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The first time your baby gets a cold, you probably have so many questions. What should I do? Is the baby going to be clear of this? Is it the RS-virus? As a pediatrician, I am not nearly as interested in whether it is RS-virus or not. I am interested in two things: whether the baby can eat and is the baby having difficulty breathing. And I know that with very simple care, overall healthy infants can cope with colds just fine.
Can the baby breathe? Can they eat?
Babies with the common cold, who have difficulty breathing, and cannot eat, are often admitted to the children’s emergency room. If your baby cannot eat and you do not know what to do about it, it is quite right to seek care. But luckily, it often doesn’t take much to help the baby. What is most often needed, can be done at home.
In fact, both breathing problems and feeding problems are often due to something as trite as nasal congestion. When you go into the children’s emergency room, the first thing that happens (after the long waiting time …) is that the nurse makes a “nasal toilet” or begins nasal irrigation. In the vast majority of cases, the infant can both eat and breathe accordingly and many can go home without seeing a doctor. That is, if you finish reading this post, there is a good chance that you will not have to seek the children’s emergency room with your baby!
Why is nasal congestion so disabling in babies?
1. Babies’ noses are tight. Therefore it easily clogs with snot and mucus and swollen mucous membranes during colds, both with RS-virus and other viruses.
2. Infants, up to about 6 months of age, can only breathe through the nose, not through the mouth.
3. Infants can and must breathe while eating (breastfed or bottle fed). If the nose is stuffy, babies will release the chest or bottle and stop eating or drinking.
It’s amazingly fascinating that last point. Babies can drink and breathe at the same time! The consequence, however, is that a congested baby can neither breathe nor eat.
Clearing an baby’s nose
There are nasal irrigation devices available to buy at pharmacies. They work well. At a children’s health service, the opposite is usually done. Instead of sucking out the snot, you flush it down into the throat. Sterile physiological saline solution is most commonly used for nasal irrigation, but salt water spray works well.
Babies’ nasal cavity is quite large (even if it is narrow). Therefore, it is not enough to drip breast milk or saline into the nose. You need to rinse the nose thoroughly. Most often, it takes 1- 2 mL per nostril. A plastic syringe without tip (available at pharmacies) is excellent for this purpose . Hold the baby’s head with your left hand (if you are right-handed) and flush straight into, not upwards, in your nose with your other hand. The baby will snort and cough and swallow and discharge a lot of dissolved snot. It can seem scary, but it’s not dangerous. Continue until it looks like the nasal cavity is clean.
It’s important to know that the nasal septum is pain-sensitive, but not the nasal wing. This means that you should avoid the nasal septum (the inner wall of the nose, against the other nostril), while you press the syringe or spray bottle against the nasal wing (the outer part of the skin around the nostril) without it hurting.
When does my baby need go to the pediatric emergency room with a cold?
If a sick baby still struggles to breathe and eat after nasal cleaning, it is time to go to the nearest children’s emergency room. Bring some sandwiches for yourself and a book, as there may be a long wait. And be careful about hand hygiene there, because there’s a lot of gastroenteritis…
When does my baby go to the medical center with a cold?
If the baby can breathe and eat, but is extra whiny and may have a little fever, then they may have otitis. In infants, it is always treated with antibiotics. Give acetaminophen for pain relief and try to let the baby sleep a little upright, perhaps in the baby carrier. Then go to the medical center the morning after to check if they have an ear infection.
If a baby under three months has a fever above 38.5 degrees, it is also time to seek medical attention. In the past, it has been recommended that pediatricians should see these children, at least in Stockholm. But now it is decided that the medical center should also assess babies with fever.