When Germ Warfare Comes to the Nursery

Because a new baby’s immune system offers little resistance to illness, pediatricians encourage mothers (when possible) to breast-feed and to bring their babies in for scheduled immunizations. Even so, all babies are vulnerable to a number of illnesses.

In newborns and babies up to about 8 weeks old, caution is always the rule and a pediatrician should be consulted about any sign of ailment.

Among babies 2 months to a year, the American Academy of Pediatrics, an organization of 50,000 pediatricians, offers a list of common illnesses.

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Infections: Minor infectious diseases are the most common illness a baby is exposed to in this age range. Mild infections actually help a baby build an artillery of antibodies, strengthening the immune system to fight illness the rest of his life. Whether the infection is caused by a virus or bacteria, it will probably last two to three days and may be accompanied by other symptoms such as rash, swollen lymph nodes or runny nose, characteristics that can lead to a more specific diagnosis.

Poor feeding and color, listlessness, a weak cry, sleeping more than usual, vomiting, diarrhea, breathing problems, fussiness and a rectal temperature of 100.4 degrees for 3 months or younger and a temperature of 101 degrees in babies over 3 months are also symptoms of an infection, according to the AAP. Fever is a healthy response of the immune system, but how a baby looks is actually a more accurate gauge of how sick she is than the fever itself.

“A baby who is pallid with 101-degree fever who does not want to move and is staring vacantly is sicker than a child with a 103-degree fever, who is playful and flushed,” says Lorraine Stern, a Valencia-based pediatrician and spokeswoman for the AAP. If a fever is greater than 102 degrees, acetaminophen or ibuprofen can be given orally to children older than 2 months. Parents can also bring down a high fever quickly with a lukewarm bath--not a cold bath, which will cause the body to increase heat production to warm up.

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Colds and Coughs: The common cold (often referred to as an upper respiratory infection and caused by a virus) usually runs its course in seven to 10 days, says Edward Malphus, a Santa Monica-based pediatrician and AAP member. The onset of a cold often begins with a slight fever (the infectious period) and progresses to a runny nose with clear to white mucous, he says.

The baby may also have a cough, which worsens when lying down. It is not uncommon at the end of the first five to seven days for mucous to turn green for a few days, but it doesn’t necessarily mean that there is a bacterial infection, which would require antibiotics, or that your baby is infectious to other children, Stern says.

Using humidifiers, saline nose drops and decongestants and suctioning out the baby’s nose can make a baby more comfortable. See the pediatrician if green mucous persists more than seven to 10 days (there may be a secondary infection requiring antibiotics), if a fever appears after the onset of the cold, if there is poor feeding or the baby is extremely irritable.

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Ear Infections: Ear infections are often secondary infections to colds, Malphus says. The symptoms in babies may be irritability, waking up at night due to increased pressure in the ear, a fever with no signs of pain, and tugging or hitting the ear. The only way to know for sure if there is an ear infection is to have the pediatrician look to see whether the ear tissue is inflamed.

Although treating ear infections with antibiotics is undergoing rigorous reexamination, babies under a year who have clear evidence of such an infection should still be treated with an antibiotic, according to the AAP.

Babies are more vulnerable to ear infections if they nurse or drink a bottle lying flat, (milk flows directly into the Eustachian tube, which leads to the middle ear), if they have allergies or colds (which inflame membranes and tissue blocking the middle ear), if one of their parents had frequent ear infections as a child or if there is tobacco smoke (a respiratory irritant) in the home.

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Mild Vomiting: Vomiting is often caused by a virus that infects the intestine and stomach and usually lasts a day or two but can last up to a week, Stern says. Such vomiting is usually followed by diarrhea. “The first impulse people have when a baby is vomiting is to feed them again,” she says, “but the stomach needs a rest, and you should wait a minimum of one hour.”

Pediatricians often recommend parents give electrolyte fluids (half an ounce every 15 minutes for an hour), clear liquids or breast milk. Mild vomiting rarely causes dehydration, but if a baby has a dry mouth and lips, no tears when crying, sunken tissue around the eyes and scant urine output (wet diapers every six hours rather than every one to two hours), call your pediatrician. If a baby can’t keep anything down after six to eight hours or if blood or green bile appears in vomit, parents should also call the doctor.

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Diarrhea: Diarrhea by definition is looser than normal bowel movements and is most often caused by acute infections but can also be caused by lactose intolerance (less common in breast-fed babies than in formula-fed). Typically, diarrhea lasts three or four days. Preventing dehydration is the main objective, and some pediatricians will recommend oral electrolytes and clear fluids and a diet of bread, rice, apples and toast. If a baby will not drink oral electrolyte replacement (which has a salty taste), don’t worry, says Malphus. “My rule of thumb is that if they are really dehydrated they will drink that stuff, and if not, they won’t,” he says.

Both Stern and Malphus say parents should not underestimate their ability to detect when baby is ailing. “The bottom line about when your baby is sick is to trust your instincts and to bring your baby in when you think there is something wrong,” Stern says.