Have you ever made a frantic call to your pediatrician or even rushed your baby to the emergency room only to find out that a worrisome symptom wasn't a problem at all? There's no reason to be embarrassed. As an emergency-room pediatrician and a mother of two, I sympathize with the parents and friends who call me when they want to know if their baby has a problem that warrants a trip to the doctor.
Babies can have true emergencies, of course, but you'd be surprised by how many issues only seem dangerous. For example, certain symptoms that could indicate a serious medical condition in an adult, like shaking uncontrollably, can actually be perfectly normal in a baby. This is because a baby's physical immaturity and rapidly changing hormones make his body react in ways that you'd never see in an adult.
To help put your mind at ease, I've compiled some of the most common frightening-but-normal cases I've seen. If you're ever in doubt about your child's health, it's always better to be safe and seek medical advice. As this first example shows, even physicians can be fooled.
New parents brought their 1-week-old to their family doctor after they saw her begin to jerk uncontrollably in her sleep. They showed the doctor a video of her spasms, and he sent them directly to a small community-hospital E.R. The doctor there put her in the intensive-care unit. But when a pediatrician saw the baby, he diagnosed her with a harmless phenomenon called benign sleep myoclonus. It was no more dangerous than another form of myoclonus: hiccups!
What made the pediatrician so sure this baby was fine was that her seizure-like movements only occurred during sleep and stopped instantly when she was awakened. My colleague Michael Zimbric, M.D., a pediatric neurologist at Rady Children's Hospital, in San Diego, explains what was going on: "Babies have an immature nervous system and their movements are even more uncoordinated during sleep than when they're awake. These jerking movements are not unlike those that we adults have as we drift off to sleep."
Doctors don't know why benign sleep myoclonus occurs, but they have observed that it can be brought on by a loud noise or by touch. Studies have shown that these movements are harmless.
When to worry A key indicator of a true seizure is abnormal eye movement along with body movements. If you see that, or your baby has trouble breathing, turns blue, or the seizure lasts longer than five minutes, immediately go to the E.R.
The mother of a 2-week-old girl brought her daughter into the E.R. because the baby had always sounded congested. Mom had a cold, and at first she worried that she'd given it to her daughter. But the baby had no other cold symptoms. At night, her breathing was very loud and the mom became afraid that her newborn had something worse than a cold.
It turns out that this normal form of stuffiness is caused by the hormone estrogen, which stimulates the nasal passages; a mother passes it to her baby in utero and while breastfeeding. (You may have felt stuffed up in the same way when you were pregnant.) This condition generally subsides within two months, whether your baby is breastfed or formula-fed. And by 6 months, when a baby's nasal passages have doubled in size, stuffiness is hardly noticeable, if it's there at all.
When to worry Go to the E.R. if your child is flaring her nostrils as she breathes (it means that this is her only way to open the passageway for air), or if her chest or tummy is pulling in. These are signs of respiratory distress.
The parents of a 6-week-old boy came to the E.R. after he awoke one morning with a warm red lump on his chest, directly under his right nipple. Here, too, estrogen was the cause. As the level of maternal estrogen falls in the baby, the milk-producing hormone prolactin temporarily increases and can cause breast growth.
In fact, at least 50 percent of healthy newborn boys and girls experience this, often on just one side. Five percent of newborn boys will even produce a milk-like substance known as "witch's milk"; that is exactly what happened in this case and explains why the lump grew so quickly. The enlargement usually goes away within the first month, but it can last for three months or longer.
When to worry If the breast appears red, seems tender, or if your baby has a fever, see your pediatrician to determine whether there's an infection. Also, while breast-tissue development is extremely common in newborns and during puberty (even in boys), this could indicate a hormonal problem if it happens at other times.
One very anxious couple brought their 5-month-old son to my E.R. when he had streaks of blood in his spit-up after breastfeeding. They feared that he'd had a bad reaction to the milk or even internal bleeding.
But blood in spit-up is almost never worrisome in a baby who is acting normal. It's either swallowed from the mother's sore nipples or may be due to a small tear in the esophagus caused by forceful spitting up. Neither condition is anything to worry about. Even a small esophageal tear will heal easily.
The mom confirmed that she did have cracked nipples -- thanks to her baby's newly erupted teeth -- and they were the source of the blood.
First-time parents brought their 10-month-old to my E.R. because her skin had turned orange. At birth she'd had jaundice, and the parents were told to return if her skin became yellow again. But I knew this baby wasn't jaundiced because her eyes remained white and her skin was orange, not yellow. This is a very common phenomenon called "carotenemia" caused by eating a lot of vegetables that are rich in beta-carotene. Babies prefer the sweet taste of carotene-rich foods like sweet potatoes and carrots, and many of babies' first foods that aren't orange are high in beta-carotene too. (You just can't see it in veggies like spinach and broccoli, because the green chlorophyll pigment covers it up.)
Carotenemia, which doesn't affect adults, happens because of the way baby food is manufactured. The extensive cooking, pureeing, and mashing of vegetables for baby food breaks open plant fibers in a way that our teeth can't, making more carotene available to be absorbed by the baby's intestines. So when a baby has eaten more carotene than he needs, the extra is released with sweat and it stains the skin. In fact, the first place you'll see the orange color is where babies have the most sweat glands: the nose, the palms, and the soles of the feet.
When to worry Honestly, never. As your baby's diet changes, the orange color will fade. If you continue to serve lots of foods rich in beta-carotene his skin will stay orange, but it's harmless.
A grandmother who was babysitting called an ambulance after her 3-week-old granddaughter paused repeatedly while breathing. The contented, sleeping baby would breathe rapidly for about 20 seconds and then stop breathing altogether. The woman feared the baby had inherited her husband's sleep apnea.
Although this intermittent breathing can look very alarming, "periodic breathing" is common. Babies normally breathe faster than older children do because their lungs are small relative to the size of their body. However, researchers suspect that the reason for irregular breathing is that the chemical sensors that detect carbon dioxide aren?t fully developed in a newborn. This means that she sometimes just doesn't know she needs to breathe, and she pauses until carbon dioxide levels become high enough to trigger these sensors.
When to worry If your baby ever has a blue or gray color around her mouth or seems to be struggling to breathe, contact your doctor immediately.
One mom brought her 2-month-old daughter into the E.R. because the baby hadn't had a bowel movement in five days. She would grunt, turn red in the face, and her stomach would become hard, but only a bit of soft poop would come out.
It might surprise you that parents are so frightened by this that they bring their babies to the E.R., but it can be quite jarring to see your newborn struggle to poop. Remember that she's lying down, which makes it harder to get the stool out. "Young babies don't yet know how to control and coordinate their anal sphincter, the muscle that holds stool in the rectum," says Rebecca Preziosi, M.D., a pediatrician at Sharpe Rees-Stealy Medical Center, in San Diego. "They have to push and grunt to get the stool past this muscle."
I explained to the mom that it's fine for a baby to poop as infrequently as once a week. As the gut becomes more efficient and better at digestion, after 6 to 8 weeks, it takes longer for the body to produce a lot of poop.
When to worry Talk to your doc if your baby's poop is hard or looks like pellets (signs of constipation), or if your child doesn't poop daily during the first month of life. It can signal a rare problem with the nerves controlling the rectum.
Originally published in the January 2014 issue of Parents magazine.
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