Medical Care

Immunizations

Immunizations protect your child from certain potentially serious diseases. Since many of these illnesses occur in the first years, it is important to immunize your child early and keep to a regular schedule. Immunizations are given at your doctor’s office or at public health clinics.

The first vaccinations immunize against diphtheria, whooping cough (pertussis), tetanus (DPT), Haemophilus influenzae type B (Hib), and polio. The DPT and Hib vaccines are given by injection; the polio vaccine by mouth. Later, measles, mumps, and rubella vaccines (MMR) may be given by injection, either alone or in combination. In addition, boosters of DPT, Hib, and polio vaccines are given. Some caregivers are now immunizing against hepatitis B virus (HVB).

Keep a record of your child’s immunizations. These records will be required by day cares, schools, and camps throughout his life. If the immunization schedule is interrupted, resume it where you left off in the series, rather than beginning again.

Possible Reactions

Many parents are concerned about the risks from immunizations and possible adverse reactions in their infants. It is true that each vaccine carries possible risks as well as benefits. Health care providers believe that in almost all cases, the risks of potentially serious childhood diseases greatly outweigh the risks of immunizations.

Following a DPT injection your baby may have local pain and tenderness at the injection site, a slight fever, and mild irritability for one or two days. Your doctor may suggest that you give acetaminophen to your baby to relieve these symptoms.

On rare occasions, severe adverse reactions occur. If your baby cries inconsolably, develops a high fever, has convulsions (shaking or unresponsiveness), or becomes limp or pale, notify your doctor immediately.

DPT injections are usually not given to an infant who had a serious reaction to a previous injection, to an infant who is ill, or to an infant who has had previous convulsions or other nervous system problems.

Reactions to the Hib vaccine include redness and swelling at the injection site and a mild fever. About 1 percent of those vaccinated have a higher fever (above 101.4 degrees F [38.5 degrees C]). Fever and tenderness at the injection site last about a day or two. Rare allergic reactions have also been reported.

Reactions to the polio vaccine are uncommon. In rare instances(one in five to ten million doses), symptoms of polio (such as high fever, muscle weakness, or paralysis) appear in the person who is vaccinated or someone who comes in contact with that person. For example, the person who changes the diapers of the infant may be exposed to polio because the virus is shed in the baby’s stools up to two months after the vaccination. Individuals whose immune systems are depressed due to drugs or illness should not provide care for a recently immunized infant. Others should wash their hands well after every diaper change.

Following an MMR injection, a child may develop a mild fever. Seven to twelve days later, he may develop a rash and fever that lasts a day or two. Some children develop mild, brief joint pain two weeks or so following the vaccination, which may show up as a limp. If any other symptoms such as high fever or convulsions occur (a very rare event), these should be reported to your doctor immediately.

Immunization Schedule

Birth to 2 months

• • DPT (Diptheria, Pertussis, Tetanus)
  • Polio
  • Hib (Haemophilus influenzae type b)

3 to 4 months

• • DPT
  • Hib
  • Polio (optional)

4 to 6 months

• • DPT
  • Hib
  • Polio

12 months

• • Tuberculosis test

15 months

• • MMR (Measles, Mumps, Rubella)
  • Hib

16 to 24 months

• • DPT
  • Polio

4 to 6 years

• • DPT
  • Polio

12 years

• • MMR

12 to 16 years

• • Td (Tetanus-Diptheria)

Every 10 years thereafter

• • Td

When to Call the Doctor

If you are worried about an illness in your baby, call your doctor. Before you call, however, give careful thought to, and then note on paper, your baby’s temperature and all the symptoms that worry you. Here are some things your doctor may wish to know:

Physical symptoms

Abnormal temperature, breathing difficulties, coughing, vomiting, diarrhea, constipation, fewer wet diapers, rash.

Behavioral symptoms

Loss of appetite, listlessness, unusual fussiness or irritability, change in typical behavior and activity level (for example, if your baby loses interest in his surroundings or is unable to muster a quiet smile).

Home treatment

What have you done to treat the illness, and how has your child responded? Have you given your child any medications? What and when?

General considerations

Has there been recent exposure to illness? Is anyone at home or day care sick?

Have a paper and pencil handy to write down your doctor’s suggestions. Also, know your pharmacist’s phone number, as the doctor may want to call in a prescription.

Colds

It is normal for babies to have a slight, stuffy, rattly noise in their noses. Your infant probably has a cold, however, if he has a very runny nose, is fussier than usual, has trouble eating and sleeping, and perhaps has a slight fever.

To lessen the chance of a cold, minimize the number of visitors (adults and children) when the baby is very young. People with colds should stay away. You will probably want to consult your physician for your baby’s first cold. He may suggest a cool-mist vaporizer, sleeping in a semireclined position (place a folded blanket or pillow under the head end of the mattress), clearing the nostrils gently with a bulb syringe, using nose drops, or giving medication.

Medications

Use the following guidelines when giving medications or vitamins to your baby:

• Give only the medication your baby’s doctor specifies. Aspirin, even baby aspirin, is no longer recommended for infants and children because of its association with Reye’s Syndrome, a very serious disease.
• Use a medicine dropper placed between the baby’s cheek and gum. Let the infant suck the medication, or gently squirt it in. You might try placing the dropper next to a pacifier or your finger.
• Pour medication into an empty bottle nipple and have the baby take it all; fill the emptied nipple with water and have the baby take all that too, to ensure that the baby has received a full dose.
• Do not put medication in formula, juice, or water. You will be unsure how much your baby has received if he refuses to finish it.