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:

  • 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

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