What to Expect the First Year (121 page)

• Sometimes in young children, vomiting and diarrhea

Cause.
The flu is caused by the influenza virus—and different strains (or, rarely, new strains like the H1N1 virus) circulate each year. Your little one can catch the flu by coming into contact with an infected person (especially if that sick someone sneezes or coughs on your baby) or by touching or mouthing something (a toy, a cell phone, a shopping cart handle, a sippy cup) that an infected person has touched. The incubation period for the flu is usually 2 to 5 days. If your little one comes down with the flu, symptoms usually last about a week, though some can linger for up to 2 weeks.

Treatment.
Treatment includes fluids and rest. To relieve flu symptoms, humidify the air in your baby's room, and give acetaminophen or ibuprofen only as needed for pain or high fever (do not give aspirin or any medication containing aspirin or salicylates). An antiviral drug may be prescribed for those children (even newborns) with severe symptoms or at high risk of complications, but it needs to be administered in the first 48 hours to be effective.

Prevention.
Since complications from the flu are more serious in children under age 5, you should do everything you can to protect your little one from the flu, including getting your older baby the flu shot (
click here
), making sure the whole family and all childcare providers are also vaccinated, and steering clear of sick people.

When to call the doctor.
If you suspect your child has come down with the flu (just check the symptom list above if you're not sure), call your doctor.

Symptoms.
In most infants, the virus causes symptoms resembling those of the common cold, including:

• Runny nose

• Low-grade fever

• Decreased appetite

• Irritability

In some infants, the infection can progress to include some or all of these lower-respiratory symptoms (bronchiolitis):

• Rapid breathing

• Hacking cough

• Wheezing sound when breathing

• Grunting

• Retractions (the skin between the ribs is visibly sucked in with each breath)

• Lethargy, sleepiness, dehydration

• Noticeable bluish color in the skin around the mouth

Cause.
RSV is such a common virus that nearly all adults and children are affected by it sooner or later. A normal cold virus or mild RSV infection affects just the nose and upper part of the lungs. But these symptoms can worsen rapidly in some babies as the virus infects the lungs, inflaming the lower part of the respiratory tract and the smallest inner branches of the airways, making it difficult to breathe (such an infection is called bronchiolitis). For most babies, the illness is mild. But babies at risk (such as premature babies, because their lungs are underdeveloped and they haven't yet received enough antibodies from their mothers to help them fight off RSV disease once they've been exposed to it) are more likely to get severe bronchiolitis and end up in the hospital.

Method of transmission.
RSV is highly contagious and is transmitted by direct hand contact from infected individuals. The infection can also be spread through the air, by coughing and sneezing. The period of greatest contagiousness is in the first 2 to 4 days of the infection. RSV infections are most common during the winter and early spring.

Duration.
Mild RSV lasts 3 to 5 days. It can last much longer in premature babies or if there are complications.

Treatment.
For mild RSV, treat as you would for a cold (
click here
). For
those whose RSV has caused more severe bronchiolitis:

• Nebulizer, which may help open up the airways

• In severe cases, hospitalization, oxygen administration, and IV fluids

Prevention. To help prevent RSV:

• Breastfeed, if possible.

• Make hand washing a priority around the house.

• Keep older siblings away from the baby as much as possible if they have a runny nose, cold, or fever.

• Do not take a high-risk baby out to crowded areas such as shopping centers during RSV season.

• Do not smoke or let anyone smoke around your baby.

• An intramuscular shot (of the antibody palivizumab) that helps prevent the illness is given once a month during the cold winter months to certain high-risk babies.

When to call the doctor. Call the doctor if:

• Your baby has breathing difficulties or changes in breathing pattern (rapid breathing, wheezing, or the skin between the ribs is sucked in with each breath).

• A fever persists for more than 4 or 5 days and/or remains elevated despite giving acetaminophen or ibuprofen.

Symptoms.
Croup (laryngotracheo-bronchiolitis) is an infection—usually seen in late fall and winter—that causes the voice box and windpipe to become inflamed, and the airways just below the vocal cords to swell and get very narrow. Symptoms include:

• Labored or noisy breathing—you may hear a high-pitched breathing sound when your child inhales (called stridor)

• A harsh, barking cough that sounds like a seal's call and usually comes on at night

• Retractions (the skin between the ribs is visibly sucked in with each breath)

• Sometimes, fever

• Hoarseness

• Stuffy nose (coldlike symptoms may appear first)

• Difficulty swallowing

• Irritability

Cause.
Croup, most common in early childhood, is usually caused by the parainfluenza virus (a respiratory virus that isn't related to the flu), though it can also be caused by other respiratory viruses, including the influenza virus. It's spread the same way other contagious germs are spread: Your child can become exposed by coming into contact with another child (like an older sib or daycare peer) who has croup (especially through a cough or sneeze), or by coming into contact with something an infected child has touched (the germs can survive on surfaces, like toys).

Duration.
Croup can last several days to a week and may recur.

Treatment.
Though the cough may sound scary, these simple measures will usually relieve discomfort in your croupy baby:

• Steam inhalation. Take your baby into the bathroom with you, run hot water in the shower, and close the bathroom door. Stay in there, if you can, until the barking noise settles down.

• Cool moist air. On a cool night, take your baby out into the fresh air for 15 minutes. Or open the freezer and have your little one breathe in that cold air for several minutes.

• Humidification. Run a cool mist humidifier in the room your baby sleeps in.

• Upright position. Try to keep your child in an upright position for a while, since this can make it easier to breathe. You can place pillows
under
the mattress to prop your baby up safely at night (no pillows in the crib).

• Comfort and cuddles. Do your best to minimize your baby's crying since it can make the symptoms worse.

When to call the doctor.
If you suspect your baby has croup, call the doctor, especially if this is your baby's first attack. If it's a repeat, follow instructions the doctor has given you previously. Also call if:

• The steam or cold air doesn't stop the barky cough.

• Your child lacks good color (if there's a bluish or grayish hue around your child's mouth, nose, or fingernails).

• Your child has difficulty catching his or her breath (especially during the day), or you can see retractions (when the skin between the ribs pulls in with each breath).

• You hear stridor (a high-pitched, musical sound made when breathing) during the day, or nighttime stridor that isn't promptly relieved by exposure to steam or cold.

Often, the pediatrician will prescribe a dose of steroids for a case of croup to relieve the swelling in the airways and make breathing easier.

Constipation is rarely a problem for exclusively breastfed babies (though a breastfed newborn who isn't having frequent soft poops may not be getting enough to eat;
click here
). But constipation can sometimes occur in formula-fed babies and in some breastfed babies once solids are added to the diet.

Symptoms.
Timing isn't everything when it comes to bowel movements—in fact, when it comes to diagnosing constipation, it's a matter of quality, not frequency. An older baby who goes a few days without pooping isn't necessarily clogged up (just as a baby who goes 4 times a day doesn't necessarily have diarrhea). If the stool comes out easily and looks normal (soft when on a pure liquid diet, formed but soft once solids are introduced), everything's moving along just fine—if at a somewhat slower pace. On the other hand, if your formula-fed newborn is producing firm stools less than once a day or your older baby is producing small, round, hard stool that seems difficult to pass, the diagnosis is most likely constipation.

Cause.
Some children (like some adults) are more prone to constipation than others. But often constipation is linked to not eating enough high-fiber foods, not drinking enough fluids, and not getting enough physical activity. The result is dry, hard stool that builds up in the lower bowels. Constipation can also develop during or after an illness (because a child's not eating, drinking, or moving much), and can be a side effect of certain medications.

Treatment.
To help get your older baby back on track (or prevent constipation in the first place), include plenty of:

• Fiber. Serve high-fiber foods as they're introduced, such as fresh fruits (ripe pears and kiwi are particularly effective), soft-cooked, minced dried fruits (especially raisins, prunes, apricots, and figs), vegetables, and whole grains. Avoid serving any refined grains (including baby cereal that doesn't specify “whole grain” or “brown rice”), which can clog up the works.

• Probiotics. These beneficial bacteria can help get things moving again—and keep them moving. Feed your older baby whole milk yogurt that contains active cultures, and ask the doctor about whether a probiotic supplement might be a good idea, too.

• Fluids. Make sure your baby is getting enough fluids (at least a quart of fluids a day)—especially if he or she was recently weaned off the bottle or breast (many babies drink much less after graduating to a cup). Certain fruit juices (such as prune juice or
pear juice) are particularly productive, but water works, too.