When new parents come into my office for their baby's first checkup, I remind them that pediatrics is a partnership between parents and doctor, and each person plays an important role. Parents need to be keen observers and accurate reporters, while a doctor must use parents' observations to help make the right diagnosis and prescribe proper treatment.
During the first year, you'll learn a lot about how your baby communicates. Before you realize it, you'll be an expert at differentiating hungry cries from sleepy ones, and wet-diaper wails from I-want-to-cuddle whimpers. You'll know your baby's sleeping and eating patterns, and the sparkle in her eyes that comes when she's happy.
Understanding when your baby is sick requires knowing her when she's well. Often a change in behavior will be the first symptom you notice, but it helps to know the signs that pediatricians look out for as well. Here, a guide to some of the most common illnesses that babies encounter during the first year.
1. Gastroesophageal Reflux (GER)
During the first few months many babies experience varying degrees of GER, which occurs when the acidic stomach contents regurgitate back into the esophagus, causing pain. GER is common in babies because the circular band of muscle that acts as a valve between the esophagus and the stomach is immature.
Symptoms: GER often gets misdiagnosed as colic. (I encourage my patients' parents not to even use the word colic, but to call it the hurting baby. This motivates each person in the parent-doctor partnership to keep searching for why a child hurts and what to do about it.) Other symptoms include frequent spitting up or vomiting (though not all babies with GER spit up), movements such as throwing the legs up or arching the back, frequent wet burps, or throaty gagging noises.
Treatment: Smaller, more frequent feedings (feed your baby half as much, twice as often) can help because less food in the stomach at one time decreases reflux. Frequent feedings will also stimulate the production of saliva, which neutralizes stomach acid and lubricates the esophageal lining. Keep baby upright and quiet for at least a half hour after feeding to let gravity hold the food down. Breastfeed if you can since breast milk is digested faster than formula is.
When to call the doctor: With mild reflux, these simple home remedies are usually enough. If the GER is severe enough to interfere with weight gain and sleep, or is causing your baby a lot of pain, the doctor may prescribe medications that block the production of stomach acid. GER usually begins to subside around 7 months, when babies spend much of their day upright.
Most babies usually get several colds during their first year. Colds are caused by viral infections that cause the membranes of the nose and respiratory passages to swell and pour out mucus.
Symptoms: Narrowed, mucus-filled breathing passages can cause baby to cough, wheeze, breathe fast, and may interfere with normal sleeping and eating patterns. Your baby may also have a low-grade fever, runny nose, sneezing, and a decreased appetite.
Treatment: If your child is having trouble breathing, sit him on your lap in the bathroom with the shower on the hottest setting for ten minutes. The steam will help loosen the congestion. I also recommend using a nasal aspirator with saline nasal spray to suction out the secretions. Doing this before bedtime can help your baby sleep. Offer your infant extra fluids. Don't use cold medicines without checking with your doctor.
When to call the doctor: If your child is under three months, you should call your doctor at the first sign of illness. For infants older than three months, call the doctor if her lips or nails turn blue, if she's having trouble breathing, or if she has a fever that warrants a call to the doctor. If your infant remains in good spirits and the nasal discharge is clear, give the cold a week on the above home treatment. If your baby's nasal discharge becomes thick and yellow, visit the doctor: She may recommend cold medicine. Antibiotics won't work because they fight bacterial infections, and colds are caused by viruses.
RSV, which stands for respiratory syncytial virus, is a common virus of early infancy that can be very serious. It is the major cause of hospitalization for respiratory illness in children under one year of age.
Symptoms: RSV usually begins like a common cold with a runny nose, low fever, and cough, but it can last for several weeks. It can infect the bronchial passages, causing bronchitis (if it's in the larger airways) or bronchiolitis (if it's in the smaller breathing tubes). You may also hear your child wheezing when he breathes. If RSV spreads to the lungs, it can cause viral pneumonia.
Treatment: If the "steam clean" home remedy described in "Colds" doesn't help, try taking your baby outdoors into the damp night air for a brief period.
When to call the doctor: If your child is under 3 months old, call your doctor at the first sign of illness. Take him to an emergency room if he's struggling to breathe. Seek medical attention if what you think is a cold lasts more than a week.
Prevention: Don't allow smoking around your baby (smoke makes breathing passages more susceptible to infection), be sure your daycare has careful policies about separating sick infants, and wash your hands frequently. If your child was born prematurely, he is more at risk for complications from RSV. The series of preventive shots known as Synagis are available during RSV season, which runs from fall to spring.
Often after babies start solid foods, they become constipated and have difficulty passing stools. It's important to treat constipation because if the hard stool is painful, your baby may refuse to go. This may then stretch the intestines, weaken the muscle tone, and make it more difficult to pass the stool.
Symptoms: In a newborn, watch for stools that are firm and infrequent (less than once a day). It may be helpful to keep track of your baby's bowel movements. If you see blood on your baby's diaper, it may be due to a rectal fissure, a tiny tear in the rectal wall caused by a hard stool. These harmless yet painful tears heal quickly once the constipation is cured.
Treatment: If you're feeding your baby formula, experiment with different brands until you find one that produces a softer stool. (Tell your pediatrician if you make a change.) If your baby is more than 1 year old and you recently switched from formula to cow's milk, try going back. Decrease constipating foods, such as bananas and rice cereal, in your baby's diet and add high fluid and high fiber ones, such as puréed prunes and pears and barley cereal. You can also add a teaspoon of flax oil (not only a natural laxative but a source of healthy omega-3 fats) once a day in Baby's cereal or bottle.
When to call the doctor: If your baby seems to be in pain and hasn't had a bowel movement for more than four days, call your pediatrician. In severe cases, she may prescribe a mild laxative or an enema.
Diarrhea refers to having bowel movements that are too frequent and too watery. It is most often caused by a virus, but can also result from a bacterial infection, an allergy, or medication. The potential danger of diarrhea is dehydration.
Symptoms: Breastfed newborns may have up to 12 small bowel movements a day, but by three months, they may go a day without any. If your infant's bowel movements become much more frequent and watery all of a sudden, he probably has diarrhea.
Treatment: Treatment of diarrhea is basically resting your baby's intestines until they naturally return to normal. Keep track of your baby's stools to report to your doctor.
When to call the doctor: If your baby has a high fever, bloody diarrhea, increasing abdominal pain, vomiting, or you suspect he's dehydrated or losing weight, medical attention is needed. (Don't be afraid to visit the doctor if you'd like to have your baby weighed.) Signs of dehydration are lethargy, dry eyes, dry mouth, and fewer wet diapers. Your doctor may suggest changing your baby's diet and replacing lost fluids with an electrolyte solution.
6. Ear Infections
When fluid accumulates in the middle ear, it can act like a culture for germs to grow in. The infected fluid presses on the eardrum, producing intense pain.
Symptoms: If your infant has an ear infection, she'll probably be cranky, wake up during the night because of pain, be unwilling to lie flat, and cry during feeding.
Treatment: To treat middle-of-the-night earaches give your baby the appropriate dose of infant pain reliever. Keep her upright, which will allow the fluid to drain away from the eardrum and cause less pressure.
When to call the doctor: If you suspect an ear infection, have your doctor examine your baby's ears. If the eardrum looks very infected, she may prescribe an antibiotic. It's important to seek medical help, since repeated untreated ear infections may lead to hearing loss and consequent speech delay.
Prevention: Breastfeed your infant if you can since breastfed infants have fewer ear infections. Control allergens (such as cigarette smoke, dust, and animal dander) since they can cause fluid buildup behind the eardrum. If your child has a cold, suction her nose, as described earlier, to prevent germs from entering the ear. If your baby is bottlefeeding, feed her in an upright position to lessen the chance of milk or formula entering the middle ear from the throat.
Fever is a symptom of an underlying illness, not an illness in itself. Like the "check engine" light on your dashboard, it's a clue that something is going on that needs attention.
Symptoms: If your baby feels hot or looks flushed, take his temperature to confirm a fever.
Treatment: If your child is over a year old, seems happy, and doesn't have related symptoms such as a cold, there's usually no need to call the doctor immediately. To lower the fever, you can give your child the infant pain reliever recommended by your doctor; a tepid sponge bath may help as well.
When to call the doctor: When to contact your doctor about a persistent fever depends on your baby's age. The American Academy of Pediatrics guidelines are as follows: For a baby 2 months or younger, call a doctor immediately for a fever over 100.2°F; for an infant between 3 and 6 months, call for a fever above 101°F; and if she's older than 6 months, call for a fever above 103°F. Otherwise, you can wait for 24 hours to see if the fever goes away on its own. Sometimes, how your baby looks can be more significant than how high the fever is. Call your doctor if your baby is lethargic, pale, or in pain.
While infant illnesses cause babies to lose sleep and parents to miss work, it helps to view them as opportunities to connect with your baby. Infants naturally become clingy when ill, so take advantage of the extra cuddle time. In addition to the treatments above, they need the tender loving care that only Mom and Dad can provide.
Contributing editor William Sears, M.D., is the author, with his wife, Martha Sears, R.N., of The Baby Book.