Baby Lessons Archives - Page 2 of 2

Welcome to Week 18 of Parenting Your Baby!

In This Week’s PediaGuide, We’ll Discuss:

Sleep & Feeding.

The Hot Topics for the Week, Including:
- Croup.
- Wheezing in Babies.

Plus, a Few Friendly Reminders.

Get Wise About It All Below…

We’re coming up on 5 months. As you venture out more with your baby, they’ll naturally be exposed to a greater number of germs. The good news is that this exposure will help build up their immunity. The not so good news is they’ll probably get a few illnesses along the way. The Hot Topics for this week focus on one of these common illnesses (Croup) and on a symptom that’s commonly seen in the pediatric population (Wheezing).

Sleep:

Your baby continues to need about 12-15 hours of sleep per day (including naps).

Feeding:

The name of the game continues to be breast milk and/or formula.

If your baby’s doctor recommends that you introduce solid foods before 6-months of age, Get Wise about how to do it again, here.

As a Reminder, the Hot Topics for This Week Are:

Croup.
Wheezing in Babies.

Get Wise(r) About These Topics Below…

Disease Spotlight: Croup

Croup (fancy name: laryngotracheobronchitis) is a respiratory illness that causes a portion of the affected child’s airway (below the vocal cords) to become inflamed and narrowed. Think: Laryngitis in babies.

Croup is typically caused by a virus (such as the parainfluenza virus) and is most commonly seen in kids 6 months to 3 years of age.¹

What are the Symptoms of Croup?

The Symptoms of Croup Include:

Cold-Like Symptoms (such as a runny nose and a low-grade fever).
A Hoarse Voice: Croup will make your child’s cries and coos raspy.
A “Barking” Cough: A “barking” cough is a classic sign of croup. Your child will sound like a dog or a seal barking. You’ll know it when you hear it. The cough may be worse at night and when your child is crying.

Inspiratory Stridor: Children with more pronounced cases of croup often make a high-pitched squeaking or whistling sound when they inhale.
- For moderate cases of croup, you may hear this sound (fancy name: inspiratory stridor) only when your child is upset.
- For more severe cases, the inspiratory stridor may be heard with every breath.

Trouble Breathing: Respiratory distress is seen in severe cases of croup and is due to an intense narrowing of the upper airway. Babies, in this case, look like they’re huffing and puffing.

Insider Info:

Days 2 and 3 of croup tend to be worse than Day 1, so call the doctor right away if you hear the classic barking cough.
If you want to impress the doctor, you can casually mention the “Westley Croup Severity Score.”

What’s That? It’s a scoring system that gives doctors and nurses a sense of how bad the croup is and how aggressively they need to treat it. This scoring system evaluates 5 factors and can be used in kids under 6 years of age.

Get Wise(r) About the Westley Croup Severity Score, Here.

How is Croup Diagnosed?

Croup is usually diagnosed based on a child’s symptoms, with the barking cough being the telltale sign.

Insider Info: If your baby develops severe croup, the doctor may recommend that they get a neck X-ray in the ER to confirm the diagnosis and to rule out other possible causes of upper airway swelling. The classic neck X-ray finding for croup is the “steeple sign” (which shows the narrowing of the trachea – aka the windpipe). See how the upper part of the trachea looks like a church steeple in the pic below?

Image Source: Wikipedia

What Can Be Done to Treat Croup?

Call the doctor ASAP if you think your child has croup.
For mild to moderate cases of croup, the doctor will either prescribe an oral steroid (to take at home) OR give your child a steroid shot in the office to reduce the upper airway swelling. Sometimes a second steroid dose is needed the following day.
In addition, you can put a humidifier in your baby’s room or take them into the bathroom and run a hot shower. The warm, moist air will help alleviate the airway swelling.
For more severe cases of croup, a trip to the ER may be in order. In the ER, the doctor will give your child steroids and may administer a breathing treatment called racemic epinephrine to open up the airways.

Symptom Spotlight: Wheezing

Now, let’s turn our attention to another noise that can be heard with respiratory problems: wheezing.

What’s Wheezing?

Wheezing is a high-pitched whistling or squeaking sound that’s made when the airways become inflamed and narrowed. Although wheezing is best heard with a stethoscope, it may be heard with the naked ear in severe cases.

Insider Info: Parents often mistake “transmitted upper airway sounds” (the Dark Vader breathing you hear with a cold) for wheezing. If you’re not sure what you’re hearing, ask the doctor to take a listen.

What Causes Wheezing?

Wheezing can be heard anytime the airways are inflamed or narrowed. For example it can be heard with colds & asthma, and when a foreign object (such as a coin or a toy) is swallowed.
Wheezing with Colds: Some infants wheeze when they get a cold, especially when they have bronchiolitis, an infection of the small airways of the lower lungs.

Wheezing with colds doesn’t necessarily mean that a child is going to develop asthma (although it’s a possibility). In the pediatric world, we typically allow at least “one wheeze” before we make any predictions about the future.

Insider Info: Children under 5 years of age who frequently wheeze with colds are often said to have “reactive airway disease” (instead of asthma). Many (but not all) of these kids are diagnosed with asthma down the road, when they’re old enough to undergo asthma testing. The asthma test (spirometry) requires some skill and maturity on the child’s part to get an accurate result (which is why it isn’t usually performed until age 5 or so).

How is Wheezing Managed?

First, the doctor needs to figure out what’s causing the wheezing. If your child swallowed something, then it needs to be removed. If the airways are tightening up because of an infection, medications can be given to reopen them.

2 Types of Medication That Doctors Commonly Use in Acute Wheezing Situations Are:

1. Bronchodilators (such as Albuterol), which dilate the airways.

2. Oral Steroids (such as Prednisolone) which decrease the inflammation in the airways.

Whether the doctor uses these medications depends on the cause of the wheezing and how bad it is.

The Bottom Line

If your child develops a cold, keep an ear out for wheezing and for the barking cough of croup.

Sneak Peek: Next week’s PediaGuide will focus on ear infections and how they’re treated. See you then!

“Ever had a job where you had
no experience, no training,
you weren’t allowed to quit,
and people’s lives were at stake?

THAT’S CALLED PARENTING”

~UC Kindies

The Reminders for This Week are Essentially the Same as Last Week’s.

Remember to Give Your Baby a Daily Vitamin D Supplement (That Contains 400 International Units Per Day) If You’re (Exclusively) Breastfeeding OR If They’re Taking Less than 32 Ounces of Formula Per Day.

Get Wise (Again) about the importance of vitamin D supplementation.

For Formula-Feeding Parents: Make sure you’re mixing the formula correctly and that it has iron in it (which it probably does). Get Wise about How to Mix Formula.

Put Your Baby on Their Back to Sleep, With No Pillows, Blankets, Bumpers, or Stuffed Animals in the Crib.

Avoid Giving Honey to Babies Under 1 Year.

Why? Because of the concern for infant botulism. Get Wise about it here.

Don’t Give Water to Babies Under 6 Months of Age (Except For What’s in the Formula, If Your Baby is Taking Formula).

Why? Because extra water can lead to electrolyte abnormalities (such as low sodium levels), which can, in turn, lead to seizures.

Call the Doctor If Your Baby Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).

Don’t Give Ibuprofen to Babies Under 6 Months of Age. Aspirin Is Off Limits For Kids Under 18 Years (Unless It’s Prescribed by the Child’s Doctor).

Do Tummy Time at Least Twice a Day For a Few Minutes Each Day to Help Strengthen Your Baby’s Neck Muscles and Improve Their Head Control.

And…That’s a Wrap!

Welcome to Week 12 of Parenting Your Baby!

In This Week’s PediaGuide, We’ll Discuss:

Sleep & Feeding.

The Hot Topics for the Week, Including:
- Relaxing the Rules on Fevers.
- The Top 8 Questions Parents Ask About Infections.

Plus, a Few Friendly Reminders.

Get Wise About It All Below…

Can you believe you’re already 12 weeks into parenting your infant? Party tricks at this age include a social smile, cooing, better head control, and “tracking” (when your baby follows you with their eyes).

Sleep:

Your baby is still clocking a solid 14-17 hours of sleep per day, including naps (2 to 3 of them).

Feeding:

Ditto from last week (breast milk and formula only).

As a Reminder, The Hot Topics for This Week Are:

Relaxing the Rules on Fevers.
The Top 8 Questions Parents Ask About Infections.

Get Wise About These Topics Below…

Loosening Up the Fever Parameters

Remember the days when the doctor told you that a temperature of 100.4°F or above in your baby meant a trip to the ER?! Well, thankfully, those days are over. Now that your baby is 3 months old, there’s more wiggle room in terms of how high their fever can go before a big workup is done.

At this age, the recommendation is to call the doctor for any fever of 102.2°F or above. You should also call the doctor if you have any concerns or are unsure of what’s going on. As always, the number on the thermometer is not the only thing that matters. If your baby is lethargic, is feeding poorly, has a fever that won’t go away, or is worrying you in general, then call the doctor even if the fever is below 102.2°F. It’s better to overreact (vs. underreact) in these situations.

A Word About Lethargy: As mentioned before, “lethargy” is a red-flag word for pediatricians and requires a visit to the ER. Many parents will throw out this word offhandedly without knowing that it freaks pediatricians out. True “lethargy” is when your baby is so wiped out that they’re feeding poorly, seem indifferent to their surroundings or can’t be easily roused.

Double Take: Fevers can make babies look “lethargic.” Then, when the fever breaks, the child seems happy-go-lucky once again. Kids love to make liars out of their parents.

So…no worries, then, if you call the doctor, thinking your baby looks terrible and then (sheepishly) call them back an hour later saying your little one looks fine and dandy.

The Top 8 Questions Parents Ask About Infections

1. My Child is Always Sick. Is There Something Wrong With Their Immune System?

Children under age 2 get 8-10 colds per year (on average).¹Therefore, it may seem like your baby always has a cold, is getting over a cold, or may be about to get a cold. Not every child has this many colds each year, but kids in daycare typically meet this number or exceed it.

PediaTip: If you’re thinking about enrolling your child in daycare, pay attention to which season they would start in. If possible, wait to start daycare until after the peak of cold & flu season (i.e. after the winter months). If this isn’t an option, make sure that your child is up-to-date on their immunizations before starting.

Insider Info: Parents who have witnessed the normal 8-10 colds per year often worry that their child has a problem with their immune system. Immune deficiencies (conditions that cause a a weakened immune system) are rare, however, and kids who have them typically develop recurrent unusual infections, not just multiple colds and coughs each year.

For example, immunocompromised kids may get random skin abscesses, severe pneumonias, or meningitis. If you have any concerns, talk to your child’s doctor, but know that ordinary colds and coughs do NOT usually signal an underlying immune disorder.

Tips for Minimizing Infections:

Practice Good Handwashing and Have Hand Sanitizers at the Ready (Especially During Cold and Flu Season).
Avoid “Sick Contacts.” Postpone play dates with sick babies and keep a polite distance from anyone with a hacking cough or a runny nose.
Keep Your Child Current on Their Vaccines.
Relax. Do what you can but let go of the rest. Germs are a part of life and, in the long run, will help your baby build up their immunity.

2. My Second Child Seems to Be Getting Sick a Lot More Than My First Child Ever Did. What Gives?

Your older child is probably bringing germs home and exposing your baby to them. You can’t do much about this except to practice good handwashing and have your older child cough or sneeze into their elbow.

3. The Doctor Told Me That My Baby Has a Virus, But Now They’re Saying It’s a Bacterial Infection. Why the Flip Flop?

Most of the infections that children get (the standard colds, stomach aches, and sore throats) are caused by viruses. During the first few days of an illness, it can be hard to determine whether the symptoms are due to a viral infection or to a bacterial infection. Because most illnesses are caused by viruses, doctors usually play the odds, and assume that the child has a viral infection (unless their symptoms and physical exam suggest otherwise).

To complicate the picture even more, lingering viral infections can turn into bacterial infections. For example, say that your child has a persistent cough caused by a virus. Bacteria can infect the fluid sitting in the lungs, and cause a bacterial pneumonia.

The Good News: There will be clues to let you and the doctor know that a bacterial infection is brewing. For example, in the case of a bacterial pneumonia, your child may spike a new fever or have a worsening cough.

The Not-So-Good News: If your child develops a bacterial infection superimposed on a viral infection, you’ll have to go back to the doctor to get a prescription for antibiotics. You may also think the doctor is an idiot for telling you that your child had a virus, when they’re now telling you they have a bacterial infection. Doctors LOVE this scenario. Yup, that was sarcasm.

Insider Info: Doctors Use the Following Tools and Tests to Help Them Determine Whether an Infection is Viral or Bacterial:

Experience: Pediatricians and family medicine doctors see a TON of infections. Over time, they develop a sixth sense for telling bacterial infections and viral infections apart.

Testing: Rapid tests can be done in the office to identify viral infections and bacterial infections. Examples include:
- The Rapid RSV Test: This test involves sticking a cotton swab up your child’s nose. Your little one will not like this.
- The Rapid Influenza Test: The rapid test for the flu also involves sticking a cotton swab up your child’s nose and isn’t fun either.
- The Monospot Test: The Monospot looks for mononucleosis (caused by the Epstein-Barr virus) and requires a blood sample. Mono is mostly seen in older kids (think: kissing teens).
- The Rapid Strep Test: During the rapid strep test, the doctor will swab your child’s throat with a long Q-tip. Strep throat is rare in kids under 3.²
- The Rotavirus Rapid Test: The rapid test for a rotavirus infection requires a stool sample.
- The CBC (Complete Blood Count): If the doctor suspects that your child has a bacterial infection, they may order a blood test called the Complete Blood Count (CBC). This blood test will show your doctor what your child’s white blood cells (their infection-fighting cells) are up to.
  
  Insider Info: Bacterial infections usually cause immature cells (called PMNs) to multiply, making the white blood cell count go UP. If you hear the doctor whisper to the medical student, “it’s a high white count with a left shift,” jump in and say, “oh, right, that means it’s a bacterial infection.” Then watch their stunned faces.
  
  Viral infections do NOT raise the white blood cell count as much as bacterial infections and may even decrease it (in a phenomenon known as “myelosuppression”).

Reality Check: Parents often want the doctor to “do something” when their child is sick, like prescribe antibiotics, do bloodwork, or get imaging. Trust me, doctors want nothing more than a quick fix, too. However, antibiotics won’t help a viral infection, and bloodwork and imaging aren’t usually necessary unless the illness is severe OR it’s been going on for a while and doesn’t have a clear cause.

4. I Thought Viruses Couldn’t be Treated With Antibiotics. So, What’s the Story with Tamiflu?

You’re right. Antibiotics are reserved for bacterial infections and can’t be used to treat viral infections. However, there are a handful of antiviral medications (such as Tamiflu) that can be used to reduce the severity and duration of certain viral illnesses.

For instance, Tamiflu (aka Oseltamivir) targets the influenza A & B viruses, which cause the flu. However, Tamiflu must be given within 48 hours of the onset of flu symptoms to be effective.

5. How Long Do Most Colds Last?

Longer than you might think. Colds generally last 7-10 days.

The typical course for a cold is a fever for 2-3 days plus a cough and a runny nose. The cough may get worse before it gets better, but most kids turn the corner around the 7-10 day mark.

7-10 days can seem like an eternity to a parent who’s worried about missing something serious. If your child’s fever continues to climb after 2 days, or the cold symptoms are severe or worsening, don’t hesitate to call the doctor. The doctor might not have the answers you’re looking for (i.e. a quick cure) but getting their input could give you some peace of mind.

6. When is My Child No Longer Contagious?

The Short Answer: It depends on the illness and what the symptoms are.

For example, a child with a fever is usually no longer contagious once the fever has gone away (without the use of a fever reducer, such as Tylenol). This is why most daycares allow children to return only after their fever has broken.

For certain bacterial infections (such as pink eye or strep throat), kids are considered safe to go back to daycare or school after 24 hours of treatment.

7. When Should I Call My Child’s Doctor About a Seemingly Never-Ending Virus?

There are no hard-and-fast rules about when to call the doctor when it comes to an illness. Much of it has to do with your gut feeling. Here are some tips, though:

Call the Doctor If:

You’re Worried (i.e. if Something Doesn’t Feel Quite Right). If you’re a new parent, you may be calling the doctor a LOT in the beginning. That’s okay and pretty standard. As your child gets older and you see different viruses come and go, you’ll become more confident in your judgment.

The Fever Hits a Certain Number. This magic number depends on the age of your child.
- If your baby is less than 3 months old, call the doctor for a rectal temperature of 100.4°F or higher.
- If your baby is 3 months to 3 years, call for a temperature of 102.2°F or higher.
- If your child is over 3 years, call for a temperature above 103.1°F.
- If the fever isn’t responding to Tylenol or ibuprofen OR you’re concerned, call the doctor regardless of the number on the thermometer.

Your Child Has Had a Fever for More Than 4 Days (or the Fever Has Been Consistently Rising for 2 Days).

The Infection Seems to be Getting Worse. For example, call the doctor if…
- The fever curve is trending UP (i.e. the fever is getting worse each day).
- Your baby’s cough is more pronounced.
- There’s now green snot instead of clear snot coming out of your kiddo’s nose.
- Your baby is having trouble breathing. In this case, call 911.

Your Baby is Inconsolable or Lethargic.

The Bottom Line: Call the doctor if your child has any of the red flag symptoms above or if you’re worried and need advice.

8. What Is a “Fever Without a Source?” What About a “Fever of Unknown Origin?”

When the cause of a fever is a mystery and the fever lasts for a week (or less), we call this a “fever without a source.”

When the fever remains at 101ºF or above for 8+ days and still doesn’t have a clear source, it’s called a “fever of unknown origin.”

These types of fevers are more worrisome than fevers with a known source and require further investigation.

Why? Because doctors like to know what’s causing a fever. If there’s no clear-cut reason for the fever, doctors worry that a bacterial infection is hiding somewhere in the body. To find the source of the fever, the doctor may order one or more of the following: a chest X-ray to look for pneumonia, bloodwork to identify a bacterial infection, and a urine test to see if there’s a urinary tract infection.

The Bottom Line

Infections, especially viral infections, are common in kids and help build up their immunity. Over time, you’ll become a pro at managing run-of-the-mill ailments like stomach viruses and the common cold. Practice good handwashing and don’t be afraid to call the doctor if you have any concerns.

Celebrities Are Just Like Us!

“Being a father is the single
greatest feeling on earth.
Not including those wonderful years
I spent without a child, of course.”

~Ryan Reynolds

The Reminders for This Week are Essentially the Same as Last Week’s (Except for the New Fever Parameters).

Call the Doctor If Your Baby Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).

Don’t Give Ibuprofen to Babies Under 6 Months of Age. Aspirin Is Off Limits For Kids Under 18 Years (Unless It’s Prescribed by the Child’s Doctor).

Make Sure to Keep Your Final Postpartum OB/GYN Appointment. This visit usually occurs within 12 weeks after delivery (and you’re at 12 weeks now – hooray!)

Remember to Give Your Baby a Daily Vitamin D Supplement (That Contains 400 International Units Per Day) If You’re (Exclusively) Breastfeeding OR If They’re Taking Less than 32 Ounces of Formula Per Day. Get Wise (Again) about the importance of vitamin D supplementation.

For Formula-Feeding Parents: Make sure you’re mixing the formula correctly and that it has iron in it (which it probably does). Get Wise about How to Mix Formula.

Put Your Baby on Their Back to Sleep, With No Pillows, Blankets, Bumpers, or Stuffed Animals in the Crib.

Avoid Giving Honey to Babies Under 1 Year.

Why? Because of the concern for infant botulism. Get Wise about it here.

Don’t Give Water to Babies Under 6 Months of Age (Except For What’s in the Formula, If Your Baby is Taking Formula).

Why? Because extra water can lead to electrolyte abnormalities (such as low sodium levels), which can, in turn, lead to seizures.

Do Tummy Time at Least Twice a Day For a Few Minutes Each Day to Help Strengthen Your Baby’s Neck Muscles and Improve Their Head Control.

And…That’s a Wrap!

Welcome to Week 11 of Parenting Your Baby!

In This Week’s PediaGuide, We’ll Discuss:

Sleep & Feeding.
The Hot Topic for the Week: The Top 10 Illnesses Seen in Babies & Young Children.
Plus, a Few Friendly Reminders.

Get Wise About It All Below…

Practice helps with parenting, and you’ve had a ton of it thus far (full-immersion style). At this point, you’re probably a pro at changing diapers, dodging flying spit-up, and falling asleep at the drop of a hat. Just keep doing what you’re doing and continue to put one foot in front of the other.

Sleep & Feeding are on Repeat:

Sleep: Your baby sleeps a total of 14-17 hours per day (including naps).
Feeding: The menu is still limited to breast milk and/or formula.

As a Reminder, the Hot Topic for This Week Is: The Top 10 Illnesses Seen in Babies & Young Children. Get Wise(r) About Them Below.

The Top 10 Illnesses Seen in Babies & Young Children:

There are several illnesses that pediatricians see frequently in infants and toddlers (especially in those who attend daycare). Check out the Top 10 below (click on the hyperlinks for more info):

1. The Common Cold: The common cold is a viral infection characterized by a runny nose. The runny nose may be preceded by a fever and/or a sore throat. Colds can occur at any time of year but are most prevalent in the fall and winter. Although they typically resolve without intervention, colds can lead to a few sleepless nights or, less commonly, to breathing issues in babies. Get Wise(r) about the Common Cold here.

2. Pink Eye: Pink eye is a relatively benign, but not-so-attractive, infection that can be caused by either bacteria or a virus. Pink eye is highly contagious and can spread to adults. Showing up to work with pink eye is basically a parenting rite of passage.

3. Croup: Croup is a respiratory illness. The classic croup symptom is a “barking” cough that makes babies sound like a dog (or a seal).

4. Bronchiolitis: Bronchiolitis is an infection of the small airways of the lower lungs. Although it’s often due to RSV (the Respiratory Syncytial Virus), it can be caused by other viruses as well.

5. The Flu (Influenza) & COVID-19:

The flu is a respiratory illness characterized by a fever, chills, nasal congestion, and a cough. It’s primarily caused by the Influenza A & Influenza B viruses. Babies 6 months and older are eligible for the flu shot.
COVID-19, on the other hand, is caused by the SARS-CoV-2 virus which has mutated many times since the pandemic. Like the flu, COVID-19 can cause a fever, a runny nose, and a cough. It’s also been known to cause vomiting, diarrhea, a sore throat and a new loss of taste or smell. Babies as young as 6 months can get the COVID-19 vaccine.

Insider Info: Because the flu and COVID-19 can mimic one another, doctors will often test for both in the office.

6. “Middle” Ear Infections (aka Acute Otitis Media): A middle-ear infection is an infection of the space behind the eardrum. Ear infections can be caused by either bacteria or a virus.

Insider Info: Swimmer’s ear is another type of ear infection commonly seen in kids, especially in toddlers and school-aged children who’ve been logging a bunch of hours at the pool. Swimmer’s ear is an “outer-ear infection” in which the skin lining the ear canal gets infected.

7. Hand, Foot, and Mouth Disease: Hand, Foot, and Mouth Disease is a viral illness in which babies develop a telltale rash that covers the palms of their hands and the soles of their feet. They even get lesions in their mouths.

Reality Check: Hand, foot, and mouth disease often looks worse than it is.

8. Gastroenteritis (a Stomach Virus): Children with gastroenteritis have “it” coming out both ends (think: vomit out of the mouth and diarrhea out of the bum).

A Word About Diarrhea: Rotavirus is the No. 1 cause of diarrhea in babies 0-11 months.¹Luckily, there are 2 oral vaccines (RotaTeq and Rotarix) that protect against it. Norovirus is another frequent cause of acute diarrhea in kids. A vaccine against Norovirus hasn’t been developed yet.

9. Fifth Disease: Fifth Disease, also known as “slapped cheek disease,” is a viral illness that causes a child’s cheeks to look bright red (as if they’ve been slapped across the face).

10. Impetigo: Impetigo is a bacterial rash that causes blisters. These blisters ooze and crust over, forming “honey-colored” lesions on the skin.

Honorable Mentions: Lice, Scabies, Ringworm, and Pinworms.

Lice. Itchy scalp, anyone?

Scabies are tiny mites that burrow into the skin and cause an itchy rash.

Ringworm is a skin infection caused by a fungus. It can affect the body or the scalp.

Pinworms are tiny parasites. Pinworm larvae can get into a child’s mouth when they suck on their fingers (e.g. after playing in a sandbox). The eggs travel down the child’s digestive tract and hatch in their intestine (where they mature). At night, the adult female pinworms lay their eggs around the child’s anus (that was not a typo), causing an itchy bum.

The Bottom Line

The illnesses mentioned above are frequently seen in the pediatric world. Thankfully, they don’t usually cause major or long-term problems in babies and toddlers. They may, however, warrant a call to the doctor and need to be taken seriously if they lead to issues like trouble breathing or dehydration.

Stay Tuned…In Next Week’s PediaGuide (the Week 12 PediaGuide), We’ll Discuss the Top 8 Questions That Parents Have About Infections.

“People who say they sleep like a baby
usually don’t have one.”

~Leo J. Burke

Sneak Peek: In a week or so, your pediatrician will start to chill out a bit if your baby gets a fever. Doctors still take fevers seriously in infants over 3 months, but they don’t pull the trigger on sending babies to the ER as quickly and they often let the fever get a bit higher (to 102.2°F) before they get their panties in a bunch.

The Reminders for This Week are the Same as Last Week’s.

Make Sure to Keep Your Final Postpartum OB/GYN Appointment (Which Usually Takes Place No More Than 12 Weeks After the Delivery).

Remember to Give Your Baby a Daily Vitamin D Supplement (That Contains 400 International Units Per Day) If You’re (Exclusively) Breastfeeding OR If They’re Taking Less than 32 Ounces of Formula Per Day. Get Wise (Again) about the importance of vitamin D supplementation.

For Formula-Feeding Parents: Make sure you’re mixing the formula correctly and that it has iron in it (which it probably does). Get Wise about How to Mix Formula.

Put Your Baby on Their Back to Sleep, With No Pillows, Blankets, Bumpers, or Stuffed Animals in the Crib.

Avoid Giving Honey to Babies Under 1 Year.

Why? Because of the concern for infant botulism. Get Wise about it here.

Don’t Give Water to Babies Under 6 Months of Age (Except For What’s in the Formula, If Your Baby is Taking Formula).

Why? Because extra water can lead to electrolyte abnormalities (such as low sodium levels), which can, in turn, lead to seizures.

Call the Doctor and Be Prepared to Take Your Baby to the ER If They Spike a Fever (a Temperature of 100.4°F or Higher Taken Rectally). Do Not Give Tylenol Beforehand (Unless the Doctor Says It’s Ok). Get Wise (Again) about Fevers in Babies Under 3 Months.

Don’t Give Ibuprofen to Babies Under 6 Months of Age. Aspirin Is Off Limits For Kids Under 18 Years (Unless It’s Prescribed by the Child’s Doctor).

Do Tummy Time at Least Twice a Day For a Few Minutes Each Day to Help Strengthen Your Baby’s Neck Muscles and Improve Their Head Control.

And…That’s a Wrap!

Welcome to Week 8 of Parenting Your Baby!

In This Week’s PediaGuide, We’ll Discuss:

Sleep & Development.

The Hot Topics for the Week, Including:
- What Goes Down at the 2-Month Visit.
- Growth Charts & How to Read Them.

Plus, a Few Friendly Reminders.

Get Wise About It All Below…

The 2-month appointment is upon us. It’s been a month since the last checkup and you probably have a bunch of questions for your baby’s doctor. No question is too silly. One of the questions that many parents ask in preparation for the 2-month vaccines is whether to give Tylenol before the visit or immediately after it to minimize the discomfort. You can run this by your baby’s doctor, but, as mentioned in last week’s PediaGuide, pediatricians typically discourage this practice for 2 reasons:

1. It’s thought that fever reducers blunt the immune response to the vaccines, making them less effective.

2. You don’t want to “mask” a fever. If the 2-month vaccines trigger a fever in your baby, the doctor will want to know that your little one is prone to this side effect.

If your baby becomes febrile later in the day and the fever is thought to be due to the vaccines, their pediatrician will probably recommend that you give your baby Tylenol, at this time.

Reality Check: Remember, a fever isn’t a bad thing in and of itself. It’s just a symptom (and a clue) that something is going on in the body (whether it’s a vaccine reaction, inflammation, or an infection).

Sleep:

Your baby is probably sleeping 14-17 hours per day (including 2-3 naps).

Development:

A 2-month-old’s main party trick is the social smile. A social smile is a “reciprocal” smile, meaning that your baby smiles in response to your smile (or to someone else’s smile). At the 2-month mark, most parents feel pretty ragged and worn down. Getting positive feedback in the form of a social smile can be the fuel that keeps them going. That, and caffeine.

In addition to smiling, your baby may be stepping up their game in the language department by adding cooing to their verbal repertoire. Cooing is a happy noise made up of vowel sounds (think: “aaaaaaa” and “ooooooo”). It sounds like the soft sound that a dove or a pigeon makes.

As a Reminder, the Hot Topics for This Week Are:

What Goes Down at the 2-Month Visit.
Growth Charts & How to Read Them.

Get Wise(r) About These Topics Below…

An Overview of the 2-Month Visit

The 2-month checkup is nearly identical to the 1-month checkup except for the addition of the 2-month vaccines. Here’s a summary of what goes down during the 2-month visit:

1. The Following Measurements Will Be Taken and Plotted on Your Child’s Growth Chart:

Weight
Length
Head Circumference (the distance around your baby’s head at its widest point).

Note: We’ll talk about growth charts and how to read them, below.

2. In Addition, the Standard Vital Signs Will Be Obtained:

Temperature (taken rectally).
Heart Rate (the number of times your baby’s heart beats in a minute).
Respiratory Rate (the number of breaths your baby takes in a minute).

Insider Info: Babies who were born prematurely and those with kidney problems, heart issues, and other chronic medical conditions will typically have their blood pressure measured at each visit too, starting at birth. The average child, however, won’t have their blood pressure taken until 3 years of age.

3. Questions Will Be Asked.

For example, the doctor will ask you questions about your baby’s feeding habits, sleep patterns, and developmental milestones. The doc will also ask you about any out-of-the-ordinary symptoms that you may have noticed.

4. A Head-to-Toe Physical Exam Will Be Performed.

The exam will be similar to the newborn exam that was done in the hospital (and all of the exams that have followed it).

Get Wise (Again) about what doctors look for during the routine physical exam for babies.

5. You’ll Get to Turn the Tables and Ask Your Own Questions.

6. Vaccines Will Be Given at the End of the Visit (Typically by a Nurse).

Get Wise (Again) about the 2-month vaccines.

The Bottom Line: There’s a lot to cover during the 2-month visit, so it may feel like a bit of a whirlwind. Take notes during the appointment or follow up with the doctor if you feel like you missed something or if you didn’t get all of your questions answered. Doctors are available to varying degrees when it comes to follow-up questions. If you feel like a problem wasn’t adequately addressed, schedule a separate visit to delve into it in more detail.

A Word About Growth Charts and How to Read Them

Your child’s length, weight, and head circumference will be measured at every pediatric checkup until they’re 2 years old. At 2 years of age, your child’s BMI (body mass index) will be measured, instead of their head circumference. BMI estimates a person’s body fat in terms of their height and weight. This measurement helps determine whether a child is underweight, at a healthy weight, or overweight for their age.

Insider Info: BMI is a somewhat controversial measurement in medicine (and amongst body positive activists) because studies have shown that it’s not a great indicator of health.¹ Get Wise(r) about BMI and how it’s measured here.

The measurements obtained at each visit are plotted on your child’s growth chart. The growth chart gives the pediatrician a sense of how your little one is growing compared to other children their age and gender.

FYI: If your baby was born prematurely, they’ll be plotted on the premature baby growth chart (aka the Fenton Growth Chart) until they reach 2 years of age.

Common Question: How Do Doctor’s Interpret Growth Charts?

The pediatrician may throw a bunch of percentiles at you when discussing your baby’s growth chart.

But What Do They Mean? The percentiles make a comparison between your child’s growth and that of other children who are the SAME age and gender.

For example, let’s say a 2-month-old boy is at the 75^th percentile for weight on the growth chart. This means that he weighs more than 75% of all male 2-month-olds in the U.S. (with the same birthday), and less than the other 25%.

PediaTip: Try not to compare your baby’s growth with that of other children. Instead, focus on whether your child is following their own curve. If so, then their rate of growth is on track.

Insider Info: It can take a little while for babies to find their “true” growth curve. This means that a baby may start out “big” but end up at a lower percentile because of genetics (i.e. because they have average-sized parents). For this reason, doctors take the size of the parents into account when evaluating growth charts.

The Bottom Line

The 2-month checkup is a big milestone. The 4-month- and 6-month-visits will be similar, except for some minor variations in the vaccines given.

Celebrities Are Just Like Us!

“I don’t know what’s more exhausting
about parenting: the getting up early,
or acting like you know what you’re doing.”

~Jim Gaffigan

Sneak Peak: Once your baby gets the 2-month visit under their belt, they won’t have another checkup until 4 months of age. This might sound like a LOOONG time since you’re used to seeing the pediatrician more regularly. But don’t worry – the pediatrician is only a phone call away. In the meantime, you’ll be doing more of the same: trying to sneak in a few zzzzs, feeding your baby like crazy, and watching them turn up the volume on their development.

The Reminders for This Week are the Same as Last Week’s (Except for the First One).

Ask the Pediatrician What the Plan is if Your Baby Spikes a Fever After the 2-Month Vaccines. As mentioned in last week’s PediaGuide, a fever in a 2-month-old baby puts pediatricians between a rock and a hard place.

Why’s That Again? Because they don’t know whether to chalk it up to the vaccines (which they usually do) or investigate further.

Some doctors provide a protocol to follow at home if a baby mounts a fever after receiving their vaccines. Ask your baby’s doctor what their protocol is.

Don’t Give Ibuprofen to Babies Under 6 Months of Age. Aspirin Is Off Limits For Kids Under 18 Years (Unless It’s Prescribed by the Child’s Doctor).

Make Sure to Keep Your Final Postpartum OB/GYN Appointment (Which Usually Takes Place No More Than 12 Weeks After the Delivery).

Remember to Give Your Baby a Daily Vitamin D Supplement (That Contains 400 International Units Per Day) If You’re (Exclusively) Breastfeeding OR If They’re Taking Less than 32 Ounces of Formula Per Day. Get Wise (Again) about the importance of vitamin D supplementation.

For Formula-Feeding Parents: Make sure you’re mixing the formula correctly and that it has iron in it (which it probably does). Get Wise about How to Mix Formula.

Put Your Baby on Their Back to Sleep, With No Pillows, Blankets, Bumpers, or Stuffed Animals in the Crib.

Avoid Giving Honey to Babies Under 1 Year.

Why? Because of the concern for infant botulism. Get Wise about it here.

Don’t Give Water to Babies Under 6 Months of Age (Except For What’s in the Formula, If Your Baby is Taking Formula).

Why? Because extra water can lead to electrolyte abnormalities (such as low sodium levels), which can, in turn, lead to seizures.

Do Tummy Time at Least Twice a Day For a Few Minutes Each Day to Help Strengthen Your Baby’s Neck Muscles and Improve Their Head Control.

And…That’s a Wrap!