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with Rod Moser, PA, PhD

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Friday, March 12, 2010

Dealing with Your Infant’s Cold

To new parents, colds in infants are highly troublesome. First, they may have little or no experience dealing with colds in babies, and second…they are babies! The first cold may be the first time that parents have to make responsible medical decisions: Is it a cold? Is it allergy? Is it RSV (respiratory syncytial virus)? Should I take them to the pediatrician, emergency room, post on WebMD, or just call my mother, grandmother, or someone with more kid experience for advice?

The first cold may not be a cold at all. Babies share a blood supply with their mothers in utero. That maternal blood contains beneficial immunoglobulins – a natural pharmacy that will protect this new baby for about 5-6 months. Mothers who choose to breastfeed will protect their babies even more. Babies, with their borrowed immune system, are generally well protected until they are six months old. However, along with all of those great maternal immunities come hormones. The mother’s blood supply is flooded with hormones, like estrogen or LSH – lactation stimulation hormones. While harmless to the baby, these alien hormones cause some interesting symptoms.

Why does my baby have boobs? Maternal hormones can cause temporary breast development in babies, so new parents are often concerned about those little breast buds. If those breast buds are big or even leak breast milk, they will freak out. When Dads see their little boys with leaky breasts, they want to call 911. New parents, who have been adequately prepared for this “4th trimester”, may know this is normal. These maternal hormones can also make the baby have a very stuffy nose. So, remember: Babies with boobies often have stuffy noses (perhaps, just like their mothers).

Just the way estrogen can cause tight jeans not to fit due to premenstrual water retention, the maternal estrogen can cause the same tissue engorgement in newborn and nursing babies. Pregnant women, especially those in the third trimester, often complain that they have a constant cold…or allergy, that is making them very congested and miserable. Those symptoms are made worse since they are unable to take most cold medicines. These symptoms may not be a cold either, but merely this flood of hormones. It is these same hormones that are transferred through the umbilical cord to the baby. Since estrogen is chemically bound to fat, and babies tend to have a lot of fat, those hormones can stick around for a few months.

A baby with just nasal congestion probably does not have a cold. A short time ago, they were floating in water (amniotic fluid) and hanging upside down. If they had a stuffy nose, no one would know…it was filled with fluid anyway. When a child is born, they emerge into a dry world; a world that can dry out those mucous membranes. There new world is also filled with germs.

Babies do get colds (sometime). Since mothers can certainly get colds, so their babies can get colds, too. I have a theory that the cuter the baby, the more likely they are to get cuddled and kissed, thus getting more colds from admiring siblings, friends and relatives. Mothers like it when I tell them that their child has a cold because they are too cute. Of course, funny-looking babies (and I see a lot of those) get colds, too. I don’t openly identify those FLKs (funny-looking kids) to their parents, mostly since the parents may be FLAs!

New parents are sticklers for hygiene. They wash their hands and everything that touches the baby. A pacifier drops on the floor and it is treated like toxic waste, and a new, sterilized one is popped in their mouths. If they also have a snotty-nosed, two-year old at home anxious to hold their new little brother or sister, there is a hygiene dilemma. You can wash their hands, change their clothing, but there is really no way to adequately sanitize a two-year old.

Can a day-care toddler touch the baby? Sure, why not. The baby has eventually get those germs in order to jump-start their own immune system, so why not from a loving sibling? Germs are often the only thing that siblings openly share. I am not suggesting that you take the newborn to visit ill people or kids, but viral exposure is really inevitable – expect it. If parents put kids in day-care at an early age, they will most likely be over-exposed to lots of viruses…from lots of different cohorts. In those babies, expect colds to come early and often.

My six month old has a bad cold! Right on schedule; almost like clockwork, colds start to develop. The maternal immunity has waned and now, vulnerable baby must make their own t-cells – build their own immunity.

The first sign of a real cold may be a fever. Any fever in a two month old baby is often concerning, but a fever in a six month old is expected. As a matter of fact, this is a normal, immune response and should not be feared. I can preach that fever is beneficial and should be left alone all day, but it often meets deaf ears. New parents do not like fevers one bit. To a new parent, any triple digit reading (100) causes sphincters to tighten and anxiety levels to rise. If a parent has two children, they can often tolerate 102 before going nuts. If they have three or four children, they can handle 104 easily. If they have the experiences of more than five children, parents will not be too concerned unless they are actually smoldering or on fire.

I let parents treat fever if they want. It makes them feel better, and since fevers can make a baby feel yucky, too, it makes the child feel better. I just warn them about over-treating a fever. Acetaminophen (Tylenol) can be easily overdosed. Ibuprofen (Advil, Motrin) is safe at recommended doses for children over six months, but there is little or no evidence to support the benefit of alternating acetaminophen and ibuprofen. I usually suggest that they just pick one, and be careful to give the correct dosage, based on changing weights.

What cold medicines can I give the baby? The easy answer – none. Not only have cold medicines been found to be ineffective, they have the potential to make things worse. Over-dosages of potent decongestants, antihistamines, and cough medications were common, so the new recommendation is to withhold giving any medications to a child under the age of six YEARS. Of course, cold symptoms can be treated with non-medicines.

A stuffy, congested nose can be miserable. Parents can liquefy this mucous (medical term for snot) by saline nasal sprays or drops, maintaining adequate hydration, and by using a cool mist humidifier. Less-visco
us snot is easier for the baby to naturally swallow than Velcro-like, sticky snot. (Gross, huh?).

Babies cannot blow their own noses. They can exert a powerful sneeze, and blow snot all over the place, but it takes years of practice to get a kid to properly blow their noses. This is where the infamous nasal aspirator – the bulb syringe – the much-feared nose sucker – comes in. The kids typically hate it, but it is very helpful to clean out snotty noses.

My technique: Loosen the snot first, if it is not already very wet. Instill a drop or two of saline in each side of the nose and let it marinate for a minute or so. Then, quickly close off one nostril with your finger, while aspirating the open side with a fully-compressed bulb syringe. Avoid touching the sensitive nasal septum if you can. Repeat on the opposite nostril. Babies are primarily-nose breathers, so do this rapidly. Finally, put another drop of saline in each nostril and leave it there. They will sniff it back and loosen the mucous you were not able to aspirate. If you do this routinely before nursing or feeding the baby a bottle, they will start to associate getting their nose sucked out with getting something to eat. They will also nurse better with a snot-free nose.

The color of snot, even if fluorescent green or canary yellow, is not medically-relevant in most cases, but parents often feel that colored snot is a definitive sign of a bacterial infection needing antibiotics. It is (s)not. There may be bacteria in the snot, but green snot does not mean the child has a sinus infection or pneumonia. In kids, the sinuses are anatomically small and much less-likely to become infected than adult sinuses, but it can happen, so having the child properly examined if green mucous persists more than 7-10 days is appropriate.

Cool mist or warm steam? Either one is fine, as long as you are careful. A cool mist humidifier does not need to be in close proximity to be effective – blown in their little faces to the point that moss is growing on their north sides. Humidifier can also grow mold, so they need to be inspected and cleaned often. Steam vaporizers can burn curious little hands or feet sticking out of crib slats, so extra, extra caution should be exercised, so kids do not pull boiling water on themselves. And, just use water. Mentholated additives or aromatic oils may smell good to caring grandmothers, but they are not particularly helpful. They can even be harmful for babies with some respiratory complications reported.

Be gentle with those tissues. Little noses are sensitive to repeated wiping. You are not stripping wax from a kitchen floor – you are wiping a nose. Be gentle and watch for increasing irritation under the nose. A topical antibacterial ointment or plain Vaseline can be used to protect the skin.

The baby coughs all night! If mucous or other liquids are clogging our airway, we must cough. Generally, this is a good thing. When people are supine – completely flat – mucous can become trapped. Safely elevating the sleeping surface may allow gravity to assist the drainage efforts. Teething babies and children tend to cough more often, since excess saliva is also completing with post-nasal drainage. Suppressing a cough with medication is really indicated, but there will be frequent nights where children (and parents) will not be quietly resting. A seal-like, barky cough may be a sign of croup or bronchiolitis. Rapid, shallow, difficult respirations, especially where children are retracting their chest muscles or using their abdominal muscles to assist breathing, may be a serious sign and should be brought to the immediate attention of a medical provider. Wheezing – a high-pitched sound – is a sign of a reactive airway, perhaps due to pneumonia, influenza, or asthma, and is another cause for concern.

How do you, as an adult, feel when you have a bad cold? You feel like crap. You may have body aches, headaches, or nausea. You do not want to eat. You are crabby and just want to sleep/rest. Your children feel the same way. If a little ibuprofen or acetaminophen makes these symptoms a bit more tolerable while Nature orchestrates the cure, then by all mean, use it. There is nothing wrong about feeling better.

Each cold helps build our immune system, just like vaccines. Colds can be miserable and untimely, but for the most part, they are harmless. Colds are incurable, but the symptoms are treatable….without drugs. There are no miracle cures, magic herbs, or vitamin supplements that have proven to be efficacious. The use of probiotics may show some promise, but more studies are needed. Vaccines against cold viruses are in the works, but don’t expect them anytime soon. So far, viruses have proven to be more tenacious than the researchers.

Comment on this blog post and ask your questions on the Cold and Flu Exchange.

Posted by: Rod Moser, PA, PhD at 7:58 am

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