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The Panic-Free Guide to Infant Illness

The first time your baby gets sick, you may end up feeling worse than she does. Figuring out what's wrong, deciding whether to call the doctor (especially if it's nighttime or a weekend), and dealing with rectal thermometers can cause your anxiety level to fly off the charts. Try to look on the bright side: Getting sick will ultimately help build her immunity, and most garden-variety illnesses pose more of an inconvenience than they do a real threat. To help you stay calm and keep your baby comfortable, this in-depth guide answers all your top infant health questions.

 SHOULD I CALL A DOCTOR?

Sometimes it's obvious. Other times, the signs of an illness are subtle. Or the fever is there, but your little one seems as active as ever. What's a parent to do? Most pediatricians will tell you that a child's behavior is often the best guide. If he acts sick (lethargic, cranky, "not quite right"), he probably is. If he's playful in spite of symptoms, it's usually no big deal. Still, it can't hurt to check with your health-care provider. And by all means, call if any of the following occur:

Fever over 100.4 degrees F in a baby 3 months or younger.
Fever over 101 degrees F in a baby 3 to 6 months.
Fever over 103 degrees F in a baby over 6 months.
Baby is unresponsive or sleeping excessively.
Baby is irritable and inconsolable.
He's wetting fewer than four diapers a day.
He experiences persistent vomiting or diarrhea (lasting for longer than 24 hours).
He has blood in his vomit or diarrhea.
He refuses to eat for three or four meals in a row.
He has difficulty breathing.
He shows signs of ear pain (pulling on an ear, crying when he's laid down), or has drainage from an ear.
He has a rash accompanied by a fever.

Most pediatricians are well practiced in the art of dealing with nervous parents, but there will always be that time when you think of the question you need to ask just as you hang up or leave the office. Before calling or heading to the office, write down your concerns ("We were visiting a child who came down with the chicken pox, and now my baby has a fever"), specific symptoms (how high the temperature is, how many times baby has vomited), and any questions you might have ("How can I tell if he's dehydrated?").

When you do reach the doctor, start by repeating your child's name and age. Pediatricians in large practices can't remember everything, and will not have your child's medical record/chart available if it is after office hours. Try to be as specific as you can: His temperature has risen 3 degrees in the past 24 hours; he has refused three meals; he's had four loose bowel movements. Have the telephone number of your pharmacy available in case a prescription needs to be phoned in. Remind your doctor too of any allergies or reactions to medicines your baby may have had in the past. Take notes or, if you're at the office, ask your pediatrician to write down treatment instructions so you have something to refer to later.

HOW DO I DEAL WITH A FEVER?

Fever isn't an illness -- it's just a sign that the body is doing its job fighting off an invading virus or bacteria. When it works right, the fever goes down and no other symptoms appear. But if your baby is very young, her temperature continues to escalate, or other symptoms appear (rash, vomiting, diarrhea, ear pain, breathing difficulty), you'll need to consult a doctor. Meanwhile, give your baby plenty of fluids to prevent dehydration, and keep her comfortable by turning down the heat, placing a fan nearby to keep cool air moving, bathing her in lukewarm water, and administering infant ibuprofen (if she's older than 6 months) or acetaminophen. Check with your pediatrician about proper dosage. Never give an infant aspirin -- not even children's aspirin -- because it has been known to cause Reye's syndrome, a potentially deadly disease. Never rub her down with alcohol. It can be inhaled by baby or be absorbed into the skin and potentially lead to poisoning.

 WHAT'S THE BEST WAY TO TAKE A BABY'S TEMPERATURE?

The rectal thermometer is the gold standard of infant temperature-taking and is recommended for children under 3 months of age, when it's important to know the exact temperature so your doctor can determine the proper course of action. For older babies, there are more options. Regardless of which one you choose, it's helpful to take baseline readings when your child is well so you'll know how to interpret her temperature. When you speak to your doctor, tell her the method you used. Here's a guide to the various techniques.

 Rectal thermometer
1. Clean the end of the thermometer with soap and water. Rinse with cool water.
2. Apply petroleum jelly to the thermometer tip.
3. Lay your baby on her belly and hold her steady with one hand on her lower back.
4. Gently slide the thermometer a half-inch to an inch into the rectum, and then hold it in place between your second and third fingers until the thermometer signals that it's finished.

 Underarm thermometer
1. Place the tip of the thermometer in the center of your child's armpit.
2. Hold her arm against her chest for about a minute or until the thermometer signals that it's finished.

Ear thermometer
1. Place a clean cover on the cone-shaped end.
2. Pull baby's ear backward slightly, and gently place the thermometer in the ear canal. Try to aim the probe toward the child's eye on the opposite side of the head.
3. Turn on the thermometer; remove after it beeps.
4. Don't use an ear thermometer with a baby under 3 months, as her ear canals are too small. It is most accurate with children who are at least 1 year old.

WHEN IS IT A COLD, AND WHEN IS IT SOMETHING WORSE?

Infants catch colds, just like the rest of us. The trouble is, you can't just pop open a bottle of relief for them. Instead, pediatricians usually recommend using a bulb syringe to suction the mucus from a young baby's nose, or giving him saline nose drops. You can also use a cool mist humidifier or take him into a warm steamy bathroom.

Sometimes a run-of-the-mill cold can progress to a more serious infection -- respiratory syncytial virus (RSV), bronchitis or pneumonia to name a few -- so watch for worsening symptoms, such as mucus that thickens and turns from clear to green or yellow, flaring nostrils, wheezing or a rattling sound inside your baby's chest.

HOW DO YOU COMFORT A TEETHER?

When it comes to infant milestones, teething is a mixed bag. Sure, it heralds a new era of dining ease -- fewer jars of pureed mush to tote. But for some families, every new tooth is accompanied by a week of sleepless nights and a serious case of the cranks.

Before you start blaming every bad mood on teething, there are a few things you should know. First, babies can "teethe" for a while before they actually have anything to show for it. The average first tooth appears at around 6 months, but anywhere from 4 months to 1 year is normal. Prior to that event, baby may experience lots of drool (which may begin about 2 months before the first tooth appears) and gnaw on everything in sight. If a new tooth is imminent, the gums can be swollen and red, and you may even see a little white about to burst through. Baby may also start to wake during the night. And while the debate over the connection between teething and loose stools continues, pediatricians insist that teething won't cause fever, colds or ear infections.

Meanwhile, there are several things you can do to ease your baby's -- and everyone else's -- resulting discomfort:

Provide something to gnaw on. Cold items work well, so try refrigerating a damp washcloth or picking up some of those meant-to-be-chilled teething toys.

Rub your baby's gums. Use a clean finger, moistened gauze pad or damp washcloth to massage your baby's gums. The pressure can ease her discomfort.

Still no luck? Try pain meds. A dose of infant pain medication will usually provide relief. Check in with your pediatrician before doing this.

As soon as your baby's teeth begin to appear -- the upper and lower incisors are usually the first to arrive -- start brushing her teeth twice daily using fluoridated toothpaste and a soft, age-appropriate-sized toothbrush. Use a "smear" of fluoridated toothpaste to brush the teeth of a child less than 2 years of age, says the American Academy of Pediatric Dentistry.

WHAT SHOULD I HAVE IN THE MEDICINE CABINET?

Rushing out to the pharmacy every time baby starts to sniffle can increase your stress level. Make sure you have all these health-care basics on hand so you can address his symptoms as soon as they appear.

Equipment
Digital thermometer (Mercury thermometers are no longer considered safe. To dispose of one, contact your local poison control center.)
Tweezers (for splinter removal)
Nasal aspirator (or bulb syringe)
Medicine dropper
Baby nail scissors
Cotton balls and swabs
A selection of self-adhesive bandages, gauze pads and bandage tape
Cold pack (keep in freezer)
Soft toothbrush

Medicines and preparations
Infant acetaminophen and infant ibuprofen drops. Generally speaking, you'll use ibuprofen for high fevers, acetaminophen for low fevers and other aches such as teething or post-vaccine discomfort. Remember: ibuprofen is for babies over 6 months old.
Rubbing alcohol for cleaning thermometers and tweezers
Diaper rash ointment
Antibiotic ointment for cuts and scrapes
Hydrocortisone cream for skin rashes and eczema (not recommended for everyday use)
Petroleum jelly
Saline nose drops
Oral rehydrating solution such as Pedialyte in case of diarrhea
Fluoridated toothpaste
Child-safe sunscreen lotion
Child-safe insect repellent

WHAT CAN I DO TO EASE INFANT COLIC?

Colic -- uncontrollable crying for long periods of time -- is still largely a mystery. Its definitive causes aren't well known. Luckily, ideas for soothing colicky babies are much easier to come by. The American Academy of Pediatrics (AAP) offers this list of tips, tricks and hints.

If you're breastfeeding, try eliminating foods from your diet that may cause baby discomfort, including milk products, caffeine, onions and cabbage. Babies who take formula may benefit from a hypoallergenic formula. (Look for the term "protein hydrolysate.")
Overfeeding your baby can make her uncomfortable. Try to wait at least two to two-and-a-half hours between feedings.
Rhythmic motion and white noise can be comforting to a colicky baby. Try rocking her while running the washing machine or vacuum in the next room.
Introduce a pacifier. Keep in mind that breastfed babies are more likely to refuse the pacifier than formula-fed babies.
 Lay your baby tummy-down across your knees and gently rub her back. The pressure against her belly may help comfort her.
Swaddle her in a large, thin blanket so that she feels secure and warm. For a step-by-step guide to swaddling, visit parenting.com.

    

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