Crying babies advice

We talk to Dr Hossam Al TaTari, chief of paediatrics at Tawam Hospital

Interview, Health

Babies cry a lot in the first few weeks. How can you tell when something is really wrong?
Most babies cry to be fed, cuddled or have a diaper change. If all of these needs are met and the baby is still crying, then most probably you are experiencing infantile colic. A baby aged three weeks up until the end of the third month of life, who cries for more than three hours per day, for more than three days of the week, and for more than three weeks at a time is considered to have colic – which is entirely normal. However, you must see your doctor if: the baby’s feeding and sleeping are disrupted by the crying; baby’s cry weakens and becomes a moan; the baby is vomiting more than five times per day and whole feeds are being vomited; the baby is vomiting bile (dark green fluid) even if it happens once only; there is blood in the stools; or the baby is lethargic, no longer smiling or making eye-contact.

What’s the best way of dealing with a fever in a small baby?
Babies can feel warm due to over-wrapping and the weather. Unbundle the baby and wait for thirty minutes before taking their temperature. Secondly, ear thermometers are not accurate in the first two years of life, so temperatures should be taken rectally. If you’re not confident doing this, take it from their armpit and add one degree to the outcome. If your baby is three months or younger and has a temperature of 38 or above, you must seek medical help immediately. Babies in this age group are at a higher risk of serious bacterial infections due to their weak immune systems, and because they haven’t received enough vaccines yet.

The first few nappies my newborn did were tinged with red. Should I be panicking?
In vast majority of cases, this kind of pinkish staining is caused by the acidity of the stool or urine mixing with the crystals in the diaper. However, blood in the diaper could come from one of three sources: vaginal secretions, urine, or stools. It’s normal for baby girls to have a slightly red discharge in their diapers as their uterine lining will naturally shed shortly after birth, and this can continue for up to 14 days. It would be extremely rare for blood to be appearing in a baby’s urine, because babies don’t have renal stones or cancer, so this can generally be ruled out. The last source would be blood in the stool, which will appear very red. This is a real concern, and warrants seeing a doctor.

My baby seems constipated. At what point should I worry about this?
The definition of constipation in bottle-fed babies is going for more than three days without a stool. But the definition of constipation in a breastfed baby is vastly different. Normal bowel movements can range between 10 dirty nappies a day, to one dirty nappy every 10 days. However, if the baby is unable to feed or sleep and seems unhappy and uncomfortable within both those time frames, I would advise parents to seek medical advice. You can also try a home remedy to help things along. One small teaspoon of sugar, dissolved in 30mls of boiled, cooled water can get things moving in the bowel. But, I would only advise trying this – and not orange juice or any other preparation. And if it doesn’t work, go and see your doctor.

What exactly is colic and are there any things I can do to ease it?
Colic can sometimes happen because mum is stressed out and tired – babies are very intuitive about such things. In this part of the world, it might also be muscle or bone pain caused by the baby being over-wrapped or feeling warm due to the heat. Still, a good number of colic cases are related to tummies because of the following: too much air during feeding and improper burping; the mother’s diet is upsetting the baby through her milk; the baby has a mild lactose intolerance; or an imbalance of bacteria in the bowel. To soothe colic, take your child to a calm, quiet room and remove their clothes so that they can move their limbs freely. Playing soft music to them can help too. If the crying is stomach related, there is a pro-biotic called Biogoia which helps to maintain the correct levels of bacteria within the gut. Studies have shown that babies who receive it have a 75 per cent drop in their colic after the first week. And, it’s available from your local pharmacy.

My five-month-old baby has a cough, but no fever. Does she still need to see a doctor?
A cough is a positive thing. The baby is trying to defend him or herself by coughing up something that’s irritating the lungs. It could be anything from environmental factors, like pollutants or smoke, or it could be germ-related. A cough in itself is nothing to worry about. However, if it’s accompanied by a fever or a wheeze, if the baby is breathing fast and is unable to feed or sleep properly, then you should contact your doctor.

My six-week-old baby’s BCG site has really swelled up, and there’s a large lump in his armpit. What’s happened?
This is a rare side-effect of the BCG vaccine and the lump is actually a swollen lymph node. Usually it isn’t associated with any long term complications and very often, over time (a period of months) it will go down by itself. However, if the parents feel that the mass or lump is soft, not firm, they do need to consult a pediatrician to see if surgery to remove it is needed. However, this is rarely necessary.

My baby had a seizure and my doctor told me it was febrile – and nothing to worry about. Can you explain why it happened?
The difference between a febrile seizure and an epileptic seizure is that in the case of a febrile fit, the baby’s brain is completely normal, while in epilepsy, there is something wrong with the structure of the brain. The febrile fit happens because the baby’s brain is immature, and reacts to a fever by producing an overly large burst of electricity. Even if they happen repeatedly, febrile seizures do not harm the brain in any way. However, they may continue to occur with fever until the age of six years, although most of them decrease significantly as the brain matures.

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