Conditions That May Affect Your Child
Jaundice is a condition, mostly in babies, where the skin and whites of the eyes become yellow because of increased amounts of pigment in the body called bilirubin. Bilirubin is produced when red blood cells are broken down in the body. This is a normal process but sometimes there is extra blood in an infant’s body, or their liver may not be able to get rid of the bilirubin fast enough. When this happens, the result is jaundice. We worry about jaundice because as the bilirubin levels get too high, the excess bilirubin can deposit into the brain and cause damage. This typically only happens at very high levels that we rarely see because we treat before the levels get this high. There are several different causes of jaundice which we will cover for you.
Physiological jaundice occurs to some extent in about ½ of all babies. The reason that this happens is that when babies are born, the liver is still developing and is slow in processing the bilirubin and in helping to eliminate it from the body. Typically, the yellow color will appear at 2-3 days of age and will disappear within 1-2 weeks. Bilirubin levels do not generally reach a high enough level to cause concern.
Breastfeeding jaundice occurs in about 5-10% of babies who are breastfed. When the baby begins feeding, the mother’s milk supply is still coming in. The relative lack of breastmilk combined with the baby learning how to feed leads to mild dehydration. The result is mild jaundice. Typically, the yellow color will appear at 2-3 days of age and will disappear within 1-2 weeks. Bilirubin levels reach a peak around day 4-6 of life. Levels usually do not require any intervention, but occasionally, they may reach 15mg/dL or greater and require treatment.
Breastmilk jaundice occurs in 1-2% of breastfed babies, occurs around 7 days of age, and can last 3-10 weeks. The cause is not completely understood, but the thought is that the milk contains a protein or enzyme that affects the elimination of bilirubin from the baby’s body. There is nothing wrong with or bad about your milk supply if this happens. The problem will resolve. Sometimes, giving formula only for 1-2 days while expressing the breastmilk to maintain supply, will bring the bilirubin levels down rapidly. Occasionally, these babies will need intervention.
Blood group incompatabilities (Rh or ABO) can cause a rapid rise in the bilirubin levels. What happens is that the mother’s and baby’s blood types are different and the mother produces antibodies to the baby’s ‘foreign’ blood. These antibodies cross the placenta and enter the baby’s blood. The antibodies cause some of the baby’s blood to be destroyed. Typically, this jaundice begins in the first 24 hours of life and can be serious depending on the level of destruction of the baby’s blood. Treatment is often needed to prevent complications.
Treatment of jaundice can help to lower the bilirubin levels and prevent serious complications such as brain damage, deafness, cerebral palsy, etc. Initial treatment consists of phototherapy and sometimes IV fluids. The ultraviolet light used during treatment helps to breakdown the bilirubin so that it can be eliminated from the body. Frequently when we first see jaundice, we will recommend to parents to place their baby in a diaper only and near a window in indirect sunlight. The ultraviolet light from the sun can help to breakdown the bilirubin as well. You still need to let your pediatrician know if there is any yellow discoloration so that we can see your baby and order a bilirubin level if needed. In rare cases, when levels get dangerously high, babies may need an exchange transfusion where we take blood out that contains too much bilirubin and replace it with fresh blood.
It is very important for parents to understand that babies are obligate nose breathers. This means that they rely on their noses to breathe. Anytime a baby’s nose becomes congested, he will become fussy and have difficulty breathing. For this reason, any time that you notice congestion, you should attempt to clear the nasal passages. To do this you will want to use a nasal aspirator (blue bulb) to suction out the nose. Frequently, the congestion is too thick for the bulb to pull out. The best treatment is to place 2-3 drops of sterile saline water into each nostril and to wait one minute before using the bulb. This will allow the saline to loosen up the congestion. Next, suction each nostril 2-3 times until clear. Avoid suctioning over and over at one time as this can cause trauma to the nose.
Cool mist humidifiers will sometimes help to loosen up the congestion. You should never use steam humidifiers around babies. Another helpful suggestion is to raise the head of the crib slightly. This will often help to relieve the stuffiness and to allow your baby to breathe better.
With babies, diarrhea is when the stools soak completely into the diaper. There are many causes for diarrhea from infection to malabsorption. The concern with diarrhea is that it can lead to excessive fluid loss and dehydration. Please call your pediatrician if your baby should have diarrhea. To prevent dehydration, use the following guidelines:
- If formula feeding, stop the formula and give Pedialyte or Enfalyte for 12-24 hours. You may then mix the Pedialyte with the formula one to one for the next 12-24 hours and then resume formula.
- If breastfeeding, continue to breastfeed and supplement with Pedialyte for 24-48 hours.
- Avoid fruit juices as these can worsen the diarrhea.
If you see any blood in the diaper and cannot see a small tear at the anus causing the blood, please let your pediatrician know immediately. Remember that infectious causes of diarrhea are transmitted via the fecal-oral route. This means that the virus, bacteria, or parasite is shed in the stool and contaminates the environment. You then transfer this contamination to your mouth via your hands. Therefore, handwashing is very important to prevent the spread of the germs contained in the diaper. Anytime you change a diaper or touch the diaper area, be sure to wash your hands well before touching anything.
Always call your doctor if you see any of the following: decreased activity/lethargy, decreased urine output, blood in the stools, decreased feeding, vomiting, or unconsolable crying. Please realize that most babies that have diarrhea develop a diaper rash from all of the stooling. Make sure that you are applying a thick protective layer of Desitin, Balmex, or Vaseline to the dry diaper area as a barrier.
Normal body temperature is 98.6 ºF with the normal accepted range of 97.6-99.6 ºF when taken orally or rectally. When taking temperature in a baby under 6 months of age, always check the temperature rectally if you are concerned that there might be a fever. You may routinely check under the arm (axillary), but if you get any temperature outside of the normal range, always comfirm with a rectal temperature. This will give you the most accurate information and will help us the most.
Pacifier thermometers are frequently inaccurate, and we do not recommend these. Thermometer strips that you place on the body are almost always wrong and should never be used. Ear thermometers can be very accurate when used properly, but this is extrememly difficult in a baby. We, therefore, recommend that you do not rely on these for accurate measure of temperature. Digital and mercury/alcohol thermometers are very accurate and are the best option for babies.
Never try to measure an oral temperature in a baby as they can not hold the thermometer correctly. Axillary temperature is best taken without clothes to interfere. Place the thermometer in the middle of the armpit and hold the arm folded down at the side over the thermometer.
To take a rectal temperature, you may use either a digital or mercury/alcohol thermometer. Lubricate the tip of the thermometer with Vaseline or A&D ointment before each use. Insert the thermometer no more than ½ inch to avoid any unneeded discomfort to your baby. Follow the instructions that came with the thermometer regarding how long to wait before taking your reading of the temperature. After each use, wipe the thermometer thoroughly with alcohol to clean.
Fever happens when your body is burning energy at a more rapid rate than everyday. Energy consumption leads to heat production that presents itself as a fever. A temperature over 100.4 ºF is considered a fever and may be a sign that your baby is fighting an infection. Always call your pediatrician anytime your baby has a fever for recommendations. Babies under 6 weeks of age have an immature immune system and are less effective at fighting off infection. For this reason, they are more susceptible to serious infections. We, therefore, take fevers very seriously in this age group.
Many parents are concerned about the myth that fevers can cause brain damage. The fever itself is a good sign that the body is doing its job. Fever, alone, will not cause brain damage, with the exception of heat stroke where temperatures reach 106 ºF and above. It is possible, however, that the underlying cause of the fever could cause brain damage in the case of meningitis or encephalitis.
Four to five percent of children may develop a seizure associated with a fever. This is known as a febrile seizure and is not related to epilepsy in any way. Your child is not at any increased risk of having seizures later in life if he experiences febrile seizures. Most frequently, this type of seizure occurs between six months and two years of age. Typically, they are caused by a rapid increase in temperature and last less than five minutes. As the fever comes down, the seizure will resolve. Febrile seizures do not cause any permanent damage to your child.
Your Child Has a Fever, What Should You Do?
- If your child is less than three months of age, he needs to be seen the same day. Please call your pediatrician for an appointment.
- Use light, cool clothing to allow heat to escape and your baby to stay cool.
- Make sure that the room temperature is around 76-78 ºF.
- Give Tylenol according to the dosing chart below
- Do not give Motrin (ibuprofen) under 6 months of age.
- For children over 6 months of age, Always give Motrin with food. Do not give both Motrin and Tylenol at the same time.
- Do not exceed the recommended doses of Tylenol or Motrin.
- If the temperature is over 102 ºF, or if it is not coming down with the above measures, place your child in a bathtub of warm water and use a washcloth to wet the back and chest. As water evaporates from the body it will help to cool your baby. Never use cold bath water or alcohol, you want to avoid shivering.
- It is okay if the temperature does not return to normal as long as it comes down with the above measures.
- Try to get your baby to drink liquid (Pedialyte/Enfalyte or diluted fruit juices). When a baby has a fever, the body loses fluid more rapidly and can lead to dehydration.
Tylenol (Acetaminophen) Dosing Chart
every 4 hours
|6-11 lbs||0-3mos||1/2 (0.4ml)||1/3 of
|12-17lbs||4-11 mos||1 (0.8ml)||1/2 tsp.||2/3 of
|18-23lbs||12-23 mos||1 -1/2 (1.2ml)||3/4 tsp.||120 mg|
|24-35lbs||2-3 years||2 (1.6 ml)||1 tsp.||1-1/2 120 mg
1/2 325 mg
Motrin (Ibuprofen) Dosing Chart
every 6-8 hours
|12-17lbs||6-11 mos||1 (1.25ml)|
|18-23lbs||12-23 mos||1 -1/2 (1.875ml)|
|24-35lbs||2-3 years||2 (2.5 ml)||1 tsp.||2 tablets||1 tablet|