Fever

No unnecessary use of thermometer. Extremities of baby are often cold and bluish.
Body temperature is best evaluated by touching forehead.
Fever is a body temperature above 37.5 °C.

In case of fever

In itself, fever is not dangerous. It’s a symptom of an illness.
The general aspect of child is more relevant than the ° in Celsius.

A baby under three months with high temperature (> 38,5 °C) needs to be examined rapidly and closely by a physician.

The three steps to lower high temperature, only if the child is uncomfortable:

1) strip baby down to nappy, in house (including when nose-cold)

2) give luke warm bath. Put baby in ordinary bath water (37°C), and then gradually add cold water until 32°C.

3) Antipyretic (preferably orally)

• First choice: Paracetamol 60mg/kg/day, or 15mg/kg every six hours
• Perdolan Mono ® suppositories (100 mg ou 200 mg)

In case of “cold”

Nasal snoring and/ or sneezing does not mean baby has a cold! Use physiological salt solution.

If “cold”, use only physiological salt solution (until the age of 3-4 months babies only breathe via nose hence risk of “sub-nasal storm” when nose is blocked up.

In case of cough

Under two years, all kinds of syrups to “cut” the cough are forbidden…

Acute Bronchitis

A bronchitis start nearly always with a cold (a rhinopharyngitis). It’s never a consequence of a “cold” badly treated. It is just impossible to prevent the cold going down on the chest… To treat an acute bronchitis, there is no specific therapy for acute bronchitis. The disease is selflimited… The tracheobronchial epithelium may become significantly damaged or hypersensitized, leading to a protracted cough lasting 1 – 3 wk.” (Nelson textbook of Pediatrics, 17^th Edition).

In case of conjunctivitis

1) infusion of camomile flowers or physiological salt solution (rub gently in direction of nose)
2) local antibiotic: only drops Example: Tobrex ®

In case of some cutaneous problems

Diaper Dermatitis

Contributing Factors

1) low defence of baby’s skin against chemical aggression and infections
2) reaction to certain chemical substances in “specially designed” creams for sore bottoms
3) reaction to certain substances in disposable nappies (scents etc.)
4) proliferation of bacteria and yeast between stool and skin, favoured by the hotbed of a wet nappy
5) decomposition of urine with release of ammonia

Clinical description

• without infection

The red area is restricted to convex zones. It appears in the genital region (big labia and scrotum) and the sub pubis.
It quickly spreads to belly, bottom and inside of thighs. At the beginning the inguinal folds and the area between the buttocks are spared.

• with infection

Bacterial pustules appear (little blisters filled with opaque liquid) as well as cutaneous erosions.
Those sometimes turn into ulcerations. The skin seems “on fire”.
When there is “yeast infection” (candida albicans) the spots take a pomegranate, sandpaper appearance and are scarlet coloured. They form authentic clusters which multiply forming a new cluster at a certain distance.
The infection is often of mixed nature, i.e. bacterial and fungal. The same applies to lesions.
They are sore. Whenever baby pees or poos this makes him cry out of sheer pain!

NB: Even if such skin lesions in the bottom area appear later (sometimes after one year) it does not mean that certain products that until then have been used without problems can be ruled out as cause of lesions (e.g. washing powders, creams…).

– “red belts” around belly or “ring” around legs are an allergic reaction to the plastic material used in nappies (contact allergy). It starts with little blisters on a red background.
– Candida albicans is also responsible for “thrush” that appears sometimes in the mouth of a newborn.

Treatment if no infection

Rule: wash, dry, isolate

1) Whenever possible, leave the region to air. e.g. make a carpet of nappies to lie naked baby on
2) Prefer textile nappies. Wash them with bar of soap (savon de Marseille) by hand or liquid/powder Le Chat in machine. Any textile softener is strictly banned.
Aggressive soaps or softeners should be the first subject of your suspicion
Thorough rinsing is of outmost importance.
3) Change nappies frequently
4) At every nappy change
– wash with water and savon de Marseille
– rinse and dry (hair-drier)
– apply aqueous Eosine 2% or Liqueur de Burrow 1/10 to dry out lesions even further
– apply unctuous water-based ointment on zinc oxide basis (Pâte de Lasar)
NB: avoid talcum powder since risk of secondary irritations
5) Line nappy with a fine cellulose sheet.

Treatment when there is infection

Rule: wash, dry, disinfect, isolate
Same treatment as in cases without infection. Possibly, oral administration of Nystatine.
In most cases the change is drastic within 48hours of treatment. Even when healed, the skin stays pink-reddish for a while, but is soft and smooth.

Be aware, during the first days or even weeks of end of treatment relapses are frequent.
Do not despair! Just keep doggedly to steps of treatment.

Seborrheic dermatitis, a special form of skin affliction

During the 2^nd month some children develop what is generally referred to as “milk crust” in French, cradle cap in English. Their head is covered by rather obstinate, yellow scales that can be more or less thick and numerous. The underlying skin bears an inflamed (red) aspect.

A small percentage of children get red in all the folds of the body (behind ears, on neck, in crack of buttocks etc.)
These red areas are wet and smooth and cause no pain to the child. They have tendency to spread and surinfect. Their borders are raised and “rounded off” like an oak leaf. All these afflictions disappear at the age of month 5.

The cause of this skin condition is unknown. There is however no reason to blame the food.
The popular term “milk crust” does not imply that the lesion is linked to food intake but refers to the age at which it appears, i.e. the time when the child lives exclusively of milk.

Treatment

• of scalp

as often as necessary:
– evening: soak in sweet almond oil or paste in Vaseline
– morning: vigorous shampooing…
If lesions are too important you may have to apply an anti-inflammatory lotion that disinfects and de-scales

• of folds and bottom

-wash and dry. Apply aqueous Eosine 2% or a cream containing local antibiotic and antifungus or cortisone cream depending on whether bacterial or fungal infection occurred or not.
Apply the same way as when treating irritation of genital-anal region with bacterial and fungal infection.

The Feeding of Infants
 
Body Care
 
Prescriptions
 
Medical Surveillance of Children in Belgium
 
The Surgery
 
What to know for your child’s, yours… and my benefit