).
• Babies that weighed less than 5 pounds at birth.
• Babies who have a family history of eye disease.
• Babies whose mothers drank alcohol while pregnant.
If you answered yes to any of these questions, then ask your pediatrician if he or she recommends that you make an appointment with a pediatric ophthalmologist, a medical doctor specially trained to treat children’s eye problems. Your baby’s vision should be checked again at six months and at three-and-a-half years. (For more information about how a baby’s eyes and vision develop, refer to 1. Your Baby’s First Half-Year).
Conjunctivitis and plugged tear ducts
Sometimes babies’ eyes get swollen or crusty, either because one or both tear ducts are plugged, or because of an infection such as conjunctivitis (pinkeye). The home remedy is to dip a clean, soft washcloth or a clean cotton ball in mildly warm water, squeeze out the excess moisture, and then gently massage the affected area every 2 to 4 hours.
If her eyes are still red and swollen, crusty, or sticky with mucus after a day of lukewarm compresses, call your baby’s health-care provider. Antibiotic eye drops are likely to be prescribed.
Febrile seizures
Sometimes a rapid rise in temperature to a high fever can trigger a seizure in a baby or young child. They occur in 2 to 5 percent of all children between the ages of six months and five years. These “fits” or “spells” can terrify parents, but they’re usually harmless and they don’t lead to epilepsy, nor do they cause brain damage, nervous system problems, paralysis, mental retardation, or death.
“Our seven-month-old had constant blocked tear ducts and sticky eyes. She can’t stand to have her eyes wiped or anything. At least once we’ve had to give her antibiotics to clear up a bacterial infection. Our doctor isn’t worried and thinks the problem will correct itself.”
If your baby has a fever-related seizure, she will start to look strange, then she will stiffen and twitch, and her eyes may roll back in her head. She may be momentarily unresponsive and have uneven breathing, and her skin may appear darker than usual. She may shake on both sides of the body, or twitching may only appear in an arm or leg on only the right or the left side of the body.
Usually the seizure will happen in the first few hours after the onset of a fever and last less than a minute. More rarely, it may go on for up to 15 minutes. After the seizure, the baby may be sluggish for a couple of hours, but will then return to normal. While it’s happening, quickly move your baby away from anything she could hit if she is thrashing. Turn her head to the side so her mouth can drain, and don’t try to put anything into her mouth or try to feed her until she has recovered.
How Can I Tell If Something Is Wrong with My Baby’s Eyes?
Here are some signs that your baby might have an eye problem:
• Crossed eyes or eyes that don’t line up after your baby is six months old.
• Milky white or yellowish pupils (the dark circles in the center of the eyes).
• The front of the eye looks swollen.
• Tearing or discharge from the eye that won’t go away.
• The white part of the eye looks red.
• A drooping eyelid.
• Eyes that move so quickly, they seem to shake or dance.
If you see any of these warning signs, inform your baby’s health-care provider. Even if you don’t see any of these signs, it’s important that your baby’s eyes are checked at six months and at three and a half years.
The tendency to have seizures with fevers during childhood runs in families. It’s rare that a baby will have more than one in a 24-hour period. Children younger than one year of age at the time of their first seizure have about a 50 percent chance of having another febrile seizure after the first one. Children older than one year of age at the time of their first seizure have only a 30 percent chance of having a second febrile seizure.
If your baby has a seizure, contact your baby’s pediatrician right away. He or she will want you to bring your baby in to see what caused the seizure and may suggest ways to bring the baby’s fever down. Your doctor may be concerned that your baby has contracted meningitis, and a spinal tap may be recommended if it is suspected, since meningitis is very serious and can be fatal.
Fifth disease
Its formal name is erythema infectiosum. A fine, lacy-pink rash starts on the cheeks, giving the baby a “slapped cheek” look, and the rash may then move to the backs of the arms and legs. It may show up and disappear over the course of 1 to 3 weeks, especially in response to a baby bath or irritation. Rarely, the rash is accompanied by a slight fever and achy joints. The rash on the face will usually disappear within 4 days after it shows up, while the rash on the rest of the body will take 3 to 7 days to go away. Usually, the only symptom is the rash, and it will disappear on its own.
Gastroesophageal reflux disease (GERD)
Is your baby screaming like she’s in pain for hours, projectile vomiting, and arching her back? Then she may have GERD, or acid reflux. The acid in the baby’s stomach backs up into the throat, frequently causing spitting up and vomiting. It is thought that many babies who have colic are actually suffering from GERD. In some cases, it can also cause coughing and recurrent croup, sore throats, ear infections, and breathing problems. Call your doctor for advice if you think your baby has GERD.
German measles (See Rubella)
Hepatitis A and B
There are many types of hepatitis. All are infections of the liver and result in jaundice—a yellowing of the skin and whites of the eyes—as well as nausea and weakness. Other symptoms may be similar to the flu, and include vomiting, diarrhea, loss of appetite, and itchiness. Most children recover from hepatitis, but some go on to have chronic liver problems.
Hepatitis B is a serious infection of the liver, which is caused by a virus that is transmitted between adults through sexual intercourse or exposure to an infected person’s blood. It can be transmitted from mother to baby during birth, unless the baby receives preventive medication following delivery and is then vaccinated against it.
Hepatitis B infects more than 200,000 people each year in the United States, and 4,000 to 5,000 die as a result of chronic problems relating to it. Since 1991, the Centers for Disease Control and Prevention have recommended that babies be vaccinated against hepatitis B through a series of shots given during the first six months after birth.
Hepatitis A is a milder liver inflammation with similar symptoms to hepatitis B. It can be passed through contaminated food or water, or contact with small amounts of an infected person’s bowel movements. It is usually short-lived and may not lead to the serious consequences of hepatitis B. (See the Your Baby’s Immunization Schedule on in this chapter for information on the hepatitis A and B vaccines.)
Hernia (See also Hydrocele)
A hernia is the protrusion of an organ through the structure that normally surrounds or contains it. With an umbilical hernia, a bit of intestine or fatty tissue near the navel breaks through the muscular wall of the abdomen. The hernia will bulge out around the belly button when the baby cries, coughs, or strains. Umbilical hernias are much more common in African-American babies than in other races, and they usually resolve on their own by age four. (Note: Having a permanent “innie” or “outie” belly button is not a hernia.)
An inguinal hernia occurs when a small portion of the baby’s intestine protrudes into the scrotal sac, causing swelling, tenderness, and redness. It may first happen after a bout of vigorous crying. Since it may cause severe problems with blockage in the intestine, medical intervention may be necessary. Although more common in boys, inguinal hernias can also appear in girls as a swelling in the labial area.
Hydrocele
A swollen fluid sac inside a male baby’s scrotum (the pouch that supports the testicles) that is often present in newborn boys. The fluid is not a problem and will be reabsorbed by the baby’s body in time, or it may be removed by a physician using a syringe.
Impetigo
Impetigo is a bacterial skin infection caused by a staph or strep bacterium. It begins as tiny blisters, which eventually burst and leave brown or red, wet patches of skin. The patches may weep fluid that forms a yellowish, honeycomb-like crust, usually around the nose and mouth or the buttocks, and sometimes the hands and forearms. Your baby’s physician may recommend applying an over-the-counter antibiotic ointment or an oral antibiotic to prevent its spreading. Also be sure to cut your baby’s nails short to prevent scratching and a spread of the infection. If applying antibiotic ointment doesn’t make the rash noticeably better in a few days, call your pediatrician. In rare cases, impetigo may lead to a kidney problem known as glomerulonephritis, which causes the urine to turn dark (cola) brown. In most cases, impetigo is short-lived and usually heals completely in children.
Influenza (“flu”)
Typically, flu starts with a fever, fatigue, and chills, followed by a runny nose with clear mucus and a cough. Your baby may also be irritable and have swollen glands, arch her back with abdominal pain, have smelly, explosive diarrhea, and projectile vomiting.
In other words, if your baby gets the flu, it’s going to be a long, long night. Your pediatrician may want to examine your baby to be sure that there are not other causes, and he or she will probably tell you that the most you can do is keep the baby fed and hydrated, and be on the lookout for a high fever or signs of dehydration: sunken eyes, and wetting fewer diapers than usual.
If your baby is older than six months, though, your pediatrician may be able to prescribe an antiviral medication that can lessen the symptoms and shorten the length of the flu by a day or two. The trick is in making the diagnosis as soon as possible, because the medication must be given in the first 48 hours. Once that 48-hour window closes, the antiviral medications are no longer effective.
Also, if your baby is older than six months, you may be able to prevent the baby from catching more serious strains of flu in the first place by asking your pediatrician to give the baby a flu shot at the beginning of winter.
Jaundice
Jaundice is not a disease; it is a symptom. If your baby has jaundice, she will have a yellowish tinge to her skin that starts with her head and may turn the whites of her eyes yellow, and then move down to the feet, tinting the rest of her body yellow. The discoloration is caused by an excess of a body chemical called bilirubin , which is created as the body recycles old or damaged red blood cells. If your baby’s body builds up too many of these cells, her immature liver may not be able to process the excess.
More than half of all babies and up to 80 percent of preemies develop jaundice in the first week after birth. It isn’t usually painful or dangerous and typically disappears on its own in 1 to 2 weeks. Most hospitals now screen for jaundice using a blood test.
Exposure to sunlight or artificial light can help to break down bilirubin so it’s easier for your baby’s body to get rid of it. Your healthcare practitioner will probably want to monitor your baby and may recommend exposing your baby to special treatment lights. She will be placed naked under fluorescent-type lights in a special incubator, which will helps her body to break down the bilirubin. Your baby’s immature eyes should be covered with a protective mask to prevent damage from the lights.
Some hospitals offer parents units that can be taken home, or fiber-optic blankets that can be wrapped around the baby’s middle, to provide the needed light.
Kernicterus is a rare complication of jaundice in which the base of the baby’s brain and portions of the spine become invaded by excess bilirubin during the second to eighth day of life. This can have very serious consequences, including permanent brain damage, or even death. Symptoms include weak crying, poor sucking, sluggish reflexes, and a very yellow baby.
“Don’t be surprised if you find your baby’s lying naked under lights an emotional, almost weepy experience, especially if you’re going through postpartum blues. Your baby will look so vulnerable and tiny, and you will feel as though you should be protecting him, but you can’t.”
Very infrequently, some babies get “breastmilk jaundice” (it accounts for less than 1 percent of babies with jaundice). For biochemical reasons, breastmilk may increase the severity of jaundice or cause it to take longer to resolve. There is no need to wean your baby, though. Your doctor may ask you to stop breastfeeding your baby for 12 to 24 hours (but you can still pump to keep your milk supply up). If your baby’s bilirubin level drops quickly during this interval (by as much as 20 percent), then breastmilk may be the culprit. You will be able to resume breastfeeding in several days without affecting the jaundice.
Measles, Rubeola (See also Rubella, German measles)
Measles is a highly contagious viral illness characterized by cold-like symptoms, fever, cough, and conjunctivitis (redness and irritation in membranes of the eyes). Around the fourth day, the baby will seem more ill as a deep red rash starts on the face and joins together as it spreads over the rest of the body.
Before widespread immunization (see MMR vaccine, in this chapter), measles was so common during childhood that the majority of the population had been infected by age 20. Over the last several decades, the number of measles cases has dropped to virtually zero in the United States and Canada because of widespread immunization. Rarely, measles can develop into pneumonia, encephalitis (brain swelling), and ear infections.
Meningitis
Meningitis is an infection of the tissues that cover the brain or spinal fluid caused by the spread of bacteria or viruses to these areas. When tissues swell from the infection, they can cut off needed oxygen and blood supplies to the brain. Bacterial meningitis is the most serious form, especially for babies younger than 2 months of age, since their immune systems are weak.
Meningitis symptoms may emerge after your baby has had a cold or runny nose and mimic those of other serious baby illnesses: fever, decreased appetite, listlessness, or increased crying and extreme irritability, and she may become even more irritable when you pick her up or move her. Other symptoms could include jaundice (yellowish tint to the skin), a stiff neck or body, a mild fever or lower-than-normal temperature, trouble feeding, a weak suck, and a high-pitched distress cry. The soft spot (fontanel) on top of the baby’s head may bulge from the swelling. Babies over two months of age may also have vomiting, and older children with the disease will complain of headache, pain in the back, or a stiff neck, and they may report that it hurts to enter bright light.
If you suspect that your baby has meningitis, contact your baby’s doctor immediately and inform the receptionist that your call is serious. Long-term complications of severe cases of meningitis may include problems affecting nerve functioning, such as hearing loss, visual impairment, seizures, and learning disabilities. Other organs, such as the heart, kidneys, and adrenal glands, may also be affected, and some babies die from the infection. Babies who are promptly diagnosed using a blood test or possibly a spinal tap, and who are given quick treatment with antibiotics, can be expected to have complete recovery.
Mumps
Mumps, an inflammation of the salivary glands in the neck, is caused by a virus. The disease used to be common, but the MMR vaccine has made it extremely rare now (see in this chapter). Mumps begins with flu-like symptoms and an upset stomach, followed by enlarged, swollen glands under the ear lobes that start on one side of the head and spread to the other, making the child look like a chipmunk. There may be a slight fever, but the baby may not seem overly sick. Mumps usually lasts 7 to 10 days and is communicable throughout that time. Mumps can lead to viral meningitis (infection of the tissue coverings of the brain and spinal cord) and, very rarely, to brain swelling. Occasionally, mumps can cause the testicles of boys and men to swell and, in rare cases, may render them unable to have children. (See MMR vaccine, in this chapter.)
Pervasive Developmental Disorders (Autism and others)
Autism spectrum disorders (ASD, or autism) cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others in babies and children. These disorders are thought to affect approximately 3.4 out of every 1,000 children ages 3 to 10. ASD symptoms can be mild or severe. Although they may show up in infancy, most are not diagnosed until two to three years of age as symptoms become more noticeable. In rarer instances, some babies may appear to develop normally during the first year of life only to lose skills and abilities later, developing develop odd behaviors during the second or third year of life.
ASDs range from a severe form, called autistic disorder, or autism, through pervasive developmental disorder, and the rarer, milder variants Asperger’s and Rett syndromes and childhood disintegrative disorder. While toddlers and children who are developing normally learn to read body signals like smiles and vocal expressions, children with autism spectrum disorders may not able to tell if someone is happy, angry, or sad, and aren’t able to respond accordingly. They may perform repetitious body movements, have unusual attachment to objects rather than to other persons, or react with extreme sensitivity to light, hearing, touch, smell, or taste, or fail to respond normally to these stimuli.
A baby with early autism may seem indifferent to surroundings, happier playing alone than relating to others, and may resist cuddling or show atypical patterns of development, such as failing to point to objects when other babies her age do. The baby may also have delayed or impaired language development, have trouble vocally expressing her needs, and she may show unusual reactions, such as over-or under-reacting to sights, sounds, or being touched.
The causes of autism are not fully understood, although it and other disorders in this category are thought to be related to brain development and chemistry and, in some cases, may be related to the baby’s genes, coupled with a sensitivity to environmental triggers that set off the brain and chemical changes and unusual behaviors.
Asperger’s syndrome is a milder variant of autism. Children with Asperger’s usually have fewer language problems than children with autism, and often speak fluently—although their words can sometimes sound formal or stilted. Individuals with Asperger’s do not usually have the accompanying learning disabilities associated with autism; in fact, they often have average or above average intelligence.
Childhood disintegrative disorder is rare and develops in children three to four years of age who have previously appeared to be perfectly normal. The child may lose bowel and bladder control, begin to show awkward movements, and lose the ability to be sociable and to communicate with others.
Rett syndrome is a genetic disorder of the X chromosome and primarily affects about 1 in 12,000 babies, usually girls. A baby with Rett syndrome will develop normally until about 6 to 18 months, and then the head circumference growth slows. (About 80 percent of Rett syndrome babies also have epilepsy.) When the syndrome begins to have effect, the toddler may lose communication skills and purposeful use of the hands, head growth may slow, and hand use and walking patterns may seem odd. Abnormal breathing patterns when awake and seizures may also happen, and there may be periods when the baby withdraws from human contact or is irritable and cries inconsolably. While problems with maintaining eye-to-eye contact with others, seizures, and irregular breathing may get better over time, problems with body skills may increase.
Unlike with a physical illness, there is no physical test for autism and other pervasive developmental disorders, although unusually slow or rapid head growth may be signs of brain changes. If your baby’s physician feels that your baby is showing unusual behaviors or abnormal head growth, you will probably be referred to a health-care professional who is experienced in the diagnosis and treatment of the disorder. There are literally hundreds of potential therapy options available. Most center upon helping to change the child’s behavior and how he, or she, relates to the social world, and some offer nutritional interventions that may, or may not, make a difference. (One good place to learn more about treatment alternatives is Kyle’s Treehouse— www.kylestreehouse.org—founded by parents with an autistic son.)
FLASH FACT: Immunizations and Autism
Should you be concerned that your baby’s shots could cause autism? In 1998, British researchers raised a furor with a controversial report that suggested there was a link between the rising number of children being diagnosed with autism and a mercury preservative in vaccines used to immunize children against measles, mumps, and rubella (MMR). Early in 2004, 10 of the 13 original authors of the study retracted the paper, saying that their data was not strong enough to support that conclusion. More recently, the Institute of Medicine of the National Academy of Sciences conducted a thorough review of a link between thimerosal (the mercury-based preservative no longer used in vaccinations) and autism. The final report, released in May 2004, found no link between thimerosal exposure and autism in children. A U.S. study looking at environmental factors including exposure to mercury, lead, and other heavy metals is still ongoing. (You can access the Institute of Medicine report at www.iom.edu/CMS/3793/4705/20155.aspx.)
Your pediatrician will measure your baby’s head circumference at every exam. If you’re worried about a developmental disorder, ask him or her to let you know if your baby’s head-growth patterns at one month, two months, six months, and one year are typical. Your pediatrician will evaluate your child’s development at every well-child visit.
In 2004, the National Institutes of Health announced it would help to underwrite a long-term study of 100,000 babies in Norway that will be probing the causes of autism. The research will be looking at each baby’s diet, vaccinations, birth weight, and head circumference, as well as each baby’s exposure to toxins including mercury.
Pneumonia (see Respiratory problems)
Respiratory problems
Babies and toddlers, with their sensitive and immature immune systems, are more vulnerable to respiratory illness than adults. Babies are “obligate nose breathers,” meaning that they MUST breathe through their noses and can’t breathe through their mouths, so a stopped-up nose may interfere with nursing and bottle drinking and make a baby resistant to feeding. Babies also have very small bronchial tubes, which can make them more vulnerable to breathing difficulties when bacterial or viral infections set in.
Sometimes simple colds can turn into something much more serious, such as pneumonia, bronchitis, bronchiolitis, or RSV (respiratory syncytial virus). It’s normal for a baby’s breathing to seem uneven or ragged, but any signs of your baby struggling for breath should be reported to your pediatrician right away.
Asthma
Asthma is a recurrent inflammatory condition of the bronchial airways. It affects nearly 5 million children in the United States and has become so widespread that it is now considered one of the most common childhood illnesses.
Asthma has a number of other names: bronchial asthma, asthmatic bronchitis, reactive airway disease, bronchitis, and wheezy bronchitis.
Some types of viral infections; allergens like dust mites, mold, pollen, or animal dander; heavy crying; colds; cigarette smoke in the air; and extreme coldness and other changes in air quality can all trigger a baby’s first asthma attack. During an asthma attack the lining of your baby’s lungs becomes inflamed and the airways develop spasms, produce mucus, and swell so that the air passages inside the lungs narrow. The first signs of an asthma attack are coughing, tightness in the chest, shortness of breath, and an unusual wheezing or whistling sound when your baby breathes out.
When the bronchial airways are exposed to the trigger, inflammation and swelling result, which make breathing difficult and, in some cases, may be life-threatening.
WARNING! Baby Breathing Problems
Report these symptoms to your baby’s doctor. They are signs of a serious respiratory infection or asthma:
• Noisy breathing. Wheezing or whistling on the “out” breath. (Croup and other respiratory infections have similar sounds during the “in” breath.)
• Rapid breathing. The baby gasps for breath and takes in excess of 40 breaths per minute during a resting state.
• Movement-related panting. Wheezing or panting with normal exertion.
• Lethargy. The baby is unusually sluggish and difficult to arouse.
• Flared nostrils. The nostrils will spread wide open as your baby struggles to breathe.
• Difficulty feeding. Flared nostrils while breathing or difficulty with feeding, whether from breast or bottle.
• Chest pulling. You see skin pulled under baby’s ribcage as she struggles to breathe.
The severity of asthma in children is graded according to the number of days and nights the symptoms occur. If the attacks are less frequent than twice a week, then the asthma is called “mild” or “intermittent.” You may be able to treat mild attacks at home using an inhaler with a breathing mask (bron-chodilator) prescribed by your baby’s doctor, without the need for daily medications.
If the attacks occur three to six times per week over a period of three to four months, it will be labeled “mild, persistent asthma” and a bronchodilator may be prescribed along with an inhaled antiinflammatory or steroid to help reduce swelling of lung tissues. “Moderate persistent asthma” is when a baby has daily asthma breathing problems and as many as four attacks per month at night. An inhaled anti-inflammatory steroid and a long-acting bronchodilator may be recommended as well as a short-acting one.
A baby with “severe persistent asthma” has daily breathing problems and frequent night attacks. More aggressive treatment for control of her symptoms may include all of the treatments above, plus the use of newer medications.
Managing asthma
There are specific steps you can take to protect your baby and reduce attacks if she has been diagnosed as having asthma:
• Eliminate triggers. Keep your home clean, eliminate carpeting, and vacuum both the floor and stuffed furniture frequently, using a vacuum with powerful filters to keep from spewing dust and dander back into the air. Change linens frequently as well, and use allergen-proof casings on your own bedding.
• Clean air. Stop smoking, and don’t allow others to smoke in your home. (Even if you smoke outdoors, your lungs will exhale smoke for days, and smoke will also cling to your hair, skin, and clothing when you are indoors.) Constantly run a fan-style air cleaner that contains high-density filtration layers in your child’s bedroom.
• Prepare for seasonal allergies. Be careful about exposing your child to outdoor activities in spring and fall, when pollen and ragweed levels are high, and avoid sudden exposure to extreme cold in the winter, which can exacerbate breathing problems.
• Follow your doctor’s instructions. Stick to the regimen that he, or she, suggests. Medications and inhalers may help your child to control asthma attacks. If you feel your child’s condition is worsening or medication is not helping, discuss the problem with your baby’s physician, and consider contacting a pediatric allergist/immunologist for a second opinion.
Bronchiolitis
A spasm and inflammation of the small airways in the baby’s chest, bronchiolitis can be caused by a virus (the most common is RSV, respiratory syncytial virus) or by an allergic reaction. It usually occurs in a baby who is less than six months old and it may cause the baby to wheeze and also to make whistling sounds when she breathes in. Other symptoms include noisy coughing; rapid, shallow, and difficult breathing; paleness; and general irritability.
Bronchiolitis is usually mild and can be treated at home with the advice of your baby’s health-care provider. If your baby has a fever, the doctor may suggest a medication to lower it and to ease discomfort so the baby can eat and sleep normally. Temporarily increasing the humidity in your baby’s room may help your baby’s breathing; try a humidifier or placing a wet towel or a bowl of water close to a source of heat such as a radiator.
If your baby continues to have severe breathing problems, the doctor may recommend medication to help the airways to relax. In rare cases when there are severe breathing problems, the baby may need to be hospitalized and given oxygen through a mask. Premature babies with bronchiolitis may be given antiviral drugs to treat the infection and may sometimes need breathing assistance from a mechanical ventilator.
Bronchitis
Bronchitis is when the bronchial tubes, the large airways that lead to the lungs, become swollen. There are two types: acute and chronic. Symptoms of acute bronchitis are fever, a painful cough, a sore throat, thick, yellow mucous, and shortness of breath. Acute bronchitis is usually the result of a cold or flu, and while it’s not dangerous in itself, it may lead to pneumonia, so if your baby shows any signs of breathing problems accompanied by a fever, you should call your pediatrician right away. The doctor will recommend a cough suppressant and/or other methods of treating the individual symptoms. The best ways to prevent bronchitis are to keep your child away from people who are ill, and away from pollution and secondhand smoke.
Chronic bronchitis is bronchitis that lasts for 3 months or longer; it is most often caused by pollutants, such as second-hand smoke or dust.
Colds and coughs
It’s likely that by the time your baby grows into a child, he or she will have more colds and other upper respiratory infections than any other illnesses. The average baby catches 9 colds during her first two years. Your baby will be more vulnerable to these infections the more public contact she has, because viruses and bacteria are spread by contact.
If your baby has caught a cold, it will usually begin with irritability and eating changes, followed by clear fluid running from the nose, sneezing, and possibly a low fever. Though exposing your baby to cold air doesn’t necessarily cause a cold, they do run rampant in winter weather. Exposure to cold weather changes the way that our bodies fight off viruses. The protective mucus and cilia in the respiratory tract do not function as efficiently. So if you get exposed to a virus in those conditions, you’re more likely to catch it. Breathing cold air seems to be the toughest on the system.
“My grandmother used to say, ‘You can treat a cold and it will be over in a week, or you can do nothing and it will end in 7 days.’ There’s some truth to that, but our baby was a lot sicker when he got colds his first two years. It was like his body had to learn to fight the illness.”
While a cold may seem like a mild illness to a child or adult, it can be serious for a young baby. If your baby is younger than three months old, the best protection you can give her is to prevent sick people from getting near her, especially if it’s winter, when nasal passages are most dry and vulnerable to infection and viruses are the most likely to circulate. You should call your baby’s doctor right away if she shows signs of an infection. Cold symptoms in babies can sometimes develop into a more serious illness such as bronchiolitis, croup, or pneumonia.
FLASH FACT: Hope for Babies with Asthma
A 2002 study published in the American Journal of Respiratory and Critical Care Medicine found that children who wheezed or coughed before age two have no increased chance of asthma compared with other children who didn’t. Wheezing or coughing in a baby age two or younger was not found to be a sign that the child would have lifelong asthma. But these symptoms after age two could signal that the child would be vulnerable to it later. The greatest majority of children who developed chronic asthma were found to have a history of asthma in the family, but even with a strong family history of asthma, more than 60 percent of children in asthma-vulnerable families did not go on to have lifelong asthma.
Colds are especially hard on young babies. That’s because they can’t breathe through their mouths—only through their noses. When your baby’s nose becomes stopped up, it makes nursing difficult since she has to stop to gasp for air in between sucks.
The best way to treat your baby’s nasal congestion is to clear the mucus from her nose by using a ball-shaped, rubber suction bulb that has a small, soft tip for pulling out the “snot.” Squeeze the bulb part of the syringe first, carefully place the tip into one nostril, and then gently release the bulb to create suction. Only a slight suction is needed to unclog the nose to help your baby breathe again.
If the secretions in your baby’s nose are particularly thick, your pediatrician may recommend that you liquefy them with mild saline nose drops. Using a dropper that has been cleaned with soap and water and well-rinsed with plain water, place 2 drops in each nostril 15 to 20 minutes before feeding, and then immediately suction with the bulb. However, don’t suction too often, as this can cause irritation. You might also try placing saline in the nose several times during the day. Never use nose drops that contain any medication because it may be harmful to your baby.
Tip
Although doctors are sometimes very liberal in their prescribing of antibiotics, these medications only affect bacteria, not the viruses that cause colds. Make sure that your baby’s illness warrants the antibiotics.
When your child has a cold or an upper respiratory infection, placing a cool-mist humidifier (vaporizer) in her room will help keep nasal secretions more liquid and make her more comfortable. Set it close to her so that she gets the full benefit of the additional moisture. Be sure to clean and dry the humidifier thoroughly each day to prevent bacterial or mold contamination. Hot-water vaporizers are not recommended because they can cause serious scalds or burns.
(Note: If you use a humidifier in your baby’s room, place it far enough away from her crib and other furniture to prevent moisture damage to wood surfaces.)
Serious cold symptoms
Here are some symptoms that you should report to your baby’s doctor if your baby is less than three months of age:
• Coughing. Your baby is coughing, and it doesn’t go away.
• Refusing to eat. Your baby has lost her appetite and she refuses more than two feedings. She wets less than three to four diapers in 24 hours.
• Fever. Anytime a baby under three months runs a rectal temperature higher than 100.5° F should be reported to your baby’s doctor.
• Extreme irritability. Your baby has other symptoms of illness, such as a fever, and she seems excessively irritable.
• Sluggishness and lethargy. Your baby seems very sluggish or is hard to wake up.
Croup
Croup is not a single problem but a symptom that occurs when a child’s upper airway swells and becomes narrowed by an illness or an allergic reaction. This causes a cough that sounds like a dog’s bark, and a squeaking noise when the child inhales. Croup is most common in children between three months and five years old, and in babies who are born prematurely.
Often croup is not serious and can be helped with a humidifier or by holding your baby in the bathroom while a hot shower fills the room with steam. However, if your child shows signs of having difficulty breathing and/or swallowing, is breathing rapidly, if you notice the skin beneath the ribs pulling in with each breath, and/or the child has a fever, call your pediatrician immediately.
In some babies and children, croup is a recurring problem, and those who are vulnerable to it may have 3 to 4 bouts of croup during flu season. Usually it doesn’t present a serious problem, but you should always seek your doctor’s advice. In most cases, children outgrow croup when their air passages mature and increase in size.
Pertussis (See whooping cough on Bronchiolitis)
Pneumonia
During pneumonia, the air sacs of the lungs fill with pus, mucus, and other liquid, causing the lungs to become inflamed and/or infected. There are multiple causes and types of pneumonia. The symptoms of bacterial pneumonia are a fever, chills, rapid breathing, fast heart rate, a wet cough, abdominal pain, and vomiting, with the baby becoming sicker over time. Viral pneumonia is marked by a low fever, no chills, and a lingering cough; babies with viral pneumonia will seem almost normal, yet their symptoms will persist for 3 to 4 weeks.
WARNING! Don’t Give Your Baby Cough Medicine
Cough medicines or cough/cold preparations should never be administered to a child younger than three years of age unless prescribed by your pediatrician. Coughing is a protective mechanism that clears mucus from the lower part of the respiratory tract, and ordinarily there’s no reason to chemically suppress it.
Lobar pneumonia refers to pneumonia in a section (lobe) of a lung, while bronchial pneumonia (or bronchopneumonia) refers to pneumonia that affects patches throughout both lungs.
In serious cases of pneumonia, oxygen can’t reach the blood, and when there is insufficient oxygen in the blood, body cells can’t function properly and may die. Prompt treatment with antibiotics and oxygen almost always cures bacterial pneumonia, but treating it aggressively and early is important.
RSV infection
RSV stands for respiratory syncytial (pronounced “sin-SHISH-al”) virus, and it is one of the most common causes of serious pneumonia and other infections of a baby’s nose, throat, and lungs. Every year, 90,000 babies are hospitalized with RSV-related illnesses.
It’s believed that nearly half of all babies catch some type of RSV every year, usually in winter. Its symptoms are like a cold with a runny nose and nasal congestion, a low-grade fever, decreased appetite, and general irritability. Symptoms similar to bronchiolitis (see in this chapter) then develop: a fever of more than 100.4° F for a baby under three months of age, or more than 102° F for older babies and toddlers; rapid breathing or difficulty getting breaths; flaring of the nostrils; a whistling noise in the chest when breathing out (“wheezing”); a deep or frequent cough; disinterest in nursing; grunting noises; a bluish color around the nose and mouth; and listlessness or unusual irritability.
For most babies, RSV is mild, but for preemies and babies with serious diseases, such as HIV (human immunodeficiency virus), congenital heart disease, or lung conditions, it can be deadly. Diagnosis is made with a nasal swab and/or a chest X-ray, and babies who become seriously ill may require hospitalization, oxygen, inhaled medication, and steroids. A vaccination is available called Synagis® that may help to protect vulnerable babies from contracting RSV, but the protection is only temporary, and monthly shots may need to be given during RSV season, which peaks between October and April.
Strep Throat
Strep throat is very rare in children under two years of age. Officially called streptococcal pharyngitis, strep throat is caused by streptococcal bacteria. In children, the infection can cause red, swollen tonsils covered in a white, smelly material, red patches on the roof of the mouth, a white tongue, a high fever, swollen glands, abdominal pain, vomiting, and trouble swallowing. Neck glands may also be swollen.
Make an appointment with your baby’s health-care provider. He or she will take a culture from your baby’s nose or throat in order to confirm that the infection is strep; this will help him or her decide whether antibiotics will be needed to prevent more serious complications such as ear and sinus infections, or involvement of other organs such as the lungs, brain, or kidneys, or rheumatic fever.
Whooping cough
Also known as pertussis, whooping cough is a highly contagious respiratory illness that used to kill thousands of people every year. But now, thanks to the DTaP vaccine (see in this chapter), there are only a handful of deaths from the disease every year. Still, cases of pertussis seem to be on the rise, particularly among infants younger than six months who are not yet protected by their immunizations, and in young adults whose childhood vaccines have begun to wear off. Pertussis poses the biggest threat to babies younger than one year old who, in rare instances, could develop pneumonia, convulsions, and, even more rarely, brain damage or death. If your baby develops a spastic, honking cough, and possibly vomits after coughing, contact her health-care provider, who will probably prescribe antibiotics. Your baby will be contagious until the course of the medication has been completed, which is about 5 days.
Roseola
Roseola (roseola infantum) is a viral illness. It sounds scary, but the virus is very common and found in children all over the world. In the United States about 1 in 3 children contract some strain of the roseola virus, and 86 percent of children have acquired the virus’s antibodies by one year.
Your baby could be a carrier for the virus and show no symptoms or not appear ill, or she could suddenly develop a fever between 102° F and 104° F that lasts for 3 to 5 days. In approximately 1 out of 10 cases, the sudden rise in the fever may lead to febrile seizures (see in this chapter).
Your baby will have decreased appetite, mild diarrhea, a slight cough, a runny nose, and she will seem more irritable and sleepier than usual. Her eyelids may seem swollen and droopy. The fever will likely break on about the third day and be followed by a faint, pink rash (not red, as with measles) on the baby’s trunk, arms, and legs that will last about a day or so. Your baby’s health-care provider may prescribe medications to help your baby feel more comfortable.
Rotavirus gastroenteritis
Rotavirus is severe diarrhea caused by a virus, and usually accompanied by fever and vomiting. It is the most common cause of severe diarrhea in infants and young children in the United States and is thought to be responsible for approximately 5 to 10 percent of all diarrhea cases among children under five years of age. Rotavirus accounts for more than 500,000 physician visits each year among children less than five years of age in the United States.
The reason rotavirus gastroenteritis is so deadly is that it causes children to quickly lose body fluids and leads to severe dehydration. Babies and children between three and 35 months of age have the highest risk for getting the infection. The illness usually starts with a fever, an upset stomach, and vomiting, followed by watery diarrhea that can be mild to severe and last for 3 to 9 days. The diarrhea can lead to the dangerous depletion of body fluids, which can result in death if left untreated— particularly in young babies. Virtually all children become infected with rotavirus in the first three to five years of life, but its most severe form occurs with infants.
The virus is spread through fecal contamination when stool gets on hands or objects, such as toys or bottles, and it can be spread before any symptoms appear. Usually the first infection is the most severe, with each subsequent infection being less severe. Giving special fluids by mouth is the most effective treatment. (For more information on oral rehydration solution see in 8. Parent’s Dictionary.) If your baby or young child has severe diarrhea, contact your baby’s doctor right away. Oral rehydration using an over-the-counter liquid may be recommended, along with a visit to your baby’s doctor for medical evaluation. Special nonprescription solutions found in most pharmacies or grocery stores, such as Pedialyte® and Rice-Lite®, may be recommended, or hospitalization may be required to provide fluids intravenously. On February 3, 2006, the U.S. Food and Drug Administration approved a live, oral vaccine (RotaTeq®) for use in children.
RSV infection (See respiratory problems)
Rubella
Sometimes called “three-day measles” or German measles, this virus starts with mild symptoms of illness, such as a low-grade fever, a slight cold, or other flu-like symptoms. Then, a pinkish-red, spotted rash develops on the baby’s face and rapidly spreads to the trunk. It disappears after the third day. The baby will look unwell and may have swollen glands behind the ears or nape of the neck, but will recover within a few days. Contact your baby’s health-care provider, although no medical treatment is usually needed. Rubella immunization is part of the MMR shots (see in this chapter).
SIDS (sudden infant death syndrome) (See page 74 in 1. Your Baby’s First Half-Year)
Strep throat (See respiratory problems)
Thrush
If your baby’s tongue and inner cheeks are coated in white patches that won’t wipe away, she may have thrush, a fungal yeast infection. This yeast infection grows in moist places like the inside of the mouth, and it may also appear as red, irritated patches in the folds of your baby’s skin, such as on the neck or in the armpits and thighs. Sometimes a cherry red diaper rash that doesn’t clear up easily can also be caused by thrush. If you are breastfeeding and your nipples are red, itchy, and cracked, sometimes with white patches, the problem may also be thrush. Both you and your baby may need to be treated to prevent reinfection. Your healthcare provider will suggest medication to treat it.
Varicella (See Chicken Pox)
Whooping Cough (See Respiratory Problems)
Your Baby, Illness, and Child Care
When to keep your baby home:
• Fever. Your baby has a temperature, according to the definition given by your baby’s childcare provider or when your baby is unusually sluggish or hard to wake up.
• Persistent crying. Your baby seems ill and unusually irritable and fussy.
• Breathing problems. Your baby has difficulty breathing or is wheezing or coughing.
• Diarrhea. Blood in stools not explainable by dietary change, or medication.
• Vomiting. Two or more episodes in the previous 24 hours.
• Persistent abdominal pain. Your baby cries and slaps her legs to her belly in a way that is not usual, for more than 2 hours.
• Mouth sores. With drooling.
• Rash. With fever or behavior change.
• Eye infection. Your baby has purulent conjunctivitis, the medical name for “pinkeye,” a highly contagious infection that causes red, swollen eyelids and a thick, mucousy discharge from the baby’s eyes.
When your baby can return to child care after a specific illness:
• At the end of a cold. Your baby is getting over a cold and has had a thick green or yellow discharge from her nose for 5 days, but she has no fever.
• Eye infection. After treatment has started.
• Strep throat or other streptococcal infection. Twenty-four hours after starting antibiotics and after the fever has ended.
• Chicken pox. Not until all sores have dried and crusted (usually 6 days).
• Whooping cough (pertussis). After antibiotic treatment has been completed.
• Mumps. Nine days after onset of swelling of the salivary glands.
• Hepatitis A virus. One week after onset of illness, jaundice, or as directed by the health department when preventive measures have been given to other children and staff members at the day care facility.
• Measles. Four days after onset of rash.
• Rubella. Six days after onset of rash.
• Rash with no fever. When your child has a new rash but she is behaving normally and does not have a fever.