When Baby's Sick

THE HEALTHY NEWBORN

At birth, your baby leaves the protective world of your womb, where warmth, oxy­gen, and nourishment were always avail­able. The newborn is suddenly exposed to all sorts of new and changing conditions. There will be different temperatures; various sights, smells, and sounds; exposure to infec­tions; and a range of new processes within his or her little body.

Dramatic changes will be happening in the respiratory system, circulatory system, and digestive system. So, it's natural that some time will pass before everything is fully func­tional and in balance. Your baby will make a lot of adjustments to the "outside world" over the first few months, and development will continue throughout life! But these developments occur naturally and without problems in most babies, and you don't need to be a professional to be a good mother.

The lungs

One of the most dramatic changes a newborn experiences is breathing air. Most babies take their first breath within 30 seconds of being born. Others may take a bit longer, because during birth they received little oxygen or their mother took certain medications.

Young infants often have an uneven breathing pattern. Fortunately, newborns can cope better with short periods of oxy­gen deficiency than older children and adults can.

The heart

When the umbilical cord is cut, the blood flow from you to your child ends. When your baby takes that first breath, the blood flow in his or her heart and blood vessels changes, and circulation of blood to the lungs begins.

The liver

The liver has several functions. One of its functions is to break down and secrete biliru­bin, the yellow coloring made when red blood cells break down as a normal part of living. Before this process starts, bilirubin accumulates in the body, so many newborns develop jaundice (yellow skin) during the first week of life. The jaundice may go away on its own. Feeding the baby 8 or more times in 24 hours also reduces it. Alternatively, some children are treated on a "light bed," where they lie under special ultraviolet light bulbs or in sunlight.

The kidneys

A baby's kidneys start producing urine toward the end of the first trimester of preg­nancy. Before birth, your baby's waste prod­ucts were discarded mainly through you or became part of the amniotic fluid. At birth, the kidneys become fully active, and the first urine is usually excreted shortly after birth. There might not be much urine during the first few days, but it increases as your child starts feeding.

The umbilical cord

The umbilical cord stump usually dries up and falls off in the first 1 or 2 weeks after birth. Once the stump falls off, it takes a few days before the navel (belly button) area is

covered by new skin. Infections can get into the new navel. If it oozes, it should be cleaned carefully— your doctor will tell you how.

The belly button usually heals without any problems, although a "plug" sometimes forms. This looks like dead skin and may leak a tiny amount of bloody liquid. Don't worry, this is not usually dangerous and it is easily treated.

Weight loss

Most newborns lose 5% to 10% of their birth weight in the first 3 days. Their weight usually starts to go up after that, when you- breast milk production is fully established. 1: your baby feeds well, his or her birth weigh: may be regained in 7 to 10 days. This could take longer, however, and the weight gain may not follow a steady pattern. Talk to your doctor if your child doesn't seem to be gain­ing enough weight.

Body temperature

The body temperature of newborn chil­dren is about 98.6°F. For some babies, the temperature increases to 99.5°F to 101.5°F as the body weight starts to climb. This rise in temperature may be due to lack of fluids. not infection.

It's important to know that infants can't control their body temperature. Young chil­dren may display a fever without being ill,

and they may be ill without getting a fever. Measuring the temperature is an unreliable mea­sure of illness during infancy .... Behavior is a bet­ter indicator. That said, a persistent or very high fever should be checked by the doctor.

Babies tend to lose a great deal of heat. Being underdressed can make their tempera­ture sink too low, and they can't increase their body temperature by shivering. (Crying is one way infants can generate heat.) Conversely, an "artificial fever" can be pro­duced by wrapping the baby in too many clothes and covers.

Hormones

During pregnancy, both boys and girls are affected by their mother's hormones. It may take a little time for newborns' hormones to adjust. During the first few weeks, some gray-white mucus may come out of the vagina of baby girls. After 5 or 6 days, some bloody mucus might also be there.

Both boys and girls may, towards the end of the first week of life, get swollen breast glands. Some liquid resembling breast milk may even leak out. This breast swelling usually goes away after a few weeks.

Birth swelling and head molding

Many children develop swelling on the part of the body that first emerged at birth. Because most babies are born head first, this

birth swelling is most commonly on the head. This does not usually mean that the area is damaged. The swelling normally dis­appears on its own.

Because the baby's head needs to fit through the birth canal, it may be somewhat misshapen at birth. This usually goes away soon.

PROBLEMS AT BIRTH

Most babies are born healthy and com­plete. Unfortunately, some newborns do have medical problems. A doctor can detect many of those problems immediately after birth.

Some birth defects and illnesses are inherit­ed, whereas others may have happened dur­ing the pregnancy or birth. In many cases, it isn't possible to find a definitive cause. Birth defects can occur anywhere in the body —including the heart, bones, nervous system, or urinary tract. Genetic problems can be inherited from one or both parents, even if both parents are healthy.

The basic organ systems are formed during the first 3 months of pregnancy. They are especially vulnerable during that time. Poor nutrition, medicines, infections, alcohol, smoking, and x-rays are just some of the things that may cause permanent deformities.

Previously, lack of oxygen during birth was believed to be the cause of brain damage or cerebral palsy. It is now known that most brain damage actually occurrs in premature

infants after birth, and in full-term infants before labor or admission to the hospital. Even if some damage has happened, the child might grow up to be healthy and normal.

FEVERS AND INFECTIONS

Small children can very easily develop a high temperature without being particularly ill. The most common cause of fever is infec­tion, usually of the throat or nose. Increasing the temperature is one way the body tries to resist infectious bacteria and viruses.

A baby's temperature typically ranges between 97.5°F and 99.5°F. Some children have even greater changes in their normal body temperature. Temperatures are lowest at night and highest in the afternoon. Putting your hand on a child's forehead is not a reli­able way to measure temperature. Your baby will have to get used to having his or her tem­perature taken with a thermometer inserted into the rectum (bottom) or in the armpit.

Of even greater importance than measur­ing the temperature is observing your baby. Signs that he or she may not be well include the following: appearing "limp" and slug­gish; not wanting to sit up, to talk, to play, or to eat or drink; and not getting any better after receiving fever-reducing medicines.

Children with fever have poor appetite. Don't force your child to eat, but do make sure that he or she drinks plenty of fluids (liquids).

When children are vomiting or have diarrhea. the fluid intake must be increased even more to replace the fluids they are losing. Weak tea, mineral water, or water with sugar are recom­mended. Avoid milk and juices.

If your child is nauseous, give fluids in small amounts. It may be easier for him or her to take sips through a straw than straight out of a glass. Older children can suck on ice chips, too. Popsicles frozen snacks and carbonated bever­ages (such as soda) contain useful amounts of fluids and may be more appetizing to a sick child than many other foods. It's more impor­tant for your child to drink than to eat. When he or she is no longer nauseous, you can give crack­ers, pretzels, mashed potatoes, or dry white toast, then gradually progress to the normal diet.

If your baby or child refuses to stay in bed with a fever, it's probably fine to let him or her get up for a while. However, he or she shouldn't be allowed outdoors and shouldn't be exposed to hot or cold rooms. Dress the baby warmly enough, but not too warmly.

It is not always necessary to use fever-reduc­ing medicines. In many cases, babies can maintain a surprisingly good state of well-being even with a temperature of 104°F! However, you should contact your doctor to make sure. To bring down fevers, you may be told to put your child into a tub of room-temperature water. It's also important to keep an eye out for symptoms of serious infections. For

example, infections such as meningitis (an inflammation of the brain covering) can seem like regular viral infections at first.

Often, appetite and fluid intake improve with fever-reducing medicines such as aceta­minophen. (Aspirin is not recommended.) Store medicines safely and follow the recom­mended dosages exactly. Giving too much medicine — or the right amount too fre­quently — can cause serious poisoning!

Febrile seizures

Approximately 1 out of 20 infants and toddlers will have at least one febrile (fever)  seizure from high body temperature. Febrile seizures usually affect children between the ages of 6 months and 5 years. During that period, the brain is especially sensitive to high temperature, particularly if the temper­ature is rising rapidly. The child stiffens and may faint, the eyes roll, the jaws clench tight­ly together, and the body jerks. Such an attack may last from a few seconds to 10 or 15 minutes.

Treatment of febrile seizures usually consists of cooling the child down. Undress your child and place a towel with cool (but not freezing) water on the forehead or around the body, especially in the armpits, around the neck, and on the groin. Don't put your finger or other object into his or her mouth. Do turn the child onto one side so that he or she doesn't choke on

or breathe in any vomit. Call the doctor, who

will give other emergency advice and will try to determine the cause of the fever. He or she will ^probably tell you to give the child a fever-reducing medicine such as acetaminophen. If your child has had febrile seizures before, the doctor may have prescribed medicine to be inserted into the rectum. This treatment usual­ly works within a short time.

Infections

Most infections are caused by viruses or by bacteria. Children can become infected even before or during birth. Premature babies and those who had complicated births are partic­ularly vulnerable.

Toward the end of pregnancy, you pass a range of antibodies to your baby. The anti­bodies provide temporary protection against certain infections, especially against "child­hood diseases" such as measles, mumps, rubella, and chickenpox. However, the natur­al protection only lasts about 2 months —after that, vaccination is essential (see Chapter 14, "Baby's Checkups and Immunizations," pages 91 to 95.) Children who are breast-fed receive specific antibodies through moth­er's milk, which also provides protection against digestive system infections.

It's hard to prevent all infections in infants and toddlers. Babies who have older sisters and brothers, in particular, are con­stantly exposed to infectious substances. It may be comforting to know that babies do gradually build up their own defense sys­tem against infections.

EAR, NOSE, THROAT, AND

RESPIRATORY PROBLEMS

It's common for children to get respiratory infections, with a runny nose and a sore throat. Older children may develop a cough, whereas infants do not generally cough much when suffering from a cold. Colds are usually caused by viruses, which are spread by droplets from others (such as by coughing and sneezing). Viruses usually take 1 to 3 days before symptoms are seen. Nose and throat infections usually run their course in less than a week.

Feeling cold or being in cold weather doesn't cause colds, however, it may reduce a person's resistance to infection. Children needn't stay in bed when they have a normal cold. Give plen­ty of fluids, and give nose drops, if necessary, to ease breathing.If the tonsils become infected and swollen, eating may become a problem, and your child

may develop a sore, painful throat. When the adenoids of the throat are infected and swollen, the child's nose may also become blocked, and he or she may snore and breathe with an open mouth. Enlarged adenoids may lead to ear infections.

Croup

Croup is inflammation of the larynx (voice box) of the throat that causes a hoarse, bark­ing cough. It usually appears in connection with a normal cold. Symptoms often show up immediately after the child has gone to bed in the evening. The coughing leads to difficulty breathing, and inhalation (breath­ing in) becomes strained and hoarse, often with an unusual, jarring noise. Some babies get croup several times during their child­hood, but the condition becomes rarer as the child grows older.

Treatment consists of calming the child, raising the main part of the body, and having the child breathe moist air. The easiest way to do this is to take your child into the bath­room and let him or her breathe the steam from a hot shower. (Don't put the child into the hot water!) Drinking plenty of cool juice or water may also help reduce symptoms. Medicines are not generally advised at first, but do call the doctor or go to the hospital if the breathing difficulties become severe or if they don't improve quickly.

Ear infection

Ear infections are very common in young­sters. Often the symptoms are associated with a cold, but they may also be the only sign of an infection. Children typically hold their ear or turn their head from side to side.

The pain in the ears may become intense, and it may last for several days. Your child might be soothed by lying with his or her head high up. Acetaminophen can be used for both relieving pain and reducing fever. Ear infections are usually treated with antibi­otics. If the eardrum ruptures, pus may leak out from the ear. This should be looked at by a doctor as soon as possible. Letting pus or fluid stay in the middle ear might cause hear­ing problems.

Bronchitis

An infection can sometimes spread from the upper respiratory system — such as the nose and throat — down to the airway tubes, which are called the bronchi. During the first year of life, one kind of viral infection of the bronchi causes asthma-like symptoms, with strained, panting breathing. Some babies get so short of breath that they have to be admit­ted to the hospital. Older children may devel­op a troublesome cough. Treatment often consists of keeping the child indoors and let­ting him or her rest for a few days. A cough syrup that breaks up mucus may also help.

Pneumonia

Pneumonia is an inflammation of the lungs. It can be caused by viruses or by bac­teria. Symptoms include high temperature, rapid breathing, deep cough, and maybe pain in the chest. These symptoms can be worse if the pneumonia is accompanied by a cold. If you suspect pneumonia, you should call the doctor immediately.

GASTROINTESTINAL SYMPTOMS

Digestive system problems are very com­mon in infants and toddlers. Problems may range from vomiting, to tummy pains, to changes in the stools, to appendicitis.

Vomiting

Regurgitation (spittin^g up) frequently hap­pens in infancy, and often means that the baby has eaten too quickl^y or too much. Vomiting may also have causes entirely out­side the stomach and intestines. For example, urinary tract infection in infants and toddlers may show up as nausea and vomiting.

Violent vomiting — possibly to the extent that the vomit is projected across the room — might indicate a narrowing in the passage between the stomach and the small intestine. This projectile vomiting is more common in boys than in girls. Symptoms usuall^y occur a few weeks after birth. If the episodes are indeed caused by a narrow­ing, the child will need surgery.

For some children, spitting up and vomiting may go on past the first 6 months, and they become habitual regurgitators. Some babies seem to enjoy the regurgitation and almost "feed" on it. They may stick their fingers in their mouth or use their tongue to bring it on. If this continues, it can cause weight loss and other health problems. In that case, you should talk to the doctor.

Stomach pain

The cause of pain in the stomach or abdomen of a child may be very difficult to determine. It could be caused by colic, in which case a gentle massage and gas-reliev­ing medication often help. Turn to Chapter 7, pages 45 to 47, and Chapter 8, pages 49 to 51 for more information about colic and baby massage.

If the pain is around the belly button and isn't associated with fever, diarrhea, vomit­ing, or other symptoms, it probably shouldn't concern you unless it continues. However, if the pain is in another part of the abdomen or your child has other symptoms, you should definitely contact your doctor.

Babies who are given breast milk some­times react to foods their mother eats. Foods that give adults indigestion can also give breast-fed infants a tummy ache. These foods include onions, cabbage, grapes, and citrus fruits, as well as chocolates, nuts, and other

fruits, and the caffeine in coffee, tea, and some other beverages.

If you are bottle-feeding your baby, check that the hole in the nipple is the right size, so that the formula doesn't flow out too quickly or too slowly. Babies who suck in too much air when feeding may get stomach pains.

Change in bowel movements

A breast-feeding child may have made a bowel movement every time you change the diaper, or as rarely as once a week. Either of these is normal. If your child seems content­ed, has no stomach pains, and gains weight well, the frequency of bowel movements is not important.

However, infants can become constipated  from drinking too much cow's milk (includ­ing cow's milk formulas). Constipation often occurs with stomach pain and discomfort during bowel movement. The first option to consider is a change of diet. Laxatives should not be used unless you've consulted the doc­tor first.

Diarrhea is frequent, loose, watery stools. Some children have frequent bowel move­ments without diarrhea. The most common cause of diarrhea is stomach infection, often with a fever and vomiting. Such stomach infections should be taken seriously, because a child can become dehydrated within a short time. Signs of dehydration include

having a dry diaper for more than 8 to 10 hours, a dry tongue, and sunken eyes. A child with stomach infection should avoid cow's milk, most juices, and foods with fiber in them. Breast-feeding can be continued. Treatment consists of sugar water, commer­cial preparations specific for babies' diarrhea, or carbonated drinks. Write down how much the child is drinking, and try to keep track of approximately how much of it your child is expelling. If vomiting and diarrhea persist, and your child shows signs of dehydration, you should call the doctor.

Some children may continue to produce loose stools — stools that are very plentiful, are strong smelling, and have a fatty-looking shine. This may indicate that nutrients aren't being absorbed well enough in the intestines. Typically, children with such stools have a noticeably protruding stomach and thin arms and legs. They should be examined by a doc­tor for malnutrition.

Bloody stools can be a sign of intestinal infection or a tear in the rectum. It's possi­ble for a doctor to locate such tears. If your child has a large amount of fresh blood in the stools, the doctor should be called imme­diately. If the child also has stomach pains and cries inconsolably, he or.she might have a severe twisting of the intestines. This con­dition is serious if it lasts for more than a few hours.

Pinworms are common in small children and toddlers. A child with pinworms may wake up during the night with an itchy bot­tom. Small worms emerge at night from the rectum and appear in large numbers around the rectal opening. The worms are white, about 1/2 inch long, and as thin as thread. The worms and their eggs can be found everywhere and are spread by flies. The eggs get into the child's body through the mouth, and hatch in the intestines. Treatment to eliminate pinworms is simple — medicines are available at pharmacies. All family mem­bers should be treated.

Hernia

Hernia is a condition in which part of one of the organs in the abdomen swells out through a weak point in the abdominal wall. The most common type is umbilical hernia, which may become hard and tight when the child is crying. The child doesn't suffer and doesn't need to receive treatment. This hernia usually heals itself within the first year of life.

Inguinal hernia is more common in boys than girls, and more common with prema­ture than full-term babies. It appears as a bulge in the groin area or in the testicles. Such hernias get lar^ger and harder when the child cries. If the child keeps crying and suf­fers pain, and the hernia does not go back into place, immediate surgery is required.

An uncomplicated hernia that doesn't show signs of being "stuck" can be treated with a simple operation and a brief hospital stay.

CHANGES OF THE SKIN

Many newborns have small, yellow-white spots on the skin, usually on the nose and forehead. This is not a sign of infection. It will disappear without treatment.

Birth marks may be found anywhere on the body, but in newborns they are most often over the nose and on the back of the head. These will probably go away on their own. Another type of birth mark is hemangiomas. They are violet in color and may seem frightening, but will usually disappear within a couple of years. It is very rare to come across malignant (dangerous) birth marks in children.

During the first months of life, a mild eczema or "cradle cap" is common. Children develop a thick fatty layer on their scalp and other places. This usually disap­pears with gentle scrubbing with a soapy cloth or with a mild cortisone cream from the pharmacy. Atopic eczema normally appears later in the first year. It is character­ized by a red, itchy rash on the cheeks, and especially on the back of the arms and legs. Atopic eczema can flare up due to food and other allergies. If your child has eczema, and allergy runs in the family, you may be advised to avoid milk, eggs, and dairy prod‑

ucts. Children with eczema should use a special neutral soap.

Diaper rash is a skin irritation caused by the ammonia in urine. The skin is red and irritated, and frequently swollen and rough. The risk of diaper rash is greatest if the child lies for a long time in a wet diaper. You can use a protective cream at each diaper change to help prevent diaper rash, too. Sometimes a child may get a fungal infection in which the skin becomes bright red and looks irritated, with white peel­ing flakes. This should be looked at by a doctor.

Impetigo (milk blotch) is a contagious skin infection caused by bacteria. Impetigo can start in small cuts or sores, often around the mouth. It may look like eczema or chicken­pox if scratched severely. Impetigo is treated with an antibacterial cream or antibiotics.

Hives are an immediate sensitivity reaction of the skin. They're rare in infants, but rela­tively common in older children. Hives are a rash of uneven white spots surrounded by red skin. The rash can appear anywhere on the body, and is very itchy. The throat may also swell up, causing the child difficulty in breath­ing. Breathing or swallowing problems require immediate medical attention! Hives are sometimes brought on by medicines, but usu­ally the cause remains unknown. The itchiness can be somewhat soothed by allergy medicine or natural homeopathic medicine, if your doc­tor recommends it.

Heat rash appears when a baby is too hot. It looks like small red spots, which disappear when the baby cools down.

Thrush is a whitish coating on the tongue and in the mouth. It is common in infants and is due to a fungal infection. Thrush often appears after antibiotic treatment. Thrush in the mouth is harmless and does disappear with antifungal medicines.                     t

TEETHING

Teething can be uncomfortable, and may cause your child to be restless and irritable. However, there is no foundation for believing that teething causes raised temperature in chil­dren. If teething is associated with or followed by fever, it usually means that an infection has occurred, and a doctor should be consulted.

URINARY TRACT TROUBLES

Urinary tract infections are relatively uncommon in infants, but they can occur. Because babies can't complain of pain as they urinate, it may be hard to determine whether the symptoms stem from the urinary tract. It's also difficult to notice whether an infant is urinating more frequently than usual. Vomiting, loss of appetite and weight, and general lack of well-being may be symptoms of urinary tract infection. The urine should always be examined by a doctor when a pos­sible infection is accompanied by fever.

Tight foreskin can, for some boys, cause a swelling like a "balloon" at the tip of the penis during urination. If the foreskin is so tight that it causes problems during urination or infections of the foreskin, surgery may be required. Otherwise, the foreskin may be turned back and washed, but don't pull the skin so far back that it tears. Circumcision —the surgical removal of the foreskin — may be performed as part of a religious or social ritual — but there's no medical reason for doing it routinely.

COMMON CHILDHOOD DISEASES

Several of the following "childhood dis­eases" are becoming more rare as children receive immunization by vaccination. (See Chapter 14, "Bab^y's Checkups and Immuniza­tions," pages 91 to 95, for more information about vaccinations.)

Measles starts out as a "cold" with a runny nose, dry cough, and fever. The child's eyes become red and irritated, and a rash appears after 2 to 3 days. The incubation period — the time between infection and the beginning of symptoms — is about 7 to 10 days. If a child is exposed to infection before he or she has been vaccinated, gamma globulin can be given within 72 hours, which may prevent the development of the disease. Mumps is characterized by fever and swellin^g of the salivary (spit) glands in

front of the ears. Mumps is caused by a virus with an incubation period of 17 to 21 days. The illness can be almost symptom-free, or it can produce considerable swelling plus pain and fever.

Rubella (German measles) symptoms include a runny nose, slight fever, and achy joints. After 2 or 3 days, a pale red rash of small spots covers the entire body. The child develops swollen and sore lymph glands, especially in the back of the neck. The incu­bation period is 1 to 3 weeks.

Chickenpox often starts with a fever (100.5°F to 102.5°F) and a rash of small indi­vidual red spots that blister within hours. The rash is very itchy, so it may be soothing to rub some calamine lotion on the rash. Remember to trim your child's nails short to prevent him or her from cutting open the skin with scratching. Incubation takes 2 to 3 weeks.

Whooping cough begins as a cold, with runny nose and cough. There is no fever, or only a very slight temperature. Within 3 weeks, the cough is accompanied by "whooping" and vomiting, especially during

the night. The cough then goes away within a couple more weeks. The illness is caused by bacteria, and the incubation period is 1 to 2 weeks. Unfortunately, it's usually hard for the doctor to diagnose whooping cough early enough for antibiotics to be effective.

Scarlet fever normally starts with fever, sore throat, and swollen, red tonsils. After about 24 hours, red spots appear, often first on the inside of the thighs. Typical character­istics are red cheeks, a red "raspberry" tongue, and a pale triangle around the mouth. Scarlet fever may cause inflamed kidneys. The incubation period is 2 to 3 days. Scarlet fever is caused by bacteria called streptococci that respond very well to penicillin.

Three-day-fever (roseola) is an illness mainly affecting children 6 months to 3 years of age. It causes high fever for about 3 days, commonly with a red throat, too. After 3 days, the temperature suddenly drops, coin­ciding with a light spotty rash covering the whole body. The disease is caused by a virus, and is not particularly contagious. Neither does it require any special treatment.