Caring for a baby involves understanding how serious medical symptoms are, then deciding if the symptoms can be managed at home, require telephone advice, or require a “same-day” visit to your health care provider. Because your infant or toddler cannot tell you specifically when something hurts, it is sometimes difficult to know what to do to help. As you get to know your baby better, and become more comfortable in your parental role, it will eventually become easier. You know your baby better than anyone else. In most cases common illness such as colds, congestion and flu, fever, diarrhea, dehydration, and vomiting can be handled at home unless a problem arises. Medical conditions such as diaper rash, cradle cap, and thrush sometimes need medical intervention. Your health care provider may be able to give you comfort or instruction for caring for your infant should colic be a problem. Medical emergencies such as choking may seem dangerous, but if you are prepared and know how to prevent them, it might save you a trip to the emergency department.

It's never easy to have a sick baby. But always remember when you are dealing with a sick child to trust your intuition as a parent, if you feel you should call your health care provider or take your child into the doctor's office or emergency department, do so.

Choking

Every year more than 100 children under five years die from choking and suffocation. It only takes a few seconds for a child to pop a small object into his mouth and choke. With a few simple precautions you can protect children against these accidents.

Never leave a baby to drink his bottle by himself. He could vomit, inhale the milk and choke.
Babies should not be given any food they cannot chew properly. Large chunks are easily breathed in.
When preparing food, remove small bones – for example from fish or chicken.
Never give children under five years peanuts because they frequently cause choking.
Avoid giving children dried peas and beans to play with.
Teach older children not to give hard biscuits or sweets to a young baby.
Choking most frequently happens to babies between the ages of five and eighteen months. Keep all small objects out of reach of the baby who is at this hand-to-mouth stage of development.
Safety pins should always be out of your baby’s reach.
Keep small toys or toys with small parts away from babies until they are old enough to handle them. Parts broken off toys and games should be thrown away or be repaired. Also rid of small pieces of crayon.
Pacifiers used should be well designed. Buy new ones every month so they do not get "gummy" and break apart.
Beware of letting small children play with beads, buttons, coins, bits of torn plastic or broken balloons. Make a habit or picking up these small items if they are lying around.

Do not panic if a child appears to be choking. His normal cough reflex will generally expel the object. If the child is small, hold him up by the heels and give him a firm slap on the back. Do not slap him hard on the back while he is sitting up as this may make him gasp and suck the object further into the air passage. Do not try to remove the object with your fingers. This will only push it further down. If this is not successful, get the patient to a doctor immediately.

If an older child is choking, stand behind him, put your arms around his waist, find the spot in the chest halfway between the waist and lower ribs. Gently press the clenched fist of your left hand as far as you comfortably can. Firmly clasp your right hand over your clenched fist and give short, sharp "hugs" pushing inwards and upwards as far as you can. Repeat if necessary. Air pressure will pop out the blocking object.

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Colic

Colic is a term often used to describe the condition of an infant who regularly cries for such a long time that the crying upsets parents. It is also known as 3-month colic and periodic irritability. Most infants fuss at some time during the day, more commonly in the evening or early morning than during the day. About two-thirds of normal, healthy infants are fussy. Most of the time they fuss for one to four hours and only once a day. A small percentage of infants cry very hard for hours at a time, even though they are fed, changed, and cuddled. These are the infants who are more likely to be labeled as "colicky." Parents need to know that long periods of crying should stop by the time the infant is about 3 months of age.

No one knows for sure what causes colic. It has never been shown that there is anything wrong with the bowels of infants who cry excessively. Also, there is no strong evidence that the problem is due to gas, wind or food allergy. Crying causes infants to swallow air, which they burp up or pass as wind. Because they strain and tighten their stomach muscles, this also forces air out of the rectum.

Crying is a normal form of self-expression and communication for healthy infants. Still, parents often feel responsible when their baby cries. Long periods of crying are even more stressful for parents and may make the problem worse for both parents and baby. What you should remember is that colic during your baby's first 3 to 4 months does not mean that there will be any problems with his health in future years. Every effort should be made to maintain a regular routine for babies who cry. Some tips to try if your baby suffers from colic or uncontrollable crying:

Their regular schedule should not be disrupted by excessive attempts to comfort them.
When they are fussy, babies do better if they are not handled too much.
They should not be passed from person to person and should not be frequently rocked, shook, patted, and fed.
Babies should be wrapped up snugly, comfortably cradled, and soothingly and gently handled.
NEVER SHAKE A BABY!
Reducing the noise and light levels may also help. Steady smooth vibrations, such as a rocking chair or a ride in the car, help to quiet many infants.

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Colds, Congestion and Flu

Respiratory infections are so common that many terms are used to describe them, depending upon how bad they are. The common cold is the most frequent and mildest type of infection. Typical symptoms are stuffed-up nose, poor appetite, headache and mild tiredness. Fever is infrequent and seldom high. Mild soreness of the throat or mild cough may complete the list of complaints. The terms "bad cold, chest cold or flu" are often used to describe more troublesome respiratory illnesses with fever, cough, tiredness and body aches. These illnesses may include sore eyes, sore throat, hoarseness or neck gland swelling. Appetite loss, vomiting or diarrhea also occur commonly in children with flu-like illnesses. A worn-out feeling may continue for a week or more. Both kinds of respiratory illness are usually caused by viruses. With the common cold, virus infection occurs mostly in the nose and throat. With flu-like illnesses, virus infection involves both the head and chest, causing greater amounts of fever and misery.

Offer plenty of fluids and encourage your child to rest, at least during the early stages of a bad cold or flu. There is not much one can do about a child's runny nose. Nose drops or sprays are difficult to use in children and provide only brief relief — do not use them more often than recommended on the label, or nasal congestion can actually get worse. Decongestants taken by mouth are not very effective and can cause rapid heartbeat or insomnia in children. Antihistamines are not effective for colds. Frequent, dry, hacking, non-productive coughs can be eased using dextromethorphan (or DM) containing syrups. Coughing that is helping to bring up mucus from the chest (productive cough) should not be treated with cough medicines stronger than DM. Acetaminophen, decongestants and antihistamines have no effect on coughing. Antibiotics are not needed for most respiratory infections, even flu-like ones. They should be used only when children develop bacterial complications, such as ear infection or pneumonia.

Colds that occur in young babies (under 3 months of age) can be troublesome because such infants do not adjust easily to having nasal blockage. They can seem to be fighting for breath when they are simply trying to breathe through a blocked nose. Feeding becomes difficult. The effect is often a miserable, hungry, gassy baby who disrupts family life for a few days. Babies having breathing trouble, fever, poor appetite or vomiting should be checked by their health care provider.

Colds can lead to a middle ear infection. Signs of ear infection are high fever (particularly fever that begins several days after the start of a cold), earache, crankiness or vomiting. Finding pus draining from the ear is a sure sign of ear infection and means that the infection has broken the eardrum. Children with signs of ear infection should be checked by their health care provider.

Infections of the eye frequently accompany colds or ear infections and are caused by bacteria. Typically, the child will wake up one morning with one or both eyes stuck shut with dried yellow pus. See your health care provider for this.

Infections of the face may develop from nasal secretions, resulting in yellow pustules or wide, honey-colored scabs (impetigo). Check with your health care provider if this happens.

Chest colds can be complicated by pneumonia, wheezing or bronchitis. Children should be checked by their health care provider if they have breathing trouble, blue-tinged lips, noisy breathing, or if they choke or cough up a lot of yellow phlegm. Coughing that is so bad that it makes the child vomit or turn red in the face should also prompt a check-up.

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Cradle Cap

Cradle cap is common among newborn infants and while not a health threat is sometimes unsightly and distressing to mothers. As a form of dermatitis it is caused largely by a reduction of the amount of sebum, or natural oils produced by the skin. Cradle cap is recognizable by its crusty yellowish/ whitish appearance which usually affects the scalp, head, eyebrows and area behind the ears. In some infants, the affected areas may look like dry patches while in others, redness can occur under the crusting.

Fortunately this is a fairly temporary situation and baby will often have no further recurrence by the time they are six months old. Your health care provider will recommend the application of baby oil, choose one made from natural oils as many commonly available baby oils are made from liquid paraffin which is a derivative of crude oil, and apply it to the scalp. Or shampoo the affected area with a gentle, all natural 'organic' shampoo. This can be effective as the 'organic' shampoos contain ingredients such as Aloe Vera, comfrey, vitamins A, C and E and almond or olive oil, all of which is nurturing of baby's delicate skin. Sometimes in severe cases, the use of cetrimide based shampoos and creams are necessary but because of baby's low body weight and their intolerance to certain drugs and chemicals, advice should be sought from your health care provider before the application of strong medication. Also if you suspect that your child has a more serious skin condition, contact your health care provider for advice.

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Dehydration

Dehydration is a loss of body fluids, which are made up of water and salts. When sick children vomit or have diarrhea, they can lose large amounts of water from their bodies and can become dehydrated very quickly. Healthy children can spit up, vomit, or have a loose stool once in a while without being in danger of dehydrating.

Dehydration can be very dangerous, especially for babies and toddlers. Children can even die if they are not treated. Now the signs of dehydration:

Decreased urination (less than 4 wet diapers in 24 hours)
No tears
Dry skin, mouth and tongue
Sunken eyes
Grayish skin
Sunken soft spot (fontanel) on infant's head

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Diarrhea

Diarrhea is a very common problem in childhood. Usually, it is mild and brief. Since every child has a different pattern of bowel movements, it is sometimes difficult to tell if a child has diarrhea or just a loose bowel movement. A child has diarrhea if there are more bowel movements than usual, or if stools are less formed and more watery. A child with diarrhea may also have fever, loss of appetite, nausea, vomiting, stomach pains, cramps, and blood and/or mucus in the bowel movement. Diarrhea germs are easily spread from person to person, and especially from child to child. They usually spread readily among children who have not learned to use the toilet. The spread of the infection can be reduced if adults and children wash their hands carefully after every diaper change and going to the toilet, and before preparing and eating food. Diarrhea can be dangerous if not treated properly because it drains water and salts from the child. If these are not put back quickly, dehydration can occur and hospitalization may be necessary. It is most important that the child with diarrhea continues to drink an appropriate quantity of fluids to avoid dehydration. If your child has any of the symptoms associated with severe diarrhea, medical intervention is necessary:

Is less than 6 months of age
Has bloody or black stools
Starts to vomit and is still vomiting after 4-6 hours
Has a fever: temperature greater than 38.5¼C (101.5¼F)
Has signs of dehydration

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Vomiting

Vomiting is common with infants and small children. Often it is caused by stomach upset from a virus. An infection, pain, excitement, or other problems can also cause it. Vomiting that lasts for more than 6 hours should be considered serious. Call your child's doctor. Vomiting can cause dehydration, which can be very serious. Dehydration happens when your child loses too much liquid. You can prevent dehydration by increasing the amount of liquid your child drinks. Call your health care provider immediately if your baby or child has any of these symptoms:

Blood in the vomited material (unless you have a breast-fed newborn and you are sure you have bleeding nipples)
Yellow or green vomitus
Abdominal distention
Constant abdominal pain over 1 to 2 hours
Signs of severe dehydration
Mottled, pale skin with cool hands and feet
History of recent abdominal injury
Is difficult to arouse, confused or lethargic
Possibility of accidental ingestion of a poison (plant, medicine, chemical)
Choking episode or ingestion of a coin or other foreign object
Projectile, very forceful vomiting more than 2 or 3 times, especially in an infant under 6 months of age
Blood in the stool, any stool that looks like " jelly"

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Fever

A fever is a symptom of an illness, not a disease in itself. Your baby might be running a fever because of an infection, a virus, a reaction to an immunization or shot, or teething. You should suspect a fever if your baby's skin feels hot and dry, your baby doesn't seem to want to eat, acts fussier or seems sleepier than usual. Take your baby's temperature. The average body temperature is 98.6^oF or 37.0^oC. A rectal reading of 100.4^oF or higher may indicate that your child has a fever. Rectal readings are usually 1 degree higher than oral readings. Oral readings over 99.5^oF indicate fever. Auxiliary (under the armpit) temperature readings tend be about 2 degrees lower than temperatures measured orally. Tympanic (in the ear) temperatures can vary greatly and are the least accurate to take a temperature but will let you know when a fever is present.

The following chart will help you decide which recommended technique should be used to take your child's temperature.

If your baby has a mild fever, no medication is needed. To reduce a high fever give your baby or child a non-aspirin fever reducer, like acetaminophen (Tylenol or Tempra) or ibuprofen (Advil or Motrin). Dress your child lightly, avoiding the temptation to bundle up. Do NOT give aspirin because it can cause a disease known as Reye's syndrome. Be sure to alert your doctor if the fever doesn't decline within 24 hours, or if your baby shows other symptoms.

The following medications are available for fever reduction or pain relief.

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Thrush

Thrush is a common yeast infection (also called Candida albicans or Monilia) that affects the mucous membranes. It can occur when the mother or infant has been treated with antibiotics or can be contracted by the baby at the time of birth if the mother has a vaginal yeast infection. Thrush is often found in infants, pregnant women or diabetic patients. It is easily spread from one person to another. When a breastfeeding mother complains of the sudden onset of sore nipples after a period of "normal" nursing, thrush may be the cause. The mother may also complain of shooting pains in the breast during or after a feeding or of itchy, burning or tender pink nipples. Her breast may also appear to be red or bright pink. The baby may have a diaper rash or white patches on the inside of the mouth, gums or tongue. Sometimes, a baby may refuse to nurse or may pull off the breast. In rare cases, feedings may be interrupted because of the infant's discomfort and could result in inadequate weight gain. While this in itself is not a symptom of thrush, it could be a consideration in a slow-gaining situation.

Thrush is not a serious condition; breastfeeding can and should continue during treatment. Thrush can persist for several weeks or longer, and may reoccur sporadically. Both mother and baby need to be treated, and in the case of a vaginal infection, the mother's sexual partner may also need treatment. If a yeast-caused diaper rash is present, it can be treated with an anti-fungal ointment. It is possible for the organism that causes thrush to be present without visible symptoms.

Usually an oral medication is given to the baby through a dropper and applied directly to the patches on the inside of the mouth. The medication is most effective when kept in the mouth for as long as possible before swallowing. An antifungal cream is used on the mother's nipples applied after each nursing.

It is necessary to continue using the medication for as long as prescribed, even if symptoms are no longer apparent. In frequently recurring cases, an oral antifungal medication in tablet or liquid form is also prescribed for the mother.

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Diaper Rash

Diaper rash usually begins as a solid patch of red, thickened skin (often around the anus) and can spread to cover the entire groin and lower buttocks. The same moist, warm, closed-off conditions causing the original rash also can lead to infection by bacteria or yeast. An infected rash can become a group of separate round spots with oozing, crusting, and surrounding redness and swelling. While many factors can cause diaper rash, it’s your infant’s very thin, delicate skin which makes him or her so susceptible to this common problem.

Breast-fed babies have less diaper rash, probably because they urinate less often and their urine and stool are chemically different from bottle-fed babies. High-protein foods raise acid levels in urine and stool, promoting diaper rash.

Treatment of diaper rash includes:

Change your baby often.
After a bowel movement, wash the diaper area well with soap and water.
Do not use plastic pants until the rash has cleared.
Rewash all cloth diapers in mild baby detergent and rinse twice in plain water. Do not use fabric softeners, bleach, detergents, or harsh soaps.
Apply a cream or use a thick zinc oxide ointment three to four times a day to help protect the skin from irritation.
Do not give your baby food or juice that you know causes diaper rash.
Leave the diaper off for a few hours during the day, especially during naps.