When baby is sick

Colds. Vomiting. Diarrhea. Nobody likes dealing with these nasties, especially in babies. Luckily most of these illnesses are caused by viruses and are self-limiting; they will go away on their own. In the meantime, your tender loving care will see your baby through minor sniffles and tummy upsets. But if you feel worried about her, or unsure of what to do, don’t hesitate to check with your doctor.

Cold comforts
When a cold attacks, the swelling and increased mucus in the baby’s narrow nasal passages make it difficult to breathe through the nose, so sleeping may be disturbed. Your baby’s eyes may be puffy, dull or teary; he may have less energy than usual or lose his appetite; he may have a fever. He feels like you do when you have a cold — miserable.

Giving extra fluids really does help. Breastfed babies can simply be nursed more often. Older breastfed babies may also be offered clear fluids that are already part of their diet, like diluted apple juice. Formula-fed babies should be offered extra clear fluids.

Nursing may be awkward because of a plugged nose: If your baby is having trouble sucking, it may help to keep him upright while he nurses. Other fluids may be given by spoon or eyedropper. Saline nose drops, given 15 minutes before feeding or bedtime, may allow him to breathe more easily. He may also sleep better with a cool-mist humidifier in his room. To help the mucus drain, some parents raise the head of the crib mattress (put a pillow or folded towel under the mattress, not under the baby’s head).

Suppressing a cough can be harmful so cough medicine is not recommended. If your baby’s cough is severe enough to worry you, check with your doctor.

And do not, advises Ottawa paediatrician William James, give decongestants to babies under one year of age.

Call the doctor if:
• your baby’s breathing is very rapid, noisy or wheezy
• she develops a barking cough (croup)
• she is short of breath or struggling to breathe (you may see her chest “sucking in” when she draws a breath
• her colour is pale or mottled
• she is lethargic or weak
• she refuses to drink
• she seems quite sick, or in pain

Breastmilk is good medicine
Breastmilk contains disease-fighting antibodies, so breastfed babies have fewer respiratory and digestive tract infections — and when they do get sick, the illness tends to be milder. So if your baby is sick, or if you have a cold or flu bug, it’s definitely best to keep nursing.

Diarrhea and vomiting
Diarrhea and vomiting are often symptoms of an infection of the digestive tract (gastroenteritis). Home care focuses on preventing dehydration while the illness runs its course.

If you breastfeed your baby, you may not be sure if she really has diarrhea. It’s normal for breastfed babies to have frequent, soft bowel movements. But if your baby is having frequent, watery, “explosive” stools and is acting sick, you should call your doctor.

When a baby has diarrhea, fluids, salts, minerals and nutrients that would normally be absorbed into the body are lost. This is the major risk of diarrhea. Your doctor may recommend that you give your baby a rehydration formula (like Gastrolyte or Pedialyte), available at the pharmacy. These solutions are designed for rapid absorption. Breastfed babies often don’t require rehydration formula, but rather can be nursed more often.

The key is to offer small, frequent doses of liquid, says Dr. James. A “continuous trickle” of liquid allows for steady replacement of fluids without stressing the baby’s upset intestines. Offer the breast every hour or so, or offer a formula-fed baby one to two ounces of a soy-based formula or rehydration solution every hour or so — even if it’s likely to come back up.

Call the doctor if:
Dehydration is the main danger of gastroenteritis. Call your doctor right away if you notice any of these early signs:
• he seems lethargic or weak
• he wets less than six diapers in 24 hours
• there are no tears when he cries (after four weeks of age)
• his mouth seems dry
• the soft spot on his head appears sunken

Severe dehydration needs immediate treatment. Take your baby to the hospital if:
• his eyes look sunken
• he has wrinkled skin
• he goes six hours without urinating
• he is very fussy or very sleepy
• he is losing weight

Also call your doctor if:
• your baby seems quite sick or in pain
• he refuses to drink
• vomiting continues for more than 12 hours
• there is blood in the vomit
• there is mucus or blood in the stool

Fever facts
Fever is not an illness in itself; it’s a symptom of an illness.

While a young baby with a fever should be seen by a doctor, it’s not unusual after six months of age for a baby to have a fairly high fever with just a mild illness. Conversely, a very sick child may have a low, or no, fever. Dr. James says that doctors treat children, not thermometers; so focus on the baby and how he is feeling, rather than on a particular degree of fever.

Bringing down a temperature doesn’t cure the cause of the fever, but it can make the baby feel more comfortable. Your doctor may suggest acetaminophen drops or ibuprofen. Never use ASA (acetylsalicylic acid). Reducing the temperature by sponging and cool baths should not be used, as they can cause discomfort and shivering. Never use alcohol sponging — the alcohol can be absorbed through a baby’s skin.

Taking baby’s temperature
The Canadian Paediatric Society recommends parents first check for a fever in a child under two by taking an axillary (armpit) temperature. Fever can be confirmed using a rectal thermometer if parents wish. Axillary temperatures are normally 0.5 to 1°C lower than a rectal temperature.

• Place the thermometer under the baby’s arm, with the bulb in the middle of the armpit, and hold the arm securely against her body.

• An average normal axillary temperature is 36.4°C (97.7°F), but some fluctuation is normal. Anything over 37.5°C (99.5°F) is a fever.

• Digital thermometers give fast, easy-to-read, reliable results. Tympanic (ear) thermometers give readings quickly, which can be helpful if your baby is upset, but they are quite expensive. Mercury thermometers are no longer recommended.

A baby under two months old with a fever should be seen by a doctor. Also call in if a fever lasts more than six hours in a baby under six months old.