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Nothing is more important to you than your children. This is particularly true when it comes to their health. When illnesses, even mild ones, strike infants and very young children it can be a time of anxiety and worry for even the most experienced parent.
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Between birth and about four years old, your baby will be exposed to
many germs and infections. Many serious diseases can be prevented
through proper and adequate vaccinations. But not all infections can be
prevented with a vaccine and in some cases, your child may become ill.
Just like adults, the majority of these illnesses will be mild
respiratory, eye, and skin infections.
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This document will help you evaluate and manage your child's illnesses in cooperation with the physician. It gives you instructions on when to call the doctor, what information to have available, and how to prevent or reduce exposure to common infections. The booklet provides some guidance to parents of children with special health needs.
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When your baby gets sick
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There's never a good time to get sick
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To most parents it seems like babies get sick at the worst possible time for reaching the doctor, in the middle of the night or over a holiday weekend. Regardless of when it happens, your pediatrician prefers a call from you so he/she can rule out a serious medical problem.
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Signs and symptoms that should immediately alert you to call your doctor include:
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You notice your baby...
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...is having trouble breathing
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...has a fever for more than two days
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...is lethargic
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...is vomiting or has diarrhea for more than 24 hours
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...has blood in the stool or blood in the vomit
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...is not taking liquids or is dehydrated
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Just the facts
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Before calling the doctor, take some time to follow these rules of thumb so you can provide detailed and accurate information about your baby's condition:
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Prepare a written list of your baby's symptoms (when they began and anything you think may have triggered them) and read it to the doctor
Let the doctor know about anything that seems to improve or worsen your baby's symptoms
Tell the doctor about any home remedies or over-the-counter medications you've tried
Point out any recent exposure to an adult or child with chicken pox, diarrhea, or any other communicable disease
Be sure to mention any changes you may have noticed in your baby's behavior such as sudden, prolonged crying in a child who doesn't generally cry excessively, listlessness, or increased irritability
Remind the doctor of your baby's age and weight, along with any chronic medical problems or recent injuries
Be prepared with the phone number of an open pharmacy and write down any instructions you receive
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Infant health assessment
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Know enough to help your child
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Although any doctor will tell you it is important not to rely too much upon self-diagnosis of yourself or your children, getting involved in your family's health is important. The more you know, the less likely you are to become frightened or anxious when your children become ill.
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Your judgment and how you communicate information can help your pediatrician get to the bottom of what is really wrong.
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The most common illnesses that can occur in the first year of life are the respiratory illnesses, including the common cold, bronchiolitis, bronchitis, and pneumonia. Many of these illnesses have similar symptoms which may include cough, wheezing, fever, and congestion, but may be different in terms of treatment.
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Bronchiolitis, often caused by the respiratory syncytial virus (RSV) is
a major cause of serious lower respiratory tract infection in children
less than one year of age. The winter months are the most common time
of year for RSV bronchiolitis to occur. While most cases of RSV
bronchiolitis are self-limited, nearly 100,000 children are hospitalized
each year; hospitalized infants with severe RSV may require antiviral
medication. Bronchitis and pneumonia may be treated with antibiotics.1 Your child's doctor can tell you more about respiratory illness in infants and very young children.
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Parents and child health professionals as partners
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When your baby is ill, any physical sign or symptom you can relay to your doctor will help in the diagnosis. Don't leave out things you think may not be important. If the doctor tells you it is nothing to be alarmed about, at least you know you didn't overlook anything. Babies can't speak for themselves when something is wrong, you know best when your child is not well.
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Here are several key signs and symptoms you should monitor and report to the doctor when your baby seems ill:
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Temperature
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If your baby feels warm or is irritable, take his/her temperature.
Remember that an infant's temperature can be affected by climate,
activity level (including crying and napping), and clothing. However;
if the temperature is over 100.5°F, seek medical attention.
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Heart Rate
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An infant's normal resting heart rate is much higher than that of an adult, in some cases up to 50 more beats per minute, and slows as the child gets older. If the heartbeat seems too fast to you, especially in combination with other symptoms, the doctor may want to know. Remember; crying greatly accelerates heart rate.
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Respiration/Respiratory Symptoms
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Difficulty breathing, persistent coughing, wheezing, or labored breathing are reasons to check with a health professional. Note your infant's respiratory rate by counting how many times his/her chest rises and falls in a minute. If breathing is extremely rapid or extremely slow, get to an emergency room. If the baby has a runny nose, note the color of the discharge (white, yellow, or green). Any cough that lasts more than three days should be reported to the doctor.
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Behavior and Sleep Patterns
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This is one area in which parental intuition goes a long way. If your baby seems unusually tired or lethargic, becomes easily irritated, or is less responsive than normal, check with your doctor. If you can't elicit a smile from a normally happy baby, make the call.
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Appetite/Digestion
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Changes in eating patterns are not always a sign that something is wrong. During periods of rapid growth babies seem to be constantly hungry. Other times they may barely eat anything at all. If your baby is refusing liquids, has trouble keeping food down, or seems to have indigestion frequently, see your doctor to rule out digestive or other problems. Vomiting and diarrhea should also be mentioned to your pediatrician. Do not use an anti-diarrheal medication without your doctor's approval and check with the doctor to find out which fluids are best for your baby to replace those lost during the illness.
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Skin
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Blotchy skin or itchy or raised rashes may signal allergies to a specific food, an item of clothing, or something in the environment. Rashes that occur immediately after an immunization should be reported to the doctor*.
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Mouth and Tongue
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Let your doctor know about red or white patches on the inside of the mouth and on the tongue, or a very dry mouth and dry or cracked lips. By about six months of age, babies usually start experiencing gum irritation as teething begins. A sore throat is difficult to determine in a baby without actually looking into the mouth. If it looks red and irritated, your doctor may want to check for strep throat.
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Eyes
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Let the doctor know if there is any redness or discharge from the eye, or a glassy or vacant stare. Conjunctivitis, commonly called pinkeye, is a possibility if a baby keeps rubbing at an eye that is bloodshot.
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Ears
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Otitis media is a common inner ear infection in babies. Often the pain is worse at night and the baby will cry and pull or poke at his/her ears. Fever, fatigue, and irritability frequently accompany ear infections. Your doctor will prescribe an antibiotic to cure the bacterial infection and also may suggest giving your baby acetaminophen for pain and/or fever.
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* It is recommended that children be given a series of vaccinations against diphtheria, tetanus, and pertussis (DTP), polio, hemophilus influenzae (Hib), and hepatitis B beginning anywhere from birth to two months of age. Any unusual reactions within 48 hours of a given immunization warrant a call to the doctor.
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Preventing illnesses in young children
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The first line of defense against infections in young children is proper and adequate vaccination
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While vaccines have eliminated or reduced the rate of many serious childhood infections, occasional illnesses like the common cold and flu are a fact of life for babies as well as adults. While it is impossible to avoid all illnesses, there are some basic and effective strategies you and your family can follow to help prevent or diminish their impact.
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It is important to keep in mind that hands are transportation centers for germs. Anything we touch can be transmitted directly to others around us or indirectly through household objects that other family members are likely to touch after us. Infections are commonly spread through one of three routes:
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Respiratory: Coughing or sneezing on someone; touching oral or nasal secretions of an infected person.
Intestinal: Germs from fecal material spread via hands to objects (toys), and surfaces (diaper changing tables, doorknobs) which are then touched by others.
Touching: Direct physical contact can spread infections like pinkeye, impetigo (a common skin infection), and head lice.
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Break the chain of transmission
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Ensure proper and complete hand washing of yourself and your baby after diaper changes or toiletings, before eating or feeding babies/children, and after contact with any bodily secretions (nasal mucus, phlegm, vomit, diarrhea, or blood).
Insist that all adults wash their hands before any contact with small children in the home.
Dispose of diapers, baby wipes, tissues, and dirty or soiled laundry in a sanitary manner.
Keep curious toddlers away from garbage cans and diaper pails.
Make sure infected family members have their own towels, eating utensils, and drinking glasses for the duration of their illness. Wash all of these items thoroughly before anyone else uses them.
Wash all clothing worn by sick family members and wash and change bed linens. If possible, air the room and clean and disinfect objects and surfaces in the room.
Sanitize medication dispensers, thermometers, toilet seats, potty chairs, and anything that may have been soiled or handled by the sick child.
Clean toys, play surfaces, changing tables, and other objects with soap and water and disinfect with a mild solution of bleach and water (1/4 cup of bleach to one gallon of water), especially after other children and adults have been at play.
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Babies with special needs
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Some infants have medical conditions or special circumstances known to make them more vulnerable to severe infections. For these babies, early evaluation and medical treatment is especially important.
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If your child has one of the following medical conditions or special circumstances, ask your doctor about specific instructions regarding common illnesses such as respiratory and gastrointestinal infections.
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Special circumstances
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Age less than six weeks:
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Infants less than six weeks of age do not handle any infection very well. Their immune systems may not be strong enough to keep an infection contained. Any fever in an infant less than six weeks of age usually requires a medical evaluation.
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History of prematurity/low birth weight:
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Infants born with low birth weight or born a month or more prematurely may continue to be immature for a period of time after their birth. This may put them at risk for more severe cases of common illnesses than more mature infants. Check with your doctor for an assessment of your child's status.
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1. Shay DK, Holman RC, Roosevelt GE, Clark MJ, Anderson LJ. Brochiolitis
- associated mortality and estimates of respiratory syncytial virus - associated
deaths among U.S. Children, 1979-1997. J Infect Dis. 2001; 183;16-22.
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