Identifying an infant’s cold – or other maladies

RX for Readers: If there is fever over 39º Celsius that cannot be brought down quickly with medication or tepid baths, that is a warning sign for parents.

By JUDY SIEGEL-ITZKOVICH
baby in cot 311 (photo credit: Illustrative photo)
baby in cot 311
(photo credit: Illustrative photo)
My husband and I are new immigrants from the US and parents to a six-month-old baby girl. Having never spent winter in Israel and now that the weather is turning colder, we wonder how to know the difference between a simple cold and something more serious that needs medical attention.– T. & B. S., Jerusalem
Prof. Shimon Reif, head of the pediatrics department at Dana Children’s Hospital of Tel Aviv Sourasky Medical Center, replies:
In Israel, summer infections usually involve the digestive system, due to the effect of heat on food, while in the winter, they affect respiratory systems due to colds and the flu. Cold temperatures don’t cause respiratory infections, but there is apparently some truth to what grandmothers have long said: “Cover up in the cold.” Low temperatures may weaken the immune system and make the body more susceptible to infections by viruses, bacteria and other pathogens.
Little babies are more likely to be infected because they have no antibodies against pathogens, as they have not yet been exposed to them; it takes time to develop such immune system protection. An ordinary cold or sniffle is usually accompanied by some fever, a running nose and cough. The baby has difficulty eating because of the runny nose but is generally in good health. It’s preferable to take her to the doctor to rule out anything more serious. Of course, if the condition is viral, one should never give antibiotics, which fight only bacteria.
Never give babies nose drops meant for adults – except for saline (salt) solution – because they have chemicals that constrict the blood vessels and thus are harmful for infants. Saline drops can be purchased in a pharmacy or made at home from boiled cooled water containing a little salt.
If the baby’s temperature is high and she looks miserable, it could be the flu, which can last for four or five days. Because it is viral, do not administer antibiotics. Alleviate the symptoms by reducing fever and giving the baby enough to drink. The flu passes by itself, but it is better to give babies over six months a flu vaccination in advance to prevent infection or at least greatly reduce it.
As many young children – especially those up to the age of two – get bronchiolitis in the winter, the word is becoming more familiar to parents. It is an infection of the bronchioles, the small tree-like structures in the lungs that bring oxygen to the alveoli, where the transfer of oxygen and carbon dioxide is carried out. It is a viral infection that narrows the airways (which are already thin) and can cause difficulty breathing. A baby or toddler with bronchiolitis should be under close medical supervision and will often need hospitalization to get medications that fight the infection and minimize excretions. When there are serious complications, the child may be moved to the intensive care unit for respiration, but the condition almost always clears up. Premature babies and those who have a heart or lung condition now get a preventive vaccine.
A throat infection can be caused by a virus or bacteria (such as Streptococcus). It’s difficult to tell them apart from the symptoms, but sometimes an experienced doctor can do so. A throat culture should be performed if there is any suspicion of a bacterial infection (known to Israelis as angina but having nothing to do with angina chest pains). Antibiotics are given for 10 days in this case. Strep throat is rare in infants and more common among children over the age of three years.
Pneumonia is every parent’s nightmare. If it is bacterial, it can be treated with oral antibiotics.
But when there is a high fever and the child doesn’t look well, antibiotics should be given by infusion in hospital. In nearly all cases, recovery is quick.
Meningitis is the most difficult infection, with complications that could cause permanent harm. Fortunately, there are preventive vaccines against some types of bacteria (although not all of them; but vaccines for them are currently in development). If meningitis is suspected, the baby must be taken to the hospital for a spinal tap for an examination of the spinal fluid. Antibiotics are given immediately just in case but then halted if the infection is found to be viral.
All this sounds scary, but new parents should be aware of the fact that most children go through winter without any problems. Yet it is almost inevitable that in a day care center with many children, some of them sick, they will come down with something. The most important thing is to observe the baby and his or her behavior. If the baby is apathetic and does not look well, don’t hesitate – bring him or her to the doctor immediately. Of course, if a baby has difficulty breathing and his or her color has a bluish tinge, hurry to get the child urgent medical attention.
If there is fever over 39º Celsius that cannot be brought down quickly with medication or tepid baths, that is a warning sign for parents.
But if the fever comes down with these means, assess the child’s condition to see if he or she reacts and smiles. That is a good sign.

Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538- 9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.