Baby

Whenever your child is ill, your observations of what’s going on are very important. When you are assessing your child’s illness, you’re really looking at two different things-signs and symptoms. These terms have specific meanings to your doctor.

A symptom is something a patient complains about. A sign is something the doctor [or you] can see, measure, hear, taste or smell. So, if your child complains of her ear hurting, that’s a symptom; if she’s pulling on her ear, that’s a sign.

Signs and symptoms are indications of illness, but they are not illnesses themselves. When your doctor treats your child, he or she may treat the signs and symptoms of the illness, the illness itself, or both. For example, aspirin or acetaminophen is frequently given to a child with a fever, either may reduce the fever, but neither affects the underlying illness causing the fever. However, an antibiotic given to your child when he has an ear infection, actually helps the body to fight off the infection and, so, is treating the illness. The earache [a symptom] and the fever [a sign] will go away because the infection [the illness] is being treated.

Most of the medicines you can buy in the drugstore without a prescription treat symptoms but doesn’t treat the illness itself. So the “cold” medicine you may buy for your child doesn’t make the cold go away any more quickly, but they may make your child feel a little better.

There’s an ongoing debate about treating signs and symptoms of common illnesses. Some doctors believe that unless the signs and symptoms are severe, you’re better off not treating them. Some of the symptoms of an illness may actually be beneficial and speed recovery. Every medicine has side effects, and sometimes these can be worse than the illness itself.

Your doctor’s well-baby examination consists of many different parts, each designed to help her find certain information. You may have to watch closely to see her do each part of the exam because she probably has developed her own tricks and techniques. Some doctors like to have the baby on the examination table; others prefer that the parents hold the baby. Sometimes the doctor will be talking to you while examining your baby.

Here are some of the major areas your doctor will consider and what she looks for in each category:

• General Appearance: cleanliness, nutrition, alertness
• Skin: color, rashes. Bruises, swelling, condition of hair and nails
• Head: Shape, softness of the anterior fontanel [soft spot]
• Eyes: redness, good movement, light reflexes [checked with an instrument called an ophthalmoscope, looking for problems with the retina]
• Ears: irritation or infection of the ear canals or ear drums
• Nose: congestion, discharge
• Mouth: gums, tongue, throat, tonsils
• Neck: swelling of the thyroid or lymph nodes, mobility
• Heart: rate and rhythm, murmurs
• Lungs: breathing rate, abnormal noises, air exchange
• Abdomen: bowel sounds [normal stomach gurglings], enlarged organs or tenderness
• Genitals: In girls-normal appearance of external genitals, redness. In boys-penis [if circumcised, check that it has healed well; if not, check that foreskin is normal], both testicles are in scrotum
• Arms and Legs: normal movement and color, absence of swelling and discoloration
• Pulses: equal femoral pulse [same on both sides]
• Neurologic: tone, muscle movement and coordination, strength

From your discussions with your doctor, you will know how she wants to deal with emergencies and after hour’s calls. Keep her guidelines in mind when you think about calling her. However, if you are very concerned about your child, then call. Most childhood illnesses can be handled over the phone, and the child won’t have to be seen by the doctor until morning.

Before you call your doctor, you need to gather some information and think about what information you want to get from the call. For example, if you feel your child is going to need some medicine, don’t wait to call until all the local drugstores are closed. In some communities, it’s next to impossible to get any medicines after the pharmacies are closed. It’s better to call your doctor earlier instead of later. Also, almost all illnesses seem to get worse as the night progresses, so if your child isn’t well at seven o’clock, there’s little chance that he’ll be a lot better by ten o’clock. If you are concerned, call at seven o’clock instead of ten o’clock. If you really want your child to be seen, tell the doctor right from the beginning. It’s helpful for her to know that. She will realize that all the reassurances she can give you over the phone won’t help if you really want to have your child examined. However, if you just want some advice over the phone, let her know that also. It will make her job easier.

Be sure your after hours call is really necessary. Think about what you would do if you didn’t have that information until morning. Would that delay change things? Remember that doctors have families and things they like to do besides practice medicine. Out of consideration for them and their families, all non-emergency calls should wait until office hours.

Once you have decided to make the call to your doctor, there’s some important information you should have on hand. By preparing for the call, it will be easier for you to let your doctor know exactly what’s going on. Here are some questions you should be ready to answer when you call:

What are the basic data on your child? Start with your child’s name, when he was last seen by a doctor, and who that was. This will help your doctor place your child. Tell her his age and weight, what medicines he’s taking, and what illnesses he’s had.

What’s wrong with your child? This may sound like a silly question to prepare for, but all too often a parent can’t answer it concisely. Think about your child’s problem and be prepared to describe exactly what’s going on. Things to think about include the following: What is your child eating [solids, liquids, nothing]? Is he urinating a normal amount? Is he having diarrhea? Is he acting normal? If not, what’s abnormal about his actions? Is he running a fever? If so. How high his temperature is and what method did you use to take it?

What’s happened or changed to make you decide to call the doctor now? This is an important question for you to think about. For example, your child’s temperature may have gone up a lot, or he may have suddenly begun to cry and pull at his ear, or he may just begin to vomit violently. Or perhaps you are just concerned and want some advice. If your questions can wait, your call can probably wait until morning.

What do you think is ailing your child? Often, parents know what’s wrong with their child. This is particularly true if their child has had many episodes of the same illness. For example, many parents know when their child is coming down with another ear infection. Or, if other members of the family have had a similar illness, there’s a good chance your child is getting the same thing. Let the doctor know what you think is going on.

Where do you want a prescription filled? You should decide which drugstore you want to use and make sure it’s opened and has a pharmacist on duty before you call. Have the phone number ready to give your doctor.

Doctors who take care of children expect interruptions and emergencies-they go with the age group. Most have no problems with appropriate phone calls at any hour. What irritate even the most caring physician are inappropriate calls and patients who abuse their services.

It’s often helpful to know your child’s temperature. It is sometimes an indicator of the seriousness if the illness, although this isn’t always true. A normal oral temperature is 98.6 degrees Fahrenheit. A rectal temperature is one degree higher; an axillary [armpit] is one degree lower. “Normal” means average-some people run a slightly higher or lower temperature, and that is “normal” for them. Temperature varies throughout the day; a person’s temperature is usually a little higher in the afternoon and evening.

The most accurate way to take the temperature of a young child is rectally. Any thermometer will do, although one designed for rectal use is shaped a little differently so it will go in more easily. If your child can’t keep a thermometer under her tongue and can’t keep her mouth closed for three minutes, it’s more accurate to use a rectal thermometer.

When you are taking your child’s temperature with a rectal thermometer, it’s easiest if you lay your child on her stomach. Shake down the thermometer to 96 degrees or lower and lubricate it with some petroleum jelly. After separating her buttocks with the thumb and first finger of one hand, gently insert the thermometer to a depth of about one inch. Then pinch closed her buttocks. Hold the thermometer in place for three minutes to be sure you get an accurate reading.

Taking the oral temperature of a young child may be difficult. After shaking down the thermometer, put it under her tongue. She should close her mouth around the thermometer and keep her mouth shut for three minutes. Be sure she hasn’t drunk anything cold within fifteen to thirty minutes before you take her temperature [if she has, the reading will be artificially low].

Axillary temperatures are not very accurate. The same applies to the strips that are held against a child’s forehead.

The new electronic thermometers are accurate and much easier to use than the older, glass ones. They are quicker and easier to read, and they signal you when they have reached their final reading.

There’s nothing scarier for a new parent than a sick baby. Your infant is fussy, not eating well, and has a fever. Should you take her to the hospital? Should you call your doctor? Or are you overreacting? As a well-informed parent, you want to know what you should do-when to be concerned and when not to worry. You want to know when to call the doctor and what to tell him. That’s what this section is all about.

What You Need to Know

All parents need to learn to tell when their child is sick, when to seek professional help, what to do in emergencies, and how to give medicines. Once you know these facts, you will be able to make the best decisions
One of the best ways to deal with illness is to be prepared. This includes knowing about common childhood illnesses and emergency measures, as well as having and knowing how to give the appropriate medicines. There are some general steps you should take to prepare yourself for illness or accident:

• Know the telephone numbers of your doctor, the hospital you use, the local poison control center, the fire department, and the ambulance service. These numbers should be posted near the telephone. Make sure your babysitters know where these numbers are located.
• Ask your doctor what he wants you to have on hand for emergencies and treatment of common ailments. Many doctors recommend that you have syrup of ipecac and activated charcoal on hand for poisonings. Some want their patients to keep certain common medicines on hand for late night illnesses.
• Discuss with your doctor what you should do in case of an emergency. If your child eats a bottle of pills or drinks a poison, should you call your doctor, the local emergency room, the poison control center? [Most doctors recommend you call the poison center, first.] If your child is injured, should you call your doctor first, or take your child to the emergency room? Asking these questions before an accident occurs will make things easier for both of you.
• Read about childhood illnesses and accidents. Books will help you be prepared for the inevitable illnesses and injuries that befall all children.
• Take a first aid course and learn CPR [cardiopulmonary resuscitation] and the Heimlich maneuver [for choking]. Be sure the instruction pertains to both children and adults [many courses only deal with adults]. Taking a class on these topics is much better than just reading about them. In the classes you have the opportunity to practice these skills on specially constructed models that are very life-like.
• Most important, in an emergency, DON’T PANIC! Your calmness is essential if you’re going to react properly to the situation and get your child the appropriate care.

Fever in a child strikes fear in the hearts of many parents. They wonder if their child will have a seizure and develop epilepsy, or if the temperature will go high enough to “cook” their child’s brain and cause permanent damage. You may be concerned about the proper way to treat your child’s fever and when you should call your doctor. Fever is perhaps the most misunderstood sign in all of medicine. It’s the body’s normal response to infection.

Everyone has an “internal thermostat’ that controls his body temperature. When an infection is present certain chemicals are released in the body that “reset” the thermostat to a higher setting. This helps to explain the chills your child may experience when his temperature is going up. He feels cold because his body wants to be a higher temperature. Once the fever breaks, he feels hot because his body wants to be at a lower temperature. The breaking of the fever means that his internal thermostat has been turned down to normal.

Understanding how a fever occurs helps you treat the chills and sweats that often accompany an illness. When your child has the chills, it’s best to add some blankets until he feels comfortable. Similarly, when he begins to sweat and feels warm, you should take off clothes or blankets. Bundling him up when he feels warm is defeating what the body is trying to do.

Doctors like to see infants at regular intervals to monitor their growth, development, and health. These visits are important because if any health problem is developing, it’s best to find it early and treat it appropriately. Although your doctor may have a slightly different schedule of visits, most infants are seen when they are two, four, six, nine, twelve, fifteen, eighteen, twenty-four, thirty, and thirty-six months old.

At each visit, your doctor will examine your undressed baby completely. He will ask you questions about your baby’s behavior and development. He’ll be looking for certain developmental milestones-things babies are usually doing at certain ages. These milestones are only guidelines, but if a baby consistently fails to meet them by certain ages, further investigation needs to be done.

During your baby’s first three years of life, she will see the doctor a number of times. These visits are important to make sure she is growing and developing appropriately. Your doctor will ask you a number of questions to see how things are going, and he will examine your baby, checking for normal growth and looking for problems. Routine and regular checkups are particularly important for you r baby during her first three years of life. Problems at this age, if not treated early, may have serious implications for her later in life.

The first time your baby’s doctor sees her will be within twenty-four hours after her birth. The doctor will do a complete examination of the baby and will want to talk to you about your pregnancy, labor and delivery. If you smoked, took any drugs, [prescribed or “recreational”], or drank much alcohol, you need to tell this to the doctor. These factors may affect your baby’s health or growth. The doctor will examine your baby daily while she’s in the hospital and also talk to you. These visits to you are important. Not only will you find out how your baby is doing, but you will have an opportunity to ask questions. Prepare for these visits; write down your questions ahead of time. Your doctor will give you advice on taking care of your new baby, such as feeding instructions and safety ideas.
One of the most important office visits is the first one. Most doctors like to see the baby when she is two to three weeks old. During her first month, the baby will change a lot. You will have many questions and concerns about your new baby, and this visit gives you the opportunity to ask them.

The doctor’s staff will probably ask you some questions before you see the doctor. How is the baby feeding? Is she sleeping well? Are there any problems with her bowels? Are there any skin problems? These are just a few of the questions you may be asked. They will also measure the baby’s weight, head circumference, [the distance around her head], and body length. These measurements are important for monitoring your baby’s growth. Each will be plotted on a growth chart. These charts are the best way to determine if your baby is growing well.

When you see the doctor, he will go over all this information and ask more questions if needed. Next comes the examination of your baby. Your baby should be completely undressed for this examination. The doctor will begin the examination at the top of her head and go to the tips of the toes, examining everything in between.

After examining your baby, he’ll tell you his findings and if there are any problems. Rarely are there any surprises found at this visit, although occasionally a congenital abnormality [a birth defect] is found that was not apparent when the baby was in the hospital. At this age, no immunizations are given.

Two relatively new health care practitioners are seeing more and more children. These are nurse practitioners and physician’s assistants-often collectively referred to as physician extenders. Nurse practitioners are registered nurses who take one or two tears of further training in physical examination, diagnosis, and prescribing medicines. Many work with physicians, although a number of them practice by themselves. Physician’s assistants graduate from a two year program in which they learn the same things as the nurse practitioner.

Many physicians employ a physician extender who sees patients in the office. Frequently, they see children for routine health care. They can spend more time talking with you, answering your questions, and teaching you what you need to know. Most often the charge is the same whether you see the physician extender or the doctor.

When you go for the “get acquainted visit” before your baby is born, you should bring with you a list of questions. The doctor’s answers to your questions are important and you should make notes. Follow up on any answers you don’t understand. Be aware of the doctor’s style and how he answers the questions.

Here is a list of some questions you should ask:

• What hospitals do you use/ you may want to be sure the doctor uses the hospital you prefer. Does he have a preference for a hospital far from your home? If so, find out why. Perhaps that hospital offers special services or has a different approach to taking care of children.
• What hours is your office open? With medicine becoming more competitive, doctors are doing more to attract and keep patients. This includes offering evening and Saturday office hours. If a doctor’s office hours are inconvenient for your family, you may want to find another doctor.
• What services do you provide in your office? Many doctors’ now provide a number of services in their offices to make things easier for you. For example, they may perform many laboratory tests there, or take blood samples that need to be sent out to a laboratory for special tests. Many doctors perform hearing and vision tests in their offices. The more done in the office, the fewer places you may have to take your child.
• What should I do if my child is sick at night or on the weekend and I can’t reach you? Most doctors arrange to have other physicians “cover” for them [take care of their patients] when they are not working or out of town. Be sure the doctor has such a system. Find out who the covering doctors are because you may have to deal with them. Be wary of a doctor who tells you to take your sick child to the emergency room when he’s not around.
• How do I fit in to the care of my child? Some doctors want parents to active participants in the medical care of their children. Other doctors want to be completely in charge and make all the decisions without input from parents. You need to know the doctor’s feelings in this area. If they conflict with yours, the doctor probably isn’t right for you.
• How do you feel about patient education? In this day of increasing medical awareness by parents, most doctors encourage parental education. However, there are still some doctors who buck this trend, believing that a little learning is a dangerous thing.
• What are your feelings on “routine” medical care? There is a controversy about some aspects of pediatric care [for example, routine immunizations and circumcisions]. Is this doctor dogmatic in his approach? Is his way the only right way? If you have strong feelings about your child’s care, such an approach may lead to conflict.
• What are your fees? This used to be a difficult question, one that both parents and doctors avoided, but this is changing. There are large differences in what doctors’ charge for the same services. Get a price list for the routine things like well-baby examinations.
• What type of training did you receive? Any doctor should be willing to tell you about his training-medical school, residency, and any special training. Don’t be impressed by a wall full of fancy diplomas. In and of themselves, they may not mean much. Almost every medical organization sends out diplomas, and many don’t signify much except the doctor paid his dues. The competence of the physician isn’t measured by the number of diplomas and certificates he has. It is, however, a good idea to ask him if he is board certified-that is, if he has demonstrated by completion of certain requirements and passage of an examination competency in his specialty.

After you have made your visits, talk to some of your friends. Find out whom they use and why. Ask them the questions you asked the doctor [especially about service and availability], and see if you get the same answers.

When you have all this information, you will be in a position to make an educated decision. Once you decide, let the doctor know. Find out if there’s any information her office needs to know about you. If your children have records with another doctor, arrange for them to be sent.

After all this work, there’s still a chance you’ll decide, after a few visits, that your new doctor isn’t what you expected. You should discus this with her. Try to explain why you aren’t satisfied. Maybe there’s a misunderstanding that’s easy to correct. Your doctor’s reaction to what you say is important. If she gets mad or rude, you should look for another doctor. Don’t feel obligated to stick with her if you don’t agree with her on some important matter, like her approach, treatment, or fees.

When you change doctors, you should get your child’s old medical records. This is easy to do. Just send a note to his former doctor asking that his records be sent to the new doctor. Physicians will do this as a service to all patients. Most states require doctors to do this. The law says the contents of the records belong to the patient even though the actual records belong to the physician. When you send your request, be sure to sign it. Without a signature, the records cannot be sent.

There are two different specialists that take of babies-family practitioners and pediatricians. Both have completed a residency [extra training after graduating from medical school]. A family practitioner’s training covers all areas of medicine including adult medicine, pediatrics, obstetrics, and surgery. A pediatrician’s residency is focused primarily on pediatrics. He has spent more time dealing with ill children and children with special problems. A family practitioner will take care of your entire family-from the very young to the very old. Most family practitioners encourage this. They find it easier to treat an individual if they know the whole family. Family practitioners frequently are better able to deal with emotional or family problems that affect everyone in the household… A pediatrician takes care of children exclusively. Usually they stop seeing a child when he is in his mid teens.

Both kinds of specialists can take care of normal children equally well, however, if your child ha special problems, a pediatrician may be better.

One of the most important decisions you’ll make about your baby’s health is selecting his doctor. Finding the right doctor isn’t easy. There are many questions that must be asked and answered before you make the selection. It’s important to find a doctor you feel comfortable with-someone whom you can talk to and who’ll answer your questions to your satisfaction. The doctor’s style must be right for you!

You should meet with several doctors before you have your baby. This will give you an opportunity to find out what they are like-their style, their approach, their fees, and so forth. Most doctors encourage this and don’t charge for it.