The first time my son Fletcher woke me after midnight, crying with a terrible cough and fever, I freaked out. There was no mistaking the hoarse, barking cough: He had croup. So my husband and I bundled him up and sped to the after-hours clinic. Just our luck -- it was closing down. "You could go to the emergency room," the last nurse suggested as she locked the door behind her. But as we weighed the dangers of exposing our baby to even more germs there, we realized that en route to the clinic, Fletcher had miraculously stopped coughing. I'd heard that cool night air could help a croupy bark -- and it had! We opted to settle him at home instead.
When the temperature dips, you know what's coming: the start of the sneezing, coughing, runny-nose season. It can be scary when your child gets sick, but you can handle most maladies with rest, fluids, a few home remedies, and hugs from Mom and Dad. Get the 411 on taking care of your under-the-weather wee one.
It looks like: Cough, stuffed-up or runny nose, occasional mild fever
What's happening: A cold is a minor infection in the nose and throat caused by any one of more than 200 viruses that your tot inhales or picks up from the things she touches. Stock up on tissues and saline nose drops. While your infant's immune system is maturing, she'll get about seven colds a year. "The first time was scary," says Boston mom Miriam Katz, recalling her daughter Dalia's bout at 5 months. "She was so congested that she couldn't breathe through her nose, and she didn't want to nurse. Taking her into our steam shower and using eucalyptus oil in the humidifier helped, and she got better fast."
Call the doctor: A cold isn't serious, but when your baby is younger than 3 months, a cold can quickly turn into croup or pneumonia. Monitor symptoms, and call the M.D. if they worsen or last more than three days. If your child is younger than 4 weeks and has a fever (100.4?F and up when taken rectally), take her to the ER. At this age, babies can get very sick very fast because they're not fully immunized, explains Stephen Turner, M.D., chief of pediatrics of SUNY Downstate at Long Island College Hospital, in Brooklyn. A spinal tap may be necessary to ensure that your baby doesn't have a bacterial infection such as meningitis. But if your child has a high fever (101?F and above), ear pain, eye redness, or discharge, or if she's not eating normally or isn't wetting as many diapers, it's more than a cold. You should dial your doc right away.
It looks like: A bad cold with a high fever (and occasionally diarrhea or vomiting) that comes on quite suddenly. Babies with flu are also fussy because they feel so awful, says pediatrician Luke Beno, M.D., with Kaiser Permanente in Atlanta.
What's happening: You should take this respiratory infection seriously. Among children, babies younger than 6 months old have the highest risk of being hospitalized and also have the highest rates of flu mortality. That's largely because their immune system hasn't fully developed and they're too young to have a flu shot. However, if you were vaccinated when you were pregnant, your antibodies cut your baby's flu risk by 41 percent during those first six months, according to research. After that, she'll be old enough for her own shot. Get the rest of the family and caregivers immunized, too, advises Orlando pediatrician Hernando Cardona, M.D., of Windermere Pediatrics. "The only way Baby is going to contract flu is if someone brings it home," he says.
Call the doctor: If it's flu season (November to April), and your little one spikes a fever, see your doc that same day. A rapid test of nasal secretions can confirm that she has influenza, and your M.D. may administer an antiviral, such as Tamiflu, which can speed recovery by a day or so. Tamiflu is generally not recommended for children younger than 12 months, "but when a baby is really sick, we'll give it, because the younger they are, the higher their risk for complications," Dr. Cardona says. One of the most common is pneumonia, which develops when a flu virus migrates into the lungs from the nose and throat, or when a bacterial infection has cropped up as well. Viral pneumonia is treated with comfort measures; bacterial pneumonia requires antibiotics.
It looks like: A simple cold, sometimes with a fever, until the coughing starts a few nights later. Croup almost always comes on after midnight. The raspy, barking cough and high-pitched whistle when Baby inhales (called stridor) are so distinct, doctors can often diagnose croup over the phone. "That seal sound! The first time my daughter Zoe had that cough, I thought, This is what they're talking about. It's so obvious," Darien Wilson, of Highlands Ranch, Colorado, says.
What's happening: Babies get croup when a virus causes swelling in the larynx, vocal cords, and windpipe. An infant's windpipe is narrow to begin with, and the swollen vocal chords are very close together. When babies get scared and cry, the airflow through the larynx as they breathe in or cough produces croup's telltale bark and whistle, Dr. Beno explains. Some reassurance: The virus that causes most cases is so benign that kids will often get only that barky cough, Dr. Cardona says. Children generally outgrow croup as their airways widen.
Call the doctor: If you hear the stridor whistle when Baby is resting, he's breathing rapidly, and you can see the skin near his ribs and throat pull in with each breath (called retractions), call the M.D. His windpipe is closing. "If you've tried running the humidifier and using cool air and he's not getting better, seek medical attention," Dr. Beno advises. Your child may need steroids or epinephrine to reduce inflammation.
It looks like: A bad cold along with a wet cough, wheezing, and loose stools: "You'll notice mucus in your child's stools and that's exactly what it is, mucus he's swallowed, because babies don't spit it out," Dr. Cardona explains.
What's happening: Infants get bronchiolitis when a virus (usually respiratory syncytial virus, aka RSV) inflames the tiniest tubes in the lungs, called bronchioles, clogging them with mucus. For many young children, this is only a minor infection. "People panic when they hear RSV," Dr. Cardona says. "Most of the scary stuff you read about happened to kids who were in the NICU, who had serious lung issues from the get-go. But if your baby was healthy before the symptoms started, she's going to be fine." Treat it like a common cold.
Call the doctor: If your munchkin refuses to eat, it's time for expert help. "Babies can't breathe and eat at the same time, so the best indicator of a problem is when your child won't breastfeed or take a bottle," Dr. Beno says. Other signs: rapid breathing, flaring nostrils, and retractions. When Wilson's son, Clark, got RSV at 3 weeks old, she counted his breaths with a stopwatch. Go to the ER if Baby is taking more than 80 breaths a minute. Doctors may try medications to open the airways, or your babe may be admitted to the hospital where she can get oxygen and IV fluids to prevent dehydration.
5 Feel-Better Fixes
Keep your lovebug content till his virus goes vamoose with these remedies.
1. Saline drops and bulb syringe
Your baby doesn't master breathing through his mouth till he?s 4 to 5 months old. When he's congested, you'll need to suction his nose so he can breathe. Mix 1/4 teaspoon salt in 1 cup water to make a saline solution. Or buy Little Noses Saline Spray/Drops or Baby Ayr Saline Nose Spray/Drops. Lay your child down and put a few drops into each nostril, wait a minute, then use a bulb syringe to suck out the secretions. Do this before meals so your baby can breathe and nurse.
2. Steamy shower
Turning on the shower and sitting for a while with your babe in the fogged-up bathroom can help clear your child's lungs and nasal passages.
3. Cool air
It's unclear why the cold quiets croup, but doctors swear by it. Too balmy where you live? "An open freezer works too," says Luke Beno, M.D.
4. Cool-mist humidifier
The moisture it releases can help Baby breathe easier.
If your sweetie's fussy with fever, this can lower it and put him at ease. But save it for temperatures of 101.5?F or above. "Fever is how the immune system recruits white blood cells to fight infection, so you don't want to abolish fever, just lower it," says pediatrician Hernando Cardona, M.D. Always consult the doc first.
Originally published in the October 2011 issue of American Baby magazine.
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