13 Nov My Baby is Sick…Checklist

Dr Sam Tormey provides a simple Checklist to look at the signs of sickness in infants.

There is a very simple checklist of the basic life functions of a baby to run through when illness strikes: is the baby breathing, sleeping, playing, feeding, weeing and pooing as he or she usually does? These six things are reliable indicators of how well a baby is coping with an illness. A doctor or nurse will want to know how each one has changed.

Here are a few specific situations when you should always seek medical help:

• If your baby is less than four weeks old and becomes unwell or refuses more than two feeds in a row.
• If your baby is listless, difficult to wake or floppy.
• If your baby has rapid or noisy breathing that is getting worse.
• If your baby is less than three months old and has a fever higher than 38ºC.
• If, for babies older than three months, a fever higher than 38.5ºC will not come down with simple treatment or is accompanied by uncontrollable shivering or mottled skin.
• If your baby has other symptoms such as fever, vomiting or diarrhoea and has had no wet nappies for more than six hours (you can allow a little longer for babies older then six months).
• If your baby has bloody diarrhoea.
• If your baby will not stop screaming, despite the usual consoling measures.
• If your baby is sick and develops a reddish/purple rash that will not blanch briefly to white with pressure from a finger.

Where To Seek Help

It is becoming less common for GPs and emergency departments to offer a phone advice service. Seeking help usually means a trip to the hospital or the medical centre. Some State Governments have recognised this trend and have set up telephone advice services, which can be very useful.

If your baby is less than four weeks old, the maternity unit where the baby was delivered is usually happy to offer advice.

Always remember that an ambulance is available. It is never a good idea to rush a baby into hospital by car. Ambulances carry all the necessary equipment to start treatment and, if the situation is desperate, the operator can give you crucial instructions over the phone.

If your baby is sick but you don’t think there is a need for immediate attention, there are several simple things you can do at home:

• Babies with blocked noses can have difficulties feeding. The mucus can sometimes be cleared by dropping some breast milk, water or saline drops into the nostrils – ideally inducing a good sneeze.
• There are several ways to get more fluid into a baby when required. Smaller, more frequent feeds are more likely to be absorbed by a baby with vomiting or diarrhoea. There are specific rehydration solutions which come as powders or ice-blocks. These are very useful for sicker babies, but initially it is worth persisting with what the baby usually drinks. If breastfed, try shorter, more frequent breastfeeds. If your baby is bottle-fed, the same applies, but add more water than usual to the formula to make it more dilute. Half-strength formula is perfectly acceptable for a day or so. Similarly, with juices and cordials, make them about a third as strong as usual by adding extra water. Plain water is also acceptable as long as it is in addition to milk or juice. Cool fluids and soft foods can soothe sore throats. Fluids can be gently syringed in small quantities into the mouth of a baby who is reluctant to drink. Carbonated soft drinks are dreadful and should be totally avoided in babies and young children.
• Fevers are very uncomfortable for infants and should be treated immediately. However, you do not need to reach straight for the drugs. Try a lukewarm bath, sponging down the baby’s skin. Avoid rugging up babies when they have a fever. Fewer clothes will help bring the fever down and cool fluids such as juice or water can help.
• Simple drugs such as paracetamol and ibuprofen are extremely safe and effective in babies (infants should be over one month old to take paracetamol and six months old for ibuprofen). In my experience, they are generally underused rather than overused. Remember that they are useful for pain as well as fever. Paracetamol suppositories are very effective for hot babies who are vomiting. These drugs should brighten up the sick baby for a while. If they are ineffective in reducing fever and other symptoms, this can be a sign of a serious illness. Always follow the instructions closely and do not give any other medications (including alternative medicines) to your baby without medical advice. Never give aspirin to a baby or child.

NOTE: This advice refers to babies who are usually well. If your baby was born significantly early or has a diagnosed condition such as a heart abnormality, or a chronic illness such as cystic fibrosis, then more vigilance is necessary in the case of an acute illness. All ages are assumed to be ‘corrected age’.

For Further Information:

Sydney

The Children’s Hospital at Westmead – Fact Sheet

Westmead Kids Health (health promotion and book shop) telephone line: 9845 3585

Tresillian Family Care Centres

Tresillian Parent Advice (from 7am)  1300 272 736

Karitane For parenting advice – Careline 1300 CARING or 9794 2350 and speak with one of the experienced Child and Family Health Nurses.

Melbourne

Royal Children’s Hospital – Fact Sheets

Maternal and Child Health Line – 24-hour telephone service  13 22 29

Brisbane

Queensland Health/Smart Service Queensland • 24•hour health advisory service: 13 74 68

Canberra

Health Direct 24-hour helpline 1800 022 222

Tresillian Parent Advice (from 7am)  1300 272 736

Adelaide

Child and Youth Health Parent Helpline (24/7)  1300 364 100

Perth

Health Direct  24-hour helpline 1800 022 222

Dr Sam Tormey is a doctor who writes on medical issues. For further advice, see our My Baby is Sick…

Note: This article provides general health information and in no way constitutes medical advice. Ideas and information expressed may not be suitable for everyone. Readers wishing to obtain medical advice should contact their own doctor.