First time parents are often nervous about their baby. This information is intended to help alleviate your anxiety as well as to inform you about basic infant care.
Fever is the most common symptom of illness in children; usually an infection is the cause of fever. Fever is one of our natural defense mechanisms. An elevated temperature, for example, stops viruses from functioning properly and from reproducing. Rectal thermometers are easily used and should not be feared: lubricate the silver tip with Vaseline®, hold your child firmly on his/her stomach, insert the thermometer about one inch until the thermometer beeps. Axillary (under the arm) thermometers are also acceptable: place the tip of the thermometer in the center of the armpit and hold the arm at your baby's side until the thermometer beeps. A normal temperature is less than 99 degrees Fahrenheit. The degree of the fever does not necessarily correspond with the severity of the illness. Some children mount higher fevers than others, while some children are more severely ill with lower fevers. Seizures do sometimes occur with fever after 6 months of age, but they are uncommon and not associated with brain damage.
Fever in a newborn baby is a concern to us. If your baby is two months or younger, and has a rectal temperature above 100.4◦ F, call us immediately. Similarly, children who exhibit additional signs of illness should be examined: call us if your baby exhibits lethargy; irritability; unusual restlessness; repetitive vomiting; refusal to eat or drink; persistent cough, wheezing, or rapid breathing; tender, swollen glands and/or tender joint(s). Children with documented fever for four to five consecutive days (even if they seem otherwise well) should be seen by a doctor. Please contact the office if you have any questions regarding fever and other associated symptoms in your child. Do not panic if your child’s high temperature does not quickly return to normal. Your main goal with regard to the fever itself is to make your child comfortable. Often fever reduction will do just that, diminishing some of the effects of fever, such as inactivity, crankiness, and sometimes vomiting and headache.
Keep your feverish child lightly clothed. Encourage more liquids than usual. When your child is older than four months and uncomfortable with fever, you should try to reduce it with medicine as needed, every four hours. We recommend avoiding aspirin because of the small but reported associated risk of Reyes Syndrome. Acetaminophen (Tylenol®) can be given in doses according to your child's weight:
|Weight (lbs)||Milligrams (mg)||
|12–16||80||1 (0.8)||1/2 tsp.|
|17–23||120||1 1/2 (0.8 + 0.4)||3/4 tsp.|
|24–30||160||2 (0.8 + 0.8)||1 tsp.|
If your child is especially uncomfortable and the fever is not responding to acetaminophen, you may try sponging: wet your child's entire body with lukewarm water, including the head. As the water evaporates, rewet the skin and repeat for 15–30 minutes. If your baby protests by screaming or if shivering occurs, discontinue the sponging as your child is just generating more heat. Do not use alcohol on the skin to reduce fever.
Eruption of the first tooth occurs around four to six months of age, within a range of birth to 16 months. Teething may be accompanied by a number of signs and symptoms: drooling, decreased appetite, softer and sometimes more frequent stools, fever, runny or stuffy nose, diaper rash, crankiness, and night awakening. Teething alone will not cause a fever over 101 degrees Fahrenheit. Sometimes teeth eruption (especially the pre–molars) may be associated with blister formation on the adjacent gums. Rubbing your baby's gums with Orajel® or Anbesol® or cool compresses may help relieve the discomfort of teething. It is also a good idea to offer ibuprofen or acetaminophen and frequent cool liquids when your baby seems uncomfortable from teething. If none of these measures help, please call the office.
Congestion, Coughing & Wheezing
Remedies vary with the age group and the cause of these symptoms; however, a cool mist vaporizer (especially while sleeping) almost always makes one more comfortable. Sometimes over–the–counter cold and cough medicines can agitate children, making them hyperactive and/or restless. If the symptoms are very discomforting or persistent, or if your child is very young, please schedule an appointment.
Many babies spit up or regurgitate small amounts of their feeds. As long as they are well and gaining weight appropriately, this is of no concern—except, of course, for the mess! Vomiting is a common symptom of illness and may occur during any fever. Vomiting may also be associated with diarrhea. It may lead to dehydration and/or body salt (electrolyte) imbalance but certainly not immediately. Call our office immediately if you notice any of the following: frequent repeated vomiting, forceful or projectile vomiting, crying (with the legs pulled up) that cannot be soothed, blood in vomit, or any signs of dehydration (dry, cracked lips, sticky or tacky tongue, no wet diapers for 6–8 hours). Also notify us if you just feel uneasy about your child’s vomiting.
Choking and CPR
We recommend you take an infant–child CPR course so that you can receive proper training to handle potentially life–threatening problems such as choking. Find classes near you by contacting the hospital or the Red Cross.
Poisoning and Accidents
As babies develop they can quickly put themselves into jeopardy. They can open the door that can’t be opened, or climb the bookshelf that you thought couldn’t be climbed. Too often children prove that they can twist childproof tops off of medicine bottles. Accidents and accidental ingestions are a major cause of illness and even death during the toddler years, and throughout childhood and adolescence. Household cleaning agents and medications must be kept out of reach and locked up. Place electric socket covers around the house. Don't leave your child unattended in potentially dangerous situations: near boiling water, in the bathtub, near the street, in the pool, or while shopping. Finally, you must have your child in an appropriate car seat or seat belt. If we can help you with any safety precautions, please let us know. Always leave an emergency phone number for babysitters and relatives caring for your child.
Should your child swallow something that could be dangerous or poisonous, please call your local (county) poison control center immediately at 1–800–222–1222, and then notify us if any follow up is recommended.
All infants should be placed in a rear–facing car seat with a five–point restraint system. The car seat should be placed in the back seat. The middle seat is safest. Either an infant carrier and/or infant/toddler convertible seat may be used. Read the labels for weight recommendations. The car seat should remain rear facing until the child is at least one year old. After the car seat is changed to forward facing, look for a toddler seat with a five–point restraint system and tether strap that anchors the car seat to your car for improved safety.
Be sure your dashboard and back seat shelf are free of all objects that could fly off if you suddenly hit the brakes. Never leave your baby alone in a vehicle. Keep the vehicle at a comfortable temperature and well ventilated. On hot days, check the car seat surface before placing your baby in the seat. Cover a leather or plastic seat with a towel to avoid burning your baby. On cold days, bring an extra blanket to cover your baby.
If you are involved in any car accident at a speed of 25 MPH or greater, you must replace your child/infant car seat, even if it looks fine. Many seats have been found to have internal cracks that would decrease their safety after an accident.
Regular Visits to our Office
The American Academy of Pediatrics recommends a schedule of "well baby" visits that allow us to check on your baby's growth and development, speak with you about the care of your baby, and offer guidance as your baby grows. Immunizations against a wide variety of important childhood illnesses are also given at these well baby visits.
Your child should be seen for routine well baby visits (checkups) at one week of age, and at one, two, four, six, nine, and 12 months during the first year of life. We then see children for physical examinations at 15, 24 and 30 months. Thereafter, we recommend seeing your child for checkups yearly starting at the age of three. For specific reasons, we may want to check your child more frequently.
We understand that you will have many questions, especially in the beginning. Feel free to call us, and remember: relax and enjoy your baby!
This advice is not intended to replace good medical care. If you have a question about your baby or are concerned about your baby's health or welfare, please call our office, contact your physician, or go to your local emergency room.
Sharon E. Barnett, MD; Eric D. Berman, DO; David E. Chasen, MD;
Mary Elaine Holmes-Bricker, DO; Kathryn T. Lafferty, MD; Stephen A. Szawlewicz, MD; Kimberly Keane DeNick, MD;
Christina I. DiNicola, MD
Advocare The Farm Pediatrics
975 Tuckerton Road, Suite 100 Marlton, NJ 08053 — (856) 983-6190
1001 Laurel Oak Road, Suite B, Voorhees, NJ 08043 — (856) 782-7400