by S. Todd Stolp MD
©October 2008
One of the great joys of being present at the delivery of a newborn is witnessing what ensues immediately thereafter, at the head of the delivery bed. The quiet moments during which mother and father carefully study this new creature are inspiring. Almost unconsciously, an inventory is completed during which parents fill their cerebral file cabinet with images of the infant – blinking eyes, pointy head, pouty lips, groping fingers and all. As the next hours, days and years pass, mother and father become familiar with every sound and facial expression emitted by their child, thus preparing them perfectly for the responsibility of recognizing when important needs arise, such as deficiencies of sleep or excesses of sewage. Any variation from what has been established as “normal” behavior becomes cause for parental investigation. The most common cause for parental anxiety and unscheduled visits to clinics at this point in an infant’s life is a respiratory infection, begging the question, “when is an infection more than a common cold?”
There are a number of viruses which are regular visitors to our respiratory tracts throughout the year, going by such family names as adenovirus, enterovirus and rhinovirus. The most famous virus is, of course, the influenza virus which prefers to visit during the winter months.
During the first year of life, there is evidence that most infants experience nine different respiratory infections. Each virus has a different method of tying itself to the dock at it’s preferred port-of-entry. Once in port, the virus enters the cells lining our nose, throat or lower airway. The virus then begins duplicating itself and causing general havoc, not unlike pirates who have been too long at sea. Some viruses are able to travel deeper into the respiratory tract where they may disrupt general operations.
Shortly after irritation develops, our bodies respond with an outpouring of mucous in an effort to wash away the troublemakers and, presumably, to assist the soldiers of our immune system as they confront the infection. Thus, the production of yellow or green mucous is a common development. At this point, an elevated temperature is often noted.
There are two signs that may indicate a need for a clinic visit for an infant with a respiratory infection. One is a disruption of the job of the respiratory machinery, usually resulting in shortness of breath, excessive irritability or an unwillingness to eat. The second sign is a fever.
A fever is an elevated temperature. According to the American Academy of Pediatrics, pediatricians the official threshold for what constitutes a fever is above 100.4°. Body temperature will typically vary from 97° to 100.4° F during the day, a little higher in the afternoon. People should not use mercury thermometers any more because of concern for the toxicity of mercury, and because new digital thermometers used properly are quite accurate.
Temperatures should be taken for infants under 3 months of age with a rectal thermometer by placing the thermometer ½ to one inch into the anus for one minute, or until the thermometer beeps. Any temperature over 100.4° in an infant under three months should be reported to your health care provider. For children three months to three years of age, a temperature may be taken under the arm (axillary temperature) or in the rectum, but it should be remembered that axillary temperatures are not nearly as accurate (they tend to be at least one degree lower). Beginning at fours years of age, you may instead take a child’s temperature under the tongue (an “oral” temperature).
New ear thermometers (“tympanic” thermometers) may also be used, although they are a little trickier and some children with ear wax may not show an accurate temperature. For infants or children with symptoms like shortness of breath or significant irritability you should always use the most accurate method to take their temperatures.
The small airways of an infant do not need to accumulate much mucous to create an impressive amount of racket. Thus, after first noting that the little one appears irritable and may not be eating quite normally, snorting, sputtering and sneezing often becomes a full time occupation. Talk to your pediatrician about how to manage such congestion, but be aware that cough medicines or so-called “cough suppressants” are not to be used for infants these days.
Finally, be aware that antibiotics are not often necessary for common upper respiratory infections in the pediatric population. In addition to vaccinations, there are many alternatives that your health care provider can suggest which will do just as well to return your little one to his/her usually entertaining self in a matter of a week or so.