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The Babytalk Guide to Winter Health

Cuddly sweaters and crackling fires, snowmen and sleigh rides... not to mention coughs, colds, and fevers. Winter is the prime season for sickness because people spend more time indoors with the windows closed, allowing viruses and bacteria to circulate more easily. In fact, it's almost inevitable that your baby will get sick in the next few months  -- most children have between six and nine viral infections in their first year alone. Here's how you can keep some of the nasty bugs at bay, lessen their severity once germs take hold, and keep your little patient comfortable.

Colds and flu

Since colds and influenza are both viral respiratory infections, you may often not be able to tell the difference.

Symptoms
* Signs of the common cold include: a sore throat (your baby may sound hoarse), a decrease in appetite, a stuffy or runny nose, fussiness and fatigue, mild fever, and a cough. Children usually improve in 7 to 14 days.

* The flu is characterized by a high fever, a dry cough, vomiting, and crankiness. Most symptoms subside after five days, but a lingering cough and general weakness may persist for another week or two.

For infants 3 months and younger, call the doctor right away if your child has a fever over 100.4¿F. For an older baby, call if the cold or flu lasts longer than a week or her symptoms worsen (her temperature goes up, for instance).

Treatment
Don't expect your child to be prescribed antibiotics. Colds and flu are not bacterial infections, so antibiotics will have no effect. Sometimes, however, a common cold can lead to a secondary bacterial infection in your child's ear, sinuses (sinusitis), or lungs (bronchitis, pneumonia), which does require a course of antibiotics.

Keep the air flowing. An over-the-counter saline nasal spray can help flush out your infant's stuffy nose. Or try a nasal aspirator to suction out the mucus.

Mist the nursery. Use a cool-mist vaporizer during naps and at night to open up your baby's breathing passages and loosen the mucus, making it easier for her to cough it out.

Contributing editor William Sears, M.D., is the author of 42 childcare books, including The Baby Book. Additional research by James Sears, M.D.

Ear infections

Infants and toddlers are prone to ear infections (otitis media) because their eustachian tube  -- which connects the middle ear and the throat  -- is short, wide, and straight, allowing mucus and other secretions to travel easily from the throat to the ear during a cold. In acute otitis media (AOM), this infected fluid presses against your baby's eardrum and causes pain. Fluid in the ear left behind from an ear infection that has cleared up is called otitis media with effusion (OME). In OME, the fluid is not infected but may cause temporary hearing loss. Three out of four infants will suffer at least one ear infection before their first birthday. Here's when to suspect that your baby has an achy ear:

Symptoms

  • He has persistent, worsening cold symptoms.
  • He wakes frequently at night since fluid can press on the eardrum when he is lying down.
  • He is cranky, irritable, and has a poor appetite.
  • He has a fever. (Not all children do, however.)
  • He pulls on his ear. If any of the above symptoms are also present, this is another indication that his ear hurts.

Treatment
See your doctor  -- your baby may require medicine. Although "watchful waiting" is sometimes recommended for older kids, children younger than 2 with AOM are usually prescribed antibiotics immediately.

Apply a warm towel to help soothe the achy ear.

Give pain relievers such as acetaminophen or ibuprofen (as directed by your pediatrician) for the first day or two until the fever subsides.

Croup

Croup is a viral infection that causes swelling of the vocal cords and windpipe (trachea), and is characterized by a barking cough that sounds like a seal. If your child has a croupy cough but is otherwise happy and playful, and has no trouble breathing or sleeping, it's unlikely her case is serious. Still, watch for the following signs, which indicate that the swelling is obstructing the passage of air:

Symptoms
* Indrawing: Your baby's throat at the front of the neck caves in when she takes a breath.

* Stridor: Your child's breathing is labored and noisy, possibly sounding like a coarse whistle. Stridor is common when a child with mild croup is crying or active, but if it occurs while she's resting, the situation is more serious.

* Anxiousness: Your child seems restless or panicky.

* Lack of breath: If your child can't speak or cry, call 911 or get to a hospital immediately.

Treatment
"Steam clean" your baby. Take your infant into the bathroom, turn on the hot water in the shower, and close the doors and windows  -- the humid air will help relax her breathing passages. (A recent study found that this time-honored treatment is not really effective, but it can't hurt and may still work for babies with mild symptoms.)

Calm her down. Anxiety makes croup worse. Try reading a story, singing softly, or nursing to help her relax.

Sleep is one of the best therapies for croup.

Your doctor may prescribe steroids, either as a liquid or inhaled through a nebulizer (a machine that converts liquid medicine into steam) in severe cases to open the airways.

RSV

Respiratory syncytial virus, or RSV, is very common. In fact, most children will have had this infection by the time they're age 2. Yet for some healthy babies, and especially for at-risk infants (those with already compromised breathing, such as preemies and babies with heart, lung, or immune problems), RSV can warrant hospitalization.

Symptoms
* He has a bad cold  -- a stuffy or runny nose, sore throat, mild headache, mild cough, and a low-grade fever.

* His cold progresses to repeated coughing, wheezing, and labored breathing.

Treatment
At-home TLC. For most cases of mild RSV, treat your child as if he has a cold. Follow the treatment tips under "Colds and flu" to make sure he's comfortable while his body fights the virus, which usually takes 7 to 14 days. In a serious case, he may require oxygen therapy.

Talk to your doctor. If you have a preemie or an otherwise at-risk baby, ask your doctor about Synagis, an expensive, yet effective, preventive antibody injection that can reduce the incidence of hospitalization by 55 percent. (It's covered by insurance only for at-risk babies.)

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