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When Your Child's Sick

When your baby cries, his face scrunched up as red as a strawberry, you'll do anything to make him feel better. But sometimes you haven't a clue what's bothering him, or even if it's really serious. Pediatricians around the country tell how they answer parents' most common health concerns:

Michele Meyer is a freelance health and fitness writer based in Texas.

"He's burning up."

If your child is flushed and sweaty, and he feels hot to the touch, take his temperature. "A fever is often a sign that a child's fighting off an infection," says Donald Schiff, M.D., professor of pediatrics at the University of Colorado School of Medicine, in Denver, and coeditor of The American Academy of Pediatrics Guide to Your Child's Symptoms.

WHAT YOU CAN DO:

A child older than 6 months can usually be treated at home safely as long as his temperature is below 103 degrees Fahrenheit and he has no other symptoms. "Try sponging him with tepid water or placing him in a bath of lukewarm water," suggests Dr. Schiff. You also might want to give him acetaminophen or ibuprofen to reduce his discomfort. (Children under 18 should never be given aspirin; it's been linked to Reye's syndrome, a serious disease that affects the brain and liver.) Finally, be sure he gets plenty of rest and drinks lots of fluids. Infants and toddlers may be given a commercial rehydrating solution, such as Pedialyte or Rehydralyte.

WHEN TO CALL THE DOCTOR: Since infants are especially prone to infection, call right away if your baby is 3 months or younger and his temperature exceeds 100.2 degrees, says Kathie Teets Grimm, M.D., clinical associate professor of pediatrics at Mount Sinai School of Medicine, in New York City. Children between 3 and 6 months with a fever of at least 101 should also see a pediatrician. If an older child's temperature hasn't improved in 24 hours, or reaches 103 or higher, call the pediatrician. You should also call if a feverish child of any age develops other symptoms, such as a rash, an earache, or swollen glands, or has trouble breathing. Your pediatrician will want to rule out the possibility of a more serious illness, such as roseola, pneumonia, or meningitis.

Occasionally, a child will have febrile convulsions when his temperature rises too rapidly. "These seizures tend to occur most often in babies between six months and two years," says Dr. Schiff. It's smart to have the doctor check your child the first time this happens to make sure it hasn't been caused by an underlying condition. Kids who are prone to febrile convulsions usually outgrow them by age 6 with no long-term effects.

"My baby has a cold."

There's usually no reason to worry when your little one coughs, sniffles, or sneezes. But if she does catch a cold, first check her for a fever. If your baby's older than 3 months and her temperature is normal, it's okay to treat her yourself as long as her condition doesn't worsen.

WHAT YOU CAN DO:

While there's no cure for the common cold, you can relieve your child's symptoms by making sure she gets plenty of rest and drinks lots of fluids, including water and fruit juice. (Babies should continue to nurse or drink formula.) A cool-mist vaporizer can help relieve congestion; a dab of petroleum jelly will soothe irritated lips and nostrils. You also might want to give her acetaminophen or ibuprofen to ease discomfort. Don't give any child under 3 an over-the-counter (OTC) cough preparation or decongestant without first asking your pediatrician.

WHEN TO CALL THE DOCTOR:

In a week, if your child isn't getting better. You should also call if she develops new symptoms, such as an earache or a scratchy throat, a few days into her illness. (A baby with a sore throat will often cry when you nurse or feed her.) According to Dr. Schiff, "cold viruses can spread to the lungs, causing pneumonia, croup, bronchiolitis, or some other upper-respiratory disorder." A bacterial infection may also develop, requiring antibiotics. Of course, if at any time your child has trouble breathing, experiences chest pain, or runs a fever, seek immediate medical care.

"My daughter has a bad cough."

Coughs are usually the result of an allergy, cold, or the flu, though a severe and unrelenting one can signal a serious medical condition, such as asthma, bronchitis, or pneumonia.

WHAT YOU CAN DO:

If your child appears to have a run-of-the-mill cough and shows no sign of a fever, make sure that she gets plenty of fluids. (A baby who's properly hydrated will have moist eyes and lots of saliva in her mouth.) It also can help to sit with her in a steam-filled bathroom for a few minutes. Again, OTC cough preparations shouldn't be given to a child under 3 without consulting her physician.

WHEN TO CALL THE DOCTOR:

If the cough takes longer than two weeks to clear up, gets worse, or interferes with her sleep. Infants under 1 month old who cough more than a few times in a row should be checked right away. You should also seek immediate medical care for any child with a cough who develops a fever, has difficulty breathing, or seems sluggish. In general, coughs that sound like seal-like barks may indicate croup (an upper-respiratory disorder); those accompanied by a "whoop" sound usually signal pertussis, or whooping cough. In both cases, alert the doctor.

"His ears hurt."

Earaches are common in children under 3, and are most often due to an infection. The usual symptoms: frequent crying, irritability, sometimes rubbing or tugging at the ears. He also may have a cold (since ear infections are often brought on by upper-respiratory-tract infections).

WHAT YOU CAN DO:

If your child is 6 months or older and doesn't have a fever, you might want to give him an age-appropriate dose of acetaminophen or ibuprofen to ease his pain and discomfort. You can also hold a hot-water bottle wrapped in a towel to the achy ear. (Since a child under 9 months may not be able to push away a hot-water bottle that's too hot, rest your baby's head on your skin for comfort instead.) When possible, keep your child propped up  -- lying flat may worsen the pain.

WHEN TO CALL THE DOCTOR:

If you suspect an earache in an infant under 6 months, he'll need to be examined. (Babies with earaches will often refuse to eat and take a long time to fall asleep.) Call if a child of any age has an earache accompanied by a fever, a cold, or a headache; if you notice any fluid coming out of his ears; or if his glands start to swell. Since eardrums can rupture, persistent and/or severe ear pain should receive prompt medical attention; antibiotics may be required. Notify the doctor if a child with an earache seems to have trouble hearing or has a history of ear infections.

"My baby won't stop crying."

All infants cry when they need something  -- food, cuddling, a diaper change. But you shouldn't confuse normal, fussy crying with colic, a condition characterized by bouts of inconsolable crying. "A child with colic can cry intensely for one to three hours at a time," says Dr. Grimm. "Though it's still not clear what causes the distress, some experts suspect that babies with colic have too much gas trapped in their intestines, causing pain." The condition usually occurs in infants between 2 weeks and 5 months of age, and it will eventually pass.

WHAT YOU CAN DO:

If your baby has a crying fit, make sure that she's been properly fed, burped, and clothed, and that she doesn't need a diaper change. If she shows no other signs of illness, and cries for less than an hour at a time, Dr. Grimm recommends waiting out the sobs.

WHEN TO CALL THE DOCTOR:

If any crying spell is accompanied by vomiting, a fever, or a distended tummy, your doctor will want to rule out the possibility of an intestinal disorder or an infection. Babies who cry intensely for hours for no apparent reason should also be checked. If your baby is diagnosed with colic, says Dr. Schiff, "it helps to lay her on her tummy across your knees and gently rub her back  -- the pressure on her abdomen may ease her discomfort." (Don't let her fall asleep on her stomach.) You may also want to tightly swaddle your baby, play or hum a soothing tune, and gently rock her. If you breastfeed, your pediatrician may recommend you cut back on caffeine and gassy foods (such as beans, broccoli, and cheese). Some bottle-fed babies improve if their formula is switched to a brand without cow's milk. What also might help: bathing infants in warm water (once their umbilical-cord stump falls off) or applying a hot-water bottle wrapped in a towel to their tummy. Some babies may benefit from sips of warm chamomile tea.

"My newborn has a rash."

Many infants develop rashes in their first few months. Most are harmless and disappear on their own; others need more care. For instance, diaper rash is very common among babies whose dirty diapers are left on too long, who have recently started to eat solid foods, or who are on antibiotics. However, a rash can also signal a more serious illness or infection, so have suspicious rashes and patches, blotches, and bumps anywhere on the body checked out.

WHAT YOU CAN DO:

For diaper rash, change your baby as soon as you realize he's wet or soiled. Wash his bottom, pat dry, and apply zinc oxide cream or petroleum jelly to protect skin from further irritation. If the problem is eczema  -- characterized by itchy, scaly, and/or red patches on the cheeks, trunk, bends of elbows, or diaper area  -- your doctor may suggest using unscented moisturizers and mild soaps, and bathing your baby no more than three times a week. An antihistamine may be recommended to help stop the itch. Some cases also require a hydrocortisone cream.

WHEN TO CALL THE DOCTOR:

If your baby has a persistent or widespread rash. Of particular concern: rashes that have yellow crusts or are puffy, as well as those that look like a red streak or a cluster of blisters (all are signs of infection). Call a doctor immediately if your child has a purple or blood-red rash; it may indicate an uncommon but potentially deadly bacterial infection called meningococcemia.

"I don't think my baby is getting enough to eat."

Many new parents worry about this, especially when their infants spit up their food or seem as if they don't have much of an appetite. Breastfed babies generally nurse every two to three hours and should have six to eight wet diapers a day. Bottlefed newborns need about two to three ounces of formula every three to four hours. At 1 month, they should take in at least four ounces every four hours or so, and by 6 months, six to eight ounces, four or five times a day. "A baby's appetite will probably slow down a little by the time she reaches her first birthday," says Dr. Schiff.

WHAT YOU CAN DO:

If she doesn't express interest in eating, but otherwise appears healthy, she may be tired or not really hungry. It might help to brush her cheek or mouth with the nipple of your breast or the bottle to stimulate her interest in feeding. Don't push her if she turns away; she knows how much her stomach can handle.

WHEN TO CALL THE DOCTOR:

If your infant is spitting up after each feeding and not gaining weight according to schedule. You should also call if an older child is losing or failing to gain weight normally.

"She threw up."

Occasional vomiting in an otherwise healthy baby is usually no cause for alarm. "Kids get sick to their stomach for a number of reasons," says Jack Swanson, M.D., chair of the American Academy of Pediatrics' Committee on Practice and Ambulatory Medicine. They may be ill or upset  -- or have eaten something that didn't agree with them. Some babies with allergies may vomit in response to certain foods or medications.

WHAT YOU CAN DO:

If your child throws up once or twice and continues to have an upset stomach, don't give her anything to eat or drink for at least an hour or two. Then offer her small sips of clear fluids, such as water, or try a commercial rehydrating solution.

"When your child hasn't thrown up for several hours, you can slowly begin introducing bland foods  -- such as crackers, toast, or boiled potatoes  -- that are easy to digest, if she's old enough to eat them. Infants and babies may be nursed again or given formula when they can keep liquids down for two to three hours," says Dr. Swanson.

WHEN TO CALL THE DOCTOR:

Infants younger than 2 months who vomit after three or more feedings in a row will need to be examined by a pediatrician, as will older babies who vomit after every feeding within a 12-hour period. You should also call if a child of any age can't keep fluids down for more than 24 hours; has a fever; vomits blood or green bile; experiences sharp abdominal pain; seems confused, irritable, or lethargic; or shows signs of dehydration (dry mouth, sunken eyes, scant urine).

"My child has diarrhea."

All children have diarrhea from time to time. It's most often caused by an infection, an allergy, or food poisoning, though excessive amounts of juice is known to cause it in young kids. Keep in mind that babies who are breastfed tend to pass watery stools that shouldn't be confused with diarrhea.

WHAT YOU CAN DO:

Infants over 3 months and toddlers may be given a commercial rehydrating solution (such as Pedialyte or Rehydralyte) after two or three bouts of diarrhea to reduce the risk of dehydration. Children old enough for solids should drink plenty of fluids and stick to a diet of bananas, rice, applesauce, and toast until their diarrhea clears up. (Avoid foods that are high in fiber and fat; they tend to worsen diarrhea.) According to Dr. Swanson, OTC antidiarrheal medications aren't recommended for kids under 2 and should only be given to older children with a doctor's okay.

WHEN TO CALL THE DOCTOR:

If your child's diarrhea doesn't subside in 48 hours, gets worse in 24 hours, or becomes bloody. Infants under 3 months with diarrhea should be seen by a doctor right away, since they're at a greater risk for dehydration. Also, consult your pediatrician if a child of any age with diarrhea has a fever, vomits, looks dehydrated, rubs his stomach as if he's in pain or becomes excessively irritable.

"She seems constipated."

Don't worry if your baby doesn't have a daily bowel movement  -- some kids go two or three days before having one. "A child is only considered constipated," says Dr. Grimm, "if she has painful bowel movements with hard, dry stools."

WHAT YOU CAN DO:

Give your baby plenty of fluids. Some parents find it helpful to add some brown sugar to formula. Kids who are eating solids should be fed lots of high-fiber foods, such as fruits, vegetables, and whole grains. Don't give your child laxatives, enemas, or stool softeners (like mineral oil) without consulting her doctor first.

WHEN TO CALL THE DOCTOR:

If your child passes hard, dry stools accompanied by vomiting and severe abdominal pain  -- this may indicate a blocked intestine. You should also call right away if your child has blood in her stool or leaks fluids between bowel movements; she may have a serious bacterial or viral infection.

The bottom line: "Trust your instincts," says Barton Schmitt, M.D., medical director of the Children's Hospital After Hours Call Center, in Denver. "If you suspect something's seriously wrong with your child, don't hesitate to call a doctor. You know your child best."

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