Laura Muha's last article for Parenting was "Your Baby's Amazing Brain," in the Fall 1999 special issue.
ColdsThere's usually no reason to worry when your little one sniffles or sneezes, even if you notice a thick, greenish discharge dripping from her nose. "That's actually very common in children with colds and isn't a sign of a bacterial infection, as it is in adults," says Carden Johnston, M.D., a pediatrician at Children's Hospital in Birmingham, AL.
Still, a seemingly harmless cold can quickly turn into a more serious respiratory illness in infants 3 months and younger, so be sure to check your baby for fever and call the pediatrician if her temperature tops 100.2 degrees F. Children between 3 and 6 months with a fever of at least 101 degrees F should also be examined. A high temperature isn't necessarily cause for alarm: "Some kids run fevers at the drop of a hat," says Joan Shook, M.D., chief of pediatric emergency medicine at Texas Children's Hospital in Houston. "In most cases, a fever just has to run its course."
If your baby is older than 6 months and has a garden- variety cold, you can treat her at home by making sure that she gets plenty of rest and drinks lots of fluids, including water and fruit juice. (Babies should also continue to nurse or drink formula.) Sponging her with lukewarm water or letting her sit in a tepid bath should bring down her temperature and help her feel more comfortable; you can also give her acetaminophen or ibuprofen (but never aspirin -- it puts kids at risk for Reye's syndrome). "A cool-mist vaporizer will help break up congestion and may keep secre- tions in her chest and sinuses loose," according to Cheston Berlin, M.D., a professor of pediatrics at Pennsylvania State University's Hershey Medical Center. "You can then use a bulb syringe to suction mucus from a little baby's nose or have your child blow gently into a tissue."
Another tip: Don't give children under 3 an over-the-counter cough preparation or decongestant without first consulting your pediatrician; such medicines don't have much effect except to make children drowsy. For all kids, avoid any medication that contains phenylpropanolamine, in light of recent evidence that this ingredient may trigger seizures and increase the risk of stroke.
Finally, stay alert for any changes in your child's condition and call the doctor if she isn't feeling better in a week, has trouble breathing, or runs a fever over 102 degrees F.
Ear InfectionsYour 2-year-old is just getting over a cold when he spikes a fever of 102 degrees F and starts tugging at his ear. The cause? Most likely an ear infection, which, after colds, is the most common reason for pediatrician visits among children under 3.
The culprits are your child's tiny eustachian tubes, which connect his middle ears with the back of his throat and normally drain fluid. When these passages become clogged, fluid builds up and presses against the eardrum -- and your child starts yelling in pain. The tubes can also be blocked when babies drink from their bottle while lying down and a small amount of milk or formula flows back into their ears. "If they have an ear infection, they'll usually cry more during feedings because sucking causes painful pressure changes in their ears," says Dr. Johnston. "They may also fuss more when they lie down and have trouble sleeping." Older children may tug at the affected ear, but that's a less than reliable symptom in children under 2 because their nerves aren't developed enough for them to pinpoint the origin of the pain, says Dr. Johnston.
If you suspect an ear infection, make an appointment with your pediatrician. In the meantime, you can ease a child's discomfort with acetaminophen or ibuprofen (for an infant under 6 months, ask the doctor first). You can also apply a warm towel to the achy ear or prop up his head on a few pillows to relieve the pressure in his eardrums. Even if your child has had so many ear infections that you're a pro at recognizing the symptoms, don't try to treat one yourself with leftover antibiotics, says Dr. Johnston. Antibiotics are effective only against bacteria; using them on a viral infection may backfire and encourage the growth of antibiotic-resistant bacteria. Some doctors also prefer to wait a day or two before prescribing medication to see if an ear infection will clear up on its own -- again, to prevent children from being exposed to unnecessary antibiotics.
Call the pediatrician if a child of any age has an earache accompanied by a fever, a cold, or a headache; if you notice any pus coming out of his ears; or if the glands in his neck start to swell.
Tummy TroublesOccasional vomiting and diarrhea in an otherwise healthy child is usually no cause for alarm. But if it's accompanied by a painful bellyache and fever, she may have gastroenteritis -- a fancy name for inflammation of the stomach and intestines. "It's most often caused by an infection, but it can also flare up if a child's on antibiotics," says Dr. Shook.
Although you should let the pediatrician know if your child has symptoms of gastroenteritis, most cases can be managed at home and will clear up within a few days. But you should watch out for signs of dehydration -- dry mouth, sunken eyes, scant urine, and a lack of tears -- particularly if your baby or toddler can't keep fluids down or passes watery stool every hour or two. He'll need to be seen right away or taken to the ER for intravenous fluids.
In mild cases, a commercial rehydrating solution, such as Pedialyte, Rehydralyte, or ReVital, may be recommended. Babies may be nursed again or given formula when they can keep liquids down for two to three hours. Call the doctor immediately if a child of any age has a fever, vomits blood or green bile, experiences sharp abdominal pain, or hasn't kept fluids down for more than 24 hours.
"If your child has a mild bout of diarrhea but otherwise seems active and healthy, you might want to take her off solid food for twenty-four hours to give her digestive system a chance to recover," says Dr. Shook. Offer her ice pops, Jell-O, small sips of clear fluids (such as white grape juice or water), Gatorade, or a rehydrating solution. Over-the-counter antidiarrheal medications aren't recommended for children under 2 and should only be given to older kids with a doctor's okay.
PneumoniaYour toddler looks limp and pale and has a fever of 102 degrees F. Her nostrils keep flaring, and she seems to be wheezing and breathing faster than usual. Call the doctor right away: She may have pneumonia, an infection of the lung that usually follows on the heels of a cold or other respiratory disorder.
"Pneumonia is usually less worrisome in a child than it is in an adult, so most children can be cared for at home," says Dr. Johnston. If your child has a viral infection, medication generally isn't necessary and the infection should clear up on its own in a few days. A bacterial infection, on the other hand, will require antibiotics. To help your child feel more comfortable, make sure she gets plenty of rest and drinks lots of fluids. (Babies can continue to nurse or drink formula.) A cool-mist vaporizer will help keep secretions in her lungs loose. Don't give her cough suppressants without a pediatrician's okay. "She needs to be able to cough up chest congestion," says Dr. Johnston.
Urinary-Tract InfectionsThese are actually very common in young children, particularly girls. The reason: "Their urethra is very short, providing bacteria from the bowel easy access to the bladder," says Dr. Johnston. There's also evidence that uncircumcised boys are at increased risk of infection because of the way urine flows beneath the foreskin. In most cases, a urinary-tract infection will cause a fever, lower abdominal pain, and painful urination. A toddler may clutch her stomach and grimace or cry when she urinates. You might also notice an unpleasant odor or blood in her urine.
Either way, UTIs should be treated with antibiotics, so see the pediatrician as soon as you suspect your child has one. He'll probably take her blood pressure (it often rises in kids with UTIs) and get a urine sample to confirm that an infection is present. In the meantime, apply a hot-water bottle wrapped in a towel to her abdomen and have her avoid bubble baths and perfumed soaps that could irritate her genitals. Finally, make sure she drinks lots of water to flush bacteria from the bladder. Some studies suggest that cranberry juice is especially effective against UTIs; it contains substances that prevent bacteria from sticking to the bladder.
CroupThe cough starts just after midnight. The sound is so horrible and distinctive, like the bark of a seal, that most pediatricians can diagnose the problem over the phone as croup -- an inflammation of the larynx and trachea. Doctors don't know why, but croup affects twice as many boys as girls; children between 6 months and 3 years of age are most susceptible because their windpipe is small, making breathing difficult if it swells up.
Croup often follows a viral infection (such as a cold ), so antibiotics are rarely helpful. Attacks usually subside when a child breathes in very cold or very hot air, which helps "shock" swollen airways into shrinking long enough to bring relief. Try taking him out in the cool night air or for a car ride with the windows down, or run a hot shower and have him breathe in the steam. "You also might want to sing to him or play soft music," says Dr. Johnston. "The more relaxed he is, the easier it will be for him to breathe."
If his breathing stays noisy and labored, call 911 or take him to the ER; he may need steroids or a bronchodilator. You should also get emergency help if he has trouble catching his breath or if he gasps or makes a whistling sound whenever he inhales.
BronchiolitisA few days into her cold, your baby suddenly starts to wheeze and gasp for air. The muscles between her rib cage and collarbone cave in every time she takes a breath. The possible cause: bronchiolitis, an infection of the smallest breathing tubes of the lungs. "It's usually caused by the respiratory syncytial virus," says Dr. Powers. "An RSV infection causes the breathing passages to swell up, and this can block air from flowing through the lungs." Outbreaks usually occur during the cold-and-flu season, between October and March.
Although RSV often causes nothing more than a cold, it's more likely to trigger bronchiolitis in babies under 6 months because their airways are smaller. It can also be life-threatening: One study found that 16 percent of children under 1 who were hospitalized were admitted because of complications from bronchiolitis. Children at high risk may be given a monthly injection of palivizumab as a preventive.
If you suspect your baby or toddler has bronchiolitis, let your pediatrician know right away. In mild cases, there's little you can do except ease her stuffy nose with a humidifier, a bulb syringe, and saltwater nose drops. "Babies may also have a harder time feeding, so watch for signs of dehydration," says Dr. Powers.
In severe cases, your child may need bronchodilating drugs to open up her airways or emergency oxygen at the hospital. Some babies may be treated with RSV-specific antibodies, a controversial therapy that's used only with infants who are seriously ill.
Hand-Foot-and-Mouth DiseaseYour child has a slight fever and tiny blisters all over his palms, the soles of his feet, and inside his mouth. No need to panic: He probably has hand-foot-and-mouth disease. HFMD is a common viral infection among toddlers, especially during the summer and fall. It's also highly contagious but is usually mild and lasts only a few days. In isolated cases, however, HFMD has led to complications, such as encephalitis (inflammation of the brain) and meningitis, so call the pediatrician if you think your child has it.
Don't be surprised if the doctor recommends nothing more than rest and acetaminophen to reduce the fever. "There's really no other treatment," says Dr. Shook, "but you can offer your child plenty of water and soft, bland foods -- such as custard, Jell-O, and ice cream -- that won't irritate the sores in his mouth." And watch out for dehydration, particularly in babies, who may find nursing painful. To keep the virus from spreading to other family members, wash your child's bottles, plates, and eating utensils in the dishwasher on the hot-water cycle or have him use disposable ones until his infection clears up. Wash your hands regularly and throw away or clean toys that your child may have put in his mouth.
The good news: Battling all these viruses and bacteria can help build up your child's resistance to these bugs. So the more he's exposed to them as a baby or toddler, the easier it will be for him to shake them off when he's older, and the happier and healthier he'll be.