Navigate Common Health Concerns for Babies

Prepare to be on a first-name basis with your child's health care provider. Babies get sick a lot. They have to--there's no other way for their immune systems to build up immunity to viruses and other germs that share our world. Most illnesses are minor, but babies are tiny underdeveloped humans, particularly when it comes to their immune systems.

That's why even the slightest fever may be cause for concern. To help you prioritize and prevent panic, we've prepared this guide to some of the top health concerns new parents need to know about.

JAUNDICE

Jaundice, identified by yellowish skin and whites of the eyes, occurs in half of all newborns,

typically around day two or three. It's caused when bilirubin, a yellow pigment in bile--the fluid produced in the liver--builds up in the baby's bloodstream. Normally, the liver filters bile from the blood and sends it to the gallbladder, where it's released into the intestines or absorbed into the bloodstream and disposed of. But, just like nearly every other organ of a newborn baby, the liver is immature and not fully developed.

Often, the bilirubin builds up and gets stored in the layer of fat just underneath the skin, which causes the yellowish or darkish cast. Another form of jaundice, found in about two out of every 100 breastfed babies, is caused by a component in breast milk that interferes with the absorption of bilirubin. Breastfed babies may also be jaundiced if they're not getting enough milk. In rare instances, jaundice occurs because the mother and baby's blood types are incompatible, or because there is an infection, or a blood or liver disease.

Generally, however, jaundice goes away without any special treatment. Your health care provider may tell you to lay the naked baby in a patch of sunlight for a few minutes a day, or if it's more serious, order a course of phototherapy, in which the infant lies under a blue or white fluorescent lamp that radiates ultraviolet B light. The light changes the bilirubin so it moves into the bloodstream, where it can be excreted. Another suggestion is to try feeding your baby more often. Whether you're breast or bottle feeding, the more you feed the baby, the more bowel movements he will have, which helps clear out the bilirubin.

The bilirubin should not be allowed to build up; in high levels it can cause brain damage. If you think your baby might have jaundice, check his or her skin in natural daylight for any signs of yellowing or darkening. It typically is a minor concern if your baby is a newborn. However, jaundice in an older baby could be a sign of something serious. Call your care provider if this occurs.

SPITTING UP
It often seems that as soon as you've finished feeding your baby, everything you worked so hard to get down comes right back up--all over your shirt. Spitting up is as endemic to newborns as the soft spot on the top of their heads. Also called reflux or regurgitation, these "wet burps" usually occur shortly after feedings.

Babies spit up because, in about half of all infants, the valve at the upper end of the stomach (the esophageal sphincter) hasn't closed properly. This should change by the end of the first year. Until then:

Try smaller feedings. If you bottle feed, use less formula per feeding. If you breastfeed, try nursing on one side and pumping the other. Wait at least two hours between feedings to give the baby's stomach time to empty. Also, don't feed a crying baby. The air gulped in crying may lead to a post-meal spit up.

Avoid putting pressure on the abdomen. This means not wrapping the diaper too tightly, especially when baby is in a sitting position.

Pay attention to position. Forget burping over the knee; that's a sure way to get your shoes covered. Instead, try to keep baby upright just after feeding in a front pack. Once baby is older, a stationary walker or jumpy seat might work. If your baby is vomiting frequently and not gaining weight, call your care provider. She may have a condition called pyloric stenosis, a narrowing of the outlet from the stomach to the intestines. If the vomit is brown, green, or tinged with blood, call your care provider.

RASHES
Baby acne. Just when you're considering showing off baby, her face erupts with the worst case of acne you've seen since high school. More than 30% of newborns develop baby acne of the face--mainly small red bumps, with some whiteheads interspersed. It's caused by exposure to your hormones just before birth. Wash your baby's face gently with warm water two or three times a day, and it will clear up. You may also see a red rash on her chin as she starts teething. With teething comes drooling, which can lead to dry, chapped skin, particularly in winter months. Keep your infant's skin clean with warm water, and change her sleeping position and sheets regularly.

Diaper rash. Up to 35% of all babies get diaper rash. No matter how careful you are, whether you use disposable or cloth diapers, it's nearly inevitable that at some point your baby will get it. Even if you've escaped diaper rash for the first six months, you may encounter it as you introduce new foods to your baby's diet. The key is catching it early and treating it immediately, or preventing it completely. Each of these preventatives also works as a treatment:

• Change diapers often to prevent skin contact with urine and feces.
• Forget the diaper wipes. They simply aren't enough after a poopy diaper, and they can actually dry out baby's skin. Use lots of warm water and a soft washcloth. And be thorough, any speck of poop left on your baby could turn into a skin ulcer or diaper rash.
• Expose your baby's bottom to air each day. Put her on a blanket naked to play for 20 minutes. She'll love it, and the air will help prevent and treat the rash.
• Avoid plastic pants. If you use cloth diapers, use diaper liners instead and terrycloth diaper covers.
• Use a protective cream or ointment. There are several available, including petroleum jelly, A & D or Desitin©. If the rash doesn't disappear in three days, it may be a yeast infection. Certain over-the-counter creams are specially formulated to treat yeast infections. But don't use boric acid or talc, both of which can be dangerous for baby. Try cornstarch instead.

DEHYDRATION
One of the most important things to watch out for with very young babies is hydration. It can happen suddenly and without much warning. Common causes include diarrhea, vomiting, or simply not getting enough formula or breast milk.
Signs to watch for include:

• Crying without shedding any tears
  
• Dry mouth, often ringed with white
  
• Cool, dry, pale skin
  
• Excessive thirst
  
• Listlessness, rapid pulse
  
• Sunken eyes
  
• Urinating less than once every 8 hours
  
• Sunken soft spot

If your baby has any of these symptoms, call your care provider immediately.

DIARRHEA
There are numerous causes of diarrhea in a baby, from food allergies, changes in diet, and reactions to medications to viruses and other infections. The most common virus is the rotavirus, which usually hits in the w inter and is particularly prevalent among children in day care. Some children have no symptoms, while others may have severe vomiting, watery diarrhea, and fever and maybe a cough or runny nose. It lasts about four to six days and is highly contagious. The best defense: Wash your hands often before touching your child and make sure any caregiver does the same. And always wash your hands--with soap--after changing a diaper.

The best treatment is time and fluids, particularly oral rehydration solutions such as Ceralyte, Pedialyte, or Oralyte. Call your care provider if your baby is less than 6 months old and in addition to the diarrhea, has a fever, bloody stools, prolonged vomiting, and signs of dehydration as described above.

Breastfed babies' bowel movements tend to be softer and looser than bottle-fed babies'. They may even be watery for the first few weeks of life. This is normal, not a sign of diarrhea.

Call your care provider if your baby exhibits any signs of dehydration described here, or if your infant has a fever.

RESPIRATORY SYNCYTIAL VIRUS (RSV)
There's nothing as heartbreaking as a baby with a cold. Yet almost all children in child care get a common cold virus called respiratory syncytial virus (RSV) their first year, usually during the winter. Typically, it results in nothing more than a bothersome cold, with half of the infections resulting in lower respiratory tract infections and ear infections.

But very young babies and children with heart or lung disease and weak immune systems are at increased risk of developing severe infections and complications. If your baby has a cold, treat the symptoms early with a humidifier, nasal aspirator and maybe some mild salt-solution nasal drops. Make sure your baby drinks lots of fluids so she doesn't get dehydrated. Call your care provider immediately if she appears at all dehydrated, if her cough gets worse, or if you notice her having trouble breathing or wheezing.

The best protection, of course, is prevention, which involves keeping baby away from crowds and other children during winter months when the RSV virus is particularly prevalent. Also, make sure you and other people holding your baby wash their hands frequently. Hand washing is the best protection against RSV.

The Food and Drug Administration approved an RSV vaccine for use in preventing RSV in infants and children younger than 24 months. However, it is only available to infants with bronchopulmonary dysplasia, a lung condition, or a history of premature birth due to a limited supply.

CROUP
There's no forgetting that horrible, seal-like barking cough that is the hallmark of this condition. Croup is an inflammation of the voice box and windpipe. It occurs when the airway just below the vocal cords becomes swollen and narrow, making breathing difficult and noisy. It's most common in children between 6 months and 3 years, when their windpipes are very small and slight swelling can actually shut them off. If you think your child has croup, call your care provider immediately.

The care provider may suggest you take the baby into the bathroom, turn the hot water in the shower on, close the door, and sit in the makeshift steam room for 15 to 20 minutes. This opens the airways and helps baby breathe. If that doesn't help, try carrying baby outside where the cool, moist air might help. If your child is truly struggling to breathe, makes a whistling sound that gets louder with each breath, seems pale or has a bluish
mouth or fingernails, drools or has real difficulty swallowing saliva, call 911.

FEVER
Fever isn't an illness in and of itself, but a sign of infection or illness. It's actually a good thing, because it means the body's immune system has kicked in. But fever in an infant still needs to be watched quite carefully, because even a relatively mild temperature could signify a serious infection that can quickly overtake a newborn's immature immune system. So follow these guidelines in relation to fever:

NEVER give any child aspirin for a fever, only ibuprofen or acetaminophen. Aspirin has been linked to Reye's Syndrome, a potentially fatal disease.

If your child has a convulsion in connection with a fever, don't panic. Febrile convulsions are fairly common in young children, and aren't usually dangerous. Put the child on the floor or bed or on his back and turn his head to the side to allow saliva or vomit to drain out of his mouth. Don't put anything into your child's mouth. If the seizure lasts more than 2 or 3 minutes, your child has trouble breathing, or has several seizures in a row, call 911.

Use a rectal thermometer to take your baby's temperature. Rectal temperature is the most accurate since it takes a reading from the body's core temperature.

When to Call Your Care Provider

COLIC
Feel like you could set your watch by your child's fussy period? From 5 to 9p.m. every night, he wails, and no amount of care can calm him down. You've described a colicky baby.

Even today, doctors still don't know for sure what causes colic. Studies suggest myriad reasons: it's an early warning sign of certain allergy-related conditions; it's fussing due to painful digestion; it's baby's way of unwinding after a stressful day. But the reasons don't matter much when you just want the screaming to end.

Most colic disappears at around three months. To cope in the meantime:

• If you're nursing, eliminate anything in your diet that may cause gassiness, such as beans, broccoli, onions, garlic and dairy.
• Try baby massage. Studies show that firmly stroking a baby's skin for 15 to 20 minutes helps calm colicky infants.
• Put the baby in the car seat and drive her around until she falls asleep. The same principle of soothing sound and motion is at work when you put her in her baby carrier on top of a running dryer.
• Wear your baby in a sling or a pouch. The closeness, warmth and sound of your heart may help soothe her.

EAR INFECTIONS
By the time your child turns five, it's likely she'll have had quite a few ear infections.
Called otitis media, ear infections affect nearly 75% of all children at least once by the time they turn three. Symptoms include inflammation of the middle ear, often with fluid building up behind the eardrum, fever, and fussiness. Your child may also tug at her ear, have problems hearing, and have diarrhea, nausea, and vomiting.

Ear infections are often caused by upper respiratory illnesses. They are also more prevalent in young children because their eustachian tubes, the small passageway that connects the upper part of the throat to the middle ear, are shorter and straighter in children than they are in adults. This makes it easier for fluid from a blocked eustachian tube to collect in the normally air-filled middle ear. Also, children's adenoids--tissue filled with infection-fighting cells located in the upper part of the throat near the eustachian tubes--can interfere with the tube opening if they get enlarged, as they often do when children are sick.

Left untreated, repeated bouts of otitis media can interfere with a child's hearing, which could delay speech and other developmental milestones. An untreated infection could also spread from the middle ear to the nearby parts of the head, including the brain. There are a number of treatments for ear infections, including antibiotics.

To prevent otitis media:

• Don't allow your child to be in smoke-filled rooms.
• Don't let your baby sleep or lie on his back with a bottle.
• Breastfeed. Studies show that breast-fed infants have fewer ear infections.
  

*by Debra Gordonx

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