Teething and Illness
Teething
Your baby’s teeth start to come in around 6 months on average - the below chart shows the typical progression
You can tell when a tooth is close to coming through as there’s subtle whiteness at the gumline and the area may feel hard; it can also look a little swollen or reddish
The most painful period is the couple days before the tooth breaks through the gums and the couple days after, when the gums are most tender
Some of the symptoms of teething include drooling, chewing/biting, fussiness, decreased appetite (mostly wanting milk and soft foods like yogurt) and sleep disruptions (joy!)
Note on sleep: if you have sleep trained your baby, I would try to maintain your normal sleep protocols - babies go through teething so often during the first years, you don’t want to be constantly undoing all your hard-won progress
Teething can cause a slight fever, but anything over 100.4 is likely due to something else; similarly, teething does not cause diarrhea or vomiting, so those symptoms would be the result of separate illness
You can provide some relief by offering toys like these silicone tubes and water-filled teethers that you chill in the fridge (don’t freeze them since toys that are too cold can actually increase the pain). You can also simply chill a washcloth and let baby chew on that.
If your baby is in a ton of pain and having trouble sleeping, consider giving the appropriate dose of Tylenol:
2.5 mL for 12-17 lbs
3.75 mL for 18-24 lbs
5 mL for 24-35 lbs
Give every 4-6 hours and no more than 4 doses in 24 hours
It will take a handful more days, or even weeks, before the tooth has fully emerged, but it shouldn’t continue cause discomfort or these other symptoms after the initial days
Technically once the first tooth emerges, you’re supposed to start brushing teeth with fluoride toothpaste; however, the research on fluoride suggests it can be harmful to babies, especially since they swallow a lot more toothpaste than older children
Instead, I recommend either:
Wiping their gums with a washcloth or gauze (or Dr Brown dental wipes)
Using fluoride-free toothpaste, like Dr. Brown’s
Also, I wouldn’t stress much about dental care until closer to 12 months old, when they have more teeth and may start consuming more sweets
Illness
If your child is in daycare/preschool, it’s unfortunately very normal to feel like it’s a never-ending cycle of illness - as they build up their immune system, it should get better, but buckle up for a couple rough years
It can be so upsetting to see your baby suffer, but they are more resilient than we realize
These periods can be especially challenging if you yourself are also sick - if your baby’s sleep is disrupted, you likely aren’t getting the rest you need to heal
Accept that you’re in survival mode and the goal is just to get through the day - give yourself grace and don’t try to accomplish much else
Consult your doctor for diagnosis and treatment plans - the below guidance is for managing as a family at home
Cold/COVID/Flu/RSV
Keep baby as hydrated as much as possible with milk and water; they’ll probably be less interested in solid foods
Manage baby’s congestion:
If baby is very congested, it may be hard for them to nurse since they can’t breathe through their nose
Clear nose with an aspirator bulb - if you find the standard type tricky, consider the FridaBaby electric version
For dried boogers, washing their face in the bath can help loosen them
Use a humidifier in their bedroom and/or Vicks Vaporizer that plugs into the wall
You can also try hanging out in the bathroom for 10-20 mins while the shower is running at the hottest setting
Ease breathing at night is to elevate their head by putting a rolled up towel or pillow under one side of the bassinet/crib mattress to prop it up
This technically goes against safe sleep guidelines which require flat surface, but it’s your own judgment call
When my baby had RSV at 2 months, we did this to help him breathe but we had a night doula monitoring him which made me feel even better
If coughing is a problem, consider gentle, baby-safe cough syrup: Mommy's Bliss or Highlands
Closely monitor for fevers
For young babies, rectal thermometer is most accurate, but the ear thermometer is often the easiest (just take a few readings to ensure accuracy)
When to seek immediate medical attention
If your baby is under 3 months and has a temperature of 100.4 or higher
If your child has a fever over 104
If your child has a fever (anything over 100.4) and is acting extremely lethargic (not just tired) and/or crying inconsolably
When to call your doctor
If baby is 3 - 12 months and has a temperature of 102.2 or higher
If your child has a fever (anything over 100.4) for over 4 days
If your child’s fever does not come down after Tylenol or other fever-reducers
It’s okay to give your baby a bath if they have a fever, just keep the water temperature lukewarm
Protecting the adults
Certain illnesses like COVID tend to hit adults worse than children, so your child may be back to full energy a few days before you are
You can try to protect yourself from getting baby’s illness by masking, but personally our family just accepts that “we’re all in this together”
When it comes to nannies, exposure to kid germs is simply part of the job, so unless there is a unique scenario (e.g. immunocompromised in some way), I’d still expect her to work when it comes to illness in this “colds” category
She should wash hands frequently and can choose to wear a mask and/or gloves
Norovirus/Stomach Bug
This comes on really suddenly and is a miserable 1-2 days of vomiting and diarrhea
The only thing you can really do is ensure your child stays hydrated - consider Pedialyte to replenish fluids and electrolytes
The virus is highly contagious and spreads through vomit and poop - children should stay home from daycare/preschool for at least 2 days after symptoms are gone
Protecting the adults:
Keep your nanny and any other caretakers away during the peak contagiousness period: while kids have symptoms and for at least 2 days after symptoms are gone
Parents should wash hands constantly, but know it’s likely you will still end up getting it
The virus can remain present in poop for up to two weeks, albeit at lower levels than in the initial few days, so all caretakers should use gloves and/or wash hands well after every diaper change, and wipe down changing pad with disinfectant
Hand sanitizer does not protect against norovirus (it’s part of that 1%) so need to use soap and hot water
The virus can remain on surfaces for up to two weeks, so disinfect high-touch surfaces like doorknobs, kitchen countertops, etc. with bleach based disinfectant, like this one (regular Clorox or Lysol wipes aren’t effective)
Hand, Foot and Mouth Disease (Coxsackievirus)
This is a very gross and unpleasant virus, but isn’t actually harmful to your child in any serious way
The biggest risk is dehydration because children often get bad sores in their mouths and drinking becomes painful - it's important to still keep pushing them to drink, even if they protest
Protecting the adults
Unfortunately, HFMD is contagious in the first few days, even before the rash/sores appear
Fortunately, most adults aren’t impacted by HFMD (though they may still be contagious), likely because they had been exposed as children
However, for adults that do experience symptoms, it can be really painful
Caregivers should wash their hands frequently
Returning to daycare/school
According to the AAP, kids can return to daycare/school once all the sores have dried up/crusted over (7- 10 days)
However, they can continue to be contagious through their poop for longer, so caretakers should be careful during diaper changes - consider using gloves