Baby's First Year: Ask the Pediatrician (cont.)

MEMBER QUESTION:
My 10-month-old has had a runny nose for going on three weeks now. She coughs some, which seems to be just from the gunk draining down her throat. I'm reluctant to medicate her for this, since she doesn't seem uncomfortable, but this has been going on for so long now ... Do colds last this long? If it's allergies, how do you test for that?

PANGBURN:
Most upper respiratory infections or colds will last seven to 10 days. The difficulty for parents, as well as pediatricians, is that young children get frequent colds and they may overlap. Children are also susceptible to allergies. Children also, like adults, get sinus infections. So seeing your own pediatrician and having your child examined can help sort out which of those might be the cause. Usually it doesn't require extensive allergy testing, especially in very young children, and most causes can be found by the pediatrician doing a thorough examination.

One of the problems only seen in small children is a foreign body in the nose, which happens more commonly than most of us parents would like to believe. So I suggest any child with a cold for more than two weeks make an appointment with your doctor and have it checked out.

MEMBER QUESTION:
My daughter is 3.5 months old and has very dry skin patches on her wrists, elbows, and knees and I'm not sure what to do about it. The doctor gave me a prescription for cortisone cream but I heard not to use it unless it gets really bad because they can build up a tolerance to it and then nothing helps, but isn't it better to nip it in the bud? Also I don't want to put the cortisone on her wrists because she rubs her eyes and puts her hands in her mouth all the time. I've tried bathing her less frequently and using Aveeno products and Lubriderm cream, but that is not working all that well. Could it be a reaction to the formula? I breastfeed, but she gets about 2 ounces of formula a day just before bedtime. Would cutting that out maybe help to clear it up?

PANGBURN:
It sounds as if your doctor has diagnosed your child with eczema. Eczema is usually an inherited skin condition that is related to allergies and asthma. There's no known cause of those conditions, other than our inheritance. But certainly allergies are known to make eczema worse.

Before changing your diet or the formula you supplement with, I would have further discussion with your pediatrician about your concerns for the prescribed steroids. If the creams are used sparingly over only the reddened areas that may appear itchy, and used for short periods of time, these medications are quite safe.

"Ask questions. There isn't any question you should hold back and worry about. If this is your first baby, you're not expected to be an expert. Don't hold back the worries."

MEMBER QUESTION:
With a fever, how do I know when to call the doctor? For a very young infant, at what temperature do I call?

PANGBURN:
This is one of the most common questions that pediatricians receive, often at 2 a.m., often from a very worried parent. Fever is a warning symptom that there is infection. Most infections in children, infants as well, are viruses that are not serious but rarely may be serious infections. A general rule about fever is that it is the body's response to infection. It implies a healthy immune response.

The definition of a fever is a rectal temperature greater than 100.5 degrees Fahrenheit. There are many types of thermometers available now, including ear thermometers, digital thermometers, and the newest called the temporal artery thermography thermometer, so you may want to talk to your doctor's office about what would be considered an abnormal temperature with the thermometer you use.

A few general rules:
  • If an infant is under 3 months of age with any fever, please call your doctor.
  • If your child is older than 3 months but the fever has lasted more than three days, call your doctor.
  • If your child appears sicker than you expect, regardless of the temperature.
  • An infant or toddler who has a fever of 103 degrees Fahrenheit but is acting normally and is playful and smiling is much less worrisome than the child whose temperature is 101 degrees Fahrenheit and has lost interest in playing or appears excessively sleepy or irritable.
  • When you call your pediatrician, it's very important to describe how your child is acting. That helps us figure out how ill the child may be.

MEMBER QUESTION:
How concerned should we be if our baby doesn't hit a developmental milestone according to the books? My husband is upset that she isn't rolling over yet. I say all babies are different and she's fine. She'll do it when she's ready. Who is right?

PANGBURN:
There are a couple of pieces of information missing from this question, such as how old your baby is. But let me assume that your baby is 4 months of age and is not rolling over yet. That would be quite common, well within the normal range of development. If your baby is 9 months of age and is not rolling over yet that is concerning. Most babies are rolling over in both directions by 6 months of age.

It's important to take a look at the whole baby and not look at one specific milestone. When we try to answer developmental questions or concerns we want to understand how the baby is doing in all areas, including how well they are feeding, how well they're waking, how alert they are, what sounds they're making, how they're using their hands, etc. Many times what you read puts the average age that a child reaches a milestone, and since not all babies are average, many will not have met the milestone by the average time but are still developing quite normally.

So I guess the big answer is, if you're worried ask your pediatrician, and perhaps have both mom and dad at the appointment to both ask questions. You're both probably right.

MODERATOR:
We are almost out of time. Dr. Pangburn, do you have any final words for us?

PANGBURN:
Yes: Ask questions. There isn't any question you should hold back and worry about. If this is your first baby, you're not expected to be an expert. Don't hold back the worries. Ask your questions. And most of all, keep your sense of humor.

MODERATOR:
Especially at 2 a.m. when they barf on you!

Unfortunately, we are out of time. Thanks for joining us, members, and thanks to David Pangburn, MD, for sharing his expertise and experience with us.



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