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6 Normal (but Alarming) Baby Health Issues

It's not breaking news that babies cry -- a lot. But when it's your baby, in your arms, screaming for hours at a time, you can't help but wonder if something is terribly wrong. "For the first three months, every night at about 5 p.m., Gavin would get really fussy," says Tricia Heiserman, of Bala Cynwyd, Pennsylvania. "You couldn't put him down. It made me depressed because I thought I was doing something wrong."

Nearly all babies, no matter how placid, get downright cantankerous as night falls and the "witching hours" begin. "Inconsolable fussiness between 4 p.m. and 7 p.m. is natural," says Benjamin Danielson, MD, medical director of Odessa Brown Children's Clinic, at Seattle Children's Hospital. This crying typically starts within the first two months, heightens between weeks five and eight, and is usually gone by the third month. While crying sprees are upsetting and inconvenient, they're entirely normal. Put your baby down for naps throughout the day to make sure he doesn't get overtired; if all else fails, try a walk outside, which many moms swear by for soothing cranky kids. You may be wondering if your baby has colic -- which Dr. Danielson says is a somewhat more intense version of the crying that most babies go through, and the same tactics that soothe a crying baby may soothe a colicky one.

And remember, it won't last forever. "Meredith cried for hours every evening from the time she was 7 weeks old, and we'd do anything to try and stave it off," says Caroline Warthen, of Greenville, South Carolina. "Then at 3 months, it ended, and all of a sudden we had a smiley baby."

The word "spit-up" brings to mind something small, like drool. But there's nothing minute about massive spit-ups that splatter all over the floor. These usually start immediately after birth and crescendo at around 3 months. "From the time my milk came in, my son was spitting up huge puddles that covered everything, about 10 times a day," says Kimberly McCreight, of Brooklyn, New York. "The sheer volume was so startling that I asked about it every time I went to the doctor."

It's not the volume that matters, says Gregory Germain, MD, associate clinical professor of pediatrics at Yale School of Medicine. There's no need to worry about a baby who's steadily gaining weight and seems happy even when she's spitting up a lot. "It's shocking," Dr. Germain adds. "A baby can spit up so much that it covers the floor, but when you measure the amount, it's just a fraction of what she ate." Your baby has a problem, such as acid reflux, if she seems to be in pain during or directly before or after spitting up; if she's gaining weight very slowly; or if she has recurrent respiratory problems, such as wheezing or pneumonia. Otherwise, trust that by about 6 months, the spit-up saga will be behind you.

In your newborn's first few weeks, it can seem like all you're doing is tallying wet and dirty diapers and hoping the daily sum adds up to the normal six wet and six soiled. And it probably will, at first. But as your baby gets older, there may be something of a shake-up in the poop department.

"When Blake was about 6 months, he went from pooping once every four days to once a week, and it put me over the edge," says Cindy Myers, of Gatlinburg, Tennessee. "He wasn't disturbed by it at all, but I was."

Although it can be hard to imagine, Dr. Danielson says infrequent stools in infants usually aren't a worrisome sign. "Somewhere around 1 month, most babies go through a sudden slowdown in terms of bowel movements," he explains. "So they will be perfectly healthy, but they may have a bowel movement only once every seven days -- and that's fine, if what comes out is soft and mushy and not difficult to pass."

You'll know your baby is truly constipated if he cries or screams while trying to poop and if his bowel movements are hard, round balls. In these cases, you should talk to your pediatrician, who may suggest giving your baby foods such as prunes that act as a mild stimulant, massaging the anal area with a Q-tip to relax the muscles, or using glycerin suppositories to lubricate the area.

Your baby's first bite of real food is one of the biggest milestones of her first year. But it may not always go smoothly.

"Babies have very varying degrees of responsiveness to solids," says Claire Lerner, director of parenting resources at Zero to Three, a nonprofit educational organization in Washington, D.C. "There are babies who will eat anything, and then there are discriminating eaters who have very specific preferences."

It can be demoralizing to continue offering spoonfuls of oatmeal or peas only to have the food flung across the room. But there's little chance that your picky eater will starve. Dr. Germain assures that, except in rare cases, as with children who have anemia or acid reflux, babies don't need anything besides breast milk or formula for their entire first year. So if your baby is protesting, it's best to back off.

"When I give Gavin rice cereal, he just spits it out," Heiserman says of her 4-month-old son. "But the pediatrician says that right now feeding is more of a play activity to teach him how to eat."

Take pleasure in experimenting with tastes and textures, and keep the process fun and relaxed. "Getting into power struggles is detrimental because nobody wins and mealtime becomes fraught with tension," Lerner says. "If the baby is pushing away the spoon and arching her back, one option is to put away what you've offered and offer it again an hour or two later." If she doesn't take to new foods at breakfast, try again at dinnertime.

For moms and dads with a newborn, sleep deprivation is unavoidable. But few parents expect a reprise when their child is nearly a year old.

"Meredith was sleeping through the night at 12 weeks, but then, a few months later, she started waking again at night, screaming," Warthen says. "We'd have to go in and calm her down, put the pacifier in her mouth, sometimes a couple of times a night."

Alas, even the dreamiest sleeper will experience plenty of setbacks during her first year. "At about 2 months, there's a honeymoon period with sleep where you feel like you're getting into a real rhythm with your child. But that starts to wane at about 4 months," Dr. Danielson says. Even little life disruptions can have a big impact on sleep, so things such as traveling, being sick, teething, growth spurts, or nearing a developmental milestone can make your baby start waking again, temporarily. In these instances, stick to your bedtime routine and soothe your child with comfort but not overinvolvement. (Pat her on the back, but don't pick her up and bring her into bed with you.)

One of the most common stumbling blocks parents encounter pops up at about 9 months. "Children start to understand the concept of object permanence, that things still exist even though they can't see them," Lerner says. "So they know that when you're not in the room, you're out there somewhere. And they know they can use their voice to make you come back."

While it can feel like your baby is backsliding, try to remember it's just the opposite -- she's taking huge developmental leaps forward. And as long as you don't pay too much attention to the protesting, your baby will sleep soundly again before too long.

"If you start getting very involved again in nighttime interactions, it can perpetuate the waking," Lerner says. "So respond, but keep the interaction brief. Peek your head in, just for 15 seconds, to let your baby know you're there but that nighttime is for sleeping."

temperature taking

Like it or not, by the time he's a year old, your baby is bound to burn up. And when he does, the thermometer's readout may make you gasp. Fevers of 102, 103, even 104 degrees F. are common in children. While they may merit a call to the doc, they shouldn't cause a panic.

"Fever and the symptoms that accompany it, such as congestion or vomiting, are your baby's way of fighting infection," Dr. Danielson says. "Babies tolerate high fever -- 104 degrees plus -- a lot better than we do, and duration is usually a much better indicator of illness than how high it is."

Here's when to bring your baby to the pediatrician, Dr. Danielson says: if the fever lasts more than a day, if other symptoms interfere with baby's ability to get rest and eat well, or if your parental instinct tells you something is wrong.

If your baby is younger than 2 months and comes down with a fever, you'll need to take it more seriously and get him checked out immediately -- with newborns, it's much trickier to figure out which infections might be brewing.

Dr. Danielson weighs in on the most common maladies of baby's first year. Here's when to wait it out and when to see a doctor.

Upper Respiratory Infection

Watch and wait if baby has a cough, increasing congestion, fever for one to two days, fussiness, or poor appetite. Ease congestion with a humidifier or a nasal aspirator, or by raising the head of the crib mattress (place a pillow underneath the mattress).

Visit the doc if fever lasts past the third day, if baby doesn't have any "up" periods when her mood is better, or if she won't drink. These symptoms may indicate a secondary infection such as a sinus infection or bacterial pneumonia.

Ear Infection

Watch and wait if you notice fussiness, fever, trouble sleeping, or pulling at the ear that lasts for one to three days following congestion or an upper respiratory infection.

Visit the doc if these symptoms last for more than three days or if baby seems to be in severe pain and younger than 6 months. Doctors prefer to let baby's immune system fight an ear infection at first, but antibiotics may be in order if he isn't better after three days.

Stomach Virus

Watch and wait if baby is fussy, has a fever for a day or two, vomits for one to two days, or has diarrhea that starts after the first or second day. As long as your baby is getting fluids and urinating consistently, she'll be fine without solids for a few days.

Visit the doc if vomiting or fever lasts more than two days, if baby doesn't want to drink, if she goes for six hours or more without urinating, or if there's blood in her stool. Your baby might have a serious infection such as salmonella or E. coli, which may require treatment with an antibiotic. And if she is seriously dehydrated, she may need IV fluids.

Originally published in the June 2008 issue of American Baby magazine.

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