8.14: Other Infant Health Considerations

Infants depend on the adults that care for them to promote and protect their health. Some physical conditions and issues are very common during infancy. Many are normal, and the infant's caregivers can deal with them if they occur. Mostly, it is a matter of the caregivers learning about what is normal for their infant and getting comfortable with the new routine in the household. New parents and caregivers often have questions about many of these regular issues (NIH information - some basics about infant health)

Bowel movements

Infants' bowel movements go through many changes in color and consistency, even within the first few days after birth. While the color, consistency, and frequency of stool will vary, hard or dry stools may indicate dehydration and increased frequency of watery stools may indicate diarrhea.

Figure \(\PageIndex{1}\): Diaper changes assure parents of the child’s nutritional intake and also help children stay warm, dry and comfortable.[1]

Diaper Rash

A rash on the skin covered by a diaper is quite common. It is usually caused by irritation of the skin from being in contact with stool and urine. It can get worse during bouts of diarrhea. Diaper rash usually can be prevented by frequent diaper changes.

Colic

Many infants are fussy in the evenings, but if the crying does not stop and gets worse throughout the day or night, it may be caused by colic. According to the American Academy of Pediatrics, about one-fifth of all infants develop colic, usually starting between 2 and 4 weeks of age. They may cry inconsolably or scream, extend or pull up their legs, and pass gas. Their stomachs may be enlarged. The crying spells can occur anytime, although they often get worse in the early evening.

The colic will likely improve or disappear by the age of 3 or 4 months. There is no definite explanation for why some infants get colic. Health care providers can help ensure there is no medical reason behind the crying.

Some infants seem to be soothed by being held, rocked, or wrapped snugly in a blanket. Some like a pacifier.

Figure \(\PageIndex{2}\): A father holding a crying infant in a “football” hold putting pressure on the infant’s abdomen helps some children with colic calm down.[2]

Shaken Baby Syndrome

Here is a PSA from the Center for Disease Control (CDC)

The crying.

The late-night feedings.

The diaper changes.

The exhaustion.

If you’ve ever been around a baby who won’t stop crying, you know there’s potential to get frustrated. Focus on calming yourself and understand that you may not be able to calm your baby. It’s not your fault or your baby’s.[3]

It’s normal for healthy babies to cry and some babies cry much more than others. And they cannot always be consoled and caregivers can feel pushed to the limit. When caregivers lose control and shake a baby it can have devastating effects.

Shaken Baby Syndrome (SBS) is a severe form of physical child abuse. SBS may be caused from vigorously shaking an infant by the shoulders, arms, or legs. The “whiplash” effect can cause intracranial (within the brain) or intraocular (within the eyes) bleeding. Often there is no obvious external head trauma. Still, children with SBS may display some outward signs:

• Change in sleeping pattern or inability to be awakened
• Confused, restless, or agitated state
• Convulsions or seizures
• Loss of energy or motivation
• Slurred speech
• Uncontrollable crying
• Inability to be consoled
• Inability to nurse or eat

SBS can result in death, mental retardation or developmental delays, paralysis, severe motor dysfunction, spasticity, blindness, and seizures.

Who’s at Risk?

Small children are especially vulnerable to this type of abuse. Their heads are large in comparison to their bodies, and their neck muscles are weak. Children under one year of age are at highest risk, but SBS has been reported in children up to five years of age. Shaking often occurs in response to a baby crying or having a toilet-training accident. The perpetrator tends to be male and is primarily the biological father or the mother’s boyfriend or partner. Caregivers are responsible for about 9%-21% of cases. The explanation typically provided by the caregiver—”I was playing with the baby”—does not begin to account for the severity of trauma. Many times there is also a history of child abuse.

Can It Be Prevented?

SBS is completely preventable. However, it is not known whether educational efforts will effectively prevent this type of abuse. Home visitation programs are shown to prevent child abuse in general. Because the child’s father or the mother’s partner often causes SBS, they should be included in home visitation programs. Home visits bring community resources to families in their homes. Health professionals provide information, healthcare, psychological support, and other services that can help people to be more effective parents and care-givers.

The Bottom Line

• Shaking a baby can cause death or permanent brain damage. It can result in life-long disability.
• Healthy strategies for dealing with a crying baby include:
  • finding the reason for the crying
  • checking for signs of illness or discomfort, such as diaper rash, teething, tight clothing;
  • feeding or burping;
  • soothing the baby by rubbing its back; gently rocking; offering a pacifier; singing or talking;
  • taking a walk using a stroller or a drive in a properly-secured car seat;
  • or calling the doctor if sickness is suspected
• All babies cry. Caregivers often feel overwhelmed by a crying baby. Calling a friend, relative, or neighbor for support or assistance lets the caregiver take a break from the situation. If immediate support is not available, the caregiver could place the baby in a crib (making sure the baby is safe), close the door, and check on the baby every five minutes.[4]

Figure \(\PageIndex{3}\): Medical professionals caring for an infant in what appears to be a trauma unit.[5]

Abusive Head Trauma

Shaken baby syndrome is part abusive head trauma (AHT), severe form of physical child abuse that results in an injury to the brain of a child. This is important to note because:

• Abusive head trauma is a leading cause of physical child abuse deaths in children under 5 in the United States.
• Abusive head trauma accounts for approximately one third of all child maltreatment deaths.
• The most common trigger for abusive head trauma is inconsolable crying.
• Babies less than one year old are at greatest risk of injury from abusive head trauma.[6]

Jaundice

Jaundice can cause an infant's skin, eyes, and mouth to turn a yellowish color. The yellow color is caused by a buildup of bilirubin, a substance that is produced in the body during the normal process of breaking down old red blood cells and forming new ones.

Normally the liver removes bilirubin from the body. But, for many infants, in the first few days after birth, the liver is not yet working at its full power. As a result, the level of bilirubin in the blood gets too high, causing the infant's color to become slightly yellow—this is jaundice.

Although jaundice is common and usually not serious, in some cases, high levels of bilirubin could cause brain injury. All infants with jaundice need to be seen by a health care provider.

Many infants need no treatment. Their livers start to catch up quickly and begin to remove bilirubin normally, usually within a few days after birth. For some infants, health care providers prescribe phototherapy—a treatment using a special lamp—to help break down the bilirubin in their bodies.

Figure \(\PageIndex{4}\): An infant receiving treatment for jaundice which includes exposure to white light.[7]​​​​​​​

Attributions:

Child Growth and Development by Jennifer Paris, Antoinette Ricardo, and Dawn Rymond, 2019, is licensed under CC BY 4.0

[1] Image by Kevin Phillips is licensed under CC BY 2.0

[2] Image by David D is licensed under CC BY 2.0

[3] Coping with Crying 3 PSA by the CDC is in the public domain

[4] Shaken Baby Syndrome by the CDC is in the public domain

[5] Image by the U.S. Air Force is in the public domain

[6] Preventing Abusive Head Trauma in Children by the CDC is in the public domain

[7] Image by Andres and Antoinette Ricardo used with permission