Your Baby’s Health

For the first few months you will need to observe your baby closely – and not just to get a glimpse of her cute smile or to hear her gurgle. You’ll need to learn how to tell what’s normal from what could be a possible symptom of illness. Temperature, feeding, bowel movements, sleeping patterns, physical behaviour and audible expressions are all important indicators of how well or unwell she is.

Through breastfeeding, natural development and vaccination, your baby’s immune system will be developing defences against most viruses, but a mild illness or two is likely at some point in the first year. There’s plenty a parent can do to reduce the risks by recognising illness early. If you’re worried, contact the 24-hour helpline Healthdirect Australia, or your doctor or the nearest hospital straightaway.

COMMON ILLNESS

A Cold

The symptoms to look out for when it comes to a cold is if your baby looks miserable or sounds ’wet’. Mucus running down the back of her throat will make her cough and sometimes her breathing will be noisy with a blocked nose.

From the age of one month, you can give a baby a dose of infant paracetamol to help alleviate the discomfort if she has trouble breathing, eating or sleeping. Check with your doctor before giving her any other medications.

Noisy breathing and a blocked nose can persist for a long time, often six to eight weeks after the cold has gone, as babies take longer than adults to clear mucus. See your doctor if your baby loses interest in food, develops a persistent fever, becomes limp, has difficulty breathing or has blue lips.

A Cough When coughing is associated with wheezing, a high fever, breathlessness or sleepless nights you need to see your doctor. Always seek medical advice before giving a cough suppressant to a baby or young child.

Croup Her cough will sound like a seal bark accompanied by a crowing noise as she breathes in because croup causes a narrowing of the windpipe. More common in toddlers than babies, it’s caused by a viral infection in the upper respiratory tract. If your baby has difficulty breathing, go to your doctor or the emergency department of your local hospital.

Diarrhoea

Viral infections like gastroenteritis are a common cause of diarrhoea. This is evidenced by loose, watery bowel motions that are often mucousy, smelly and an unusual colour. Don’t confuse these with the normal loose green/yellow stools young breastfed babies pass.

The recommended treatment is oral rehydration fluid such as Gastrolyte or fluids that contain sugar and salt, such as (non-diet) fruit cordials diluted to a ratio of one part cordial to 20 parts water. Give these frequently in small amounts for 24 hours. If you’re breastfeeding, this is not necessary; instead, offer your baby extra feeds.

Most children respond best if their normal diet is reintroduced early on during the course of gastroenteritis, although they may vomit after eating or have further bouts of diarrhoea.

While it’s unusual for exclusively breastfed babies to get gastroenteritis in their first three months, rotavirus is the most common cause and can be prevented with an oral immunisation (ask your doctor). Most babies respond to these measures but, if not, take your baby to the hospital.

For most cases of infectious diarrhoea, medication isn’t part of the treatment, with antibiotics used only occasionally. The medications to stop adult vomiting or diarrhoea are dangerous for babies, and must not be given to them.

Ear infections

The middle ear is the usual site of ear problems in older babies and toddlers, as their Eustachian tube, which connects the middle ear to the throat, is narrow and gets blocked easily.

Viral infections can cause the throat’s lining to swell, blocking the tube and preventing drainage from the middle ear. This in turn allows a secondary infection to grow behind the eardrum.

Infected mucus can lead to a painful acute ear infection, which may change your baby’s behaviour. She may have screaming attacks, be unsettled or develop a sleep problem. If these occur have her ears checked. Pain relief may be given to your child, but antibiotics aren’t always necessary.

Glue ear – a more chronic collection of mucus in the middle ear – is another cause of infection. It can lead to earaches, especially at night, which means disrupted sleep patterns. Treatment ranges from observation to the insertion of plastic tubes, depending on the frequency, discomfort and extent of hearing loss.

Eczema – This is a dry skin condition affecting babies to varying degrees and doesn’t appear until after three months, so don’t confuse it with the normal newborn flaky skin.

Most children outgrow eczema (atopic dermatitis) before they turn five, and it’s most likely to occur in those who have asthma or hay fever in their families, though about one in five infant sufferers has no such genetic circumstances.

Treatment involves the use of moisturiser, cortisone cream, unperfumed sorbolene, 50% liquid paraffin, 50% soft white paraffin formulations such as Dermeze, and Pain d’Alep soap. For more severe eczema, consult a skin specialist.

Nappy rash

Ammonia dermatitis – commonly called nappy rash – will appear
as small red dots on your baby’s bottom, with an inflamed area of broken skin or even pus-filled spots in more serious cases.

Breastfed babies are less prone to nappy rash, which can occur if a baby is left in a wet or dirty nappy for too long. But some babies will suffer regardless of frequent changes. The bacteria from your baby’s stools breaks down the urine to ammonia, which irritates and burns the skin. Loose bowel motions, which often occur when your baby is ill, can have this effect after just one nappy. The following treatments may help.

● Start using nappy rash cream at the first sign of broken skin.

● Don’t use plastic pants, as they prevent the evaporation of urine. Use one-way fabric training pants or acrylic nappy covers instead.

● Be aware of nappy preparations that aggravate the condition.

● After your baby’s had nappy rash, it’s important to allow her skin to be aired between changes for up to 20 minutes.

● In severe or persistent cases, seek your doctor’s advice.

Oral thrush

This infection is very common in babies. It can be acquired if mum had vaginal thrush during labour, if baby or her breastfeeding mum is on antibiotics, or from objects coming into contact with baby’s mouth.

Oral thrush looks like milky transparent bubbles, mostly inside the cheeks and on the inside of the lips. A white tongue can be a sign of thrush, although this is also seen in young babies without the infection. Mild thrush in the mouth of a healthy baby usually doesn’t cause discomfort.

Anti-fungal gels are sold at chemists (use it on your nipples, too). You will also need to boil any feeding equipment, as the fungus that causes thrush can still survive in sterilising solutions.

Fevers

Babies and toddlers are more prone to fevers than older children and adults. It’s an in-built warning that indicates a cold, gastroenteritis or an infectious disease – though they won’t always show feverish symptoms with these illnesses.

Your baby has a fever when her temperature rises above 37ºC on a thermometer placed under her arm, or above 37.8ºC on an infrared ear thermometer. A good test is to place the back of your hand on your baby’s tummy to feel whether she is warm, hot or burning. Teething can often make babies feel warm, but doesn’t cause a fever.

To treat a fever, undress your baby down to her singlet and nappy, and keep her under a light sheet in a cool room. If she’s still hot after 30 minutes, sponge her with tepid (not cold) water, then pat her dry. Don’t let her shiver, as this will raise her body temperature. If you feel uneasy about the cause of the fever, or your baby is under three months old, take her to a doctor.

INFECTIOUS DISEASES

Infectious diseases aren’t common in a baby’s first year, but they do happen. Listed ahead are the more common infectious diseases and the symptoms which may appear.

Chickenpox

A mild fever and fussy behaviour over a day or two can be signs your baby has this illness. A rash begins as small, raised pink spots that turn into blisters and then form crusts.

Treatment for chickenpox includes adding an anti-itch solution, such as Pinetarsol, to her lukewarm bath water, and giving her infant paracetamol to relieve the fever. There is a vaccination available for this infection and it’s recommended at 18 months of age; it is more effective in children aged over 12 months.

The incubation period is 14 to 16 days, so there can be a large gap between other family members being infected. If a pregnant woman comes into contact with chickenpox she needs to consult her doctor to check that she has immunity.

Measles

The incubation period for measles is seven to 18 days. It first appears as a cold, and your baby will be miserable with a runny nose, watery eyes, a cough and fever. Two days later spots will appear on her neck, behind her ears and on her face, and within hours her body will be covered – the rash often joins and becomes one red mass or lots of blotches.

Give infant paracetamol to ease discomfort, and encourage extra fluids. Babies can be vaccinated at 12 months, but a small number of babies catch measles before they’re immunised. If this happens it will not be necessary for the child to be immunised at 12 months since the disease provides immunity for several years if not for life.

Measles can be severe, though it’s rare due to high rates of vaccination. If you suspect your baby has measles it’s vital she is seen by a GP.

Mumps

This infection is not common among babies, since it mainly affects children between the ages of five and 15. Mumps causes swollen and painful glands just below and in front of one or both ears. It usually lasts up to seven days, and the child can become feverish and lose her appetite.

Mumps is treated with rest, a diet of soft, easy-to-chew food and plenty of fluids. Your baby’s immunisation program includes an MMR (mumps, measles and rubella) vaccine at 12 months.

Rubella

It’s often hard to diagnose rubella (German measles) in babies and it is frequently confused with measles, roseola, an allergy or a viral rash. Rubella has an incubation period of two to three weeks, and the most reliable sign is swollen glands at the back of the neck and behind the ears.

Your baby may have cold-like symptoms and a rash will rapidly spread over her arms and body. It appears as small, pink dots, and is unlike the measles rash, which is red and blotchy. It only lasts three days with immunisation included in the MMR jab. If you are pregnant and concerned that you may have been around a child with rubella, consult your doctor.

Roseola

This acute viral disease is most often seen in babies between six and 36 months. The incubation period of roseola is five to 15 days. While your baby may have a high fever for several days, there are often no other obvious signs of illness, except perhaps slightly swollen glands at the back of her head or neck. After a few days the fever will come down and your baby will break out in a fine, pink, slightly blotchy rash on her trunk, which usually fades soon after.

Whooping cough

Small babies who catch whooping cough (pertussis) are at great risk and need hospital care for constant monitoring. In Australia there has been a prolonged epidemic of whooping cough since 2008, with 1621 reported cases in the first quarter of 2013.

Symptoms take seven to 20 days to appear and start with a runny nose that progresses to a dry cough then bouts of coughing, vomiting, difficulty breathing and ’blue’ attacks (darkening of the skin and lips). Your baby will not always exhibit the classic ’whoop’ sound. Mild cases last six weeks, but severe cases may last for months and cause permanent lung or brain damage.

The whooping cough vaccine protects around 85% of children. If she acquires the illness despite being vaccinated, it is usually milder and less likely to cause complications. It is recommended that parents, carers and anyone who comes into contact with babies under six months old be immunised, too.

OTHER HEALTH ISSUES

Constipation

Exclusively breastfed babies are rarely constipated, but between the ages of six weeks and three months they open their bowels less regularly, sometimes as little as twice a week. Worried mothers often mistakenly believe their child is suffering constipation, which refers to motions that are hard, dry and difficult to pass – not to the frequency of bowel motions.

When your baby begins to breastfeed less and starts on solids from six months, her motions may change and she may get constipated. If this happens, make sure her food is being prepared correctly. If your baby is still constipated, try offering more water, give her a gentle tummy massage or a warm bath to relax the muscles. If the constipation persists, speak to your doctor.

Vomiting

It’s normal for healthy babies to regurgitate a little bit of food, but if vomiting is accompanied by a green hue to the skin, weight loss, fever, screaming, a change in bowel motions or loss of interest in feeding, then see your doctor.

Babies who are suffering from gastro-oesophageal reflux can vomit frequently in the first year of life. If your baby is growing well, doesn’t cough or wheeze, and doesn’t seem to have pain, she may not need treatment, and the problem will usually settle as she spends more time upright and begins to eat solids. If you’re concerned, talk to your health nurse or doctor.

If a well baby is gaining weight, producing plenty of wet and soiled nappies, and is reasonably settled, occasional small amounts of vomit are nothing to worry about.

Poisoning

It’s highly unlikely, but if your baby swallows, inhales or gets a poisonous substance in her eye, call an ambulance and the Poisons Information Centre (see page 82) immediately. For stings and bites try, if possible, to identify the culprit or make a note of its description. The website of your state’s Poisons Information Centre will also carry advice on prevention and first aid.

Immunisation

By vaccinating your child you’re protecting her against harmful diseases that can cause serious health complications, even death.

Australia’s childhood immunisation rate is now the highest in the world: by the age of two, around 93% have received the vaccines as set down by the Australian Immunisation Schedule.

It’s important to keep the immunisation rate – known as herd immunity – high, around 95% for most diseases, to prevent the diseases from getting a foothold and spreading throughout the wider community.

Most babies go to a doctor for vaccinations, but they can also be vaccinated at hospitals, local council health centres or other local authority facilities.

Bear in mind that immunisation does not develop immediately: babies are not protected until a few weeks have passed. For some vaccines, protection doesn’t start until two or more doses are administered, and the child must have been given all the recommended doses to be protected against the illness.

Premature babies are especially in need of immunisation – start vaccinating two months after birth and follow the normal schedule.

For mothers of children with an approved medical exemption from having vaccinations, welfare payments and allowances are still available provided parents fill out the relevant Medicare form and submit a doctor’s letter validating the reasons they are being refused.

Possible side effects

While no vaccine is completely free of side effects, any symptoms that appear are normally much less severe than having the disease itself. If you’re concerned, it’s important you discuss the options with your doctor.

A reaction to vaccinations is serious if your baby’s temperature goes above 40ºC, if she has convulsions within 72 hours, screams for more than three hours or suffers shock.

MMR

A combined measles, mumps and rubella (MMR) vaccination is given at 12 months. About 5% of babies develop very mild measles symptoms such as a rash, fever and runny nose six to 10 days after the injection. These symptoms are not infectious and will clear up in a few days. It’s important to note that research shows the MMR vaccination is not associated with any increase in the incidences of autism.

Polio

The injection is safe for most of the community. If there’s a history of problems with immunity in your baby or in the family, discuss your concerns with your doctor. However, all polio vaccines are ’inactivated’ now.

Whooping cough

The DTPa (diphtheria-tetanus-whooping cough) vaccine is used in all whooping cough vaccinations for children. Acellular pertussis was introduced for all doses in 1999 as it causes less side effects than the previous whooping cough vaccine (whole-cell pertussis).

It’s not recommended that your baby has a dose of infant paracetamol prior to vaccination as research has shown it may reduce the effectiveness of the vaccine.

After the injection, if your little one screams a lot, seems overly drowsy, develops a high temperature or has a lot of swelling and redness at the injection site, contact your doctor immediately.

Special precautions

Avoid vaccinating your child if she:

● is suffering from a fever or has an illness that is acute or is related to the nervous system

● is receiving cancer treatment

● has worsening convulsions

● has an immune system that
is damaged

● takes cortisone by mouth or has had a dose recently.

If you’re worried about a risk to your child’s health when her vaccination is due, discuss any concerns you have with your doctor.

What’s the best way to treat gastroenteritis?

Don’t follow the old wives’ tale about giving sick children flat lemonade – it offers no healing properties to babies with gastroenteritis.

Instead, breastfeed with greater frequency – other fluids for babies under six months aren’t needed unless your doctor advises it. Over six months, they can also be given water to keep their up fluids.

Commercial preparations such as Gastrolyte, Pedialyte, Hydralyte and Repalyte may be prescribed; see your GP first.

Medicare Safety Net

Remember to register your family for the Medicare Safety Net, which covers you for the ongoing healthcare costs for your family. This benefit is particularly useful during the years when your child or other family members need multiple medical tests, treatment or medicines (covered by the Pharmaceutical Benefits Scheme Safety Net, part of the Medicare Safety Net).

Once your costs for certain items go beyond a set threshold, which is revised annually and according to your family circumstances, then you can apply to receive a rebate.

Can I use natural remedies on my baby?

If you want to try alternative therapies with your baby, ensure your doctor is kept informed, as there may be conflicting or adverse implications. Always seek your doctor’s advice before using natural remedies for babies under six months of age, and only ever use them to treat mild to moderate symptoms. Remember, natural therapies are not always safe therapies, especially for children.

Keeping track

Children under seven who are enrolled in Medicare are automatically included in the Australian Childhood Immunisation Register. This means you’ll be sent reminders of when your child’s vaccinations are due. Ask at a Medicare branch to learn more.

Your baby’s immunisation schedule

The National Immunisation Program (NIP) outlines the recommended child vaccines. Variations may occur between states and territories and for some Aboriginal and Torres Strait Islander children.

Birth

● Hepatitis B (hepB) – as soon as possible (no later than seven days after birth), and again at two, four and six months.

Two months

● Diphtheria-tetanus-whooping cough (DTPa) – boosters at four and six months, and at four years.

● Haemophilus influenzae type b (Hib) – boosters at four, six and 12 months.

● Polio, inactivated poliomyelitis (IPV) – boosters at four and six months and four years.

● Pneumococcal conjugate (13vPCV) – boosters at four and six months.

● Rotavirus – boosters at four months and six months.

12 months

● Measles, mumps, rubella (MMR) – booster at four years*.

● Meningococcal C (MenCCV).

18 months

● Chickenpox varicella (VZV)*.

• From 1 July 2013, the combination vaccine Priorix-Tetra will be added to the National Immunisation Program to replace individual doses of the MMR and varicella vaccines. Children will also be protected against measles, mumps and rubella at 18 months, rather than four years under the existing schedule.

When to get help

Seek help or get a second opinion if you suspect your baby is ill and:

● is under three months old, is sick or was born prematurely

● has a high fever

● vomits repeatedly, or the vomit contains grey material or blood

● appears to have severe tummy pains

● has continual diarrhoea or her faeces contain blood

● becomes drowsy and has a dry mouth or dry nappies

● has a severe cough

● has difficulty breathing or her lips are bluish.