Sometimes it can feel scary being a new parent. What is normal? When should you be worried and call the doctor? On this week’s On Call for All Kids, Jennifer Arnold, M.D., is a neonatologist and serves as medical director for the Center for Medical Simulation and Innovative Education at Johns Hopkins All Children’s Hospital, gives new parents important tips.
Why your baby is crying and could it be colic?
Crying, especially in the late afternoons and early evening, may increase during the first six to eight weeks. Two to three hours of crying a day in the first three months is considered normal.
There is no standard definition for the term "colic." For clinical purposes, we define it broadly as crying for no apparent reason that lasts for three hours or more per day and occurs three days or more per week in an otherwise healthy infant under 3 months of age.
Persistent or excessive crying (colic) is one of the most distressing problems of infancy. Colic is a benign self-limited condition that resolves with time. Colic symptoms resolve spontaneously in 90 percent of infants by 8 to 9 weeks of age.
Colic must be differentiated from a number of other conditions that can cause prolonged crying or irritability in infants and may require specific treatment. The evaluation of a child with suspected colic typically includes a history and examination for identifiable causes of crying and fussiness.
What causes jaundice and when to be concerned?
Jaundice is common, but can be scary if your baby is looking a yellow-orange color. Yellow skin, starts at the top and moves down. Look for signs of bilirubin-induced neurologic dysfunction (BIND) — sleepiness, decreased feeding, poor urine output that progresses to neurologic symptoms.
Leading experts recommend that all newborns have their bilirubin levels tested before going home from the hospital, regardless of age. This is especially true for babies who are jaundiced before one day of age, in which case repeated testing is needed.
Parents, other caregivers and health care providers should watch babies closely if jaundice develops. Hyperbilirubinemia is usually easy to prevent and treat initially. However, complications can be serious and irreversible if treatment is delayed. You should contact your baby's health care provider immediately if you are concerned about worsening jaundice.
Babies with high bilirubin levels should be treated by a qualified health provider to safely reduce bilirubin levels and prevent the risk of brain damage. Parents and health care providers should not delay treatment for any reason.
Visible jaundice resolves within the first one to two weeks after birth. Clinical jaundice typically resolves by one week in formula-fed Caucasian and Black infants, and by the 10th day in Asian infants. Jaundice resolves by three weeks in about 65 percent of exclusively breastfed newborns, although about one in five are still jaundiced at four weeks. Persistence of hyperbilirubinemia beyond 2 weeks of age has been labeled as prolonged hyperbilirubinemia/jaundice and these infants require an assessment of their direct or conjugated bilirubin levels to rule out cholestatic jaundice.
Importance of Meeting Baby’s Vaccine Timeline
It's important for parents to stay on track with their children's vaccines. These are immunizations routinely recommended for infants and children in the United States.
- Hepatitis B vaccine – HepB vaccine is routinely recommended within 24 hours of birth, at age 1 through 2 months, and at age 6 through 12 months. HepB vaccine is inactivated. It is administered intramuscularly (IM).
- Rotavirus vaccine – The routine schedule for rotavirus vaccine depends upon the vaccine formulation. Human rotavirus vaccine (RV1) is administered at 2 and 4 months of age. Both rotavirus vaccines are live attenuated viral vaccines. They are administered orally.
- Diphtheria, tetanus and/or pertussis vaccines – DTaP vaccine is routinely recommended for infants and children at ages 2 months, 4 months, 6 months, 15 through 18 months and 4 through 6 years. Booster doses are required beginning at age 11 years. DTaP vaccine is an inactivated vaccine. It is administered IM.
- Influenza type b conjugate vaccine – Hib conjugate vaccine is routinely recommended in a two- or three-dose primary series (at age 2 and 4 months or at age 2, 4 and 6 months, depending upon the vaccine formulation) with a booster dose at age 12 through 15 months. Hib vaccines are inactivated vaccines. They are administered IM.
- Pneumococcal conjugate vaccine – The 13-valent pneumococcal conjugate vaccine (PCV13) is routinely recommended at age 2, 4, 6 and 12 through 15 months. PCV13 is an inactivated vaccine. It is administered IM.
- Inactivated poliovirus vaccine – IPV is routinely recommended at age 2 months, 4 months 6 through 18 months, and 4 through 6 years. IPV is administered IM or subcutaneously.
- Influenza vaccine – Influenza immunization is recommended annually for all children 6 months of age or older, particularly those at high risk for complications
- Measles, mumps and rubella vaccine – MMR vaccine is routinely recommended at age 12 through 15 months and age 4 through 6 years. MMR is a live attenuated virus vaccine. It is administered subcutaneously.
- Varicella vaccine – Varicella-zoster virus (VZV; chickenpox) vaccine is routinely recommended at age 12 through 15 months and age 4 through 6 years. VZV vaccine is a live attenuated virus vaccine. It is administered subcutaneously.
- Hepatitis A vaccine – Two doses of hepatitis A virus (HepA) vaccine are routinely recommended between 12 and 24 months; the doses should be separated by at least six months.
It is important to give vaccines on time and at the ages recommended as these are the times when they are the most effective at promoting immunity AND provide the optimal protection possible for your baby. Vaccines are more than just a checkmark at the doctor’s office — they are a crucial stepping stone to set their child up for a healthy beginning, and also help protect others in the community against serious illnesses.
Should I space out my baby’s vaccinations?
Some parents question the schedule and ask whether they should space out the number of vaccines their babies receive, or are unaware that a schedule and multiple vaccine doses exist. Children under the age of 2 are among those at higher risk for serious infectious disease, which is why it is essential parents know how important it is to follow the recommended schedule to build their child’s immunity when they are more vulnerable, and not skip or delay any vaccines or doses.
If a baby receives less than the recommended dosage, his or her immunity may be lowered during a time of greater risk. Some parents ask if too many shots given at the same time will overload a baby’s immune system.
The schedule of recommended vaccines may seem overwhelming, but research shows that healthy babies’ immune systems respond to challenges from germs around them every day. The Centers for Disease Control and Prevention recommends specific times to receive doses based on when they will work best to support a baby’s developing immune system and when they are at a higher risk. By receiving all recommended doses, a baby’s immune system will develop the antibodies shown to help him or her fight disease. Talk with your baby’s doctor if you have questions about vaccines.
On Call for All Kids is a weekly series featuring Johns Hopkins All Children's Hospital experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report. You also can explore more advice from Jen Arnold, M.D., and advice for parents of infants and toddlers.