When is my baby’s fever too high? Is a humidifier a good idea? Do antibiotics cure colds? Is Tylenol safe? What if my baby is sick and won’t eat? Is my infant at risk for COVID-19? New parents have so many questions! Especially today.
In this video interview, Dr. Steven Goudy speaks with Dr. Jennifer Shu, a pediatrician in Atlanta, Georgia and the co-author of Heading Home With Your Newborn. Dr. Shu answers many of the burning questions new parents in this interview, and her book covers the rest—from breastfeeding and allergies to questions about extended stay in strapped-in positions (car seats, bouncy chairs), swaddling, diaper options, and more!
Watch the video or read the transcript, below. And definitely pick up the book (the 4th edition is newly revised and edited).
Dr. Shu: I'm Dr. Jennifer Shu, and I am a pediatrician in Atlanta, Georgia. I'm also co-author of "Heading Home With Your Newborn." My co-author and I wrote a book specifically for the newborn period because this is such a time of transition for most parents. We really wanted to instill some confidence and give them some reassurance with some medical backing to it. There's so many new parent books out there that are written by non-pediatricians, that when I had my first child, I really felt like there was a need to have something that was written by doctors but also very relatable to parents.
Dr. Noze Best (DNB): So what are the highlights of your book? what are the kind of big things that you found that you've tried to demystify as far as being a new parent?
Dr. Shu: So it's pretty much everything that your pediatrician would tell you at the very first visit or even at the prenatal visit, what to expect once you go into the hospital and have the baby, what they're gonna do for the baby and how they check the baby, as well as what you're gonna need to know for those first few months. And that would include things like doctors visits and immunizations and car seats and bathing and clothing, and just how to take care of all the body parts. So it's a very basic primer and our goal was really to make sure parents could build that confidence in their own parenting skills, and then just kind of reassure them along the way. We try to make it really user-friendly and readable, too.
We're about to put out our fourth edition. I believe that'll be coming out this fall, but I've gotten a lot of feedback saying that parents really loved the fact that it was informative but not judgmental…you get all this advice from different people and you don't know what to do with it. And we basically tell them that there are many right ways to parent a child and you have to take all the information that you can find, from a medical standpoint, and then make that work for your family.
DNB: what is your book's approach or your personal approach to say the first-time parent, their first baby cold. That's a kind of a anticipated and necessary but also a frightening event and maybe how you counsel your families that comes to you for their pediatric care, but also in the book, how you address that.
Dr. Shu: Well, the first thing to know is the important stuff. So, is it something that's urgent or emergent? Does your baby need to seek care right away? And so, you look for things like fever. So, a fever in a newborn would be really important for seeking care because that could be a sign of a serious infection, or something that could spread very easily to the rest of the body. So, is there a fever and is there any respiratory distress? And that would be labored breathing, such as the fast breathing, the heavy breathing, does your baby look like they're panting? Some parents have a pulse oximeter at home, which is a good way to measure how a baby is doing with their oxygen level. And we can teach parents how to count their babies respiratory rate as well. So, how many times is your baby breathing per minute? And anything above 60, or anything that looks super labored would be a warning sign to seek help immediately. So, those are the danger signs...
In general, for the first two or three months, a fever can be very serious, but up to about a year, any breathing that's faster than about 60 times a minute probably needs to be checked out.
DNB: Say they have a fever, but it's not crazy high. What would be crazy high to you, or what would be concerning.
Dr. Shu: So, a newborn, anything higher than 100.4 and then, under age two, 104 is considered a warning sign, or any temperature if the baby isn't acting right. So, not eating, not sleeping, just lethargic, looking really sick.
DNB: Say that the baby is six months old, has a fever of 102, it's Saturday night, and has got a stuffy nose, or whatever. What then? 'Cause that's really... Pediatrician's office is closed. You're staying at home. It's midnight. And then, you're looking at each other like what do we do?
Dr. Shu: So, if in doubt, I always encourage people to call their pediatrician's office. There's always somebody on call. Whether that's somebody at a nurse advice line, or somebody in the pediatrician's office themselves, taking call from home. In general, a lot of these things can be managed by the parents at home. So, the pediatrician would tell you that. Something like a stuffy nose might be made better with a humidifier, with some saline drops, with holding the baby upright for a while with some kind of suction. And that can really help the baby be able to sleep and eat better.
So, if the baby is just noisy and not having any type of distress, so no laboring to breath, no fast or heavy breathing, then you can just leave that nose alone. If they are having trouble sleeping or eating, then that's when you might need to intervene. And that's where we talk about the saline, the suctioning, and the humidifier.
DNB: When you're talking to those families, can they do too much suctioning? Can they do too much saline? Are there tips, tricks, etcetera with the humidifier?
Dr. Shu: So, sometimes if you do too much saline or too much suctioning, it can irritate the nose and cause it to be more swollen. And so, there's usually a happy medium, no more than about two or three times a day of steady, gentle suctioning, is probably totally fine.
The humidifier works best if it is in a smaller room. So a very wide open floor plan, for example, in the living room, it's not going to do a whole lot of good. But in an enclosed bedroom, it can humidify the air so that it moisturizes a baby's nasal passages, and so they can breathe a little bit better.
Too much humidification to the point where there's moisture on the walls, or you're developing mold or mildew in your house isn't a good idea. You also want to make sure you're cleaning the humidifier according to the manufacturer's instructions so that you don't build up things like mold and mildew.
DNB: Right. Okay. And so, the parent brings a patient in. You as the pediatrician are seeing them. You diagnose them with an upper respiratory tract infection. Is that a terrible thing? Is that an expected thing? How do you manage it personally or in your book for say, a six-month-old who is in day care, and has a runny nose, and a cough, and a fever of 102 or something?
Dr. Shu: Yeah. So, so kids who are in day care can be expected to get colds a lot, maybe once a month. So, on average, maybe eight to 10 or 12 times in a year, with each one lasting about two weeks at a time. And they often happen during the winter months when people are in more enclosed spaces and closer contact with each other. So, it might feel like the baby has a constant cold through the winter months. If you have any suspicion that it could be an ear infection, baby is really fussy when they lie down, pulling on the ear, fever lasts longer than a couple of days, then definitely get that checked out by the pediatrician. But other than that, you can expect your baby to get a lot of colds because they're building their immune systems until they're at least two or three years old.
For some kids who get colds over and over, then it gets a little bit more complicated. So some parents will take their kids out of daycare, some kids need... They end up getting ear tubes, for example, if they get a lot of ear infections because the immune system is a little bit weaker before about age two, if the kid's getting sick a lot, then it might be helpful to keep them out of daycare for a season or two, and then they'll build their immune system when their bodies are a little bit bigger and stronger.
DNB: Right, and so talk about your approach to using antibiotics in the face of colds or ear infections or what have you. how do you approach that with families to choose the right time and indications for using antibiotics?
Dr. Shu: For the most part, common colds are caused by viruses, and an antibiotic is not going to help it. People may have said, "Well, every time my kid gets an antibiotics, they get better," that may just be a coincidence, and we also know that too many antibiotics can cause resistance and then antibiotics won't end up working on a child anymore, so we really are trying to balance all that out and avoid antibiotic overuse. There are certain guidelines that we take a look at for kids with ear infections, for example, and certain ages maybe under the age of six months, we would be more likely to treat with an antibiotic, and then over two years, we maybe able to wait it out and watch the child because they're old enough then, to be able to tell us, "Gosh, my ear doesn't hurt anymore." And they may be able to fight off that ear infection by themselves, and then around six months to two years is kind of that gray zone where if there's a high fever, or the baby is really fussy, we might err on the side of treating whereas if it's found on a routine check-up, we might give something called... We call it a safety net prescription, where the parent might hang on to the prescription and then start it in a couple of days if the baby gets worse.
DNB: what are the kind of complications or things that you see for people that are on multiple courses of antibiotics or what?
Dr. Shu: So in general, it can take two or three days before the antibiotic kicks in, so you're not really gonna get that quick fix from it for the most part. So a parent who is trying to get their kid to be more comfortable, is probably better off using a pain reliever such as acetaminophen, which is Tylenol, or ibuprofen which is Motrin or Advil. So you're probably not gonna get a quick fix from an antibiotic. And then we can see side effects such as a skin rash or allergy that might break out. Or diarrhea is a very common thing that I see in patients who take antibiotics and stomach ache. So sometimes the side effects maybe... May cause a baby to be even more uncomfortable than the infection itself, which could go away on it's own.
DNB: any particular tips about when age-wise, when you can use Tylenol versus Motrin or ibuprofen or what have you.
Dr. Shu: Yeah, so Tylenol or acetaminophen is thought to be safe to use from early infancy. So, at birth if needed, but only with the recommendation of your pediatrician because it needs to be weight-based. And we also don't want to, we don't want to mask a disease or illness that could potentially become more serious. So definitely talk to your pediatrician before giving acetaminophen or Tylenol in the first few months. And so that's something that we might recommend up until six months of age for a child who's teething for example or who has a mild fever and doesn't seem to be very sick. Over the age of six months, then ibuprofen which is Motrin, Advil can be an option. And that's also dosed based on a child's weight, so regular doctor's visits with your pediatrician can keep you up to what your... Can keep you updated on how much your child weighs if you don't have a scale at home.
DNB: Yeah, that's great. And then what about other medicines. what is there over the counter now that parents can use when their kids have a upper respiratory tract infection to help manage some of their symptoms besides acetaminophen and ibuprofen?
Dr. Shu: So, the safest things now would be a humidifier and suctioning and saline. We used to recommend a lot of over the counter decongestants and antihistamines and cough suppressants. But probably in the past almost 10 years or so, we know that the risks can outweigh the benefits. So any side effects such as a fast heart rate or increased blood pressure or the worst thing would be respiratory suppression or depression, which makes your child not want to breath, those are serious, but unusual side effects, but we don't want to take a chance in young children. Because under the age of six anyway, the medicines aren't proven to work. So, there's high risks and a little proven benefit. We try to stay away from a lot of those over the counter medicines till about six years old.
If parents know that these colds can be expected to last about two weeks, then they know how to pace themselves. so they won't get so impatient. I've seen some kids with certain viruses that will last anywhere from two to six weeks and they can be super miserable, but as long as they're not getting worse during that course of illness then it's probably not turning into something more serious, like an ear infection or a pneumonia.
Dr. Shu: If a child has a persistent cough, especially one that seems to be worsening, fever that either lasts for a long time or gets worse, and any of the fast or labored breathing symptoms that you would see. So breathing more than about 60 times a minute for an infant, looking like you're panting or heaving. The muscles in between the ribs and the chest might start sucking in and out, that's called retractions, and you might hear the child grunt a lot, so I see that in a lot of babies with distress.
They're trying to open up their lungs to get more oxygen in. And then, the last thing to look for is nasal flaring. So all those signs would be possibilities that your child is having trouble breathing and pneumonia is one cause of that.
DNB: Right. And so obviously, if you see that, that's an emergency, you need to seek help.
Dr. Shu: Seek help right away, whether that's calling 911 or taking your baby to the emergency room or to the doctor's office right away.
DNB: Let’s say their child has a bad cold, and kinda bad upper respiratory tract infection, they just don't wanna eat, or they're just... They're having a hard time eating, etcetera. how do you manage that or provide guidelines about what to give them to eat, how much they should be eating, even though they're sick, etcetera.
Dr. Shu: Yeah, when kids are sick, they may not eat for various reasons. First of all, they might be so stuffed up that it's hard to coordinate breathing and eating at the same time. They may not have an appetite because nothing smells or tastes good to them, and they just might not have the energy to want to eat. So it's okay if a child doesn't wanna eat for a few days. It's not okay if they don't wanna drink however, and so it's really important to make sure that the child stays hydrated. And one way to tell that is to make sure they're peeing at least every six to eight hours. So if a child is peeing every two or three hours, even though it's less volume than before, the diaper is not as heavy, that's probably still okay. You can also look at their mouths to make sure the mouth is moist and check if there are tears. But it's really important to keep them drinking, whether that be breast milk, or formula, or water, or some type of electrolyte solution, like Pedialyte. And if they won't drink a large volume at a time, give them little sips every five or 10 minutes to keep that trickling in. For older kids, a popsicle might help or even like a crushed popsicle that you can spoon to them. So there are many ways to keep the child hydrated, but if you really can't get the fluids in, that child might need to go to the emergency room, get some intravenous fluids, so by IV.
DNB: What about RSV?
Dr. Shu: Yeah, RSV is a virus, it stands for respiratory syncytial virus, which I don't expect any parents to remember, and it's the cause of a common cold in most people, especially older children, let's say two or three and older, but in younger kids under six months, under two years, it can cause something called bronchiolitis, where the smallest airways of the lungs can get blocked and filled with a little bit of fluid, so you might hear some wheezing or whistling in their lungs when they're breathing in and out, it might sound like that child has asthma. They may have rapid heavy labored breathing, they may be coughing a lot, and there may be a fever. And so, those kids, the problem is that even though they sound like they have asthma, asthma-type medicines don't typically help them get better. So if a child with RSV bronchiolitis is still eating well and able to stay hydrated, then a parent would probably be able to manage that at home, but if you're starting to see a fever that lasts for longer than a couple of days or gets higher and higher if they're having any respiratory problems, then that child may need to go to the hospital because sometimes they'll need to get some oxygen to help them through this type of condition, and some kids need some help with feeding and staying hydrated with an IV or possibly tube feeds.
DNB: God forbid, your kid gets admitted to the hospital, what can you expect or what do they typically do for those babies?
Dr. Shu: So kids who end up having to go to the hospital will be monitored and they'll usually have some type of probe, like a little... It'll look like an elastic bandage, for example, that goes around their finger, or their foot, or their toes to measure their oxygen levels, and if it goes low, then those kids may need to get some oxygen and that might look like a face mask, or a hood that goes over their crib, or little... A nasal cannula, which is little tubing in the nose. Some kids need a little extra oxygen if they have the RSV bronchiolitis and need to get hospitalized.
DNB: Are you, as a pediatrician or your office looking at how you're going to assess these common colds in children as we kind of work through the COVID-19 crisis?
Dr. Shu: Yeah, it's definitely a challenge to have COVID-19 along with common colds and flu once it's flu season, so with people being separated now that a lot of daycares and schools are closed, we're not seeing as much illness in the office right now, but I know that, that will definitely pick up once the weather changes and people are exposed to one another a little bit more. In general, common cold, will be kind of like low level symptoms for one or two weeks and then go away. Something like the flu, you'll have a sudden fever and that can last maybe a week and go away. And then, with COVID-19 in kids, we don't see it as much as with adults, which is wonderful. But babies under a year, and anybody with certain medical conditions who put them already at risk from... Especially a respiratory standpoint, could get sick more quickly and more seriously than typical kids without any medical problems. So, I really do have an eye out for kids under one-year old especially.