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Take Charge of Your Child's Health

Recently, Susan, a wise yet exhausted mother, brought her 6-month-old baby to the office because she was concerned about his nonstop crying. "Nathan hasn't slept well since he was born," she said. "I'm up with him three or four times a night, and the only thing that settles him is nursing. He's fine during the day as long as I hold him a lot, but as soon as I put him down, he screams. I've been to four pediatricians and no one can help. I'm tired of people telling me I'm spoiling my baby by holding him too much, because I know something is wrong."

Her hunch turned out to be right. After delving into Nathan's medical history and looking at the notes his mom had kept, I suspected the baby was having severe pain from gastroesophageal reflux disease (GERD). Sure enough, a test quickly confirmed this diagnosis.

It's unfortunate that it can sometimes take so much time (and so many doctors) to get to the bottom of a child's health problem. The good news? There are things that you, as a mom, can do to speed up the process:

Listen to your mommy gut. No one knows a baby like his own mother does.

Take notes. When your child gets sick, write down his symptoms and anything else that seems relevant.

Team up with your pediatrician. Getting the best health care for your baby is a partnership between you and his doctor. Your role is to be a keen observer and accurate reporter; the doctor's role is to take what you report and make the right diagnosis.

Get a little medical training yourself. Some childhood health problems can be easy to overlook. What follows here are five of the most common ones -- plus what you need to know to help your doctor catch them.

1. Strabismus

What it is: A misalignment of the eyes -- one may seem to "wander." The eye muscles on one side may be weaker than on the other, there could be a disconnect between the eyes and the part of the brain that's responsible for focusing, or both. If strabismus isn't treated (with an eye patch over the stronger eye to give the weaker muscles a workout; surgery; glasses; or some combination), it can lead to amblyopia, or lazy eye, in which the weak eye stops working properly altogether.

Why it can be hard to catch: Your baby's eyes might appear straight during a checkup, so the doctor may not notice a problem. A newborn's eyes may wander, but by 3 to 6 months, they should be in sync most of the time.

How you can help: Check your baby's eyes once a week by shining a flashlight in them -- hold it 6 to 12 inches away and look for the dots of light to be in the same place in each eye. If they're not, have the doctor check her more closely.

2. Ear infection

What it is: An infection of the middle ear that's caused when fluid builds up, creating a breeding ground for bacteria. At least 70 percent of the time, ear infections are preceded by a cold. Young kids are especially susceptible to ear infections because their eustachian tubes, which allow fluids to drain, are so narrow.

Why it can be hard to catch: Some of the symptoms are the same as those of the common cold -- a stuffy nose, slight fever, and irritability, for instance. Often a child will pull or rub his ear if it hurts, but it might not hurt.

How you can help: This is where your detective skills can come in handy. Mothers will often say they can tell their baby is getting an ear infection when he's had a cold and doesn't want to lie down, or nurses differently (the pressure caused by fluid in the middle ear makes it too painful to be horizontal or swallow). Other signs you should watch for: yellow drainage from the inside corners of the eyes; frequent night waking; thick, mucus-y nasal secretions; increasing crankiness and irritability; blue circles under the eyes; droopy eyes; and that overall facial expression that means "I'm really feeling lousy!"

Also, moms commonly call the doctor when they're unsure if there's something more serious than a cold going on. If you're convinced there is, say so right away.

3. Developmental delay

What it is: Any significant lag -- five or six months -- in a child's physical, cognitive, behavioral, emotional, or social development.

Why it can be hard to catch: Because there's such a wide range of infant development -- there are "normal" late walkers and late talkers -- often a doctor can't make a diagnosis until a child is well beyond the outer range. Plus, chances are your doctor sees your child for only 15 minutes every few months; it's hard to make a judgment with so little time to observe. And in order for developmental testing to be accurate, a child needs to be relatively calm and relaxed, and, of course, during a checkup your kid could be tired, cranky, scared, or simply not in the mood for a full exam.

How you can help: Try to gauge your child's progress objectively by keeping track of it in her baby book or health book. Note where she was three to six months ago when you're making entries; if she's progressing steadily, then you most likely have nothing to worry about. Above all, don't compare your child with other kids. If you notice a plateau in your child's progress, bring it up with your pediatrician.

4. ADD and ADHD

What they are: Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) cause some kids to learn, think, and act differently from others. These conditions are characterized by distinctive behaviors such as inattentiveness, distractibility, impulsiveness, and, in the case of ADHD, hyperactivity.

Why they can be hard to catch: Just as your doctor has only a few minutes during each appointment to check out your child's developmental progress, she also has a limited amount of time to evaluate behavior. And it's virtually impossible for her to get a sense of how your child behaves in a variety of situations (at school, on playdates) while doing a quick checkup.

How you can help: While it's often tough for both parents and pediatricians to tell whether a child is simply a quirky kid or really is struggling, there are clues to ADD and ADHD, including excessive and volatile tantrums, a short attention span that doesn't increase as he gets older, and inappropriate social behaviors (he interrupts other people a lot, for example). If you notice any of these, keep track of them in your child's health book, including how frequently they occur and how much they're affecting your child; you might notice that he isn't doing well in school or doesn't seem to enjoy learning, or that his self-esteem is low (that's one of the most important things your doctor needs to know). If you're concerned and aren't getting the help you need from your pediatrician, get a second opinion or a referral to a specialist.

5. Urinary-tract infection (UTI)

What it is: An infection of the bladder, kidneys, or urethra (the tube through which urine exits the body), caused by bacteria that enter the urinary tract -- either through the urethra or via the bloodstream from other parts of the body. The bladder is most commonly affected, with girls suffering these infections more often than boys due to their shorter urethras.

Why it can be hard to catch: UTIs are one of the toughest conditions to detect in babies and toddlers. When an adult has a UTI, she tends to have frequent, painful urination. But in kids under 3, the symptoms can be quite vague. The one that's most likely to prompt a doctor to test for a UTI is an unexplained fever. Vomiting and inconsolable crying are also clues.

How you can help: A UTI that goes undetected (and therefore untreated) can lead to serious kidney damage. Besides fever, vomiting, and crying, the most reliable signs of one in a very young child may be those that only a mother can pick up on: The child simply isn't acting like herself, but she's clearly sick and not feeling well. In that case, ask: "Could she have a urinary-tract infection?" Note that once your child can talk well (by age 3 or so), she'll be able to tell you straight out, "Mommy, it hurts when I pee."

Longtime contributor William Sears, M.D., is the author, most recently, of The Healthiest Kid in the Neighborhood.

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