What to Expect the First Year (122 page)

• Exercise. While there's no need to sign your baby up at the local gym, do make sure his or her whole day isn't spent cooped up in an infant seat or carrier. Moving gets your child's digestive system moving. Baby isn't mobile yet? Try bicycling his or her legs to get things moving down below.

• Lubrication. Daubing a bit of petroleum jelly at the anal opening may help the movement slip out more easily. For an extra-stubborn case, consider slipping in a lubricated rectal thermometer to help stimulate the muscles that get movements going.

Don't give any medication or laxatives for constipation unless it's been recommended or prescribed by the doctor.

When to call the doctor.
Call the doctor when:

• Your formula-fed newborn baby has firm stool less than once a day or your older baby has not had a bowel movement for 4 or 5 days or is producing small, round, difficult-to-pass stool.

• Constipation is accompanied by abdominal pain or vomiting.

• There is blood in or around the stool.

• Constipation is chronic and the treatments described above have been ineffective.

Chronic constipation can be very painful and can affect your child's appetite and sleep. Some kids suffering from constipation also develop anal fissures (cracks or tears in the skin near the anus) that bleed and cause stool to have streaks of blood. The fissure should heal once the constipation clears up.

This problem, too, is unusual in breastfed babies, since breast milk protects against diarrhea.

Symptoms.
When your baby's poop flows a little too freely (very loose, watery poops—not seedy like a breastfed baby's stool—that make an appearance several times a day), you're dealing with diarrhea. Other symptoms of diarrhea include poop color and/or odor that may vary from the usual, mucus in the stool, and/or redness and irritation around the rectum. When diarrhea continues for several days to a week, dehydration and weight loss can occur. Keep in mind that some children are naturally on a more-frequent pattern of elimination, but as long as that stool—even if it comes frequently—is normal in appearance, that's not considered diarrhea.

Cause.
Diarrhea occurs most often when your child has a virus, has eaten something irritating to the digestive system, or has gone a little overboard in the fruit department (apple juice is a common culprit). An allergy or food intolerance (to milk, for instance) can also cause diarrhea, as can certain medications (such as antibiotics). Diarrhea that lasts longer than 6 weeks (after all the above mentioned culprits are discontinued) is called intractable and may be linked to an overactive thyroid gland, cystic fibrosis, celiac disease, enzyme deficiencies, or other disorders.

Method of transmission.
Diarrhea that's caused by microorganisms can be transmitted via the feces-to-hand-to-mouth route or by contaminated foods. Diarrhea can also be triggered by excesses of, intolerances of, or allergies to, certain foods or drinks.

Duration.
An occasional looser-than-normal stool (lasting anywhere from a few hours to several days) is not a cause for concern. Some intractable cases can last indefinitely, unless the underlying cause is found and corrected. A very sick baby may need hospitalization to stabilize body fluids.

Treatment.
To treat diarrhea:

• Continue breast or formula feedings. Since a baby with persistent diarrhea may develop temporary lactose intolerance, a switch to a lactose-free formula may be recommended if the diarrhea doesn't improve on baby's regular formula.

• Give fluids. Make sure your baby is breastfeeding or taking a bottle often (at least as often as usual, if not more). For older babies, water or diluted white grape juice (a better choice than apple juice—which you should probably stop altogether until the diarrhea clears) may be sufficient in mild cases. If there is substantial fluid loss, and particularly if there's also vomiting, ask the doctor about giving your older baby an oral electrolyte solution (such as Pedialyte) to replace sodium and potassium lost in the diarrhea and to help prevent dehydration.

• Feed right. Is your little one on solids already? Mild diarrhea tends to improve more quickly when solids are continued. Severe diarrhea (with or without vomiting) usually calls for oral electrolyte solution (if the doctor recommends it) the first day, followed by a slow resumption of the normal diet over the next couple of days.

• Become a pro. Some research suggests that probiotics can help prevent or treat diarrhea in babies. If your baby is formula-fed, choosing a formula with probiotics could help. For older babies on solids, yogurts containing active cultures or a probiotic supplement (in drops or powder form) can help prevent or help treat a case of diarrhea—particularly during antibiotic therapy.

Prevention.
Prevent diarrhea by:

• Giving probiotics regularly if the pediatrician recommends it

• Following food safety guidelines (
click here
)

• Thoroughly washing hands after bathroom use or after changing diapers.

When to call the doctor.
Call the doctor if your baby:

• Shows signs of dehydration (see
box
)

• Has loose, watery stools for 24 hours (but not seedy breastfed stools, which are often watery)

• Is vomiting for longer than 24 hours

• Refuses fluids

• Has stools that are bloody, or vomit that is greenish, bloody, or looks like coffee grounds

• Has a bloated or swollen abdomen or if there seems to be anything more than mild abdominal discomfort

Symptoms.
The symptoms of UTI (some of which are hard to recognize in young babies) include frequent and painful urination, blood in the urine, pain in the lower abdomen, lethargy, unusual-smelling urine, and/or fever.

Cause.
UTIs occur because bacteria enter the urethra (the tube that carries urine from the bladder for excretion), causing infection. Because the urethra is shorter in girls and bacteria can travel up it more easily, girls have UTIs more often than boys (and when boys do get a UTI, it's more likely the result of a urinary tract abnormality). Not getting enough fluids can encourage the development of a UTI.

Treatment.
The treatment of choice is antibiotics. Also important: making sure baby gets enough fluids.

Prevention.
To prevent UTIs, take extra care when diapering your baby: Wipe front to back, and wash your hands before and after diapering. Again, make sure your baby gets enough fluids and diaper changes, and avoid using potentially irritating bubble baths and soaps.

When to call the doctor.
As soon as you notice symptoms of a possible UTI, call the doctor.

What is it?
Asthma is a condition in which the small breathing tubes (called bronchial airways) occasionally become inflamed, swollen, and filled with mucus, often in response to an irritation to the airways, such as a cold (or an allergen, although this is less common in a baby or toddler than in an older child). Asthma flareups can cause shortness of breath, tightness in the chest, coughing, and/or wheezing—and when it happens to your baby, it can be downright frightening for both of you. In young children, sometimes the only symptom may be a recurrent croupy, “barky” cough that is worse with activity or at night and may sometimes lead to vomiting. But there may also be rapid and/or noisy breathing, retractions (the skin between the ribs appears to be sucked in with each breath), and chest congestion.

Asthma is the most common chronic disease in children, and 70 percent of all cases of childhood asthma develop before a child turns 3. Certain hereditary and environmental risk factors can predispose a child to developing asthma, including a family history of asthma or allergies, having eczema or other allergic conditions, living with a smoker, exposure to smoke in the womb, living in an urban, polluted area, low birthweight, and overweight.

It's often not easy to diagnose asthma in babies, because it's hard to distinguish between a viral respiratory tract infection (like RSV) and asthma that results from a virus, since the symptoms are so similar. That means the doctor will rely heavily on what you reveal about your child's symptoms. So take careful notes about what your baby's symptoms are, how often they happen, and under what conditions—and bring these notes with you to your appointment. The doctor will also ask you about your family's medical history (does baby's mom or dad have asthma or other allergic conditions?) to try to determine if your baby is genetically predisposed to developing asthma

Management.
Depending on the nature of your child's asthma, the doctor might prescribe one or both of these types of medications:

• A quick-relief (short-acting) “rescue” medication called a bronchodilator that quickly opens up your child's airways when they are swelling during an asthma attack

• A preventive (long-acting) medication, like an anti-inflammatory corticosteroid, which your baby would need to take daily to keep the airways from getting inflamed in the first place

Unlike other medications that come in a liquid form that's swallowed, most asthma medications need to be inhaled so they get delivered directly into your baby's airways. The doctor will prescribe a metered-dose inhaler with an attachable plastic tube (or holding chamber) spacer device, which makes the inhaler easier to use and more effective (the medicine gets farther down the airway). You place the mask that is attached to the spacer device over your baby's mouth and nose, activate the inhaler by pressing down on the canister so the correct dose goes into the spacer device, and then your child breathes normally for a few breaths and the medication makes its way into the airways.

Another option is a nebulizer machine, which creates a mist from the liquid medicine and delivers it to your baby via a mask (see
illustration
). The nebulizer is powered by a small air pump that you plug in.

Asthma nebulizer

Whether or not your baby is prescribed medication, it's also crucial that you do your best to prevent your little one from catching colds, flu, and other infections that can step up symptoms (the flu shot is a must for little ones over 6 months with asthma). Probiotics may show promise, also, in helping to manage asthma while boosting the immune system in general.

Prognosis.
While many children with asthma exhibit prolonged remission as they approach the teen years, airway hypersensitivity is lifelong. Symptoms often return in adulthood, though sometimes only mildly and intermittently. But even when asthma continues into adulthood, most asthmatics can keep the condition under control with the right medicines, medical care, and self-care.