The Diseases and Disorders that Afflict Infants
Your new-born baby comes to an alien atmosphere for which it is not accustomed since so far it has been in your womb. It is, then, natural for it to feel discomfited. Breasts, milk, water, air, the environment, etc. could be a source of its unexpressed discomfort. Every mother should recognize this as common and natural and should, therefore, minister to the needs of the child with intelligence, courage, and caution. Since no two children have identical mental, physical or emotional makeup even in the cases of the identical twins, also-she has to take care of every child individually. Many a time overlooking the child, these needs give rise to various disorders. We shall be discussing the common ailments and disorders which afflict child in infancy.
Some babies suffer from retching and vomiting within a few days of birth. Even breast milk does not seem to agree with them, being regurgitated or vomited out. The main reason in such cases is usually the ingestion of the amniotic fluid, which has remained in the baby’s system. This is not a serious matter, and gradually the vomiting will subside. If necessary, the baby should be taken to a pediatrician to get the excess fluids drawn out of the stomach.
If the child shows a tendency to vomit just after feeding, the reason is probably a faulty method of feeding it, resulting in air being drawn into the stomach along with the milk. The child should be held comfortably in the lap and given milk with a small clean spoon. After giving it milk, the child should be placed with its belly resting against the chest and its head on the shoulder of the mother and should be thumped lightly on the back, so that it burps out the air. If it is convenient, the child can be laid on its belly in bed and induced to burp in the same manner. Bottle-fed babies are much more likely to swallow air, and should invariably be treated as above after every fed. Sometimes a mouthful of milk or curdy liquid is regurgitated along with the air, but there is no need to worry about that.
Vomiting for such reasons is common and will reduce in frequency as the baby grows older. But the mother should remain vigilant. If vomiting is too frequent or excessive, or if the vomit liquids change their colour to green or yellow or have blood in them, or if vomiting is accompanied by distention of the stomach due to an accumulation of gas in the stomach-called flatulence-or if the baby stops passing stools or wind but continues to vomit, the condition must be regarded as serious and the advice of a qualified doctor should be sought. One of the possible reasons for such a condition could be an obstruction in the intestine, or in the esophagus.
However, occasional vomiting should not be taken so seriously if it is not excessive. If your baby sleeps well, gains in weight and has no apparent symptoms of constipation and flatulence the vomiting should not cause any alarm. The doctor should be consulted only when vomiting is excessive or the baby’s palate appears swollen or he continues to vomit intermittently and refuses feeds.
Within twenty-four hours of its birth, the baby starts passing stools. The first stool is viscous and invariably blackish. In case the baby is healthy and feeding normally his stools will change color from black to dark green to brown or yellow. A two days or three days old baby may pass stool six or seven times a day. If the child feeds normally, urinates freely and no untoward signs appear, this frequency of passing stools need not be regarded as worry causing and hence no treatment is called for. The frequency should reduce in one or two weeks to three to four times a day. Defaecation just before or after feeding is considered quite normal.
However, if puking and diarrhea are due to some infection, then vomiting is likely to be accompanied by this watery stools, the stomach will be distended, the amount of urine will decrease and the baby would be averse to feed. Its temperature may rise or fall drastically. The infection’s symptoms are the child’s becoming lethargic, its eyes sulking into their sockets and the crown of its head may develop a depression. Then the doctor should be consulted at once or the child should be hospitalized.
Household Remedy: Give the child plenty of previously boiled water with sugar, soda bicarb, and some salt in the following way.
(1) A glass of water (about 200 c).
(2) Two teaspoonfuls of sugar.
(3) One teaspoonful of salt.
(4) Juice of half a lemon.
(5) Half a teaspoonful of soda bicarb (cooking soda).
Frequent administration of this solution will save the baby from dehydration.
For preventing such infections, the following precautionary measures must be taken :
(1) As far as possible the baby must be fed exclusively on breast milk.
(2) The ingredients used in the first medicinal drink traditionally given to the baby just after birth (i.e. the ‘galthuthi’) should be pure.
(3) The baby should always be given water that has been previously boiled and cooled and kept well covered.
(4) In no circumstances should dirty vessels, cloth or cottonwool be used for giving milk or water to the baby.
There can be other causes of vomiting and diarrhea, such as the natural constitution of the baby, inefficient digestion, emotional disturbances etc. In such cases, ordinary medication will not be of help. The expert advice of specialists should be sought.
Even healthy babies pass stool only on alternate days or even three days or so. This is normal and should not cause any concern if the baby does not show any worry causing signs of indisposition, such as vomiting, distension of the stomach, a tendency to cry unceasingly, lack of sleep or disinclination to feed at the breast, etc. But if the baby fails to defaecate within the first 24 hours after birth, it is advisable to get it ascertained that there is no defect in the anal opening, and treatment initiated as directed by the doctor. The notion that the bowels of the baby should invariably move once a day is not justified. No purgatives such as castor oil should be administered to the baby under any circumstances. Sometimes simply giving it a drink of warm water with a little sugar is sufficient to induce a bowel movement.
(iv) Enlarged Breasts:
Some babies on birth have their breasts enlarged, both of boys and girls or they have the breasts enlarged when the babies are three to four days old. A liquid resembling milk may be exuded on pressing the breasts. But the swelling subsides in ten to fifteen days, and the breasts revert to normal. No special treatment is necessary, and there is no cause for worry. In fact frequent testing of the swelling by pressing the breasts, expressing the milky fluid, massage or fomentation may cause harm to the baby. Let the condition subside in the natural course.
(v) Vaginal Bleeding:
Sometimes there is a small amount of bleeding from the vagina of a girl baby in the first two weeks. This is a rare but natural occurrence, not a symptom of a disease or a serious disorder. It stops spontaneously in three or four days. No medication and no other treatment is needed. Of course, the mother should have the patience and the strength of will to refrain from undue worry and quack remedied. If the discharge persists longer, see a doctor.
(vi) Skin Troubles:
Many babies have red spots or rashes appearing on their skin in a day or two after birth. These cover the entire body of the baby. Mostly these spots disappear spontaneously in two or three days without any treatment. The skin of a baby born later than full-term may temporarily dry up. This is another condition that corrects itself spontaneously. Some area of the skin on the hips and buttocks of the baby may turn bluish in colour, but they will revert with time to the natural colour without any medication. Furuncles may develop on the head of the baby, and also on the throat, in the armpits, and such other places, where there are folds in the skin. The furuncles fill with colourless fluid. Keeping the affected areas clean, washing them with carbolic or a mild disinfectant like Dettol will be enough to get rid of them. In case they persist then a specified ointment should be obtained and applied to them after consulting the doctor.
(vii) Loss of Hair:
In some cases the few hairs on the head of the new-born baby are sometimes shed completely, leaving the skin of the head bald. This is only a temporary condition as the hair will soon grow and hence should cause no alarm.
Tremor or trembling may be seen in some baby’s case-their hands or legs may start to tremble rather uncontrollably and all of a sudden. This often happens mostly when the baby is started into wakefulness from deep sleep. They may also stop equally suddenly. Such trembling is not a form of convulsions or spasms. (If the trembling movement is really a mild attack of convulsions, it would be accompanied by other signs. Its eyes become fixed, the eyeballs turn up, the baby stops playing or feeding.) Generally, it is only underweight babies that are subject to such attacks of tremor. At such times the baby should be given more breast milk than usual or boiled water with sugar.
(ix) Disorders of the Eyes and Ears:
Small flecks of blood or thin irregular red lines are seen on the sclerae (whites of the eyes) of new-born babies in some cases. These disappear spontaneously in course of time and do not need any treatment. In other cases, if good hygienic conditions have not been maintained at the time of birth, the eyes of the baby may become infected. The effects of the infection, such as reddening of the eyes, the formation of rheum in the eyes with consequent sticking of the eyelids, copious watering of the eyes, etc., may persist for two or three days. The condition should be treated with sulfacetamide eye-drops or other similar and eye-drops, applied every two to three hours. The eyes should be cleaned with cotton, using a different wad of cotton for each eye. There is no need of applying kajal (carbon black with ghee) to the eyes. In some cases, the eyes of the baby keep watering constantly. Occasionally only one eye is affected. In such cases, a doctor must be consulted. Conjunctivitis, or reddening of the eyes, should be treated by washing the eyes with the warm boric acid solution and applying an ointment or eye-drops as prescribed by the doctor.
(x) Abnormalities of the Skull and Head:
Lump-like swellings sometimes appear above the ears in the head of a baby. This is due to local coagulation of blood. The mother gets anxious about these lumps, but this is not a serious or harmful condition in any way. Do not massage or press these lumps, and do not apply any ointments. And there is no need to go running to a doctor to get the coagulated blood let out by an incision.
The heads of many new-born babies are misshapen, and the areas around the eyes appear swollen. This is the result of pressure exerted on the head of the baby as it passed through the vagina at the time of its birth if the passage was a little too narrow for its head. The shape will gradually change back to normal in a few days. But if the mother wishes, she can apply light pressure on appropriate parts of the head at the time of bathing the baby to hasten the process.
(xi) Disorders of the Mouth:
White furuncles (vesicles) sometimes appear in the mouth, or the gums, and perhaps covering two sides of the palate as well. These are not painful. The child experiences no difficulty in feeding normally. The furuncles gradually subside without any treatment. But if there is an ulcer in the mouth of the baby, suckling and swallowing become difficult. This is due to a kind of infection. The condition should be treated by the application of an oral antiseptic, such as the commonly used ‘blue solution’. But a doctor should also be consulted.
(xii) The Excessive Tendency to Cry:
For the period of a few days after birth, some babies sleep peacefully during the day, but begin to cry steadily at night, and cannot be pacified or quietened by any means. The parents and other members of the family are completely at a loss as to what they can do to help it, and so are greatly perplexed. Such incessant crying may be due to a number of reasons: the baby may be hungry or thirsty, it may have difficulty in passing stool or urine, it may have wetted its clothes, or it may be suffering from gas in the stomach. Or it may be crying for an entirely different reason, such as pain in the ears due to suppuration. If it feels better when laid face down in bed, the presumption would be that it is suffering from colic. If giving it water, feeding it, changing its clothes, laying it on its belly or picking it up and carrying it about does not quieten it, you should consult a doctor.
(xiv) The Tendency of Over-Sleeping:
Some babies keep on sleeping twenty-four to forty-eight hours after birth. They have to be woken up at intervals to be fed. Even then they may swallow a couple of mouthfuls of milk and promptly go back to sleep. However, such tendency is natural if not usual, and there is no cause to worry. But if a baby that has normally not been very sleepy in the beginning and begins to sleep rather excessively after a few weeks or a few months and shows the disinclination for breast milk or other types of milk, the condition may be indicative of a serious disorder warranting immediate consultation with the doctor.
(xiv) Suppuration in the Umbilicus:
Secretion of exudation of sticky fluids from the umbilicus of a baby is a natural occurrence. Occasionally pus is also exuded and suppuration sets in. The umbilicus and the surrounding area becomes red due to inflammation. To protect the baby from infection of the umbilicus, the baby should always be wrapped up in clean clothes, and the umbilicus kept clean and dry. If possible, clean the umbilicus with the spirit or eau de cologne twice a day. If in spite of all these precautions, the umbilicus does get infected, it should be cleaned with spirit, and antiseptic powder like Neosporin or an antiseptic liquid or ointment such as savlon should be applied. If the infection seems to be serious, a doctor should be consulted. If timely and efficacious treatment is not given in such cases, the infection may spread to other regions of the body. In case the infection reaches the brain, the whole body will be affected. Such a condition can obviously have very serious consequences, affecting the functions of the brain adversely, and even causing the death of the baby in the span of a few days. Infection of the umbilicus is largely responsible for many cases of tetanus.
In view of the possibility of such grave consequences, the umbilicus should be sedulously taken care of, treatment by a doctor being availed of whenever necessary. The umbilicus is especially vulnerable to infection for a few days after the umbilical cord has been shed, so close attention should be paid to it during that period. Dressings of savlon can be applied with advantage.
(xv) Other Serious Infections:
Lack of care in observing hygienic requirements in feeding the baby or while giving it water often cause white deposits on the tongue, palate and the gullet. Attempts at scrapping out deposit usually result in bleeding. The baby, consequently, cannot be fed properly and so it becomes weak. Its resistance diminishes, rendering it susceptible to other infection as well. One of the common consequences of such infection is ulceration in the baby’s month, warranting the doctor’s consultation.
Some of the serious infections cause symptoms that may vary from case to case and from time to time. Some babies keep lying listlessly without moving their arms and legs. In any such case, the doctor needs to be consulted immediately.
We have already hinted about physiological jaundice in the infant’s case. Nearly 30% of newly born babies develop jaundice. This jaundice differs greatly from jaundice that affects grown-up persons. The causes, consequences, and treatment of both the type of jaundice also differ greatly.
Infantile jaundice begins to manifest itself some three to seven days from birth. The red blood corpuscles (RBCs) of the baby, when it is resident in the uterus as a fetus, differ from the normal RBCs. After the baby is born, these cells break down and release a yellowish pigment. This pigment has to be removed by the liver. But the liver functions of the new-born baby are not yet fully developed or mature enough to carry out this task efficiently. As a result, the pigment accumulates in the blood, causing the symptoms of jaundice to appear. This kind of jaundice is normal and harmless. It needs no medication or other treatment. But it is difficult to detect it, as the skin of the newly born baby is usually bright pink. If the skin of the face or nose of the baby is pressed slightly, the yellow coloration characteristic of jaundice can be detected more easily. Moreover, the eyes of the baby remain closed for a few days after birth, and that, too, makes it difficult to detect jaundice. It would be advisable to example the baby in broad daylight to determine whether the baby has jaundice.
As jaundice develops, its effects become discernible on the face, abdomen, arms, legs, palm etc. and later on all over the body. If the yellow colour can be seen on the abdomen, the disease can be said to have developed to a considerable extent. If the palms and the soles of the feet also appear yellow, the condition of the baby is adjudged to be very serious, and it should be immediately hospitalized.
Normally the jaundice of the newly born does not require such treatment, because it gets cured quickly in a few days as the liver becomes more efficient. If jaundice persists for fifteen to twenty days in the case of the baby relatively weak in health or it is a premature child or if on testing its blood the amount of ‘bilirubin’ in the serum is found to be greater than 2 mg, treatment becomes essential. In order to ascertain whether there is the probability of such a serious type of jaundice, the blood of the mother-to-be ought to be tested before the delivery and an opinion of the expert doctor must be obtained. In such cases, the delivery’s venue must be a hospital.
Causes of Jaundice (Infantile)
(1) If the mother-to-be contracts certain infections during her pregnancy, the baby may develop jaundice at birth or immediately afterward.
(2) If certain drugs have been given to the mother-to-be in excessive amounts, the baby may develop jaundice in 8 to 10 days after birth, as a consequence of a congenital defect of the liver due to the damage caused by the drugs. The baby may also suffer from thyroid deficiency and may be abnormally susceptible to infections.
However, in cases of acute jaundice, it is essential to consult a doctor and institute treatment well in time. If there is a delay, the brain of the baby may be affected adversely; the baby may have spasms, may go into a coma, and in the absence of timely intervention, even death may occur. Even if the child survives, the long-range effects of the disease may include mental retardation, deafness and speech impediments.
(xvii)Spasms or Convulsions:
It is not uncommon for a newborn baby to suffer from spasms or convulsions, but it must be borne in mind that they can have serious consequences. The spasms of a new-born baby differ from those that older children have: the eye-balls turn up, and the arms and legs make sudden, irregular and violent movements because of irregular tensing of muscles.
Spasms or convulsions in a new-born baby are mainly due to some injury to its head during delivery. If the baby fails to start breathing and crying immediately after birth, it suffocates. As a result, the supply of oxygen to the brain is cut off. The effects of the damage caused to the brain by even a temporary break in oxygen supply may become apparent-immediately, or after a long period,- in the form of convulsions. If the percentage of glucose in the blood of a baby that is born weak gets reduced for some reason, the brain may be affected in a similar way, resulting in convulsions. This is most likely to happen on the second or third day after birth.
There are also other reasons for spasms in babies such as dehydration due to vomiting and diarrhea or inadequate intake of water and salts because the baby has lost its desire for feeding, owing to some sickness or infection. If the blood groups of the mother and the baby are different, the baby may develop severe jaundice, which also affects the brain in a similar way, causing convulsions. Damage to the brain caused by any of these factors, as indicated earlier, may result in mental retardation and other defects like deafness, paralysis, etc.
The spasms of the baby, if they are due to ordinary and transient causes, are likely to be cured spontaneously in a few days. But it is always advisable to consult a doctor in cases of spasms and convulsions, to ensure that there are no untoward consequences.
(xviii) Retention of urine, or difficulty in passing urine:
Failure of the baby to pass urine within 48 hours of its birth should be viewed as a serious matter, and a pediatrician should be consulted in such a case. In summer, the requirements of the baby for water increase. Previously boiled and cooled water should, therefore, be given frequently to the baby in sufficient quantity to obviate any difficulty in passing urine. If the baby gets abundant supplies of breast milk, it will need fewer additional drinks of water. Some babies experience discomfort while passing urine, and have to exert themselves in the act. This may result in a burning sensation in the urinary organs, making the baby cry. In such a case, gently lifting the skin around the urinary outlet and releasing it a few times may ameliorate the condition a little. But sometimes a minor operation any become necessary, so a doctor should be consulted.
In all cases of difficulty in passing urine, drinking plenty of water is beneficial.
In infants’ case, there can be many reasons for fevers. When the temperature of the atmosphere rises above 33 ° C, the body temperature of many babies, especially those that have been born prematurely, tends to rise. This kind of fever begins to subside as the external temperature goes down, and at night, the temperature reverts to normal. Such type of fevers don’t last for more than three to four days and have no adverse effects on the baby’s general health. The baby remains normally alert and continues to feed normally. No treatment is called for such a fever.
If, however, fever is accompanied by vomiting, diarrhea, labored breathing, swelling of the palate or such other symptoms, a doctor should be consulted immediately. Mean which the baby should be given, pure water, the temperature of the environment must be reduced, and if necessary wet cold compresses should be placed on the head.
There is one more febrile condition which is very serious. If there is a sudden and large drop in the baby’s temperature, the baby should be wrapped in warm clothing and a doctor should be consulted immediately.
There are other types of fevers that affect the infants which are briefly described below:
- (a) Colds:
What is “only a cold” in an adult may develop into bronchitis or pneumonia in a child. A cold sometimes may cause running of ear accompanied by ear-ache and diarrhea with green stool in early infancy. This common cold is caught by the infant from adults kissing the child out of affection. The kissing of the child by one who has tuberculosis may produce tuberculosis, which is called a “primary complex” in the early phases of infancy. General treatment for ‘cold’ in infants is making the baby rest in bed. The room temperature is to be maintained in between 20 to 25 °C. The baby should not sleep directly under a running fan. Due to the stuffy nose, the child may become breathless and may not be able to breathe easily-so it may cry frequently. If the child is older let him breathe some steam so that it may loosen the mucus. You can use some nasal drops for decongestion.
- (b) Pneumonia:
This is a very serious disease in an infant. As previously stated, even a cold in a newborn child is as serious as pneumonia in an adult. Pneumonia may develop after a cold, whooping cough, measles or other infections or by itself. The child may have fever, cough, and difficulty in breathing. The child has convulsions and high fever. In this case, the baby should be immediately hospitalized.
- (c) Measles (Including German Measles):
Measles is a more serious disease in young children than in older ones. It is very contagious. The spread is through the nose and mouth of an infected person or child. This is not infectious in the first week before the first rash appears and later for about a week. The disease usually develops in seven to 14 days. The symptoms are fever, cough, watery eyes, running nose and general fatigue. The rash appears three to four days after the beginning of the symptoms with high fever. The rash is irregular and begins to appear on the body from top to bottom. Small bluish spots (Koplick’s spots) from inside and appear early before the rash appears. Though the disease may pass on without any complication, it may be a serious disorder in infants if the baby develops other complication like pneumonia, prolonged fever, ear discharge etc. If an unexplained fever follows for sometime after this disease you should also look for early tuberculosis (primary complex) in the child as this disease is a trigger point to promote that disease. The injections that the doctors normally prescribe for prevention of measles are Measles serum and Injection of Immune Globulin.
German Measles or Three-Day Measles is not is the serious disease. Complications are very rare but the disease is very contagious. The rash may look like that of the measles but redness appears in 24 to 36 hours of illness unlike the measles, which took four to five days with the high fever. The rash is often the first and may be the only sign of illness. The glands of the neck are enlarged. There is no specific treatment except relieving the symptoms.
The importance of German measles lies in the dangerous to the growing fetus when the pregnant woman gets it. If a pregnant woman gets it in the early months of pregnancy the new-born is likely to get many types of congenital anomalies.
- (d) A Whooping Cough:
This is called whooping cough because the child has an unproductive cough running into a prolonged spasm and ending in a whoop i.e. indrawing of the air producing a whooping sound. This is caused by whooping cough organisms, hemophilia pertussis. The disease may affect a baby even if it is only a few days’ old, especially if other children in the house are suffering from the same disease. As in diphtheria, the triple antigen is the cure-which produces antibodies that protect against this disease.
- (e) Meningitis And Encephalitis:
Meningitis is a serious infection or disease that inflames the covering of the brain. It can be caused by a variety of germs like meningococcus, influenza bacillus, staphylococcus etc. The early symptoms of meningitis are abrupt fever and the baby’s not taking feeds. Sometimes if the child is too young there may not be even fever. If the child is too sleepy and drowsy and is not taking the feeds, one must immediately consult the doctor. In slightly higher age groups, fever, headache, and stiffness of the neck are noted. If there are fever and convulsions, the doctor must be immediately consulted.
Sometimes virus infections may also cause brain fever, that is encephalitis. This sets suddenly in an apparently healthy higher age group child, with high fever, vomiting, and convulsions. The child must immediately be taken to the doctor or to a nearby hospital. There are many new methods of treatment both for meningitis and encephalitis, with greater cure rate for meningitis.
- (f) Rheumatic Fever:
Rheumatic fever is a disease that affects the young ones at quite an early age. There will be painful swelling of joints and the swelling will be fleeting. Chorea is another form of rheumatic disease. The dance-like movements in this disease are more noticeable when the child cries at the time of feed and is found to drop articles. A doctor should be consulted immediately and necessary treatment be given. It is important to note that rheumatic fever is one of the causes of heart disease in children. Sometimes the disease is prolonged and long convalescence is necessary to prevent recurrence. A doctor must be consulted for the necessary line of treatment.
- (g) Diphtheria:
When you examine the mouth of the child suffering from diphtheria you may find patches on the tonsils or on the sides of the throat. The child may have high temperature. The baby should be immediately shown to the doctor. Diphtheria is prevented by injections of diphtheria toxoids from infancy. This is included in the triple antigen. Every child is to be given this triple antigen beginning from the end of the second month. Very few persons (and children) will get diphtheria more than once. This is a disease with very serious complications ending in fatality sometimes in spite of good treatment. Prevention is a must against this disease.
- (h) Tetanus:
In this disease, the toxin produces lockjaw i.e. inability to open the mouth and if it is an infant the complaint will be that the baby is not able to suck its feeds. This may be the first sign or convulsions and twitching of the muscles also occurs. The child may bend backward in a spasm like the arch of a bow retracting its head and legs. That is why it is called in Sanskrit ‘Dhanurvata’ i.e. the disease in which a person is bent like a bow.
This is most common in the newborn period due to injection of the umbilical cord when cut by injected instruments, by an untrained person usually engaged in the villages. Road accidents and the application of cow during to the injuries as practices in the villages also cause the infection.
- (i) Asthma:
Infants who are exposed to certain substances, or due to some change of climate for which they are sensitive, may develop symptoms of asthma, hay fever, and hives. Asthma is a condition in which the child has difficulty in breathing. Sometimes it is associated with fever. In children during infancy, the upper respiratory tract infection i.e. colds and running of the nose may cause this type of asthmatic attacks. If the child is sensitive to egg or other foods, house dust, feather, animals etc., colds or other infections may precipitate an attack. One should not worry that it may become chronic when the word asthma is heard. In infancy, once you remove the cause the child will be better. Generally, they get over this allergy by three to five years of age, sometimes by 12 years. They look quite different when they get over these difficulties. In addition to medical treatment, breathing exercises play a good part-when the child is encouraged to do it in preventing and controlling the disease.
- (j) Hay Fever:
This is also seasonal and is characterized by sneezing, itching of eyes and stuffing of the nose. It is generally caused by pollen of weeds and grasses.
- (k) Hives:
In this disease, there is itching and raised areas on the skin which look like the large mosquito bite. They come quickly and then disappear. There is some sensitiveness to some foods, climate etc. In all these things the child is to be properly investigated and allergic foods are to be avoided to prevent the attacks.