Some of the common symptoms seen in infants ( young children upto one year of age) are summarized as below:
1. Crying
Parents commonly report problems about a crying baby, in the first 3 months of life. In most of the cases no cause is found. Crying peaks at 6–8 weeks old (~3h/day, worse in the evenings) and subsides by 4 months. Cries of hunger and thirst are indistinguishable.
Sometimes a crying baby makes a disturbed parent angry and if mother has been suffering from postpartum depression it can worsen it. Sometimes it is OK to leave a baby crying if it is in the
child’s best interests. A baby who is abused due to excessive crying would rather have been left alone.
The following measures can be done for a crying baby:
• Don’t make parents feel inadequate; Explain them the normal crying and sleeping pattern of babies appropriate for the age. Parents can take turn in looking after the baby.
• Help parents recognize when their baby is tired and hungry and to apply a consistent approach to care.
• Vocal (singing), vestibular (rocking, going for a drive) or tactile stimulation (hugs) may help. Encourage help from friends/family. Simplify daily living.
• If not coping, admit to a parenting center or hospital.
2. Baby Colic
Paroxysmal crying with pulling up of the legs, for >3h on ≥3days/wk. Most commonly seen in 3 month old babies so also known as 3 month colic.
Causes:
- Cows’ milk protein allergy,
- transitory lactose intolerance, and
- parental discord
Management:
- Movement (carry-cot on wheels) is often tried and may help.
- Let the baby finish the first breast first. Fisher’s rule (hindmilk is easier to digest).
- Pre-incubation of feeds with lactase (eg 2 drops of Colief Infant Drops® per formula feed, left in the fridge for 4–12 hours before heating) helps.
- If breastfeeding: express ~15mL of milk into a sterilized container; add 4 drops of Colief®; feed to the baby on a sterilized plastic spoon, then start breastfeeding at once.
- Alternative: dimeticone (simeticone) drops (40mg/mL; 2.5mL PO with feeds).
- Few other drugs are licensed at this age.
- Consider 1mL of 30% glucose given orally.
- There is some evidence that probiotics (Lactobacillus reuteri) may be beneficial.
- If breastfeeding, a ‘low-allergen’ diet may help.
- Reassurance to the parents is strongly adviced which helps reduce the stress.
3. Nappy rash/diaper dermatitis
It is of four different types but may co-exist
1.The common ‘ammonia dermatitis’—red desquamating rash, sparing skin folds, is due to moisture retention, not ammonia.
It responds to frequent nappy changes (cloth nappies retain more moisture than disposables), or
nappy-free periods, careful drying, and emollient creams.
Best treatment: leave nappy off . Use barrier cream: eg Sudocrem® (zinc oxide cream).
2. Candida/thrush is isolatable from ~½ of all nappy rashes. Its hallmark is satellite spots beyond the main rash.
Treatment: as for nappy rash as well as clotrimazole (± 1% hydrocortisone cream, no stronger, eg as Canesten HC®). One trial favors thrice-daily mupirocin ointment. Avoid oral antifungals as these may be hepatotoxic for the baby and gentian violet (staining is disliked).
3. Seborrhoeic dermatitis: a diffuse, red, shiny rash extends into skin folds, often occurs with other seborrhoeic areas, eg occiput (cradle cap).
Treatment is same as for nappy rash
4 Isolated, psoriasis-like scaly plaques , which can be hard to treat
4. Vomiting
Effortless regurgitation of milk is common during feeds (‘posseting’). Vomiting between feeds is also common.
Causes:
- gastro-oesophageal reflux,
- overfeeding (150mL/kg/day is normal),
- pyloric stenosis (projectile, at ~8 weeks old), or
- UTI.
- Rarer causes: pharyngeal pouch, metabolic conditions,
- almost any other illness.
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