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Your Baby's Health

Becoming a mom opens up a world of talents you didn't know you had, not the least of which is medical detective. You're discovering all the tiniest details about your baby  -- from the way the top of his head smells to his quirky smile as he's drifting off to sleep. So it's no surprise that you're often the first to notice when something isn't quite right  -- when he seems a little pale or is fussing at a time when he's usually calm, or even when what's in his diaper looks unusual. But once you notice these subtle changes, do you know what to do next? While you can't anticipate everything that might happen in your baby's first year, it helps to know the common problems and the best response.

1. The most effective way to take your baby's temperature is:
A In the ear
B Under the arm
C Rectally
D In the mouth
E With a temperature strip on the forehead

2. Your baby used to have two or three bowel movements a day, but now hasn't had any in 24 hours. She's probably:
A Constipated
B Not eating enough
C Just fine
D Sick

3. The best approach to treating a baby's stuffy nose, no matter how young, is to:
A Gently squirt saline drops into his nose
B Remove the mucus using a bulb syringe
C Give him a decongestant prescribed by your pediatrician
D Do nothing; it'll clear up on its own

4. You should never apply sunscreen to a baby younger than 6 months of age. True or false?
A True
B False

5. Your 3-week-old spikes a 101-degree fever. What should you do?
A Give her infant acetaminophen and take her temperature again in an hour
B Cool her down with a sponge bath
C Call her pediatrician immediately
D Monitor her carefully for the next hour

6. Your baby may have signs of a food allergy if:
A She breaks out in a rash and has diarrhea or vomits after the third time you give her a food
B She cries inconsolably after eating
C She turns her head away each time you try to feed her a food
D She gets a rash after the first time you give her a food

7. Your baby just received a vaccination, and now he has a fever and is really fussy. What should you do?
A Call his doctor right away
B Avoid the vaccine in the future
C Soothe him with a cool bath
D Give him a pain reliever, such as acetaminophen, and monitor his fever for the next day

8. Your baby has diarrhea.What should you do for him?
A Feed him the BRAT (bananas, rice, applesauce, toast) diet
B Give him frequent fluids and, if he's eating solids, small amounts of food that combine fiber and fat
C Give an antidiarrhea medication
D Cut back on the fluids you give him

9. Your baby still spits up after every feeding. You should:
A Shift the position she's in when you feed her
B Change her formula, or your diet if you're nursing
C Give her a mild antacid
D All of the above

10. Your 3-week-old baby has started screaming for at least three hours every night. She probably:
A Has digestive problems
B Is having nightmares
C Has colic
D Isn't getting enough to eat

See page 2 and 3 for answers and results...

Laura Flynn McCarthy, a mom of two boys, also writes for Reader's Digest and Vegetarian Times.

Answers to questions 1 to 6

1) Answer: C Rectal temperatures are the most accurate. Ear temperatures are okay, but getting a good reading can be tricky because the thermometer needs to be positioned just right, which can be painful if your baby has an ear infection. Under the arm gives an external body temperature, which tends to be falsely low. Forehead strips, while handy, aren't considered exact when it comes to getting a baby's reading (although they're great for kids over 1). An oral one works well for children around age 4 or older, but an infant doesn't have the muscle control to keep it under her tongue.
For easier rectal temperature taking, use a digital thermometer, apply KY or petroleum jelly to the tip, insert it one inch into the rectum, and wait about 60 seconds  -- or until the thermometer beeps. Remove and read. (And don't be surprised if your baby immediately poops.)

2) Answer: C It's normal for bowel habits to change over the first year. In the first six weeks babies usually have several BMs a day. But at around 6 to 8 weeks, when digestion slows, they begin to poop less frequently.
You also may see changes in bowel habits when your child starts on solids, says Ari Brown, M.D., coauthor of Baby 411: Clear Answers and Smart Advice for Your Baby's First Year. If you've been breastfeeding, switching to or supplementing with formula can slow down bowel habits, too, because formula takes longer to digest. Once your baby is past the newborn stage, no bowel movement for several days is usually not a problem. If a week passes, your baby seems uncomfortable or fussy, his belly is distended, or he's vomiting or running a fever, call his doctor.

3) Answer: A Put two or three drops of saline into each nostril. "Don't suction his nose with a bulb syringe without applying the drops first; you may irritate the nose," says Carolyn Lopez, M.D., chair of the department of family and community medicine for the John H. Stroger Jr. Hospital of Cook County in Chicago. "Saline loosens the mucus, making it easier to remove with the syringe."
Decongestants aren't usually recommended for babies. If the saline drops don't work and the stuffiness is interfering with your child's ability to breathe, sleep, or eat, call your doctor.

4) Answer: B Until recently, the American Academy of Pediatrics did recommend waiting until your child was 6 months old before applying sunscreen, to encourage parents to keep infants that young out of the sun entirely or, at least, to stress the importance of making sure your baby is completely shaded and covered when outdoors. The new thinking: You should apply sunscreen (sparingly, though, around the mouth and on the hands), as long as you use a product that says "chemical-free" on the label. This means that the sunscreen contains a physical block, such as zinc oxide or titanium dioxide, which won't irritate your baby's skin. (Steer clear of products containing a chemical block, which can trigger a skin reaction in your baby.) Look for SPF 30, and reapply it every one and a half to two hours. (Two good options: Neutrogena Sensitive Skin Sunblock Lotion and Coppertone Water Babies.)
Of course, it's still a good idea to keep your baby out of the sun as much as possible, no matter how old she is, and to shade and cover her (with lightweight clothing and a hat) when she's outdoors (especially at midday).

5) Answer: C "Any fever during the first month of life is an automatic ticket to the hospital for two days to be evaluated," says Dr. Brown. "Infections can progress rapidly in a young baby, especially if she's under a month old, because the immune system is immature and may not be able to fight them off well." The risk of a serious infection is also higher in the first month because birth itself can sometimes lead to it. For example, some moms naturally carry group B streptococcus bacteria; it's harmless to them, but in a newborn it can cause an infection and even meningitis, which may not occur for up to a month after delivery. A high fever can also be an early symptom of an infection caused by structural abnormality in the kidneys or bladder.

6) Answer: A Since it can take more than one exposure to become sensitized to any allergen, your child wouldn't break out in a rash the first time she tries a food. Turning away from a food doesn't mean your baby's allergic to it; she probably just doesn't want it. Crying inconsolably can be a sign of a food allergy but usually would be accompanied by a rash or diarrhea or vomiting.
About 6 percent of children under age 5 have a food allergy, most commonly to milk, eggs, and/or peanuts. Your baby is more likely to have allergies of any type if they run in your family. He can develop a food allergy directly by consuming a food, or indirectly by nursing if you've eaten it.
Doctors recommend introducing solids slowly. Begin between 4 and 6 months with rice cereal, followed by barley and oat cereal, yellow vegetables, fruits, green vegetables, meats, and wheat. Allow five to seven days between the introduction of each new food to see if symptoms develop. If your baby gets a rash or diarrhea, is vomiting, or is crying endlessly, call your pediatrician. She may do tests to confirm the allergy and recommend that you stop giving your child the food or avoid consuming it if you're breastfeeding. If the allergy is to milk, you may have to switch to a soy formula or a nonallergenic formula, or avoid drinking milk if you're breastfeeding.
Most kids with food allergies eventually outgrow them, says Robert Wood, M.D., director of the pediatric allergy clinic at Johns Hopkins Medical Institutions, in Baltimore. Sometimes you can reintroduce a food safely within a few months of a reaction (check with your doctor first); in other cases, you may need to wait it out a few years.

Answers to questions 7 to 10, plus results

7) Answer: D Give your child a pain reliever and watch his fever and other symptoms carefully for the next 24 hours, contacting your pediatrician if things don't improve in a day or so. "A low-grade fever after a shot is very common. It means the immune system is revving up," says Dr. Lopez. "Some fussiness is normal, too, but if your baby is inconsolable for more than three hours or if the fever begins to spike higher  -- 102 or 103  -- call your doctor."

8) Answer: B Although the BRAT diet used to be standard for treating diarrhea in older infants and young children, recent research shows that eating fat and fiber together bulks up the stool, slowing down the frequency of diarrhea, and reduces water loss in the stool, lowering the risk of dehydration. Try yogurt or oatmeal with a little milk or formula. Yogurt has an added bonus if it contains acidophilus, a "good" bacteria that aids in digestion. If your baby isn't eating solid foods yet, continue to feed him breast milk or formula as usual.
If there's vomiting, offer only clear fluids that contain salt and/or sugar (such as Pedialyte, Gatorade, or diluted juice). Then reintroduce breast milk, formula, and, if your baby's on solids, shoot for the fat-fiber combination.
Most doctors don't recommend giving antidiarrhea medications to babies under 1 year because they may actually prolong a bacterial infection. Since the majority of stomach bugs are caused by either a virus (in most cases) or bacteria, treating the diarrhea can extend the illness by slowing down the elimination of these organisms from the body. Also, some of these medications (such as Pepto-Bismol) contain aspirin, which isn't recommended for babies or young children.

9) Answer: A All babies up to age 6 months have gastroesophageal reflux to a certain degree, says Dr. Brown. As long as it's a small amount of spitup, your baby doesn't seem upset by it, and she's continuing to gain weight, it's harmless. But to minimize the mess for you, try burping her frequently and changing her to an upright position during feedings and for 30 minutes after each feeding. If this doesn't work, your pediatrician may suggest thickening her formula, or expressed breast milk, with a little bit of rice cereal.
Spitting up is rarely due to a dietary problem in infants. So changes in formula, or your diet if you're breastfeeding, usually won't help. If the spitup is projectile, there's a lot of it, or your baby has other symptoms, such as weight loss, lethargy, or fussiness, call your doctor.
In some cases of severe reflux, doctors do prescribe antacids for babies or even suggest minor surgery. You'll want to talk over your options with your physician.

10) Answer: C Colic occurs in around 20 percent of all infants. Colicky babies typically cry for more than three hours a day and more than three times a week, for more than three weeks. Colic usually develops at around 3 weeks and usually resolves by between 3 and 6 months of age. There are some experts who believe these intense crying episodes are because young babies have trouble calming themselves; all infants have to learn this skill, and in babies with colic, it takes longer.
"There's been a lot of speculation about the cause of colic," says Dr. Brown. "It could be a combination of factors  -- from intestinal to neurological  -- that makes these babies less able to settle down." What's the bottom line? The jury's still out. The good news is that babies outgrow colic, and it has no bearing on a child's future temperament or personality. If it lasts beyond the 3- or 4-month mark, it's likely there's another cause, such as reflux; contact your pediatrician.
There's really no known "cure" for colic. In order to soothe your fussy infant, try motion (rocking, a car ride, an infant swing), "white noise" (shushing, a ceiling fan), swaddling, or a pacifier.

How'd you do?
10 correct answers: Mom of the year!
A perfect score; what more is there to say?

8-9 correct answers: Pediatrician-in-training.
You're almost there but not quite. Your doctor can still teach you a thing or two. When in doubt, call her.

6-7 correct answers: Gullible gal.
You've got a lot of information but have trouble sorting reality from myth.

5 or fewer correct answers: June Cleaver.
Sure you're a good mom, but your medical know-how needs some updating.

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