Though severe reactions to immunizations are exceedingly rare, you should call the doctor if your baby experiences any of the following within two days of the shot:
High fever (over 104°F)
Crying that lasts longer than three hours
Seizures/convulsions (jerking or staring)—usually because of fever and not serious Seizures or major alterations in consciousness within seven days of shot
An allergic reaction (swelling of mouth, face, or throat; breathing difficulties; immediate rash)
Listlessness, unresponsiveness, excessive sleepiness
Should you note any of the above symptoms following an injection, call the doctor. This is not just for your baby’s sake, but also so that the doctor can report the response to the Vaccine Adverse Events Reporting System. Collection and evaluation of such information may help reduce future risks.
As with other vaccines, Hib vaccine should not be given to a child who is very ill (mild illness isn’t a problem), or who might be allergic to any of the components (check with the doctor).
Hepatitis vaccines. Hepatitis B (hep B), a chronic liver disease, can cause liver failure and liver
cancer in future years. Three doses are needed. It is recommended that the vaccine for hepatitis B be given at birth (it may be delayed for premature infants), one to four months, and six to eighteen
months. (If the Pediarix combo vaccine is administered, the doses are given at two, four, and six months instead.) Side effects—slight soreness and fussiness—are not common and are short-lived.
The vaccine for hepatitis A (hep A), which also affects the liver, is recommended for children over age two living in high-risk states and countries, mostly in the western United States (check with your doctor to see if you are living in a high-risk area).
Pneumococcal conjugate vaccine (PCV7). The pneumococcus bacterium is a major cause of illness among children, responsible for some ear infections, meningitis, pneumonia, blood infections, and other illnesses. Though the PCV vaccine is one of the newer vaccines, large studies and clinical trials have shown that it is extremely effective in preventing the occurrence of certain types of ear
infections, meningitis, pneumonia, and other related life-threatening infections. Children should get the vaccine at two, four, and six months, with a booster given at twelve to fifteen months. Side effects, such as low-grade fever or redness and tenderness at the injection site, are occasionally seen and are not harmful.
Influenza. The influenza, or “flu” vaccine is now recommended for all healthy babies between six and twenty-two months old. In the past, it was recommended that only young children at high risk for flu complications receive the vaccine. But studies indicate that even healthy children under age two are at increased risk for hospitalization from flu-related complications. The vaccine is especially important for those at high risk—those with serious heart or lung disease, those with depressed
immune systems, asthma, HIV, diabetes, and those with sickle-cell anemia or similar blood diseases.
The flu vaccine should not be given to anyone who has had a severe allergic reaction to eggs. High- risk children may, instead, be given antiviral medications to prevent development of influenza. When having your child immunized, ask for a thimerosal-free flu vaccine. (Flu Mist, the nasal spray flu vaccine, is not recommended for children under age five.)
If for some reason any of your baby’s vaccinations are postponed, immunization can pick up where it left off; starting over isn’t necessary. Work with the doctor to get your child caught up as soon as possible.
CRADLE CAP
“I wash my daughter’s hair every day, but I still can’t seem to get rid of the flakes on her scalp.”
Don’t pack away those dark-shouldered outfits yet. Cradle cap, a seborrheic dermatitis of the scalp common in young infants, doesn’t doom your daughter to a lifetime of dandruff. Mild cradle cap, in which greasy surface scales appear on the scalp, often responds well to a brisk massage with mineral oil or petroleum jelly to loosen the scales, followed by a thorough shampoo to remove them and the oil. Tough cases, in which flaking is heavy and/or brownish patches and yellow crustiness are
present, may benefit from the daily use of an antiseborrheic shampoo that contains sulfur salicylates, such as Sebulex (make sure you keep it out of baby’s eyes) after the oil treatment. (Some cases are aggravated by the use of such preparations. If your baby’s is, discontinue use and discuss this with the doctor.) Since cradle cap usually worsens when the scalp sweats, keeping it cool and dry may also help—so don’t put a hat on baby unless necessary (such as in the sun or when it’s cold outside), and
then remove it when you’re indoors or in a heated car.
When cradle cap is severe, the seborrheic rash may spread to the face, neck, or buttocks. If this occurs, the doctor will probably prescribe a topical ointment.
Occasionally, cradle cap will persist through the first year—and in a few instances, long after a child has graduated from the cradle. Since the condition causes no discomfort and is therefore
considered only a cosmetic problem, aggressive therapy (such as use of topical cortisone, which can contain the flaking for a period of time) isn’t usually recommended but is certainly worth discussing with your child’s doctor as a last resort.
CROOKED FEET
“Our son’s feet seem to fold inward. Will they straighten out on their own?”
Your son’s not alone in his stance; most babies appear bowlegged and pigeon-toed. This happens for two reasons—one, because of the normal rotational curve in the legs of a newborn, and, two, because the cramped quarters in the uterus often force one or both feet into odd positions. When baby emerges at birth, after spending several months in that position, the feet are still bent or seem to turn inward.
In the months ahead, as your baby’s feet enjoy their out-of-utero freedom and as he learns to pull up, crawl, and then walk, his feet will begin straightening out. They almost always do so without treatment.
Just to be sure there isn’t another cause of your baby’s foot position, express your concerns at his next well-baby visit. The doctor probably has already checked your baby’s feet for abnormalities, but another check to put your mind at ease won’t hurt. It’s also routine for the doctor to keep an eye on the progress of a baby’s feet to make sure they straighten out as he grows—which they almost certainly will in your son’s case.
In the very unlikely event a baby’s feet don’t appear to be straightening out on their own, casting or special shoes may be recommended at a later date. At just what point treatment is considered will depends on the type of problem and on the doctor’s point of view.
UNDESCENDED TESTICLES
“My son was born with undescended testicles. The doctor said that they would probably descend from the abdomen by the time he was a month or two old, but they haven’t yet.”
The abdomen may seem a strange location for testicles, but it isn’t. The testicles (or testes) in males and the ovaries in females both develop in the fetal abdomen from the same embryonic tissue. The ovaries, of course, stay put. The testes are scheduled to descend down through the inguinal canals in the groin, into the scrotal sac at the base of the penis, somewhere around the eighth month of gestation.
But in 3 to 4 percent of full-term boys and about one third of those that are preterm, they don’t make the trip before birth. The result: undescended testicles.
Because of the migratory habits of testicles, it’s not always easy to determine that one hasn’t descended. Normally, the testicles hang away from the body when they are in danger of overheating (protecting the sperm-producing mechanism from temperatures that are too high). But they slip back up into the body when they are chilled (protecting the sperm-producing mechanism from temperatures that are too low) or when they are handled (again protective, to avoid injury). In some boys the testes
are particularly sensitive and spend a lot of time sheltered in the body. In most, the left testicle hangs lower than the right, possibly making the right seem undescended (and making a lot of young boys worry). The diagnosis of undescended testicle or testicles is therefore made only when one or both have never been observed to be in the scrotum, not even when the baby is in a warm bath.
An undescended testicle causes no pain or difficulty with urinating, and as your doctor assured you, usually descends on its own. By age one, only three or four boys in a thousand still have un- descended testicles, at which point surgery (a minor procedure) can easily put them in their proper place. Hormone therapy can be tried first, but it isn’t usually successful.
PENILE ADHESION
“My son was circumcised as a newborn, and my doctor says he’s developed a penile adhesion.
What does that mean?”
Whenever tissues of the body are cut, the edges will stick to the surrounding tissue as it heals. After the foreskin of the penis is removed during a circumcision, the circular edge remaining tends to stick to the penis as it heals. If a significant amount of foreskin remains after the circumcision, it, too, can stick to the penis during the healing process, causing the foreskin to reattach. This penile adhesion is not a problem as long as it’s gently retracted periodically to prevent it from becoming permanently attached. Ask the doctor how you should do this or if it’s really necessary to do at all. When boys, even baby boys, have their normal erections, the sticking skin surfaces are pulled, helping to keep them apart, without any adult intervention. Rarely, if a bridge of skin has permanently attached, a urologist may need to separate the skin and remove the remaining piece of foreskin to prevent the problem from recurring.
INGUINAL HERNIA
“The pediatrician said that my twin boys have inguinal hernias and will have to have surgery. Is this serious?”
A hernia is often thought of as something that develops when a grown man does too much heavy lifting. But even infants too young to lift a finger—never mind a heavy package—aren’t too young to experience a hernia. Hernias are not unusual in newborns, particularly boys, and especially those born prematurely (as twins often are).
In an inguinal hernia, a part of the intestines slips through one of the inguinal canals (the same channels through which the testes descend into the scrotum) and bulge into the groin. The defect is often first noted as a lump in one of the creases where the thigh joins the abdomen, particularly when a baby is crying or very active; it often retracts when he is quiet. When the section of the intestines slips all the way down into the scrotum, it can be seen as an enlargement or swelling in the scrotum, and may be referred to as scrotal hernia.
A hernia doesn’t usually cause any discomfort, and while it must be treated, it isn’t a serious condition and isn’t considered an emergency. Nevertheless, any parent who notices a lump or
swelling in their baby’s groin or scrotum should report the finding to the doctor as soon as possible.
Doctors usually advise repair as soon as the hernia is diagnosed—assuming the baby is fit for surgery. Such surgery is usually simple and successful, with a very short (sometimes one-day) hospitalization. Only very rarely does an inguinal hernia recur following surgery, though in some
children another hernia occurs on the opposite side at a later date.
If a diagnosed infant inguinal hernia is not treated, it can lead to the herniated section becoming
“strangulated”—pinched by the muscular lining of the inguinal canal, obstructing blood flow and digestion in the intestines. Vomiting, severe pain, even shock can result. Parents who note a baby suddenly crying in pain, vomiting, and not having bowel movements should call the doctor
immediately. If the doctor can’t be reached, the baby should be taken to the nearest emergency room.
Elevating the baby’s bottom slightly and applying an ice pack while en route to the ER may help the intestine to retract, but don’t try to push it back in by hand.
INVERTED NIPPLES
“One of my daughter’s nipples sinks in instead of standing out. What’s wrong with it?”
It’s inverted—not at all uncommon in the nipples of infants. Often, a nipple that is inverted at birth corrects itself spontaneously later. If it doesn’t, it won’t be an issue until she’s ready to nurse her own baby, at which point (if necessary, and it likely won’t be) she can take steps to draw the nipple out.
FAVORING ONE BREAST
“My little girl hardly ever wants to nurse on my left breast, and it’s shrunken to be considerably smaller than the right.”
Some babies play favorites. It could be that your baby’s more comfortable cradled in your favored, and probably stronger, arm, so she developed a taste for the breast on that side. Or that you often place her on the left breast, so that your right hand is free for eating, holding a book or the phone, or handling other chores, leaving the right breast to dwindle in size and production (or the reverse, if you’re left-handed). Perhaps one breast is the better provider because you favored it early on in the nursing relationship, for any number of reasons—from the location of the cesarean incision pain to the location of the TV set in your bedroom.
Whatever the reason, preferring one breast over the other is a fact of nursing for some babies, and lopsidedness a fact of life for their mothers. Though you might try to increase production on the less favored side by pumping daily and/or starting every feeding with it (if your baby will cooperate), these efforts may not do the trick. In many cases, mothers go through the entire nursing experience with one breast larger than the other (though you’ll probably be the only one who notices the difference). The lopsidedness will diminish after weaning, though a slightly greater-than-normal difference may continue.
Very rarely, a baby rejects a breast because it harbors a developing malignancy. So do mention your baby’s penchant to your doctor.
USING A BABY CARRIER OR SLING
“We usually carry our son around in a baby carrier. Is this a good idea?”
It’s been a good idea for millennia. Baby carriers and slings—cloth sacks that harness infants to their parents or other caregivers—have, in one form or another, been helping transport babies in other cultures since prehistoric times. There are at least three good reasons. First, babies are usually happy
riding in a carrier; they enjoy the steady gentle movement and the closeness to a warm body. Second, babies tend to cry less if they’re carried around a lot—and carrying is made a lot easier with a
carrier. And, third, carriers provide parents and other caregivers with the freedom to attend to their daily chores—tote packages, push shopping carts or the vacuum cleaner, make phone calls—while carrying baby.
Different kinds of baby carriers come with different benefits; see a discussion of these on page 60. But if baby carriers are a boon to today’s parents, they can also be a bane if overused or misused.
Keep in mind the following when carrying your baby:
Overheating. On a very warm day, even a scantily clothed baby can simmer in a baby carrier—
particularly one that encloses the baby’s legs, feet, and head or is made from a heavy fabric such as corduroy. Such overheating can lead to prickly heat and even heat stroke. If you use a carrier in warm weather, in overheated rooms, or on a hot bus or subway (baby carriers should never be used instead of a safety seat in the car), check your baby frequently to be sure he isn’t sweating and his body
doesn’t feel warmer than yours. If he does appear to be overheated, remove some clothing or take him out of the carrier completely.
Understimulation. A baby who’s always cooped up in a baby carrier that limits his visual
perspective to a chest and, if he looks up, the bottom of a face doesn’t have the opportunity he needs to see the world. This is not a major problem in the first few weeks of life, when a baby’s interest is usually limited to the most basic creature comforts, but it can be now, when he’s ready to expand his horizons. Use a convertible carrier or a sling in which baby can face in for a nap or out for viewing the world, or limit baby’s sojourns to times when he will be sleeping or will be pacified only by being carried and you need your arms for other purposes. At other times, use a stroller or infant seat.
Too much sleeping. Babies who are toted in baby carriers tend to sleep a lot—often a lot more than they need to, with two less-than-desirable results. First, they get used to catnapping on the go (fifteen minutes when you run out to the corner grocery store, twenty when you walk the dog) rather than taking longer naps in their cribs. Second, they may become so well rested during the day that they don’t rest much at night. If your baby immediately falls asleep when placed in a carrier, limit use to make sure he doesn’t nap the day away in it.
Risk of injury. A young infant’s neck isn’t strong enough yet to support his head when he’s jiggled and jostled a lot. Though securing your baby in a baby carrier or sling while you jog may seem like an ideal way of getting your exercise and keeping your baby happy, too, the bouncing could be risky.
Instead, strap him in a stroller when you go for a jog. Also be careful to bend at the knees, not the waist, when wearing the carrier—or your baby could slip out.
While judicious use of a baby carrier can make your life easier and your baby’s life happier, he won’t be ready for a back carrier until he can sit by himself.
THE CHALLENGING BABY
“Our little girl is adorable, but she seems to cry for the least little reason. If it’s too noisy, or too bright, or even if she’s a little wet. We’re going crazy trying to cope with this. Are we doing something wrong?”