Baby
BABY'S HEALTH: SICK ALERTS
By Mike Kelly, M.D.
One of the most challenging aspects of infant care is to know if an
infant is sick or not. Infants are unable to tell us verbally how they
feel, so we must rely on their actions. Often, what a baby does not do
is as important as what s/he does. For example, an infant's appetite,
or lack of one, can be an indication of how a baby is feeling. When
babies are feeling ill, they will not feed as often or consume as much,
whether it be due to fever, nasal congestion (babies need their noses
cleared to breathe easily), or something more serious.
If a baby doesn't eat well, s/he is becomes at risk of dehydration.
In this condition, the body does not have enough fluid to supply
nutrients to the different organs, such as kidneys or skin. Infants who
are dehydrated will appear less active than normal, have fewer wet
diapers, and have cool or clammy skin. Their lips may appear dry, and
they may not produce tears when they cry. As dehydration progresses,
the baby will become very sleepy and difficult to arouse. These are
signs of severe dehydration and warrant immediate medical attention. If
the signs of dehydration are recognized early on, it may be treated
with a brief visit to the doctor's office or emergency room.
It's important to recognize other signs, besides poor feeding, that
place a baby at risk for dehydration. The most common cause of
dehydration in childhood is diarrhea. A baby may drink a normal amount
of milk but have increased loss of fluid, due to diarrhea, and become
dehydrated. More frequent feedings can help prevent dehydration, but
keep an eye, in conjunction with your physician, on the baby.
Babies can also lose fluid from vomiting. Babies often "spit up"
after feeding, but vomiting is very different. It is usually more
forceful in nature and larger in volume. Spitting up often occurs right
after a feeding, while vomiting can occur at any time. Vomiting can
cause dehydration or be a sign of serious dehydration. The presence of
blood or greenish fluid (called bile) in the emesis is a red flag for
medical attention immediately. Vomiting may be the result of
dehydration, intestinal blockage, or infection.
A common sign of infection is fever. The best way to take your
baby's temperature is with a rectal thermometer placed in the rectum.
Using thermometer strips on the forehead and touching to determine
temperature are not reliable ways to learn of a fever. In babies less
than 3 months of age, a temperature greater than 100.5 may be a sign of
a potentially serious infection, so you should call your doctor
immediately. A fever doesn't always indicate a serious infection, but
in infants it is very hard to distinguish serious from not-so-serious
infections. A fever is a sign that the body is fighting an infection,
which makes a fever every now and then a good thing. However, the cause
of the fever should be investigated.
A good clue to your baby's health is his or her appearance and
actions. A sick baby is too tired or sleepy to eat and is not active,
smiling, or babbling. The sicker the baby is, the less s/he will do and
the sleepier s/he is. Many illnesses in childhood have some of these
features, but there is one that deserves specific mention, bacterial
meningitis. This is a devastating infection of the tissues that line
the brain. Children with bacterial meningitis often have many of the
symptoms noted above - fever, poor feeding, decreased activity, and
vomiting. The infant's "soft spot" may feel tense or even hard. This is
an extreme medical emergency, and the baby needs to be examined in a
hospital right away. If diagnosed and treated in time, the serious
complications can be avoided, but time is of the essence. Fortunately,
the Hib vaccine has prevented many cases of bacterial meningitis. With
the introduction of the vaccine against the bacteria called
pneumococcus, even more children will hopefully be saved from bacterial
meningitis.
There is no substitute for good medical judgment, and you should
always call your doctor whenever you have a question about your baby.
As vaccines demonstrate, however, prevention is the best medicine. Pay
attention to the early signs of any behavior that seems uncommon - you
could prevent a problem, be it infection or something else, from
getting worse.
Top
About The Author
Mike Kelly, M.D. is Pediatric Intensivist at Maimonides Medical Center in Brooklyn, New York.
