Cold Comfort

The fall and winter months are Sicky City. We've got expert advice on helping her through the illnesses that bother babies most.

The first time my son Fletcher woke me after midnight, crying with a terrible cough and fever, I freaked out. There was no mistaking the hoarse, barking cough: He had croup. So my husband and I bundled him up and sped to the after-hours clinic. Just our luck -- it was closing down. "You could go to the emergency room," the last nurse suggested as she locked the door behind her. But as we weighed the dangers of exposing our baby to even more germs there, we realized that en route to the clinic, Fletcher had miraculously stopped coughing. I'd heard that cool night air could help a croupy bark -- and it had! We opted to settle him at home instead.

occasional mild feverg :

A cold is a minor infection in the nose and throat caused by any one of more than 200 viruses that your tot inhales or picks up from the things she touches. Stock up on tissues and saline nose drops. While your infant's immune system is maturing, she'll get about seven colds a year. "The first time was scary," says Boston mom Miriam Katz, recalling her daughter Dalia's bout at 5 months. "She was so congested that she couldn't breathe through her nose, and she didn't want to nurse. Taking her into our steam shower and using eucalyptus oil in the humidifier helped, and she got better fast."

A cold isn't serious, but when your baby is younger than 3 months, a cold can quickly turn into croup or pneumonia. Monitor symptoms, and call the M.D. if they worsen or last more than three days. If your child is younger than 4 weeks and has a fever (100.4?F and up when taken rectally), take her to the ER. At this age, babies can get very sick very fast because they're not fully immunized, explains Stephen Turner, M.D., chief of pediatrics of SUNY Downstate at Long Island College Hospital, in Brooklyn. A spinal tap may be necessary to ensure that your baby doesn't have a bacterial infection such as meningitis. But if your child has a high fever (101?F and above), ear pain, eye redness, or discharge, or if she's not eating normally or isn't wetting as many diapers, it's more than a cold. You should dial your doc right away.

Influenza :

You should take this respiratory infection seriously. Among children, babies younger than 6 months old have the highest risk of being hospitalized and also have the highest rates of flu mortality. That's largely because their immune system hasn't fully developed and they're too young to have a flu shot. However, if you were vaccinated when you were pregnant, your antibodies cut your baby's flu risk by 41 percent during those first six months, according to research. After that, she'll be old enough for her own shot. Get the rest of the family and caregivers immunized, too, advises Orlando pediatrician Hernando Cardona, M.D., of Windermere Pediatrics. "The only way Baby is going to contract flu is if someone brings it home," he says.

If it's flu season (November to April), and your little one spikes a fever, see your doc that same day. A rapid test of nasal secretions can confirm that she has influenza, and your M.D. may administer an antiviral, such as Tamiflu, which can speed recovery by a day or so. Tamiflu is generally not recommended for children younger than 12 months, "but when a baby is really sick, we'll give it, because the younger they are, the higher their risk for complications," Dr. Cardona says. One of the most common is pneumonia, which develops when a flu virus migrates into the lungs from the nose and throat, or when a bacterial infection has cropped up as well. Viral pneumonia is treated with comfort measures; bacterial pneumonia requires antibiotics.

Croup :

A simple cold, sometimes with a fever, until the coughing starts a few nights later. Croup almost always comes on after midnight. The raspy, barking cough and high-pitched whistle when Baby inhales (called stridor) are so distinct, doctors can often diagnose croup over the phone. "That seal sound! The first time my daughter Zoe had that cough, I thought, This is what they're talking about. It's so obvious," Darien Wilson, of Highlands Ranch, Colorado, says.

Babies get croup when a virus causes swelling in the larynx, vocal cords, and windpipe. An infant's windpipe is narrow to begin with, and the swollen vocal chords are very close together. When babies get scared and cry, the airflow through the larynx as they breathe in or cough produces croup's telltale bark and whistle, Dr's explains. Some reassurance: The virus that causes most cases is so benign that kids will often get only that barky cough, Dr. Cardona says. Children generally outgrow croup as their airways widen.

If you hear the stridor whistle when Baby is resting, he's breathing rapidly, and you can see the skin near his ribs and throat pull in with each breath (called retractions), call the M.D. His windpipe is closing. "If you've tried running the humidifier and using cool air and he's not getting better, seek medical attention," Doctors advises. Your child may need steroids or epinephrine to reduce inflammation.

Infants get bronchiolitis when a virus (usually respiratory syncytial virus, aka RSV) inflames the tiniest tubes in the lungs, called bronchioles, clogging them with mucus. For many young children, this is only a minor infection. "People panic when they hear RSV," Dr. Cardona says. "Most of the scary stuff you read about happened to kids who were in the NICU, who had serious lung issues from the get-go. But if your baby was healthy before the symptoms started, she's going to be fine." Treat it like a common cold.