What to Expect the First Year (117 page)

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Eyes.
Do your baby's eyes look different from usual? Do they seem glazed, glassy, vacant, sunken, dull, watery, or reddened? Is there yellowing of the whites? Do they have dark circles under them, or seem partially closed? If there's discharge, how would you describe its color, consistency, and quantity? Do you notice any “pimples” on the eyelids? Is your child squinting or unwilling to open his or her eyes in the light?

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Ears.
Is your baby pulling or poking at one or both ears? Is there a discharge from either ear? If there is, what does it look like?

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Upper digestive system.
Has your baby been vomiting (forceful throwing up of stomach contents through the mouth as opposed to just the usual spitting up)? How often? Is there a lot of material being vomited, or are your baby's heaves mostly dry? How would you describe the vomit—like curdled milk, mucus streaked, greenish (bile stained), pinkish, bloody, like coffee grounds? Is the vomiting forceful? Does it seem to project a long distance? Does anything specific seem to trigger the vomiting—eating or drinking, for example, or coughing? Do you know, or suspect, that your baby has ingested a toxic substance? Is there an increase or decrease in saliva? Excessive drooling? Or any apparent difficulty swallowing?

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Lower digestive system.
Has there been any change in bowel movements? Does your baby have diarrhea, with loose, watery, mucousy, or bloody stools? Are color and smell different from usual? Are movements more frequent (how many in the last 24 hours?), sudden, explosive? Or does your baby seem constipated?

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Urinary tract.
Does your baby seem to be urinating more or less frequently? Have diapers been dryer than usual? Is the urine different in color—dark yellow, for example, or pinkish—or have an unusual odor?

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Abdomen.
Is your baby's tummy flatter, rounder, more bulging, or firmer than usual? When you press on it gently, or when you bend either knee to the abdomen, does baby seem to be in pain? Where does the pain seem to be—right side or left, upper or lower abdomen, or all over?

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Motor symptoms.
Has your baby been experiencing neck stiffness (can he or she bend chin to chest without difficulty?), chills, shakes, stiffness, or convulsions? Does he or she seem to have difficulty moving any other part of the body?

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Other unusual signs.
Do you note any unusual smell coming from your child's mouth, nose, ears, vagina, or rectum? Is there bleeding from any of these?

The progress of the illness so far.
No matter what the illness, symptoms won't tell the whole story. You should also be ready to report:

• When did the symptoms first appear?

• What, if anything, triggered the symptoms?

• Are symptoms affected by the time of day? (Are they worse at night?)

• Which over-the-counter or home remedies, if any, have you already tried?

• Has your baby recently been exposed to a virus or infection—a sibling's stomach bug, the flu at daycare, or pinkeye at playgroup?

• Has your baby recently been involved in an accident (like a fall), in which an unnoticed injury could have occurred?

• Has your baby recently had a new or unusual food or drink or one that might have been spoiled?

• Have you traveled with baby out of the country lately?

Your baby's health history.
If the doctor doesn't have your baby's chart at hand (sometimes the case when you're calling, especially between office hours), you'll have to refresh his or her memory about certain relevant details. This information is especially important if the doctor has to prescribe medication:

• Your baby's age and approximate weight

• If your baby has a chronic medical condition and/or is currently taking medication

• If there is a family history of drug reactions or allergies

• If your child has had any previous reactions to medications or known allergies

• The telephone number, fax number, and/or email address of your pharmacy (if a prescription is to be called, faxed, or emailed in)

Your questions.
In addition to details of your baby's symptoms, it will also help to have ready any questions you have (about recommended dietary changes, calling back if the symptoms continue, and so on) and to have a place to write down answers. Keeping an illness journal (in your child's health history record) will come in handy in the future when you're trying to remember which medicines your baby won't tolerate and how many ear infections baby's had.

It's hard to relax when your little bundle spikes a fever. But while fevers in babies can unnerve even the most seasoned parent (especially in newborns, when a fever needs immediate attention)—not all fevers are panic-worthy. In fact, fever is actually one of the immune system's most effective tools. It's the body's way of letting you know an infection has settled in, and that your baby's immune system is fighting it with all it's got. Still, fever always needs to be evaluated, and here's how to do it.

The fastest and easiest way to tell whether your baby has a fever is to touch your lips or the back of your hand to the center of his or her forehead, the nape of the neck, or the torso. With a little practice, you'll quickly learn to figure out the difference between normal and feverish, low fever and higher (though the system may be thrown off if your little one has just woken up or has recently been outside in the cold or the heat, or in a warm bath, or if you recently sipped a hot or cold drink). But your touch can't read a temperature precisely—for that you'll need to use a thermometer.

What kind of thermometer should you reach for? Definitely not a glass one (even those that are mercury-free are unsafe, since they can break during use). While there are safe plastic thermometers available that are non-digital and nonmercury, most parents opt for the digital versions because they're readily available, relatively inexpensive, and easy to use, registering temperature quickly (within 20 to 60 seconds), which is an advantage when dealing with a squirmy baby. There are a number of ways to take a temperature (some of which require a specialized thermometer):

Rectal.
When it comes to taking your little one's temperature, most experts agree that the bum is best. A rectal temperature is the most accurate of all methods because it indicates core body temperature, and that's why it's considered the standard for young children—especially babies in their first year, when every degree counts. Start by cleaning the end of the thermometer with rubbing alcohol or soap and water, and rinse with cool water. Turn the thermometer on and make sure you've erased any old readings from its memory. (Since every digital thermometer is different, be sure to read the instructions
before
you have a half-naked baby on your lap.) If you're using a non-digital thermometer, shake it down before using it. Prepare the thermometer by lubricating the sensor tip (the package instructions will tell you whether a water-soluble lubricant, like K-Y, or petroleum jelly, like Vaseline, is preferred). Sit down and place your baby belly-down in your lap with a pillow for comfort (see
illustration
). Keep your hand on the lower back to keep your squirmy baby stable. If that's uncomfortable, lay him or her tummy-down on a flat surface, or tummy-up with his or her legs bent in toward the chest, positioned as for diaper changes (see
illustration
). To ease anxiety in an older baby, be gentle, talk reassuringly, and try distraction (with a couple of favorite songs, a toy).

Spread the buttocks with one hand, so you can see the rectal opening. Then slip the thermometer in until about a half inch to one inch of the bulb is in the rectum (don't push if you feel resistance). A thermometer with a flexible tip may provide extra comfort, but it's not a must. Hold the thermometer in place until it beeps or visually signals that the reading is done (usually 20 to 60 seconds). Don't worry if baby poops immediately after a temperature reading—that sometimes happens because the thermometer stimulates the muscles that help elimination.

Positioning baby as you would for a diaper change can make taking a rectal temperature a lot easier.

Placing your little one belly-down on your lap can keep a squirmy baby stable while you take a rectal reading.

Temporal artery.
This easy-to-use, noninvasive thermometer reads your baby's temperature by measuring the heat coming from the temporal artery, which runs across your little one's forehead. To use, place the sensor of the specialized temporal artery thermometer on the center of your baby's forehead (midway between the eyebrow and the hairline), hold down the button, and keep pressing it while sliding the thermometer straight across the forehead toward the top of the ear. Make sure it stays in contact with the skin (which might be difficult if baby is squirming a lot). Stop when you reach the hairline on the side of baby's head, and release the scan button. Within a few seconds the thermometer will beep and show the temperature reading on the display. A big plus of the temporal artery thermometer is that you can take your baby's temperature when he or she is sleeping. Studies have shown that temporal artery thermometers are more accurate than underarm and in-ear thermometers, but they're still not as precise as rectal readings.

Temporal artery thermometer

Axillary (underarm).
Use this somewhat less precise method of temperature taking when your baby won't lie still for a rectal or has diarrhea, which would make the rectal route messy and uncomfortable, and if you don't have a temporal artery thermometer. Clean the thermometer with rubbing alcohol or soap and water, and rinse with cool water. Place the tip of the thermometer well up into your baby's armpit (the thermometer should touch only his or her skin, not any clothing) and hold his or her arm down over it by gently pressing the elbow against his or her side (see
illustration
). Hold the thermometer in place until it beeps or visually signals that the reading is done.