What to Expect the First Year (118 page)
Read What to Expect the First Year Online
Authors: Heidi Murkoff
Axillary thermometer
Oral.
Using a standard oral thermometer is not appropriate for babies, obviously, but pacifier thermometers have some advantagesâthey're inexpensive and relatively easy to use. But there are enough disadvantages that might make you think twice before using one. First, they're not as accurate as a rectal, temporal artery, or underarm reading. Second, the pacifier has to stay in your baby's mouth for at least 90 seconds to get an accurate reading. If baby won't keep the thermometer in for that long, it won't work. Finally, some babies gag on the pacifier since the nipple is longer than it is on a regular pacifier. If you do try a pacifier thermometer, be sure the pacifier portion stays in your baby's mouth for about 2 to 3 minutes.
Tympanic (ear).
Ear thermometers aren't recommended for babies under 6 months because an infant's narrow ear canals make it hard to insert the sensor properly. And though ear thermometers are safe and can provide a reading in just seconds, they can be difficult to position in babies over 6 months as wellâif you don't insert the ear thermometer exactly right, it can be hard to get an accurate, consistent reading. Wax in the ear can also interfere with the temperature reading. In general, a reading in the ear is less reliable than an underarm one, and neither is as accurate as a rectal readingâstill considered the gold standard. If you want to try the ear method of taking temperature, make sure you have the correct specialized tympanic thermometer, and ask the doctor or a nurse to show you how to use it (or follow the package directions), practicing until you get a consistent result.
Tympanic thermometer
After reading and recording your baby's temperature, wash the thermometer with cool, soapy water or clean it with rubbing alcohol. Be careful not to wet the digital display, on/off button, or battery cover. And be sure to follow the manufacturer's instructions for proper storage.
What's in the numbers? It depends where the reading's coming from. When the doctor asks what your little one's temperature is, it's a given that he or she is referring to a rectal reading, so if you've taken another kind of reading, let the doctor know:
⢠Rectal. Normal rectal temperature averages 98.6°F, but it can range from 98°F to 100°F. Anything over 100.4°F is considered a fever.
⢠Temporal artery is nearly as accurate as a rectal reading. Anything over 100.4°F is considered a fever (though if your baby is under 3 months, follow up with a rectal temperature to confirm).
⢠Axillary (underarm). Normal axillary temperature may average around 97.6°F, but it can range from 96°F to 99°F (about 1 to 2 degrees lower than a rectal reading). Anything over 99°F is considered a fever (though if your baby is under 3 months, follow up with a rectal temperature to confirm).
⢠Oral. Pacifier thermometers yield results that are a bit low, so add half a degree to the reading you get. Anything over 100°F is considered a fever (though if your baby is under 3 months, follow up with a rectal temperature to confirm).
⢠A tympanic thermometer can be adjusted to give a reading that is comparable to a rectal reading, but it's not recommended for babies under 6 months. Anything over 100.4°F is considered a fever.
Different fevers need different treatmentâand some don't need any treatment at all. A fever that's triggered by a viral infection (upward of 90 percent of all fevers in young children are) will come and go with the virusârunning its course whether it's treated or not. While the doctor may recommend dosing with acetaminophen (after age 2 months) or ibuprofen (after age 6 months) to make a feverish child more comfortable (especially if fever's affecting sleep or appetite), fever relief won't make your baby better faster.
A fever that's triggered by bacteria will usuallyâthough not alwaysâbe treated with antibiotics, which lowers temperature indirectly (usually within 24 hours or so) by wiping out the infection. Depending on the type of infection, the antibiotic being given, the child's level of comfort, and how high the fever is, antibiotics and fever reducers may or may not be prescribed together.
A fever that always needs immediate treatment is one that's caused by environmental heat-related illness (brought on by a too-warm environment or overbundling);
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In general, take these steps when your baby has a fever (unless the doctor has recommended otherwise):
Keep your baby cool.
Dress your feverish baby lightly to allow body heat to escape, and maintain a comfortable room temperature. When necessary, use an air conditioner or fan to keep baby's environment comfortably cool, but keep your little one out of the path of the airflow or draft. If your baby has chills or goose bumps, the environment is too cool. When that happens, heat is retained, causing your baby's temperature to stay elevated.
Up the fluid intake.
Because fever increases the loss of water through the skin, it's important to be sure a feverish baby gets an adequate intake of fluids. Give young infants frequent feedings of breast milk or formula. Older babies can also have water or diluted juice. Encourage fluids, but don't force themâand if your little one refuses to take any fluids for several hours beyond his or her normal mealtimes, tell the doctor.
Dose the fever.
Acetaminophen can be given without the doctor's advice once your baby is 2 months old. Ibuprofen can be given once your baby is 6 months old. Younger than that, you'll need to ask the doctor for specific recommendations for a fever. Read dosing instructions carefully each time you give fever-reducing medication, and be careful not to exceed the recommended dose. Do not give any medication (other than acetaminophen or ibuprofen), except under a doctor's directions. Do not give any medication (including acetaminophen) when you suspect heat illness.
Encourage a slow-down.
Fever or no fever, a little one who's really feeling yucky will naturally slow down and get the rest his or her body needs. Your baby's running a fever and still running (or crawling) circles around you? That's common, too. Take cues on activity mostly from your babyâallow moderate activity if your little one's raring to go, but put the brakes on babies-gone-wild behavior, since strenuous activity can raise body temperature. Divert to a calmer activity.
Feed the fever.
The work of running a fever raises the body's caloric requirements, which means that babies who are sick actually need more calories, not fewer. Don't force food, though.
It's estimated that 2 to 5 of every 100 young children between the ages of 6 months and 5 years experience convulsions (their eyes roll back, the body stiffens, arms and legs twitch and jerk involuntarily) caused simply by a high fever, usually at its onset. Though febrile convulsions are frightening for parents, studies show they are not usually harmful and don't cause neurological damage. Though these convulsions tend to run in families, in most cases febrile convulsions are due to a young baby's immature brain. When the brain matures, febrile seizures stop happening.
If your baby has a febrile convulsion, stay calm (remember, these kinds of seizures aren't dangerous) and take the following steps:
⢠Check the clock, so that you can time the seizure.
⢠Hold your child gently in your arms or place him or her beside you on a bed or another soft surface, lying on one side, with his or her head lower than the rest of the body, if possible.
⢠Don't try to forcefully restrain your child in any way.
⢠Loosen any tight clothing.
⢠Don't put anything in your baby's mouth, including food, a drink, or a pacifier. Remove anything that you see in baby's mouth, like a bit of food, a pacifier, or another object. To do this, use a sweep of one finger, rather than a two-finger pincer grasp, which might force the food or object farther into his or her mouth.
A child may briefly lose consciousness during a seizure, but will usually revive quickly without help. The seizure will probably last only a minute or two (though it'll feel like a lifetime to you).
Call the doctor when the febrile seizure has ended (unless this is a repeat and the doctor has told you it isn't necessary to call). If you don't reach the doctor immediately, you can give acetaminophen to try to lower the temperature while you're waiting. But don't put your child in the tub to try to reduce the fever, because if another seizure occurred, your baby could inhale bathwater.
If your child isn't breathing normally after the seizure, or if the seizure lasts 5 minutes or more, get immediate emergency help by dialing 911 or your local emergency number. A trip to the emergency room will probably be necessary to determine the cause of this kind of complex seizure.
Medication
Sometimes, all you'll need to make a sick baby all better is cuddles, comfort, and rest. Other times, you'll need to add medication to the mix. But before you dole out any drugâprescription or over-the-counterâto your little one, you'll want to make sure you're using the right one the right way. Here's what you need to know about medication safety for babies.
Whether the doctor has suggested an over-the-counter pain reliever or a prescription antibiotic, you'll need to do more than pick it up at the pharmacy. You'll also need to become familiar with what the medication is, what it does, what dose should be given, how to give it, how to store it, what side effects might be expected, and more. Hopefully, the prescribing doctor will give you most of the information (and if not, hopefully you'll have remembered to ask for it). But you should also do some homework at the pharmacy before you bring the medication home. When it comes to medications and your baby, of course, it pays to be extra careful.
Pharmacists provide an information sheet along with prescription drugs that usually answers most (if not all) of these questions. Prescription drugsâand some over-the-countersâwill also come with a manufacturer's package insert or detailed labeling. Check out the information when you pick up the prescription, and if you still have questions or need clarification, ask the pharmacist or the prescribing doctor. Here are some of the questions you may need answers
to before you give your baby a medication (some questions may not apply):
⢠Does this medication have a generic (less expensive) equivalent? Is it as effective as the brand-name equivalent?
⢠What is the drug supposed to do?
⢠How should it be stored?
⢠Does it have a baby-friendly taste, or can the pharmacist add a more pleasant flavoring? Keep in mind that some babies lap up all medications, no matter what flavor, and others clamp shut for most or all of themâbut it helps to try different flavorings if you're facing resistance.
⢠What is the dose?
⢠How often should the medication be given? Should I wake my baby in the middle of the night for a dose? (This is rarely necessary, fortunately.)
⢠Should it be given before, with, or after meals?
⢠Can it be given with formula, juice, or other liquids? Does it interact negatively with any foods?
⢠If the prescribed medication is to be given 3 or more times a day, is there an equally effective alternative that can be given just once or twice a day?
⢠If the dose is spit out or vomited up, should I give another dose?
⢠What if a dose is missed? Should I give an extra, or double, dose? What if an extra dose is inadvertently given?
⢠How soon can I expect to see an improvement? When should I contact the doctor if there is no improvement?
⢠When can the medication be discontinued? Does my baby have to finish the full prescription?
⢠What common side effects may be expected?
⢠What adverse reactions could occur? Which should be reported to the doctor?
⢠Could the medication have a negative effect on any chronic medical condition my baby has?
⢠If my baby is taking any other medication (prescription or over-the-counter), could there be an adverse interaction?
⢠Is the prescription refillable?
⢠What is the shelf life of the medication? If any is left, can it be used again at a later date if the doctor advises use of the same medication?
To be sure that your child gains the maximum benefit from medication, with the least amount of risk, always observe these rules:
⢠Do not give a baby under 2 months of age any medication (not even an over-the-counter one) not recommended or prescribed for him or her by a doctor.
⢠Do not give your baby medication of any kind (over-the-counter, his or her own leftover prescription, or anyone else's prescription) without a specific go-ahead from the doctor. In most cases, this will mean getting an okay to medicate each time your baby is sick, except when the doctor has given standing instructions. (For example, your doctor may tell you that whenever your baby runs a temperature over 102°F, give acetaminophen; or when wheezing begins, use the asthma medicine.)