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By Claudia Kalb
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YOU'VE JUST BEEN HANDED your seven-pound bundle of joy and your first reaction is: Help! How do I keep from breaking it? Take heart. Babies may not bounce, but neither do they get a fatal infection if they suck a dirty thumb. Here are the top 10 conditions that parents of 0-to-3s should look out for:
1. It isn't called the common cold for nothing. In their first two years, most children will have eight to 10 colds, complete with ninny nose, sneezing, decreased appetite, cough and sore throat. Most toddler colds aren't serious. But in infants under 6 months, colds can develop into bronchiolitis (see worry No. 2), croup (a distinctive barky cough) or pneumonia. If the baby is irritable, feverish, coughing, breathing rapidly or uninterested in eating, her cold could be developing into something worse. Parents should call the pediatrician.
2. "All that wheezes is not asthma," says Dr. Joseph Zanga of the American Academy of Pediatrics. In infants, wheezing, accompanied by rapid breathing, is more often a symptom of bronchiolitis, a viral infection of the lungs' small breathing passages. Treatment includes saline drops in the nose and a nasal aspirator. Parents should keep the home free of cigarette smoke and use clean humidifiers (dry air aggravates nasal passages and sore throats). Severe cases, where babies turn blue around the lips and fingertips from lack of oxygen, may require hospitalization.
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3. Two thirds of all children will have at least one ear infection ("acute otitis media") by their second birthday. Most pediatricians prescribe antibiotics; left untreated, infections can lead to scarring and hearing loss. But recently, questions have been raised about whether antibiotics fight ear infections any better than the body's natural immune system does (page 44).
4. High temperatures make kids miserable and parents nervous. But fevers are the body's natural defense against infection, so some pediatricians let them run their course. Others prescribe acetaminophen. (Aspirin is out because of its link to Reye's syndrome--a rare but serious illness that can damage the brain and liver.) Because newborns' immature immune systems make them more susceptible to unusual infections, their fevers should be monitored closely: temperatures above 100.3 need immediate medical attention. "We hop on it very quickly," says Dr. Alan Woolf of Children's Hospital in Boston. In toddlers, fevers that reach 103 or linger for more than a day or two also concern does.
5. The most common cause of vomiting in young children is a stomach or intestinal infection. But vomiting can also he a symptom of a more serious illness like pneumonia, meningitis or appendicitis. Danger signs include severe abdominal pain, repeated vomiting that lasts more than 24 hours and blood or bile. Most vomiting will cease on its own, but doctors recommend extra fluids to prevent dehydration.
6. Symptoms of dehydration include a parched, dry mouth, less urination, irritability and listlessness. Children should be given small amounts of "rehydrating" liquids--electrolyte solutions that contain a balance of salt, sugar and minerals. Liquids should be administered slowly--first teaspoons, gradually tablespoons. Dehydration is dangerous because it can lead to kidney failure, shock and even death: severe cases may require hospitalization for intravenous rehydration.
7. Diarrhea generally goes away by its self within a few days. "Except for a somewhat sore bottom, the infant will be fine," says the AAP's Zanga. Sweet liquids like juices and Jell-O should be avoided: sugar aggravates diarrhea. Give small amounts of liquid to prevent dehydration. Diaper rash, usually caused by wet diapers that stay on too long, is easy to identify because of where it appears. Impetigo, a skin infection characterized by pimply, crusty, itchy sores, is common in 2- and 3-year-olds. Rashes and skin irritations are seldom dangerous unless accompanied by other symptoms, especially a high fever. "That's a child I want to see immediately," says Woolf, bemuse it can indicate a more serious bacterial infection.
9. When a baby or toddler falls from a height much greater than a bed, watch for repeated vomiting, clumsiness or dizziness. Any could indicate a brain injury and require immediate medical attention.
10. Parents often worry that their child is growing too fast or too slow or taking too long to walk or talk. But many delays simply reflect a child's unique developmental schedule. "There isn't a single age that a child has to develop a particular trait," says Dr. Ron Kleinman of Massachusetts General Hospital. "There's a range for all of us."
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