Most incidents are easily treated with common sense and a hug. But sooner or later, you'll encounter a situation that requires real medical attention. "It's not a question of if an accident will happen, but when," explains Lisa Asta, M.D., associate clinical professor of pediatrics at UC San Francisco School of Medicine. Doctors explain whether you should grab the first-aid kit or call 911 when your baby...
It's an emergency if your baby is under 3 months old and his rectal temperature is 100.4° F or higher. Head to the emergency room. Fever in new babies is taken very seriously in part because they haven't gotten most of their vaccinations yet and can quickly get very sick if there's an infection. The big concern here is meningitis, a potentially fatal infection of the membranes covering the brain and spinal cord. "We'll do lab work and if the baby is less than 4 weeks old, we'll do a spinal tap to test for meningitis," explains Luke Beno, M.D., staff pediatrician at Cascade Pediatrics in Atlanta. "If he has it, we'll admit him to the hospital."
It's probably not if your baby has passed the 3-month mark and has received his first haemophilus influenza type b and pneumococcal conjugate vaccines, which help prevent meningitis. In fact, fever can be a normal reaction to vaccines. However, your child's doctor will most likely start treating the fever if it reaches 101.5° F. Pediatricians may be more aggressive about fever if a child has not been immunized, says Hernando Cardona, M.D., of Windermere Pediatrics, in Orlando. "The higher the fever, or the sicker-looking the child, the greater risk of an acute invasive bacterial infection."
There's no need to do anything if your older baby seems unbothered by fever. If he's fussy, though, some acetaminophen (or ibuprofen for babies 6 months or older) can bring it down, says Dr. Cardona. "I usually advise using a fever reducer and then giving the baby a tepid bath if his temperature hits 102° to 103° F. I suggest keeping him in the water until the fever goes down." This can take as much as a few hours. But if you've used the maximum safe doses of medication and your baby's fever continues to rise, be sure to call your pediatrician. She's very likely to want to see you to determine the cause of the fever and whether treatment is necessary, Dr. Cardona explains.
It's an emergency if your baby isn't breathing. Start CPR and call 911. If she's breathing and not responsive, skip the CPR and go straight to calling 911. Since falls can cause fractures and serious head injuries, let your baby's behavior guide you. Check her entire body for any signs of injury: redness, swelling, pain from touch, bleeding, or other worrisome signs including excessive crying, vomiting, and abnormal eye movements. If she refuses to move an arm or leg, doesn't seem like herself, won't wake easily from sleep, is inconsolably fussy, or vomits 12 to 24 hours after she's fallen, seek immediate medical attention.
It's probably not if you can easily soothe your baby's cries after a fall, and she seems to behave normally. Even vomiting within the first 12 hours after a fall is not concerning, assures Dr. Beno. "After a bump on the head the brain is irritated, and vomiting in the first 12 hours is normal." After that, however, it may signal a brain injury.
Make sure there's no swelling or bruising anywhere and that your baby can still move her arms and legs, advises pediatrician Samira L. Brown, M.D., of Ochsner for Children in New Orleans. Then watch for unusual behavior. If any of the more serious symptoms develop within 24 hours after the fall, see your doctor immediately. "Once you get through the first 24 hours, your baby should be fine," says Dr. Beno.
It's an emergency if you think your baby put an object like a small toy in his mouth, and he can't breathe or is struggling for breath, or he swallowed a button battery. Call 911. "Batteries are incredibly toxic," explains Dr. Beno. Indeed, a button battery that gets lodged in the esophagus needs to come out immediately; it can cause severe chemical burns within two hours.
It's probably not if the object isn't toxic or making him cough or vomit green bile (a sign of intestinal blockage), and if your child is otherwise breathing and behaving normally, says Dr. Beno. But your pediatrician may still want to order an X-ray to locate the object and determine whether to wait for it to come out the other end or have it removed immediately. If your baby is coughing, he may cough out the object by himself. You can help the process along by leaning him forward. If his airway is completely blocked, give him five sharp blows between his shoulders. If you can see the object, try to remove it, but don't do a blind finger sweep. "That can actually push the object even farther down," explains Dr. Brown.
It's an emergency if your child has flaring nostrils, wheezing or high-pitched whistles as she inhales, swollen lips, or is turning blue. A severe allergic reaction (called anaphylaxis) can quickly close off your baby's airways. If you have an EpiPen (containing epinephrine, which can stop an allergic reaction), use it. You can also give her an antihistamine such as Benadryl. But you should call 911 as well, explains Dr. Cardona, because you can't predict how much worse your child's reaction will get.
It's probably not if the reaction doesn't immediately jeopardize your baby's breathing. Milder allergic reactions can vary widely, showing up as anything from eczema and angry-looking diaper rash to reflux, diarrhea, or even bloody stools. These can be handled at the pediatrician's office, says Dr. Cardona. You can also follow up with your doctor for testing to see what else your baby is allergic to. (And keep in mind that the trigger food could have been passed to your baby through your breast milk.) Babies with one allergy typically have others, says Dr. Cardona. Your doctor may also prescribe an EpiPen for dealing with future accidental exposures, if your baby's allergies are severe.
It's always an emergency. Hands down, this should be treated as an emergency, says Dr. Cardona. Even in small amounts, common household products, medications, and even chewable kids' vitamins can be hazardous to a baby. Call Poison Control at 800-222-1222. Operators can tell you what to do based on your baby's age and what he ingested.
Originally published in the April 2012 issue of Parents magazine.
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