How To Know When Your Infant Is Sick
Submitted by Dr. Gwenn Is In Blog
The Lancet published an article last week attempting to outline a path to determine serious illness in infants under 2 months of age.
This is one of the most important topics in pediatrics and one as pediatricians we all get a great deal of training on. The reason is that this group of babies is quite difficult to assess. Their physical exams are not reliable and by the time they look very sick they are even sicker than that. Moreover, the illnesses they get can become life-threatening quickly because of their immature immune systems. So, we worry and tend to bring these babies into the office for any changes from the norm because those subtle changes may very well mean something serious.
So, it is not surprising that neonatal experts are attempting to help us do our jobs better and give us more definitive guidance to pass on to parents. But, I worry when research gets passed on so specifically as it has in the Reuters summary of the article so I want to discuss it a bit so you are not alarmed.
As the Reuters summary on MSNBC accurately stated, the 7 signs are:
• history of difficult feeding
• history of convulsions
• movement only when stimulated
• breathing rate of 60 breaths per minute or more
• severe chest in drawing
• over 37.5 degrees Celsius (99.5 degrees Fahrenheit)
• under 35.5 Celsius (95.9 degrees Fahrenheit)
Many of these signs may be difficult for a parents to notice while some may be obvious because infants can be a tough group to read, especially if the infant is under a month of age. The signs you are most likely to see are the feeding and temperature changes.
In the United States, we tend to separate out birth to one month, then one to two months when thinking about fever and illness in infants. And the older and infant gets, the less we worry. The authors of the study were clear in their discussion that the algorithm presented is best applied for infants in the first week of life but can be extrapolated to older infants under 2months of age depending on the clinical situation. This is where your pediatrician comes in and having a good relationship with your pediatrics office.
Keep in mind, that we only do full infection work-ups on infants we are very worried about. And, when we are worried, we truly pull out the entire kitchen sink of work-ups and test everything, hunting for infection that the infant’s body can’t tell is is there on exam. That’s why you’ll see us test the blood and urine, do a chest x-ray and sometimes even a spinal tap. In this age group, the infection can truly be any where, so we have to look under every anatomical stone.
Then comes the decision of treatment. As you know, we don’t like to use antibiotics much these days. Well, in this age group we do and is one of the few times you’ll see us use “just in case” antibiotics until the situation is more clear. What makes the situation clear? Getting back the final blood, urine and spinal fluid cultures which takes 72 hours. To keep the babies safe, we have to use the strongest antibiotics we have and this has to be done either by an IV line in the hospital or by a shot at home and which occurs depends a great deal on not only the age of the baby but how the baby appears, as well as the initial lab results.
Keep in mind that every decision is made for the safety of the baby. The good news is that most babies end up “ruling out” for serious infection. And, the babies who “rule in” have had their treatments started early.
Now that you have a sense of how those 7 signs translate into action in the medical world,put this all out of your mind except for one point: call if you are concerned that one of the seven signs is occurring. That’s your job. We’ll take care of the rest and work with you to make sure your baby has the work up needed for what his or her exam is telling us.
By the way, if you do find yourself needing to make that call, don’t panic that you don’t know your pediatrics group well yet. You spent a lot of time during your pregnancy choosing a pediatrician and a pediatrics group. You knew what you were doing when you picked that group - trust in that now.
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