If there isn’t adequate space in your new arrival’s baby book, buy a notebook to use as a permanent health history. Record all your baby’s birth statistics, as well as information about each illness, medications given, immunizations, doctors, and so on. What follows is a sample of the kinds of things to include.
AT BIRTH
Weight: Length: Head circumference:
Condition at birth:
Apgar score at one and five minutes:
Results of other tests:
Any problems or abnormalities:
INFANT ILLNESSES
(for each illness record the following information)
Date began: Date recovered:
Symptoms:
Doctor called:
Diagnosis:
Instructions:
Medications given: How long:
Side effects:
IMMUNIZATIONS
Type: Received: Reactions:
Cause: GER is the return of stomach contents into the esophagus. Normally during swallowing, the esophagus propels food or liquid down to the stomach by a series of squeezes. Once food has entered the stomach, it is mixed with acid to start digestion. When this mixing occurs, the circular band of muscles at the lower end of the esophagus becomes tight, keeping the food from backing up. In
premature and some term infants, the junction between the stomach and esophagus is underdeveloped and it sometimes relaxes when it should be tightening. This relaxation of the muscles allows the liquid and food to come back up. Reflux of the acidic stomach content irritates the lining of the esophagus and causes a form of heartburn.
Duration: GER usually begins between two and four weeks of age and can last until the child is one or two years old. Symptoms peak around four months and begin to subside around seven months when the baby begins to sit upright and take more solid foods.
Treatment: Mild forms of GER are common, usually require no treatment, and subside on their own over a period of months. For more serious GER, treatment is aimed not at curing the illness but at making baby feel better until he or she outgrows it. Use the strategies for prevention (below) to help ease your baby’s discomfort. Medications that reduce stomach acid, that neutralize stomach acids, or that increase stomach motility are sometimes helpful but should be given only if the doctor prescribes or recommends one for your baby. If the condition is serious and other forms of treatment have failed, surgery may be performed to tighten the lower esophageal sphincter.
Dietary changes:
Avoid overfeeding. Offer smaller amounts of breast milk, formula, or solid food more frequently.
When the infant is old enough to eat solids, serve thicker, rather than thin, watered-down foods.
Gravity holds down heavier foods more easily. Also, avoid acidic (once introduced) or fatty foods in large quantities.
Prevention: GER can’t always be prevented, but there are things you can do to reduce its severity:
Breastfeed for as long as possible. GER is usually much less severe in breastfed babies because breast milk is more easily and more quickly digested than formula and acts as a natural antacid. If you are breastfeeding, eliminate caffeine (a known contributor to reflux) from your diet.
Make feedings as calm and quiet as possible, avoiding interruptions.
Burp your baby frequently.
Prop your baby upright during feeding and for one to two hours after feedings. If possible, do this in a quiet place. If your baby falls asleep after a feeding, put him or her to bed flat, but at an
incline. You can do this by placing a couple of pillows under the head of the mattress or using a slanted wedge pillow specially designed for babies with GER (Velcro straps keep baby from sliding down).3
Try offering a pacifier after feedings; sucking on a pacifier often eases reflux.
Avoid playing or jostling the baby immediately after feedings. Don’t give baths after feeding.
Don’t smoke around baby. Nicotine stimulates gastric acid production.
Complications:
Failure to thrive
Severe choking spells
Wheezing, aspiration pneumonia, and other lung problems Apnea
When to call the doctor:
If GER is severe enough to interfere with weight gain or sleep.
If your baby seems to be in a lot of pain.
Chances of recurrence: The good news is that almost all babies with GER will outgrow it. And once they do, it usually doesn’t recur. Occasionally, reflux can continue into adulthood.
Conditions with similar symptoms:
Viral or bacterial infections Asthma
Pyloric stenosis Metabolic diseases Hirshsprung’s disease
URINARY TRACT INFECTION (UTI)
Urinary tract infections (UTIs) are bacterial infections of the urinary tract (kidneys, ureters, bladder, and urethra).
Symptoms: Symptoms of a UTI can be hard to recognize in a baby or young child, but they’re important to look for when a child is sick with a fever and urination appears painful. Symptoms include:
Unexplained fever in a baby
Crying, irritability, holding the genitals, or showing other signs of pain when urinating Stomach or back pain (hard to detect in infants)
Foul-smelling urine Cloudy urine
Bloody (brown, red, or pink) urine More frequent than usual urination
Nausea, vomiting, or diarrhea with other urinary symptoms Decreased appetite or lack of interest in eating
Irritability
Poor growth in an infant Season: All year round
Cause: The urinary tract includes the kidneys, the bladder, the tubes that carry urine from the kidneys to the bladder (ureters), and the tube that carries urine from the bladder to outside of the body
(urethra). Urinary tract infections occur when bacteria (or, more rarely, a virus or fungus) begin to grow in the urinary tract. UTIs are common in young children because the urethra is very short, providing bacteria with easy access to the bladder.
Method of diagnosis: The doctor will need to perform a urine culture on sterile urine to determine if the child does indeed have a UTI. To do this on a young baby, the doctor may place a plastic bag over the genitals to collect the urine. This method of collection isn’t very accurate because bacteria (from the rectum, from the environment) can contaminate the sample. A better way of collecting a urine sample for culture is by inserting a catheter up the urethra and retrieving urine directly from the bladder.
Method of transmission: The bacteria can come from the skin around the rectum and genitals and then travel up the urethra to the bladder. Some UTIs are caused by bacteria in the blood moving through the kidneys.
Duration: Depends on the type of infection and how severe it is.
Treatment: Most UTIs are effectively treated with antibiotics.
Dietary changes:
Increase fluid intake
Prevention: Some children are prone to UTIs because of their anatomy. Preventive measures include:
When changing a diaper, always wipe from front to back, even for boys.
Make sure your baby gets a lot of fluids to help flush unwanted bacteria out of the body.
Avoid bubble baths and perfumed soaps, which can irritate the genitals, especially in girls.
Some studies suggest that cranberry juice is effective against UTIs, but the studies have all been done on adults, not children; consult with your baby’s doctor.
Possibly, circumcision for boys. Some research shows that uncircumcised boys are slightly more prone to UTIs.
Complications: Untreated urinary infections can lead to kidney infections, which, if left untreated, can cause serious damage.
When to call the doctor: If your baby has a fever for a few days without any signs of a cold (such as runny nose), if urination seems to be painful, or if your baby is experiencing any of the symptoms
listed above.
Chances of recurrence: Can recur at any time.
RESPIRATORY SYNCYTIAL VIRUS (RSV)
RSV is the leading cause of lower respiratory tract infections in infants and young children.
Approximately two-thirds of infants are infected with RSV during their first year. For most babies, RSV infection causes no more than a minor illness. In certain high-risk babies, however, RSV may lead to something much more serious.
Symptoms: In most infants, the virus causes symptoms resembling those of the common cold, including:
Nasal congestion Runny nose
Low-grade fever Decreased appetite Irritability
In some infants, it can sometimes cause lower respiratory (lung) symptoms (bronchiolitis):
Rapid breathing Flaring of the nostrils Rapid heart rate Hacking cough Grunting
Noticeable bluish color in the skin around the mouth (cyanosis) Wheezing sound when breathing
Skin between the ribs is sucked in with each breath Lethargy, sleepiness, dehydration
Season: Peaks between October and April.
Cause: RSV is such a common virus that nearly all adults and children are affected by it sooner or later. A normal cold virus or mild RSV infection affects just the nose and upper part of the lungs. But these symptoms can worsen rapidly in some babies, as the virus infects the lungs, inflaming the lower part of the lungs and the smallest inner branches of the airways, making it difficult to breathe (such an infection is called bronchiolitis). For most babies, the illness is mild. But babies at risk (such as premature babies whose lungs are underdeveloped and who have not yet received enough antibodies from their mothers to help them fight off RSV disease once they’ve been exposed to it) are more
likely to get severe bronchiolitis and end up in the hospital. Those considered at higher risk include babies who:
Were born prematurely
Have pre-existing lung disease Are not breastfed
Are exposed to tobacco smoke
Were one in a multiple birth (such as twins), since they’re more likely to be premature Were born within 6 months of the RSV season (birthday in April or later)
Attend day care (because these babies are more likely to be exposed to RSV infection in the first place)
Have school-age siblings; again, because exposure is more likely
Method of transmission: RSV is highly contagious and is transmitted by direct hand contact from infected individuals. The infection can also be spread through the air, by coughing and sneezing. RSV can survive for four to seven hours on surfaces such as cribs and countertops.
Method of diagnosis: Diagnosis is generally made by nasal swab, with a chest X ray to confirm the diagnosis.
Incubation period: Four to six days from exposure.
Duration: Children with mild RSV bronchiolitis are treated at home and improve within three to five days, though they may remain contagious for up to a week.
Treatment: For those whose RSV has caused more severe bronchiolitis:
Oxygen administration if there is respiratory distress or blood oxygen levels are low. Rarely, infants may need to be briefly placed on a ventilator.
Albuterol, a medication that opens up the airways and is given through a nebulizer, may help. The nebulizer machine turns liquid medicine into a mist that is then inhaled.
Steroids have been found to decrease inflammation in the lungs and are sometimes used to treat severe RSV bronchiolitis.
Antibiotics are not effective because RSV is a virus, not a bacteria.
Dietary changes: As with the common cold, be sure your baby gets plenty of fluids.
Prevention:
Breastfeed, if possible.
Make hand washing a priority around the house.
Keep older siblings away from the baby as much as possible if they have a runny nose, cold, or fever.
Do not take a high-risk baby out to crowded areas such as shopping centers during RSV season.
Do not smoke around your baby.
Vaccination is available to prevent RSV (not as a treatment), but the vaccine, called Synagis, does not give long-term protection and must be administered monthly during RSV season to high-risk infants in the hospital. It is also extremely expensive.
Complications:
High-risk children who are infected with RSV disease often need to be hospitalized Dehydration
Respiratory failure When to call the doctor:
If your infant has any symptoms of bronchiolitis (see page 760).
If a fever persists for more than four to five days and/or remains elevated despite giving acetaminophen.
If your infant has changes in breathing pattern (rapid breathing, wheezing, or if the skin between the ribs is sucked in with each breath) or is difficult to console.
Chances of recurrence: Almost all children recover fully with no lasting effects. Reinfection throughout life is common, though lower respiratory tract symptoms are most common in infants and toddlers and most marked in the first infection. In older children, RSV is indistinguishable from the common cold.
Conditions with similar symptoms:
Common cold
Asthma (though less often in younger infants) Pneumonia
Gastric reflux with aspiration of the stomach contents may also produce the symptoms of bronchiolitis, but cold-like symptoms do not precede respiratory distress in these cases.
What It’s Important to Know: ALL ABOUT FEVER
Though you may remember your mother standing over you, thermometer in hand, concern in her voice, announcing, “You’ve got a fever, I’d better call the doctor,” fever hasn’t always been considered cause for alarm. The ancients welcomed an elevated temperature because they were convinced that it burned out bad “humors.” Hippocrates, too, speculated that fevers did more good than harm. In the
Middle Ages, fever was actually induced on occasion to fight syphilis and certain other infections.
And in fact, fever was believed so beneficial historically that it wasn’t even treated until about 100 years ago, when aspirin, with its fever-reducing capabilities, came on the scene. With the advent of aspirin, however, came a reformulating of medical opinion about fever. Throughout much of the twentieth century, even the slightest rise in temperature became a cause for worry, and a high fever for all-out panic.
Oddly enough, as it turns out, Hippocrates and the other ancients had a better notion of what fever is all about than did the modern medical community of a few generations ago. Research has confirmed that most fevers serve to heal, rather than harm—that they exist in a sense to burn out, if not the bad humors, at least the bad germs that invade and threaten the body. Instead of being a condition to be feared and fought, fever is now recognized to be an important part of the body’s immune response to infection. Fever is not a disease; rather, it is a sign of illness—and a sign of the body’s effort to overcome the illness.