Caring for Common Problems of Your Infant at Home

Call your clinic to make a follow-up visit for your infant as told by your caregiver. You should make an appointment for your baby to be seen at 2 weeks of age for a well baby visit, unless your caregiver wants to see you sooner.

For appointments, bring:

  • A diaper and a change of clothes.

  • A bottle of formula if your baby is bottle-fed, or a bottle of water if your baby is breastfed.

If you have questions, please write them down. Bring your list with you when the baby is examined. If something seems unusual or you are worried about a problem, call your caregiver.

COMMON QUESTIONS

What are the white spots on my baby's face?

Both neonatal acne and milia are common in the newborns. Both conditions are normal for newborns, and both usually resolve on their own in 6 to 8 weeks.

What should I do for diaper rash?

If there is diaper rash for more than 3 days, you can treat it with an over-the-counter cream, powder, or ointment for a fungal infection. If there is no improvement within 3 days, call your caregiver or make an appointment for your baby to be seen.

How much pain medication should I give my baby?

Do not give any medication to your baby until at least 6 weeks of age and then only after checking with your caregiver.

What is fever?

Fever in a newborn or infant younger than 2 months can be very serious. Call your doctor if:

  • Your baby is 3 months old or younger with a rectal temperature of 100.4° F (38° C) or higher.

  • Your baby is older than 3 months with a rectal temperature of 102° F (38.9° C) or higher.

  • You think your baby has a fever and you are not able to measure it.

What are the white spots in my baby's mouth?

It is common to see thrush in newborns. This condition is causing the white spots. This condition is not serious. The white spots are a very mild fungal infection that can be easily wiped off and treated with over-the-counter or prescription medications.

SAFETY

Accidents are the leading and most preventable cause of death for children. Consider these safety tips:

  • Your child should ride in a rear-facing car seat until your doctor tells you that your child can face forward. Be sure to have your seat checked to see if it is appropriately installed. Never allow your infant to ride in the front seat.

  • There should only be 2 3/8 inches (5.08 centimeters) between slats in your child's crib. An older crib may have spaces that are too big. The mattress should fit snugly so that your child will not get trapped between the crib and mattress. Do not place blankets or large stuffed animals in the crib that could smother your baby.

  • Always place your baby on his or her back to decrease risk of sudden infant death syndrome (SIDS).

Vomiting In Infants and Newborns

Forceful vomiting in newborns and young infants is not normal and may be serious, especially if associated with:

  • Fever (temperature greater than 100.4°F [38°C]).

  • Weight loss.

  • Irritability, decreased activity, or crying for a prolonged period.

  • Not eating.

  • Vomit that looks green or yellow (bilious) or is forceful.

  • Hunger after vomiting.

  • Signs of abdominal pain.

If your baby is vomiting and has any of the above symptoms, call your caregiver.

Most of the time vomiting is not serious and may just represent gastroesophageal reflux disease (GERD). Gastroesophageal reflux disease is normal in newborn and infants, and your child may be what caregivers call "a happy spitter". This is when your baby painlessly and effortlessly spits up their milk but appears perfectly happy. This will gradually improve as your baby gets older. Most infants with GERD will gain weight appropriately and not develop any problems.

If you are concerned about GERD affecting your baby, you can discuss the following lifestyle changes with your caregiver:

  • Changing formula.

  • Changing how you position your baby when you place them down.

  • Breastfeeding.

  • Thickening your baby's feeds.

Less commonly, vomiting in babies can be caused by an allergy to a protein in their formula called milk protein allergy. Most often newborns and infants with milk protein allergy are irritable and have bloody diarrhea, but they can also have vomiting.

Another condition called pyloric stenosis occurs in about 3 of every 1,000 births. In this condition infants have forceful or projectile vomit. Parents often describe this as vomit "shooting" across the room. Shortly after vomiting, infants appear to be very hungry.

If your baby's belly appears swollen or you see what looks like a green or yellow fluid in the vomit, your baby could have twisted and blocked bowels. This requires prompt evaluation by your caregiver.

Vomiting In Older Infants

Vomiting and diarrhea in infants may occur with infections. The most common cause of vomiting in older infants is gastroenteritis, usually caused by a viral infection. However, a sore throat, ear infection, or bladder infection can also cause vomiting.

If your infant is between 6 months and 36 months old and suddenly gets crampy, abdominal pain and vomiting that progressively worsens, call your caregiver. Older infants are at risk for a type of intestinal obstruction (intussusception). Also, if vomiting is associated with a headache, you should discuss this with your caregiver.

If vomiting or diarrhea occur in large amounts, and the baby is not taking enough fluids, the baby may lose too much body water and body salts and become dehydrated (loss of body fluids). Suspect dehydration if:

  • The eyes look sunken in.

  • The tongue and mouth are dry.

  • Diaper wetting decreases.

Babies younger than 3 months require special care and close watching because they lose body water and become dehydrated a lot faster. True vomiting is when food is brought up from the stomach. This is different from when babies "spit up" small amounts. The most common cause of diarrhea in infants is intolerance to the protein in the formula. It is most important to prevent dehydration in infants. Dehydration can come on quicker when there is both vomiting and diarrhea.

Diarrhea In Newborns And Older Infants

Many parents often confuse diarrhea with normal baby stools. Normal baby stools are soft and loose. Your baby may have a stool after each feeding during the first 2 months of life, especially breastfed babies. As a result, determining what is diarrhea and what is normal baby stool can sometimes be hard for parents. Diarrhea is watery stools, not just one or two loose stools during the day but several.

You should be concerned about changes such as stools that are more frequent or watery. Realize that babies stools may change as a result of the use of antibiotics or a change in diet. Additionally, if you are breastfeeding, similar changes by you, such as changes in your diet, could affect your babies stools.

As infants get older, diarrhea can be caused the infections. The most common infection is caused by rotavirus for which there is now a vaccination.

In young infants, the main concern is dehydration. If your baby is 3 months old or younger and you suspect he or she has has diarrhea, call your caregiver. Call your caregiver anytime you see pus or blood in your baby's stool or if your baby has fever and diarrhea last more than 3 days.

What To Do

Infants

Breastfed babies have stools that are more loose than formula-fed babies. If your baby is breastfed and develops diarrhea, continue to breastfeed, unless your doctor tells you to stop, and monitor their urine output closely. If your baby urinates less often than normal or you have to change fewer diapers, call your caregiver. Breast milk is more easily digested than any other fluid and can be used for mild dehydration. You can breastfeed for 5 minutes every 30 minutes. If your baby does not vomit for 2 hours go back to your regular schedule.

Guidelines for replacing fluid:

Replace any fluid lost through diarrhea or vomiting with ¼ to ½ cup or 2 to 4 oz (60 to 120 ml) of oral rehydration solution (ORS) for each diarrheal stool or vomiting episode. If there is no vomiting for 2 hours go back to your normal feeding schedule.

Older infants

Older infants can continue to eat if they want to, as long as you monitor them for signs of dehydration. Encourage older infants to continue to drink fluids even if they do not want to eat but avoid giving them large amounts of any drinks with a high sugar content, including juices and soda. The best fluids are commercially available ORSs.

Guidelines for replacing fluid:

Replace any fluid lost through diarrhea or vomiting with ORS as follows:

  • If your baby weighs 22 lb or less (10 kg or less), give him or her ¼ to ½ cup or 2 to 4 oz (60 to 120 ml) of ORS for each diarrheal stool or vomiting episode.

  • If your baby weighs more than more than 22 lb (10 kg), give him or her ½ to 1 cup or 4 to 8 oz (120 to 240 ml) of ORS for each diarrheal stool or vomiting episode.

If your baby continues to vomit even these small amounts or continues to have diarrhea in spite of treatment, contact your caregiver.

Colic

All babies experience fussiness. Fussiness that occurs for an extended period or becomes uncontrollable is referred to as colic. Babies with colic will differ in the:

  • Amount of symptoms.

  • Duration of colic.

The cause of colic is not known. Colic can occur in either breastfed or bottle-fed babies. It is usually worse in the late afternoon or evening.

Colic often happens between 3 weeks and 3 months of life and usually goes away after that time. If your baby is 3 weeks old or younger and has colic symptoms talk with your caregiver. The cause of colic is unknown, but there may be several factors involved. A baby who swallows a lot of air and does not burp easily may develop colicky symptoms. Colic also may be secondary to rapid feeding or over feeding. Sometimes a change your baby's diet, including formula, will cause him or her to have colic. Colic is not a serious medical condition. Your baby will eat, grow, and gain weight with no long term affects.

Symptoms

  • Your baby may have facial redness (flushing), arch his or her back, pull his or her arms and legs up to the belly, have a tense belly (abdomen), cry loudly with fists clenched, and generally seem irritable and fussy.

  • Usually there is no weight loss, fever, diarrhea, or vomiting.

  • Symptoms may last as long as 3 hours per day on more than 3 days of the week. Symptoms often occur at the same time of day.

  • Symptoms improve as he or she tires himself or herself out.

  • Symptoms generally begin to improve after 6 weeks.

  • If your baby is older than 3 months and symptoms continue, talk with your caregiver about other possible diagnoses.

  • Happy spitters do not benefit from medications for GERD.

What Can Be Done About Colic?

  • Be sure your baby has burped after each feeding.

  • Provide a quiet, calm place for your baby. Avoid stress and tension. Many parents find holding their baby is an effective way to comfort him or her. Gentle rocking or swinging are also effective. Singing lullabies or playing music can soothe your baby. Pacifiers allow babies to suck, which can be comforting. Place your baby on his or her tummy and rub his or her back, but do not let him or her sleep on their belly.

  • Your caregiver might recommend changing formulas. Your caregiver may want you to change from an iron-fortified formula to a plain or soy bean-based formula.

  • Colic can be very frustrating and cause extra stress on the parents. It is important to get help and support from family and friends. It is important to find counseling if necessary. Be observant. Do you notice symptoms after feeding or certain medications? Avoid overfeeding or feeding too quickly.

  • If the condition persists or if the child vomits, has a fever, diarrhea, or bloody stools, call your caregiver. Medication might sometimes be ordered in cases of severe colic.

Diaper Rash

Diaper rash is a common condition in infants. Do not become alarmed if your infant has a mild rash. You can initially treat it with over-the-counter products for rashes that are present for 3 days. If there is not any improvement after 3 days of treatment, discuss other treatment options with your caregiver.

Causes

  • Too much moisture.

  • Urine and stool are left touching the skin for a long time.

  • Infection.

  • Allergy to the diaper.

  • Diarrhea.

  • Babies begin eating solid food.

  • Antibiotic use or nursing mothers taking antibiotics.

What Can Be Done About Diaper Rash?

  • Change your baby's diapers more often.

  • Wash your baby's buttocks with warm water and mild soap after each bowel movement. Dry the skin well and be sure all of the soap is removed. Wipe your baby with water and a clean cloth after each urination.

  • Expose your baby's buttocks to air for 10 minutes many times a day or leave the diaper off during your baby's nap.

  • Avoid the use of rubber or plastic pants. These trap in moisture and can cause irritation. Sometimes the elastic band at the top of the pants causes irritation and a rash.

  • Consider changing the type of diaper you use.

  • Sometimes a baby's skin will react to various types of commercial baby wipes. Avoid using wipes that can dry the skin. Consider using a clean cloth with water or a paper towel for a time to see if this helps clear up the rash.

  • If your baby's skin is irritated, use a barrier paste-like zinc oxide or petroleum jelly on your baby's buttocks after washing it. Other ointments may also be used. However, do not use creams with steroids without your caregiver's permission.

  • Use 2 regular diapers or extra-absorbent disposable diapers at night and nap times.

If you have tried all of these suggestions and have not been successful or if your baby's rash is severe ,with sores, pus, fever, or bleeding, see your caregiver. Your baby could have an infection causing the rash. The rash should clear up with proper medication.

Constipation

Causes

  • The most common constipation in infants is functional constipation. This means there is no medical problem. In babies not yet eating solid foods, it is most often caused by a lack of fluid.

  • Older infants on solid foods can get constipated due to:

  • A lack of fluid.

  • A lack of bulk (fiber).

  • Some babies have brief constipation when switching from breast milk to formula or from formula to cow's milk.

  • Constipation can be a side effect of medicine, but this is uncommon in infants.

  • Constipation that starts at or right after birth can sometimes be a sign of problems, such as problems with the intestine or the anus.

Possible Solution:

  • Use pediatric glycerine suppositories as directed by your caregiver. You insert these gently into your infant's rectum, and often they will cause your baby to expel stool with the suppository shortly thereafter.

Do not become alarmed if your baby's stooling pattern changes as long, as he or she seems to be content. None of these remedies need to be done unless your child has gone 4 or 5 days without having a bowel movement and seems to be experiencing some abdominal pain as a result of this.

Normal stool for bottle-fed and breastfed babies often will be:

  • Mustard color or sometimes green.

  • A stain on diapers to loose, unformed, pea soup consistency.

  • Yellowish green to brownish in color.

  • Mild in odor or not unpleasant.

Green and watery stools are not always a concern in an otherwise healthy baby.

SEEK IMMEDIATE MEDICAL CARE IF:

Your baby has the following symptoms and is younger than 6 months old.

  • If diarrhea and vomiting are accompanied by other signs of infection. These signs include:

  • Pulling ears.

  • Sore throat.

  • Crying when wetting.

  • Your baby is 3 months old or younger, with a rectal temperature of 100.4° F (38° C) or higher.

  • Your baby is older than 3 months, with a rectal temperature of 102° F (38.9° C) or higher.

  • Blood or pus in the stool.

  • Vomit is forceful or projectile.

  • Your baby develops signs of dehydration with fever:

  • Sunken eyes.

  • Dry mouth.

  • Weight loss.

  • Irritability.

  • Drowsiness (lethargic).

  • Decrease in urination. If your baby does not urinate in an 8-hour to 12-hour period, contact your physician.

  • Your baby has diaper rash that will not clear up after 3 days of treatment or has sores, pus, or bleeding.

  • Your baby will not take fluids as recommended, if the vomiting or diarrhea is persistent, or if the baby seems ill.

  • Your baby has not had a bowel movement in 4 to 5 days.

  • You need help with your baby because you cannot control your baby's crying because of colic.