Chapter 11: When the Baby Is Unwell

From the Diary

Month 5. Our daughter has her first cold. It began with a runny nose and a little cough, and now her nose is so blocked that she has to stop again and again during feeds to breathe. She is cross and tired, and so am I. My husband's parents phoned this evening with a long list of advice, all of it kindly meant. I thanked them and did none of it. I had already called the nurse this morning, and she had listened, asked how our daughter was feeding and how many wet nappies she had, and told me what to watch for. I wrote her words on the back of an envelope and stuck it to the fridge.

Month 5, the night after. I am writing this down so that I remember it. At bedtime she felt warmer than usual. I checked her temperature, and it was high, higher than I had ever seen it. Her cheeks were red and her cry was thin and tired. My hands started to shake. My husband read the thermometer to me twice, and I still could not take it in. Then I remembered the envelope on the fridge, and the nurse's voice saying, "If she has a fever, call, day or night." I took one long breath and called the doctor's after-hours line.

The woman on the line was calm. She asked me questions one by one: how our daughter was breathing, whether she was feeding, whether she had wet nappies, whether she woke and looked at me, whether she had a rash. I answered each question and felt my own breathing slow down. She told me what to watch for during the night and which signs meant calling the emergency number straight away, and she made an appointment with the doctor for the morning. My husband and I took turns sitting beside our daughter's cot. Neither of us slept much. She fed a little, slept a little, and every time she opened her eyes and looked at me, I felt my heart start again.

Month 5, a few days later. The doctor saw our daughter the next morning, examined her carefully and explained what to watch for in the coming days. Today our daughter is herself again: hungry, noisy and grabbing at my nose. I am still tired from that night, and when I think about it my stomach tightens. But I also feel something new. I was frightened, and I still did the right things, one after the other. I have started a small notebook for her health, and my husband has saved the after-hours number at the top of the list in his phone. Next time I will still be scared. I will also know what to do.

Small Illnesses in the First Year

Most babies have a few minor illnesses in their first year, and for many families the first cold arrives in the middle months, as in the diary. Babies meet new germs everywhere: from older brothers and sisters, from visitors, from parent groups and later from childcare. A cold usually brings a runny or blocked nose, sneezing, sometimes a cough, and a baby who is more tired and unsettled than usual. Because young babies breathe mainly through the nose, a blocked nose can make feeding and sleep harder for a while. Most colds pass on their own. The doctor, nurse or pharmacist can explain ways to make your baby more comfortable and tell you what to watch for.

Rashes are also common in babies, and most of them are harmless: small spots on the face in the early weeks, dry patches, or redness in the folds of the skin. Nappy rash, which means red, sore skin in the nappy area, happens to many babies at some point. The nurse can show you how to care for the skin in the nappy area and tell you which creams, if any, are suitable for your baby. Ask the nurse or pharmacist before you use any cream, and contact a doctor if a rash spreads, looks very sore or does not get better. A rash together with a fever, or a rash in a baby who seems unwell, is a reason to contact a doctor straight away.

Many babies bring up a little milk after a feed, especially when they are burped or moved. This is common, and it usually becomes less as the baby grows. A baby who brings up a little milk but is feeding well, has wet nappies and is growing well at the check-ups is usually fine. It is different when a baby vomits forcefully again and again, brings up green fluid or blood, refuses feeds or seems unwell. These are reasons to contact a doctor straight away. Diarrhoea, which means very loose and frequent stools, also needs a call to the doctor or nurse in a young baby, because babies can lose fluid quickly.

You cannot keep every germ away from a baby, and you do not need to. A few everyday habits that health workers describe can still lower the number of illnesses and protect a very young baby. Washing your hands before feeds and after nappy changes, and asking others to do the same, is one of the simplest. Kindly asking visitors who have a cold, a cough or a stomach illness to wait until they are well before they visit is not rude; most people understand at once. A smoke-free home and smoke-free car protect a baby's breathing. Vaccinations, given on the schedule that applies where you live, protect against several serious illnesses.

Every family meets these small illnesses, and they are part of a baby's first year. They often come at the worst possible time, when you are already tired and your routine is just beginning to work. It is normal to feel frustrated, worried or simply worn out when your baby is unwell for several days, and it is normal to miss the easier days before the illness. Sharing the nights, as the parents in the diary did, and accepting help with meals or shopping can make these days easier to get through. A partner, if you have one, or someone close to you can take a turn so that each adult gets some rest. Colds also travel through families, and parents often fall ill a few days after their baby. If that happens, rest when you can, lower your expectations for the house, and let simple meals be enough. Looking after yourself is part of looking after your baby.

How to Watch Your Baby

When your baby is unwell, the most useful thing you can do is to watch carefully and calmly. Doctors and nurses often ask about the same few things, and knowing them helps you notice changes and describe them clearly. They usually want to know how the baby is feeding, how many wet nappies the baby has, how the baby is breathing, what the colour of the baby's skin looks like, and how the baby wakes and responds to you. The nurse and the woman on the after-hours line in the diary asked exactly these questions. You can learn them now, long before you need them.

Feeding and wet nappies tell you a great deal. A baby who keeps feeding, even a little less than usual, and who still has wet nappies is getting fluid. A baby who refuses several feeds, or who has far fewer wet nappies than usual, may not be getting enough fluid, and that is a reason to contact the doctor straight away. Watch the baby's breathing too: whether it looks easy or like hard work, whether the skin pulls in between or below the ribs with each breath, whether the baby grunts with each breath, or whether the breathing seems very fast. A blocked nose can make breathing noisy, but breathing that looks like hard work needs a doctor.

How your baby wakes and responds is just as important. An unwell baby may be sleepier and fussier than usual, which is common. But a baby who is very hard to wake, who does not respond to you, who feels very floppy when you pick the baby up, or who has a weak, high-pitched or very unusual cry needs help at once. Look at the colour of the skin, the lips and the tongue as well: a baby who looks very pale, blotchy, blue or grey needs emergency help. Trust your own eyes. You know your baby better than anyone, and a parent's feeling that "this is not my baby's usual self" is information that health workers take seriously.

When you call a doctor, a nurse or an after-hours line, it helps to have a few things ready: your baby's age, what you have noticed and since when, how the baby is feeding, how many wet nappies there have been, any temperature you have measured and how you measured it, and any medicine the baby has already had. Speaking slowly and answering one question at a time is enough. You do not need to know medical words. "She is breathing fast and she will not feed" is a clear and helpful sentence. If you are too upset to speak clearly, it is fine to hand the phone to another adult, or to say, "I am very frightened, please help me go step by step."

Fever and Signs That Need Help Now

A fever means a body temperature that is higher than normal, and it is one of the ways the body fights an infection. In older babies and children, many fevers come with common infections and pass. In a very young baby, however, a fever is a reason to contact a doctor straight away, day or night, even if the baby otherwise seems well. Temperature can be measured in different ways, and what counts as a fever can depend on the method and on the baby's age. Ask your doctor or midwife which temperature they want you to call about and how to measure your baby's temperature, and write their answer down before you need it.

For a baby of any age, contact a doctor straight away if the baby has a fever and seems unwell, if a fever comes with a rash, if the baby is feeding much less than usual or has far fewer wet nappies, if the baby is vomiting again and again, is much sleepier than usual, or simply seems to be getting worse. Contact a doctor too if you are worried and cannot say exactly why. Outside office hours, many places have an after-hours line or service for exactly these moments. The official contact points where you live can tell you how it works, and it is wise to find out before you need it.

Some signs mean calling the emergency number at once, without waiting. Call the emergency number if your baby has trouble breathing, if the lips or face look blue or grey, if the baby is very floppy or very hard to wake, if the baby has a seizure (a fit, which may look like stiffening, jerking movements, or staring without responding), or if the baby has stopped feeding and seems very unwell. Call too if you think your baby may have swallowed something harmful. When you call, stay with your baby, and do what the person on the line tells you.

These lists can feel frightening to read. Most of the time, a baby with a cold or another mild illness gets better at home with care and watching. The reason to know the warning signs is not to worry every day, but to feel ready on the rare day when you need them. If anything concerns you, ask a doctor or midwife. Health workers would much rather hear from you early than late, and calling about a baby who turns out to be well is never a waste of anyone's time.

Medicines, Notes and Your Own Fear

Babies are not small adults, and medicines that are safe for older children or adults can harm a baby. Do not give your baby any medicine, including medicines you can buy without a prescription and remedies suggested by family or friends, without advice from a doctor or pharmacist. The doctor or pharmacist can tell you whether a medicine is suitable for your baby's age and weight, and exactly how much to give. If a doctor prescribes a medicine, follow the instructions carefully and ask again if anything is unclear. Advice from relatives is often kindly meant, as in the diary, and you can thank them warmly while you follow what the health workers say.

A small health notebook can make unwell days much easier. In it you can write the phone numbers of your baby's doctor, the after-hours line and the emergency number, and the answer your doctor or midwife gave you about temperature. During an illness, you can add short notes about feeds, wet nappies, temperatures, sleep and any medicine given, each with the time. When you are tired and worried, memory is not reliable, and a page of notes helps you answer the doctor's questions. It also helps when parents take turns, because the person starting a turn can see at once what has happened.

Keep the notebook somewhere everyone in the home knows, and take it with you to every appointment. You can also note in it the things the doctor or nurse told you at each visit, such as what to watch for and when to call again, because it is easy to forget these details once you are home. Some parents add a small page about their own feelings during an illness, a line or two each day. Looking back at these lines later can show how much calmer you have become with each illness.

Fear is a natural response when your baby is ill, especially the first time. Your heart races, your hands may shake, and your thoughts may jump to the worst possibilities, as the mother in the diary describes. This reaction is the body's way of preparing you to act, and it shows how much you care. But strong fear can also make it hard to think. A few simple steps can bring you back to the moment: take one slow breath in and a longer breath out, feel your feet on the floor, and say out loud what you will do next, such as "I will call the after-hours line." Then do one thing at a time. If another adult is there, share the tasks: one person makes the call while the other stays with the baby. You do not need to feel calm in order to act well.

After a frightening night, many parents feel shaky, tearful or on edge for days, even when the baby has fully recovered. Some find themselves checking the baby again and again, or replaying the night in their mind. This is a common reaction, and it usually fades. Talking about what happened with a partner, if you have one, or with someone close to you can help. If the fear stays, keeps returning or makes daily life hard, or if it joins with a low mood that has been there most days, for more than a couple of weeks, tell your doctor, midwife or nurse. Parents who had low mood or anxiety earlier in the year, like the mother in the diary, may notice old feelings returning at times like these, and support is there for that too.

It also helps to remember what went right. In the diary, the mother was frightened, and she still called for help, answered the questions and watched her daughter through the night with her husband. That is what caring for an unwell baby looks like: not a parent without fear, but a parent who acts while afraid. Each time you get through an illness, you learn a little more about your baby and about yourself, and the next time is often a little easier.

A Checklist of Things to Prepare

A health notebook: a small notebook for your baby's health, with space for notes on feeds, wet nappies, temperatures and sleep during an illness. Keep it in the same place every time.

The important phone numbers: your baby's doctor, the after-hours line where you live and the emergency number, written in the notebook and saved in each parent's phone. Find out now how the after-hours service works where you live.

Your doctor's answer about fever: ask your doctor or midwife which temperature they want you to call about and how to measure it, and write the answer in the notebook.

A thermometer suited to babies: ask the nurse or pharmacist which kind suits your baby's age and how to use it, and practise once on a calm day while your baby is well.

A page of warning signs: copy the reasons to contact a doctor straight away and the reasons to call the emergency number onto one page, and keep it with the notebook.

A plan for sick nights: agree with your partner, if you have one, or with someone close to you, how you will take turns, and who can help with meals or shopping when your baby is unwell.

A first aid course for babies: many places offer courses where parents learn what to do in an emergency with a baby. Ask the official contact points where you live or your baby's nurse where to find one.

A calm sentence for frightening moments: choose a few words to say to yourself, such as "One breath, then one step." Practising them on an ordinary day makes them easier to find on a hard one.