What to Expect the First Year (116 page)

Recommended Immunization Schedule

This is the schedule for childhood immunizations set by the CDC and recommended by the AAP. Keep in mind that different brands of the same vaccine may require a slightly different dosing schedule, and that some vaccines may be given as combos (a good thing for your baby, since it means fewer needle pricks). A pediatrician may also adjust the schedule if a child gets behind on immunizations and needs to catch up.

Influenza (flu).
One dose of the flu vaccine, given at the start of flu season (usually October or November), is recommended for children 6 months of age and older. Children younger than 9 years of age receiving the vaccine for the first time need two doses at least 4 weeks apart. Once your child is over the age of 2, he or she can receive the yearly FluMist, an influenza vaccine that is delivered as a nasal mist instead of a shot. If your baby is under 6 months during flu season, it's especially important that everyone around him or her receive a vaccine.

Influenza, or flu, is a seasonal illness spread through droplets that are made when an infected person coughs, sneezes, or even talks, and then land in the nose or mouth or on a surface that's later touched (or mouthed by a baby). The influenza virus (there are many different strains) causes fever, sore throat, coughs, headache, chills, and muscle aches. Complications can range from ear and sinus infections to pneumonia and even death. Influenza is different from most other diseases in that the viruses are always changing, meaning that immunity acquired one year may not protect against future influenza viruses. That's why a yearly vaccine is recommended, and it can reduce the chances of getting the flu by up to 80 percent during the season.
Click here
for more on the flu.

Rotavirus (Rota).
This oral vaccine (given as drops) prevents rotavirus—an intestinal virus that causes vomiting, watery diarrhea, and often dehydration. It's extremely contagious, spreading easily through contact with contaminated hands or objects and through the air, and before the vaccine was made available, infecting nearly all children by the age of 5. The vaccine is given at either 2, 4, and 6 months or at 2 and 4 months, depending on the brand. Studies show that the vaccine prevents 75 percent of cases of rotavirus and 98 percent of severe cases of the disease.

Most pediatricians want to hear from you if you think your baby is really sick—no matter what the time of day or night. But how will you know what calls for a call? How high does baby's fever have to be? Does a runny nose deserve a call? What about a cough?

Here's what you need to know about calling the doctor.

Deciding which symptoms say “Call immediately,” which say “Call sometime today,” and which say “Wait and see” isn't always easy—especially for a new parent. That's why you should ask your child's doctor, nurse-practitioner, or physician's assistant for specific when-to-call recommendations for your baby … preferably before those first symptoms strike. Have a pediatrician who answers questions from parents via email or text? Ask what the protocol is for those forms of communication, too. (Is a call a better bet than an email when a situation is time sensitive—say, when your baby is running a high fever or has taken a fall? Or is a text better than either?)

No matter what instructions you've been given, call immediately (or go to the emergency room if the doctor can't
be reached) if you feel that there is something very wrong with your baby—even if you can't confirm it with the help of this list and even if you can't quite put your finger on what it is. Parents—yes, even brand new parents—often know best.

If your baby develops any of the following symptoms, call as noted. If a symptom that warrants a call during regular office hours appears on the weekend, you can wait until Monday to contact the doctor. If a symptom that requires a call within 24 hours appears on the weekend, call within that time frame, even if you have to call the doctor's answering service.

• In a baby under 2 months with fever 100.4°F or greater—call immediately

• In a baby over 2 months with fever over 104°F or greater—call immediately, particularly if he or she is acting ill

• In a baby 2 to 6 months with fever over 101°F—call within 24 hours

• In a baby older than 6 months with fever over 103°F—call within 24 hours

• In a baby older than 6 months with fever 100.4°F or greater, with mild cold or flu symptoms, that lasts for more than 3 days—call during regular office hours

• That isn't brought down at all by a fever-reducing medication within an hour—call within 24 hours

• Of 100.4°F or greater that returns after being gone for a couple of days, or that suddenly develops in a baby who has been sick with a cold or flu (this may indicate a secondary infection, such as an ear infection)—call within 24 hours, unless the baby appears sicker or if breathing becomes fast and labored, in which case, call right away

• That appears following a period of exposure to an external heat source, such as the sun on a hot day or the closed interior of a car in hot weather—immediate emergency medical attention is required (see heat illness,
here
)

• That suddenly increases when a child with a moderate fever has been overdressed or bundled in blankets. This should be treated as heat illness—call right away

• Limpness or unresponsiveness—call right away

• Convulsions (the body stiffens, eyes roll, limbs flail)—call immediately the first time it happens. If your baby has had convulsions in the past, call within 24 hours, unless the doctor has advised you to do otherwise (
click here
)

• Convulsions that last longer than 5 minutes—call 911 immediately for emergency assistance

• Inconsolable, out of the ordinary crying (i.e., not colic) that lasts 2 or 3 hours—call right away

• Crying, as if in pain, when your child is touched or moved—call immediately

• Purple spots appear anywhere on the skin—call immediately

• Difficulty breathing—call immediately

• Excessive drooling and a refusal to swallow liquids—call immediately

• Neck stiffness (baby resists having his
or her head moved forward toward the chest)—call immediately

• A mild rash (not dark or purple)—call during regular office hours

• Repeated vomiting (baby's not able to keep anything down)—call within 6 to 12 hours. Repeated and forceful vomiting—call right away

• Mild dehydration (
click here
for typical signs)—call within 12 hours

• Any dehydration that seems to be more than “mild” (
click here
for signs)—call immediately

• Uncharacteristic behavior—excessive crankiness or crying, excessive sleepiness, lethargy, sleeplessness, sensitivity to light, total loss of appetite, more than usual ear pulling or clutching—call within 24 hours

• That is mild (not barking or whooping) and lasts more than 2 weeks—call during regular office hours

• That disturbs sleep at night—call during regular office hours

• That brings up blood-tinged phlegm—call immediately

• That sounds very barky or chesty—call during regular office hours, unless it's accompanied by breathing problems, in which case you should call sooner (see below)

• Difficulty breathing (it seems like it's hard for baby to breathe)—call immediately

• Wheezing (a whistling sound on breathing out)—call during regular office hours, unless breathing seems labored, then call immediately

• Retractions (the skin between the ribs appears to be sucked in with each breath)—call immediately

• Rapid breathing (
click here
)—call during regular office hours. If persistent or accompanied by fever—call the same day

Report any of the following symptoms to the doctor immediately:

• Blood in the urine

• Blood in the stool, except for small streaks of blood, which you can wait to report until regular office hours

• Blood in coughed-up mucus

• Blood leaking from the ears

Call immediately if your baby displays any of the following symptoms:

• Noticeable lethargy, with or without fever; a semi-awake state from which he or she can't fully be roused; lack of responsiveness

• Crying or moaning (as if in pain), when moved or touched

• Continuous crying for more than 3 hours not related to colic, high-pitched crying, faint whimpering or moaning

• Refusal to eat or drink anything at all for a few hours beyond a normal feed time

• Swollen glands that become red, hot, and tender—call within 24 hours

• Severe pain anywhere in the body (a nonverbal baby might clutch, tug, or swat at the affected body part)—call immediately

• Yellowing of the whites of the eyes or of the skin—call during regular office hours

Once you've decided that a call to the doctor is necessary (or you think it might be—when in doubt, go with your gut), make the most of the call by being as specific as possible when describing your baby's symptoms and by having the answers to questions the doctor may ask.

Information on your baby's symptoms.
Often, just looking at your baby will tell you something isn't right. But the doctor or nurse needs more information to figure out what's going on. So before you call to report an illness, check your baby for any of the following symptoms that might be related:

•
Temperature.
If your baby's forehead feels cool to the touch (with the back of your hand or your lips), you can assume there's no significant fever. If it feels warm, get a more accurate reading with a thermometer (
click here
).

•
Breathing.
Newborns normally take about 40 to 60 breaths per minute, older babies around 25 to 40. Breathing is more rapid during activity (including crying) than during sleep, and may speed up during illness. If your baby is coughing or seems to be breathing rapidly or irregularly, check respiration (rate of breathing). If your baby's respiration is faster or slower than usual or is outside the normal range, or if his or her chest doesn't seem to rise and fall with each breath or breathing appears labored or raspy (unrelated to a stuffy nose), report this to the doctor.

•
Respiratory symptoms.
Is your baby's nose runny or stuffy? Is the discharge watery or thick? Clear, white, yellow, or green? If there's a cough, is it dry, hacking, heavy, crowing, or barking? Has your child vomited mucus during a forceful cough?

•
Behavior.
Is it behavior as usual, or is there any change from the norm in your baby's behavior? Would you describe your baby as sleepy and lethargic, cranky and irritable, inconsolable or unresponsive? Can you elicit a smile (for babies over 2 months)?

•
Sleeping.
Is your baby sleeping much more than usual, or is he or she unusually drowsy or difficult to wake? Or is he or she having more trouble sleeping than usual?

•
Crying.
Is your baby crying more than usual? Does the cry have a different sound or unusual intensity—is it high pitched, for instance, or low pitched?

•
Appetite.
Has there been a sudden change in appetite? Is your baby
refusing fluids and/or usual solids? Or eating and drinking as per usual?

•
Skin.
Does your baby's skin appear or feel different in any way? Is it red and flushed? White and pale? Bluish or gray? Does it feel moist and warm (sweaty) or moist and cool (clammy)? Or is it unusually dry or wrinkly? Are lips, nostrils, or cheeks excessively dry or cracking? Are there spots anywhere on your baby's skin—under the arms, behind the ears, on the extremities or trunk, or elsewhere? How would you describe their color, shape, size, and texture? Is your baby scratching or rubbing them?

•
Mouth.
Are there any red or white spots or patches visible on the gums, inside the cheeks, or on the palate or tongue? Any bleeding?

•
Fontanel.
Is the soft spot on top of your baby's head sunken or bulging?