Children under 3 are especially vulnerable: Their immune systems aren't yet fully developed, so they're less capable of fighting off illness. And when they do get sick, their symptoms can be more severe than those of older kids exposed to the same viruses or bacteria. It's very nerve-racking when your child is sick and he can't tell you about it, so it's crucial to know the ailments to which your baby or toddler is most susceptible and when you need to call the doctor.
Colds & Ear Infections
There'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, Alabama.
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°F. Children between 3 and 6 months with a fever of at least 101°F should also be examined. A high temperature in older babies 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.) There's no need to treat the fever unless your baby is uncomfortable. If she's fussy you can give her acetaminophen or ibuprofen (but never aspirin -- it puts kids at risk for the serious disease Reye's syndrome). A lukewarm sponge bath may also help (if given in conjunction with a fever-reducing medicine) to make her more comfortable. "A cool-mist vaporizer will help break up congestion and may keep secretions 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." Don't give children under 3 an over-the-counter cough preparation or decongestant without first consulting your pediatrician.
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°F.
Your 15-month-old is just getting over a cold when he spikes a fever and you notice that his ear is red or that he is tugging at it. The cause? Most likely an ear infection, which, after a cold, is the most common reason for a visit to the pediatrician in 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 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. (To reduce the risk of Sudden Infant Death Syndrome, never let a baby fall asleep near soft bedding.) 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. Many ear infections are viral and antibiotics are effective only against bacteria; using them on a viral infection may backfire and encourage the growth of antibiotic-resistant bacteria.
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 Troubles & Pneumonia
Occasional vomiting and diarrhea in an otherwise healthy child is usually no cause for alarm. But if it's accompanied by a bellyache and fever, she may have gastroenteritis -- which is a fancy name for an uncomfortable inflammation of the stomach and intestines. "It's most often caused by an infection, but it can also flare up if a child is 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 in a baby over 8 months -- particularly if your baby or toddler can't keep fluids down or passes watery stool every hour or two. She'll need to be seen right away or taken to the ER for intravenous fluids.
In some cases, a commercial rehydrating solution, such as Gerber's Pediatric Electrolyte, Pedialyte, 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, acts listless, vomits blood or green bile, experiences sharp abdominal pain, or hasn't kept fluids down for more than 12 hours.
If your child has a mild case of diarrhea, give her plain foods (if she's started solids) such as rice cereal, bread, or jarred baby food. Avoid giving her too much juice, which can irritate the intestines.
Your baby looks limp and pale and has a fever of 101°F. His nostrils keep flaring, and he seems to be wheezing and breathing faster than usual. Call the doctor right away: He may have pneumonia, an infection of the lungs that usually follows 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 baby is under 3 months of age, however, you'll want to call your doctor at the first sign of illness, and take him to the emergency room if he's having trouble breathing. 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 he gets plenty of rest and lots of fluids. (Babies can continue to nurse or drink formula.) A cool-mist vaporizer will help keep secretions in his lungs loose. You can also loosen congestion by turning your shower to the hottest setting and sitting with your child in the steam-filled bathroom for ten minutes. Don't give him cough suppressants without a pediatrician's okay.
Urinary-Tract Infections & Croup
These are actually very common in young children, particularly girls. The reason: "Their urethras are 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 (UTI) 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. Younger babies may have vomiting, diarrhea, and irritability.
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 and get a urine sample to confirm that an infection is present. If one is confirmed, your child should have an evaluation of her urinary tract (usually by x-ray or ultrasound) to make sure that her kidneys have not been affected. 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 out bacteria from the bladder.
The 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 your baby out in the cool night air or for a car ride with the windows down, or run a hot shower and then sit in the bathroom and have him breathe in the steam. "You might also 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.
Bronchiolitis & HFMD
A 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 Synagis, a protective medicine.
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. If your baby was born prematurely, she may be more susceptible to complications from RSV. Your doctor may also suggest she receive preventive injections.
Your 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). This is a common viral infection among toddlers, especially during the summer and fall. It's 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 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 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 healthier and happier he'll be.
Laura Muha is a freelance writer based in New Jersey.