Most parents wouldn’t consider treating a baby’s symptoms with anything stronger than acetaminophen without first placing a phone call to the pediatrician. Some won’t even reach for the Infant Tylenol without the doctor’s okay. Yet many of the same parents wouldn’t hesitate to visit the local health food store to look for a holistic remedy for their baby’s cold, flu or constipation—or think twice about dosing baby with an herbal remedy without checking in with the doctor first.
They have plenty of company. According to some estimates, up to 40 percent of parents in the U.S. have joined the ranks of those choosing alternative therapies for their children.
Whether it’s a dose of echinacea to nip a cold in the bud, a sniff of lavender to relieve stress, a bottle of chamomile to soothe a colicky baby, or a visit to the chiropractor to prevent
recurrent ear infections, complementary and alternative medicine (CAM) has clearly found its way into the nursery.
But the question is—is the nursery any place for CAM? For years, alternative medicine—
and those who practiced it—was considered the province of fringe practitioners. Today, it’s being integrated in one form or another into almost every area of traditional medicine, from cardiology to oncology. Unfortunately, however, the study of CAM in pediatric practice has lagged seriously behind. Virtually no CAM therapies have been tested on children, making determining which treatments are safe for the littlest patients and which aren’t an imprecise science—even for scientists. For parents, who have only anecdotal information to go on, the answers are even more elusive.
Some study is under way; much more needs to be done. In the meantime, here’s what you need to consider before taking a CAM approach to your child’s health. First, unlike over-the- counter and prescription medicines, herbal remedies are not rigorously regulated by the FDA.
They haven’t been tested for effectiveness, safety, or proper dosing, even in adults. Second,
“natural” doesn’t necessarily mean safe. Herbal remedies are not necessarily any safer than pharmaceutical preparations, and in some cases may be a lot less safe. In fact, some herbal remedies can actually cause serious side effects in children; others may interfere with traditional care a child is receiving—interacting badly with a prescribed medication, for instance. Third, while there are almost certainly CAM therapies that are beneficial,
proceeding with any treatment—traditional or alternative—without consulting a
knowledgeable physician is unwise and potentially unsafe. If you’re considering using a CAM therapy on your baby, always check with his or her doctor first.
Stool streaked with blood, if there are anal fissures (cracks in the anus caused by the passage of hard stool)
Gastric distress and abdominal pain Irritability
Season: Any time
Cause: A sluggish digestive tract, illness, insufficient fiber in diet, not enough to drink, insufficient activity, or an anal fissure that makes defecation painful; rarely, a more serious medical condition.
Duration: May be chronic or occur just occasionally.
Treatment: Though constipation is not unusual in bottle-fed infants, symptoms should always be reported to the doctor, who can, when necessary, check for any abnormalities that might be causing it.
Occasional constipation or mild chronic constipation is usually treated with dietary changes (see below); an increase in exercise may help (in infants, try moving the legs in a bicycle fashion when you see your baby having difficulty with a movement). Do not give laxatives, enemas, or any medication without the doctor’s instructions.
Dietary changes: Make these only after consultation with baby’s doctor:
If they’ve been introduced, give an ounce or two of prune or apple juice by bottle, cup, or spoon.
For a baby on solids, increase intake of fruits (other than banana) and vegetables.
In older babies, cut back on dairy products (but not breast milk or formula).
Prevention: When solids are added to baby’s diet, be sure to include mostly whole grains plus plenty of fruits and vegetables. Also be sure fluid intake is adequate and that baby has plenty of opportunity for physical activity.
Complications:
Fissures
Impacted stool (stool that is not passed naturally and may be painful to remove manually)
If it continues chronically through the toddler and preschool years, difficulty with toilet training can result.
When to call the doctor: If your baby seems to be constipated often or regularly; if the problem suddenly arises when it has not been noted before; or if there is blood in the stool.
Chance of recurrence: The problem can become a “habit” if it isn’t dealt with when it first occurs.
Conditions with similar symptoms:
Intestinal obstructions or abnormalities
DIARRHEA
This problem, too, is unusual in breastfed babies because there appear to be certain substances in breast milk that destroy many of the microorganisms that cause diarrhea.
Symptoms:
Liquidy, runny stools (not seedy like a breastfed baby’s stools) Sometimes:
Increased frequency Increased volume Mucus in stool Blood in stool Vomiting
Cause: Very varied:
Gastrointestinal infection (viruses, most often rotavirus; also bacteria, parasites) Sometimes, another infection
Teething (possibly)
Sensitivity to a food in the diet
Too much fruit or juice (particularly apple or pear)
Antibiotic medication (feeding yogurt with live cultures to a baby on antibiotics may prevent this type of diarrhea)
Method of transmission: Infectious cases can be transmitted via the feces-to-hand-to-mouth route.
Also transmitted by contaminated foods.
Incubation period: Depends on the causative organism.
Duration: Usually anywhere from a few hours to several days, but some cases can become chronic if the cause is not discovered and corrected.
Treatment: Depends on the cause, but most common approaches are dietary (see below). Sometimes medication may be prescribed. Do not give antidiarrheal medication to an infant without the doctor’s approval—some can be harmful to young children. Protect baby’s bottom from irritation by changing diapers as soon as possible after they’re soiled and by spreading on a thick ointment after each
change. If diaper rash develops, see page 269.
A very sick baby may need hospitalization to stabilize body fluids.
Dietary changes:
Continuing breast or formula feedings in most cases is best. Since a baby with diarrhea may develop a temporary lactose intolerance, a switch to a soy-based, lactose-free formula may be recommended if the diarrhea doesn’t improve on baby’s regular formula.
High fluid intake (at least 2 ounces an hour) to replace fluids lost through diarrhea. To augment breast milk or formula, a rehydration fluid (such as Pedialyte), available over the counter at any pharmacy, is sometimes recommended. Offer a few sips by spoon, cup, or bottle every two or three minutes, working up to 8 ounces between loose bowel movements. Do not give sweetened drinks (such as colas), undiluted fruit juices, athletic drinks, glucose water, or homemade salt-and- sugar mixtures.
Continuation of solids, if baby takes them regularly. The sooner a baby is fed, the less severe the diarrhea will be. Research shows that eating fat and fiber together bulks up stool. Good choices for solids include oatmeal and yogurt (which has the added bonus of “good” bacteria to aid in digestion). Small amounts of protein foods (such as chicken) are also appropriate. Steer clear of other fruits (besides bananas) and vegetables in the short term.
If there is vomiting, solid feeding is usually not resumed until vomiting has stopped. But do offer sips of clear fluids (diluted juices or oral rehydration fluid, if prescribed). Offering small amounts (no more than a tablespoon or two at a time, less for a very young infant) will greatly increase the chance that it will be held down. Once vomiting has stopped, foods can be added as above.
When stool begins to return to normal, usually after two or three days, the doctor will recommend that you begin to return your baby to a regular diet but continue limiting dairy products (other than breast milk and formula) for another day or two.
In diarrhea that lasts for two weeks or more in a bottle-fed infant, the doctor may recommend a change in formula.
Prevention: Diarrhea can’t always be prevented, but risks can be reduced:
Attention to sanitary preparation of foods (see page 328).
Careful hand washing by baby’s care providers after handling diapers and going to the bathroom.
The dilution of fruit juices taken by babies; limiting total intake to no more than 4 to 6 ounces a day; switching to white grape juice (see box, page 554).
Complications:
Diaper rash
Dehydration, if diarrhea is severe and left untreated
When to call the doctor: One or two loose stools is not a cause for concern. But the following indicate diarrhea that may need medical attention:
You suspect baby may have consumed spoiled food or formula.
Baby has had loose, watery stools for 24 hours.
Baby is vomiting (more than the usual spit-up) repeatedly, or has been vomiting for 24 hours.
There is blood in baby’s stools.
Baby is running a fever or seems ill.
Call immediately if baby shows signs of dehydration: significantly decreased urine output
(diapers aren’t as wet as usual and/or urine is yellow); tearless and sunken eyes; a sunken fontanel (“soft spot”); dry skin; scanty saliva.
Chance of recurrence: Likely, if cause has not been eliminated, some babies are more prone to diarrhea.
Conditions with similar symptoms:
Food allergies Food poisoning Enzyme deficiencies
MIDDLE EAR INFLAMMATION (OTITIS MEDIA)
Babies and young children are more susceptible to earaches of all kinds, for a variety of reasons.
Most outgrow the susceptibility.
Symptoms: In acute otitis media (AOM), infection of the middle ear, symptoms include:
Usually:
Ear pain, often worse at night (babies sometimes pull or rub or hold their ears but often give no indication of pain except for crying, and sometimes not even that; crying when sucking on breast or bottle may indicate ear pain that has radiated to the jaw)
Fever, which may be slight or very high Fatigue and irritability
Runny nose and congestion (often, but not always) Sometimes:
Nausea and/or vomiting Loss of appetite
Occasionally:
No obvious symptoms at all
On examination, the eardrum appears pink (during the early stages of infection), and then red and
bulging (later on). In many cases, AOM will get better without treatment (though the decision of
whether to treat or to “wait and see” should be left to the doctor; see page 554 for more on treatment).
Sometimes, however, if the infection is left untreated, pressure can burst the drum, releasing pus into the ear canal and relieving pressure. The eardrum heals eventually, but treatment helps to prevent further damage.
In serous otitis media (SOM), also known as otitis media with effusion, or fluid in the middle ear, symptoms include:
Usually:
Hearing loss (temporary but can become permanent if condition persists for many months untreated)
Sometimes:
Clicking or popping sounds on swallowing or sucking (as reported by older children)