Babyquant

Should I give my child a pacifier?

[mme_highlight] The pacifier should be offered to babies, but only after the breastfeeding is correctly established and its use must be limited to the first twenty four months of life. The pacifier, if correctly used, promotes well-being and gives babies a sense of comfort. [mme_highlight]

The question of giving a pacifier to a child is not a consensual one, not only among parents but also among health care providers. In many cases, using a pacifier soothes a baby, but parents are often afraid that a pacifier can impair breastfeeding, cause dental caries or deformations in children’s teeth.  Nevertheless, many pediatricians often refer the benefits of using a pacifier, including its role in the prevention of the Infant Sudden Death Syndrome.

Definitions and statistics

Since ancestral eras, pacifiers have been used, even if not in the same format as we see them today – there is evidence of their existence dating from 3000 years ago. It is estimated that nowadays, in the developed countries, the percentage of utilization of pacifiers is between 75 to 79%.

In babies, suction is a reflex, which means it is done in an involuntary way. It is present since the intrauterine life through the first to third years of life.

There are two types of suction: nutritive suction (present in breastfeeding) and non nutritive suction (like in finger suction or with pacifiers).

Can I give my child a pacifier even if I am breastfeeding?

The benefits of breastfeeding are widely known and it is recommended as the only nutritional source during the first six months of life. As the suction movement is different during breastfeeding from that with a pacifier, many parents fear that the baby can confuse both or that a baby using a pacifier does not want so many breastfeeds leading to a decrease in milk production. However, many scientific studies conclude there is no interference and pediatricians recommend offering a pacifier after breastfeeding is already established.

Can the use of a pacifier prevent the Infant Sudden Death Syndrome?

The American Association of Pediatrics recommends the use of a pacifier to prevent Infant Sudden Death Syndrome during the first year of life, after breastfeeding is fully established; however, parents should not force their babies to have a pacifier if they refuse it. In addition, the pacifier should not be put back in baby’s mouth after falling in the floor or if dropped during sleep. The pacifier should not be linked to clothes by other objects, as there is an asphyxiation risk.

[mme_databox]
Reduction of Incidence of Infant Sudden Death Syndrome with the use of a Pacifier

• About 30% reduction if used regularly (OR 0.71 with CI 0.59-0.85)
• About 60% reduction when used during last sleep (OR 0.39 with CI 0.31-0.50)
• About 17% reduction when regularly used during sleep (OR 0.39 with CI 0.31 a 0.50)

OR – Odds Ratio; CI – Confidence Interval
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Does a pacifier cause damage or caries in my child’s mouth?

The pacifier occupies the oral cavity and, overtime, it can produce changes in its development.

The majority of scientific studies conclude that the consequences are more important in children who continue using pacifiers after twenty four months of age. The later the pacifier is left, the higher the probability of these consequences in the teeth arcades.

Regarding caries, the Canadian Society of Pediatrics states that the appearance of caries can be associated only with a continued use of a pacifier past 5 years of age or with its utilization in association with sugar solutions.

What other benefits do pacifiers have?

It is nowadays acknowledged that a pacifier can relief pain in neonates and babies during painful procedures (like vaccines, punctions, test for rethynopathy of prematurity), thus a pacifier should be offered in these moments. This relief effect can be explained by the release of pain relieving substances (like serotonin) during the suction. In these situations, the relief of pain can be greater if a sugar solution is used with the pacifier.

[mme_databox]
Reduction of Crying Time with the use of a Pacifier

(study of the use of pacifiers for infants venipuncture in a pediatric emergency department)

• 0-1 month infants: reduction of 52 seconds
• 1-3 month infants: reduction of 123.9 seconds

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Is there any health problem related with the use of pacifiers?

Some studies have concluded that not using a pacifier can decrease about 29% the recurrence of an ear infection (acute otitis), which means that not using a pacifier decreases the odds for an ear infection to appear again. This conclusion lead to the recommendation that in children with history of ear infection, it may be prudent not to use a pacifier as it is a risk factor for recurrence of the infection.

Summary

• The pacifier should be offered to babies, but only after the breastfeeding is correctly established, which happens around the first month of life.
• Prefer to offer the pacifier during the main sleeping period of the child.
• Do not use objects to hold the pacifier to the child’s clothes, as there is a risk of asphyxiation.
• Do not offer your child a pacifier that has fallen in the ground.
• Careful consider not offering a pacifier to a child that is prone to ear infections.
• The use of a pacifier must be limited to the first twenty four months of life, since after this age its use raises the likelihood for dental caries and alterations in teeth structure.
• Pacifiers should be offered during painful procedures, as they promote the release of pain relieving substances.
• The pacifier, if correctly used, promotes well-being and gives babies a sense of comfort.

[mme_references]
References

• Sexton S, Natale R. Risks and benefits of pacifiers. American Family Physician. 2009
• Richard H. Schvartz, MD, Infant Pacifiers: An Overview. May 2008
• M Ponti. Recommendations for the use of pacifiers. Canadian Paediatric Society. Paediatr Child Health 2003;8(8):515-9 2003
• Niemelä M, Pihakari O, Pokka T, Uhari M. Pacifier as a risk factor for otitis media: randomized, controlled trial of parental counseling. Pediatrics. 2000;106:483-8.
• Hauck, F. R., Omojokun, O. O., & Siadaty, M. S. (2005). Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116, e716–e723.
• Mitchell, E. A., Blair, P. S., & L’Hoir, M. P. (2006). Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics. 2006 May;117(5):1755-8.
• SJ, Jou H, Ali S, Vandermeer B, Klassen T. A randomized controlled trial of sucrose and/or pacifier as analgesia for infants venipuncture in a pediatric emergency department. BMC Pediatr. 2007;7:27.

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Screening tests in Newborns

[mme_highlight] The goal of screening newborns is to detect diseases early, either because the tested diseases are life-threatening or because they can bring serious complications. The conditions which can be detected include inborn errors of metabolism, endocrine disorders, hemoglobinopathies, immunodeficiency, cystic fibrosis, and critical congenital heart defects.
[mme_highlight]

The goal of screening newborns is to detect diseases early, before symptoms appear, either because the tested diseases are life-threatening or because they can bring serious complications for health if the diagnosis is done late. In addition to the early detection, the screening has the aim of providing referral and treatment of babies thought to be affected by such conditions.
Newborn screening began in the 1960s when the scientist Robert Guthrie developed the blood spot test, which initially only detected Phenylketonuria (PKU), a metabolic disorder.  Nowadays, the test can detect more than 60 disorders, depending of the panel of diseases defined by every country.  The conditions which can be detected include inborn errors of metabolism, endocrine disorders, hemoglobinopathies, immunodeficiency, cystic fibrosis, and critical congenital heart defects.

My baby looks healthy…why will she/he be screened?

Yes, newborn screening is part of Public Health programs developed by each country and all babies undergo screening even if they look perfectly healthy, because some diseases do not cause symptoms or show any manifestation soon after birth but can become serious later. Statistics show that newborn screening detects treatable conditions in 1 in each 300 babies per year.

How is the blood spot test done?

This test is generally performed by a nurse between the 3rd and 6th days after birth. A lancet is applied on the lateral borders of the baby’s heel. It is necessary to wait till a drop of blood is formed, which will then fill in each circle on the screening paper sheet. This sheet is then sent to the laboratory and parents have to wait for the test results. In most countries, parents know the results 4 weeks after the test, if they are normal. In case of alterations in the test, parents are usually notified sooner than this.

What does it mean if the test results are normal?

If the results are negative it means that none of the conditions included in the screening was detected. The test is highly specific (99 to 100%), which boosts the security of a negative result as truly negative.

What does it mean if the test results are abnormal?

A positive or out-of-range result does not mean your baby has got a disease. It means that he/she will need further testing. The apparent sensitivity for most of diseases screened are 100% and specificity levels are all above 99%. However, there is a lack of evidence regarding the false negatives and false positives for individual diagnosable disorders included in this screening and the positive predictive values range from 0.5% to 6.0%. Consequently, on average, there are more than 50 false-positive results for every true-positive result identified through newborn screening in the United States.

What diseases can be diagnosed with this screening?

[mme_databox]
Screening Outcomes (United States statistical data)

• Detection rate: 1:4000 live births
• 5 most frequently diagnosed diseases:
• hearing loss
• primary congenital hypothyroidism
• cystic fibrosis
• sickle cell disease
• medium-chain acyl-CoA dehydrogenase deficiency

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Primary congenital hypothyroidism

The diagnosis of this condition of the thyroid gland is based on the levels of TSH (a hormone). If diagnosed lately, primary congenital hypothyroidism can lead to serious mental retardation and non-reversible neurological problems. The prognosis depends on the time passed before replacement therapeutic is initiated.

[mme_databox]
Incidence Rates of Congenital Hypothyroidism (United States statistical data)

• 1991: 2.89 cases per 10000 births
• 1996: 3.67 cases per 10000 births
• 2000: 3.86 cases per 10000 births

Incidence – number of new cases within a specified time period in a population.
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Hemoglobinopathies including sickle cell disease

Sickle cell disease is a common hereditary blood disorder in which red blood cells present an odd shape caused by a mutation in the hemoglobin gene. The life expectancy is shortened. Finding sickle cell disease early through newborn screening helps to prevent deaths and other complications that can appear.

[mme_databox]
Sickle Cell disease-related mortality  0 to 3 years age group (United States statistical data 1983-2002)

• 1983: Death rate 2.42 per 100.000 black children
• 2002: Death rate 0.78 per 100.000 black children

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Cystic fibrosis

This is an inherited disorder of the mucus glands. Mucus is a substance that covers lungs, digestive system, reproductive system as well as other organs, protecting them. In cystic fibrosis, the body produces too much mucus, which is abnormally thick and sticky, which. Without an early diagnosis and treatment, this condition can cause serious complications and even early death.

Hearing loss

1 to 3 in each 1000 apparently healthy newborns have hearing loss, 20 to 40 per 1000 if risk newborns. This should be identified before 3 months and intervention should start not after 6 months, since a normal hearing function is required to language development.

Phenylketonuria

This is an inherited disease characterized by a deficiency in the enzyme phenylalanine hydroxilase, whose function is to metabolize phenylalanine (an amino acid). The accumulation of this amino acid becomes toxic in the body. Treatment consists in a hypoproteic diet, with restriction of phenylalanine.

Summary and Recommendations

• Newborn screening, known as the blood spot test, tests a long list of diseases which may be life threatening or cause severe complications if not diagnosed and treated early.
• All newborns should be screened with this test, even if they look healthy, because many diseases do not show signs after birth and can only become apparent when it is too late.
• The blood spot screening test results are very reliable.
• Examples of diseases that can be diagnosed with this screening are: hearing loss, primary congenital hypothyroidism, cystic fibrosis, sickle cell disease, phenylketonuria.

[mme_references]
References

• Centers for Disease Control and Prevention (CDC). CDC Grand Rounds:Newborn Screening and improved outcomes. MMWR Morb Mortal Wkly Rep 2012; 61:390.
• Kwon C, Farrell PM. The magnitude and challenge of false-positive newborn screening test results. Arch Pediatr Adolesc Med. 2000 Jul;154(7):714-8.
3. http://www.cdc.gov/ncbddd/pediatricgenetics/newborn_screening.html (accessed 29.10.2013).
4. http://www.cdc.gov/ncbddd/pediatricgenetics/data.html (accessed 29.10.2013).

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“My baby is yellowish… “- Neonatal jaundice

[mme_highlight] Neonatal jaundice is a yellow coloration of skin caused by a yellow pigment called bilirubin. If the levels of this substance get too high there is a risk of brain damage. It generally appears between 72 to 96 hours after birth, disappearing by one to two weeks of life. [mme_highlight]

What is Jaundice?

Jaundice is the medical term for a yellowish coloration of the skin or when the white part of the eye turns yellow.  It generally appears between 72 to 96 hours after birth, disappearing by one to two weeks of life.

Jaundice is a sign that reflects a high blood concentration of a substance called “bilirubin”. This substance is released to blood by the disruption of red blood cells, but usually the liver does its clearance and bilirubin is excreted in urine and stool. However, if the pace of red blood cells disruption gets too fast, bilirubin is not adequately eliminated and accumulates, causing jaundice. As bilirubin is a yellow pigment, it causes a yellow coloration of tissues.

Why does my baby have jaundice?

Neonatal jaundice can be caused by different reasons:

• High turnover of red blood cells: this is a normal situation, because baby’s blood is richer in red blood cells than the adults’ blood and, in addition, these red blood cells have a shorter life than the ones from adults’ blood (approximately 85 days vs. 120 days); as the turnover of red blood cells increases, more bilirubin is produced.
• Deficiency of UGT1A1, an enzyme envolved in the clearance of bilirubin. This enzyme does not work properly until around 14 weeks of age, so the bilirubin is not well cleared and accumulates.
• Mild injuries occurred during birth can leave to red blood cells destruction, hence causing a raise in bilirubin concentration.
• Incompatibility of blood types between mother and child, which causes destruction of red blood cells.
• Inherited diseases causing destruction of red blood cells (such as deficiency of glucose-6-phosphate dehydrogenase, an enzyme).
• Asian race baby or having asian ancestors also rises the odds of having jaundice.

Can jaundice be related to breastfeeding ?

Yes, in two distinct situations. When the intake provided by breastfeeding is not adequate, because this way the blood concentration of bilirubin increases. The other situation is the called “breast milk jaundice”, which happens due to the babies immature organs and occurs mainly during the first two weeks of life. It is not a reason to stop breastfeeding if the baby is gaining weight, but this situation should be monitored by a doctor.

Does jaundice happen to many babies?

Yes, it is very common in babies. In fact, the so called benign jaundice is physiologic and affects almost all newborns. However, as it consists of a mild elevation in bilirubin levels, there is generally no danger for babies. A concentration of blood bilirubin greater that 1mg/dL is above the upper normal limit for an adult. The highest levels are those above 25 mg/dL, which is called hyperbilirubinemia, which associates with a greater risk for brain damage, as the study below shows.

[mme_databox]
Odds of Having Acute Brain Damage (ABD) at Admission and/or at Discharge (logistic regression analysis)
(Study population: 249 newborns with severe hyperbilirubinemia)

• High total serum bilirubin: 1 time more risk for ABD (OR 1.09 – 95% CI 1.03-11.6)
• Higher admission weight: 17% less risk for lactation mastitis (OR 0.83 – 95% CI 0.74-0.93)
• Incompatibility Rh: 48 times more risk for ABD (OR 48.6 – 95% CI 14-168)
• Sepsis (general infection): 20 times more risk for ABD (OR 20.6 – 95% CI 4.9-87.5)

OR – Odds Ratio; CI – Confidence Interval
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How can I check if my baby has jaundice?

To check if your baby has jaundice, press one finger on her/his forehead or nose. If it is the case, the skin will appear yellow when you release your finger from the baby’s skin.

What are the symptoms of jaundice?

The yellow coloration that appears in jaundice is generally first noticeable in face, but can also been seen in the chest, belly, and arms; legs are usually the last part of the body affected.

Sometimes, when the level of bilirubin are very high (hyperbilirubinemia), jaundice can be severe. There are some symptoms a baby in this situation can show, although they do not appear only in the case of severe jaundice: if a baby is difficult to wake up, has a high-pitched cry, gets difficult to console and bends her/his body or neck backwards.

How is neonatal jaundice treated?

The most common treatment for neonatal jaundice is called phototherapy, where babies are put under a light therapy, either using a special light or a light blanket over skin. The light breaks the bilirubin molecule, making it easier to eliminate through urine and stool. Generally, this treatment is enough to treat the baby.

Adequate breastfeeding is also very important to prevent and treat this condition, as it promotes the elimination of bilirubin through urine and stool. The study below investigated 22547 infants and shows the estimated number needed to treat (NNT) with phototherapy to prevent one infant from reaching a high bilirubin level with need for exchange transfusion (this is the treatment used for high bilirubin levels when phototherapy is not enough).

[mme_databox]
Estimated NNT with Phototherapy to prevent one infant from reaching the exchange transfusion level (first 24 hours of life)
(Study population: 22547 newborns)

• Boys, 35 weeks of gestation: NNT= 14 (we have to treat 14 with phototherapy to prevent one baby from needing transfusion)
• Boys, 39 weeks of gestation: NNT= 74
• Girls, 35 weeks of gestation: NNT= 21
• Girls, 39 weeks of gestation: NNT= 113

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Summary and Recommendations

• Neonatal jaundice is a common and usually benign condition in neonates. It generally appears between 72 to 96 hours after birth, disappearing by one to two weeks of life.
• It can be caused by situations that raise the levels of bilirubin (yellow pigment) or that difficult its elimination, which can be normal in the first weeks of life, because the baby’s organs may be not mature and the turnover of red blood cells is higher. There are also diseases that can cause jaundice.
• The most common therapy for neonatal jaundice is that with a special light, which generally is successful.
• You should always seek medical advice if: your baby’s jaundice worsens, if your baby bends is body backwards and also if she/he is irritable, difficult to wake up or shows a different pattern of crying (high-pitched).

[mme_references]
References

• Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med 2001; 344:581.
• American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114:297.
• Preer GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis Child Fetal Neonatal Ed 2011; 96:F461.
• Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med 2008; 358:920.
• Gamaleldin R, Iskander I, Seoud I et al. Risk factors for neurotoxicity in newborns with severeneonatal hyperbilirubinemia. Pediatrics. 2011 Oct;128(4):e925-31.
• Newman TB, Kuzniewicz MW, Liljestrand P et al. Numbers needed to treat withphototherapy according to American Academy of Pediatrics guidelines. Pediatrics. 2009 May;123(5):1352-9.

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My baby is vomiting…

[mme_highlight] Vomiting is one of the most common reasons for parents to take their child to the Emergency Department. The most frequent conditions that cause vomiting in infants are gastroesophageal reflux, pyloric stenosis and intestinal obstruction. Preventing dehydration and spread and being aware of alarm signs are fundamental measures.  [mme_highlight]

Vomiting is one of the most common reasons for parents to take their child to the Emergency Department. Vomiting is not a disease, but a non-specific symptom which is often related with benign self-limited conditions, but it can also be associated with serious illness. The reason for vomiting varies with age, but the most frequent is a viral infection.

What can be considered vomiting?

Vomiting can be defined as an oral expelling of the gastric content, either in a voluntary or involuntary way, associated with a contraction of abdominal and thoracic muscles. It should be distinguished from spitting up (regurgitation), in which the gastric content comes to mouth without contraction of abdominal muscles. However, in infants, this distinction may not be easy to make, as some infants reflux in large amounts or forcefully.

Why does vomiting appear?

Vomiting occurs when a message to do so reaches the “vomiting center” in the brain. This message can be transmitted from various triggers, such as an infection, food poisoning, certain medicines or motion.

Vomiting is a response of the body to eliminate potentially harmful substances and, in this sense, it is beneficial. However the use of medicines or manual induction of vomiting is not recommended even if a child has ingested a harmful substance; in this case, call the emergency number immediately.

What are the most common causes of vomiting in infants?

Gastroesophageal Reflux

Gastroesophageal reflux (GER) is the most common cause of vomiting in the first year of life; generally, it is self-limited (this means it goes away without any treatment). It results from the immaturity of the lower esophageal sphincter (a muscle between stomach and esophagus). The presentation signs and symptoms are generally regurgitation, refusal to eat, poor weight gain, irritability and episodes in which the baby turns blue (cyanotic).

[mme_databox]
Prevalence of Gastroesophageal Reflux during the first year of life

• 4 to 5 months of age: 67% of all babies have GER
• 6 to 7 months of age: 21% of all babies have GER
• 12 months of age: 5% of all babies have GER

Prevalence – The total number of cases of a disease in a given population at a specific time.
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Intestinal Obstruction

Depending on the location of the constriction, vomits can appear bile-stained (“greenish”); if this is the case, take your child immediately to the emergency department. If the constriction is more proximal (more close to esophagus), generally the vomitus is not bile-stained and can be caused by different conditions (pyloric stenosis, upper duodenal stenosis, gastric volvulus, or annular pancreas).

Pyloric Stenosis

If the pyloric muscle is too thick, this can lead to an obstruction, and children may present with non-biliary vomitus during the first weeks of life. This condition is nowadays early diagnosed, using an ultrasound examination of the abdomen.

[mme_databox]
Epidemiology data for Pyloric Stenosis

• Prevalence in population – 3:1000 (3 babies per 1000 live births)
• More common among boys – 4:1 (4 boys for each girl with pyloric stenosis)
• 30% of cases occur in firstborn children

Prevalence – The total number of cases of a disease in a given population at a specific time.
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Gastroenteritis
This condition is characterized by a sudden onset but also a fast resolution, most times without any specific treatment. It is more frequent during winter season and caused by a viral infection – most frequently Rotavirus. Vomiting can be the only symptom during the first two days of a Rotavirus infection. Bacterial gastroenteritis may be associated with more prolonged and severe illness.

What can I do to help my infant?

Monitor your child’s hydration: Vomiting leads to a great loss of water from body, so your child can become dehydrated. If your child is thirsty and presents a slightly dry mouth, give her/him fluids. Do not give time for signs of severe dehydration to appear; these are: dry mouth,   decreased quantity of urine (6 or more hours without going to the bathroom or wetting a diaper), lack of tears when crying, sunken eyes.

Oral rehydration therapy: Vomiting leads body to lose water and fluids, which are very important for health balance, so in cases of dehydration these have to be replaced with a liquid solution that contains glucose (a sugar) and electrolytes (sodium, potassium, chloride).

Medicines: Always seek for medical advice before giving your child’s a medicine. Your doctor can recommend the use of antiemetics to prevent vomiting from occur, this way preventing dehydration if your child is vomiting repeatedly.

Preventing spread: Wash your hands and your child’s! It is a simple measure but very effective to prevent spreading a gastroenteritis. Your child should not go to school until she/he stays without a vomiting episode for 24 hours.

Summary and Recommendations

• The most frequent conditions that cause vomiting in infants are gastroesophageal reflux, pyloric stenosis and intestinal obstruction.
• Preventing dehydration and preventing spread if a contagious cause is present are fundamental measures.
• Be aware of alarm signs:
• any episode of vomiting in a newborn;
• vomiting that lasts more than 24 hours in an infant;
• green or blood-stained vomitus;
• signs of dehydration;
• refusal to eat;
• if your child seems more sleepy than usual;
• high fever.

[mme_references]
References

• Nelson, S, Chen, EH, Syniar, GM, Christoffel, KK. Prevalence of symptoms of gastroesophageal reflux during infancy: a pediatric practice-based survey. Pediatric Practice Research Group. Pediatr. Adolesc. Med. 1997; 151:569-572.
• Ikeda H, Matsuyama S, Suzuki N, et al. Small bowel obstruction in children: review of 10 years experience. Acta Paediatr Jpn 1993; 35:504.
• Sondheimer JM. Vomiting. In: Pediatric Gastrointestinal Disease: Pathopsychology, Diagnosis, Management, 4th ed, Walker WA, Goulet O, Kleinman RE, et al (Eds), BC Decker, Ontario 2004. p.203

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My baby has a common cold…what should I know?

[mme_highlight] Young children have about 6 to 8 colds per year.  The most common virus causing colds are rhinovirus in all age groups. The symptoms of a common cold are seen about 10-12 hours after the viral infection. Generally cold is well tolerated by babies but in certain situations take your baby to the doctor for medical help. [mme_highlight]

According to research studies, young children have about 6 to 8 colds per year. During the initial years of life, boys seem to have more respiratory infections as compared with girls. Daycare attendance has been cited as one of the most important risk factors for respiratory illnesses in children and it is known that the frequency of cold increases with the number of children in a daycare group with respiratory infections.

What causes common cold?

Studies have reported that there are more than 200 different cold viruses. The relative proportion of the virus causing cold is dependent on factors such as age, season and viral detection method. The most common virus causing colds are rhinovirus in all age groups. It has been found that by the age of 5 years, virtually all children have been exposed to one or the other cold virus. 5% of all the patients suffering from cold are dually infected by two viruses.

Research studies have shown a high incidence of rhinovirus infection in children during their first years of life. By the age of 6 months, over 20% of the children have shown a rhinovirus infection confirmed by the laboratories. By the age of 2 years rhinovirus infection has been proved in almost 79% of the children while 91% had developed antibodies against the rhinovirus infection.

The table below enlists the most common viral causes of common cold (Heikkinen & Jarvinen, 2003).
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What are the symptoms of common cold?

The symptoms of a common cold are seen about 10-12 hours after the viral infection,  while influenza virus may take 1 to 7 days to present symptoms. The mean duration of a common cold is 7 to 10 days in children but in younger children it may linger longer.

The most common symptoms of common cold in babies and children are:

• Runny nose (watery discharge at first, which later becomes thicker and yellowish);
• Sneezing;
• Nasal congestion.

More aggravated symptoms (which are rare) are;

• Dry cough worsening when the baby lies down;
• Fever;
• Itchy throat;
• Fatigue;
• Loss of appetite.

What can be the complications of a common cold in my child?

The symptoms of a common cold may persist in some children even after 3 weeks. The most common complication arising as a result of coldis acute otitis media occurring in almost 20% of children with viral upper respiratory infections; the viral infection may the middle ear fluid and cause inflammation in the mucosa of the middle ear. Bronchitis, pneumonia and sinusitis are other complications associated with cold.

How is common cold diagnosed?

The biggest problem associated with a cold in infants and younger children is that they may not show the typical symptoms. Diagnosis in infants is especially difficult when fever is the major symptom during the early phase of the infection and the doctor is faced with the difficulty of distinguishing viral infections from severe bacterial infections.

A survey conducted for Disease Control and Prevention in 1991 showed that almost two thirds of three year olds had taken a medicine for cough or cold in the preceding 30 days. It is very important that physicians correctly diagnose the cold before deciding on the use or refuting the use of medications in young babies.

How is common cold treated?

There is not a cure for common cold, but symptoms can be treated to provide relief for the baby or the young child. The treatment options that have been recommended for common cold in babies and young children are the following:

• Suctioning of mucus with a suction bulb. Over the counter saline nasal drops may be used to soften the hard mucus before the suctioning of mucus. This will help the baby to feed properly and sleep well.
• Keep the air in the room humidified to moisten the air, reduce congestion and facilitate breathing in babies.
• Make the baby sleep on his /her belly with head elevated to ease breathing.
• Petroleum jelly or similar ointment should be applied lightly to the outside of and under nose to prevent chapping and reddening of the skin.
• Decongestants prescribed by the physician should be given to ease congestion so that the baby can eat and sleep properly.
• Nose drops may be used when prescribed by the doctor to ease the congestion. Overuse may lead to a rebound reaction, thus worsening the condition of the baby.
• Cough medicine may be prescribed by the doctor to ease a dry cough in extreme cases. However, generally, cough suppressants are not prescribed for the babies. The American Academy of Pediatrics cautions against the use of any cough medicines in infants and children. Antibiotics should be used only in case of secondary bacterial infection.
• The baby should be isolated from others in the family for the initial three days to prevent spreading of the cold to others.
• Dietary changes: baby should be continued on normal diet. The intake of milk and other dairy products may be reduced as these can thicken the secretions. Fluid intake should be increased to replenish the lost fluids. Vitamin C rich foods, like strawberry and orange, should be given to the baby.

What are the alarm signs parents should be aware of?

Generally cold is well tolerated by babies but in certain situations take your baby to the doctor for medical help. These situations are:

• If this is the first cold of your baby;
• If your baby is under 3 months or 4 months of age and has a fever over 101˚F (38 ºC);
• If the temperature suddenly goes up or stays high for more than 2 days;
• A dry cough lasting more than 2 weeks or interfering with the baby’s sleep, or which causes choking or vomiting, becomes thick and productive or wheezy;
• A cough lasting for more than three weeks in an infant or six weeks in an older baby;
• If breathing difficulties develop;
• If a thick greenish yellow nasal discharge develops lasting for more than a day;
• If the nasal discharge is streaked with blood;
• Unusual amount of crying or loss of appetite.

Summary and Recommendations

• It is normal for young children to have common colds: the average frequency is estimated in 6 to 8 per year. It seems to be more prevalent in boys.
• Being at a daycare facility is a risk factor to catch a common cold.
• The most frequent agent causing common cold is rhinovirus.
• It has been documented that almost all fiver-year-old have already contacted with common cold viruses.
• Possible complications are: acute media otitis, bronchitis, pneumonia, and sinusitis.
• Some options to relieve symptoms are: nasal mucus drainage, keeping air humidified, use decongestants when you have a medical prescription, reinforce oral hydration and give your child aliments rich in vitamin C.
• Your baby’s first cold, a cold in young infants, dry cough that lasts more than 2 weeks and difficulty to breathe are indications to seek for a doctor.

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References

• Eisenberg, A., Murkoff, H. E., & Hathaway, S. E. (1996). When Baby is Sick. In A. Eisenberg, H. E. Murkoff, & S. E. Hathaway, What to Expect The First Year (pp. 418-420). NewYork: Workman Publishing.
• Heikkinen, T., & Jarvinen, A. (2003). The Common Cold. THE LANCET, 361, 51-59.
• NHS, C. (2011, June 10). Common Cold in Children. Retrieved from NHS choices: http://www.nhs.uk/Conditions/Cold-common/Pages/Commoncoldinchildren.aspx
• Simasek, M., & Blandino, D. A. (2007). Treatment of The Common Cold. American Family Physician, 515-520.

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