Last updated on Feb 17th, 2021 at 08:37 am
As distressing as it is for parents, it’s important to understand that colic is not a diagnosis or a condition, says Dr Paul Sinclair, a paediatrician at Life Vincent Pallotti Hospital in Cape Town. “It’s a description of a young child who is crying excessively (more than three hours a day for more than three days a week), which may be associated with leg lifting or motions that suggest abdominal cramping. There are many reasons why babies cry for long periods of time and these need to be excluded before assigning a label of an immature gut or colic,” he explains. A good discussion with your healthcare provider will help to clarify the cause of an unhappy baby.
This could include:
- A urinary tract infection (UTI)
- Lactose intolerance (the lack of, or deficiency in, the lactase enzyme)
- A cow’s milk (or other protein) allergy
- A middle-ear infection
- Heartburn and gastro-oesophageal reflux disease (GORD)
It’s far better to try identify the cause of the crying and change the trigger or treat the problem, than to use colic remedies that generally contain a basic pain reliever, a sedating antihistamine and antispasmodic agents. Safe, preventative and measured therapy of maternal dietary exclusion, probiotics and sensory input control can also be useful. These can be used cautiously to alleviate a bad day and assist you in maintaining your sanity, but they are not a cure. Babies cry and the so-called “suicide hours” from 5pm until late into the evening can be stressful with a fretful baby, so always seek help, answers and assistance, advises Dr Sinclair.
Infant eczema occurs mainly on the face, scalp, ears, arms and upper body, typically fluctuating from day to day, and appears crusty with a layer of yellow sebum often forming as a protective layer to avoid moisture loss. Most babies outgrow this in the first few months of life, says Dr Sinclair. Although the condition is unsightly, it will rarely irritate your baby. “It’s best treated with careful skincare, using moisturisers and non-steroidal anti-inflammatory agents, and avoiding certain chemicals and foods,” advises Dr Sinclair.
“Eczema is also a common problem in childhood. The more severe the condition, the more likely it is that contact or food allergens are the triggers. Again, the mainstay of therapy after avoiding proven triggers is maintaining a healthy barrier through liberal use of emollients. Topical steroids are still mainly used for flare-ups, though non-cortisone options do exist at a price,” says Dr Sinclair. Using these in combination with controlling “bad” bacteria and itching with antihistamines has made eczema a far more manageable condition.
Jaundice is not a disease but a symptom of an elevated blood bilirubin level, a yellow substance that causes discolouration of the skin and/or whites of the eyes that is often seen in newborns, explains Dr Natasha Padayachee-Govender, a paediatrician at Life Fourways Hospital. “Jaundice initially causes the skin to become yellow. Later, the whites of the eyes may have a yellowish tinge. These changes may be difficult to recognise in children with pigmented skin, or if a baby is unable to open his eyes, so it’s essential for a newborn with suspected jaundice to be tested to check the bilirubin levels, as skin colour change is subjective. If your baby goes home sooner than 72 hours after birth, you will need to monitor his skin colour every day. In addition, your infant should see a doctor or nurse one to three days after going home.”
There are different types of jaundice, continues Dr Padayachee-Govender. “Physiological or benign jaundice, which affects nearly all newborns, is caused by a mild elevation of bilirubin and is not usually harmful to infants. It develops between 72 and 96 hours after birth, and usually goes away within two weeks. However, newborns with higher levels of bilirubin in the blood are at risk of developing severe hyperbilirubinemia, which can be toxic to an infant’s nervous system, potentially causing brain damage. Frequent monitoring and early treatment of infants at high risk for jaundice can help to prevent this.”
- Encouraging feeding Providing adequate breast milk or formula is an important part of preventing and treating jaundice, because it promotes elimination of the yellow pigment in stools and urine. You will know that your child is getting enough milk or formula if he has at least six wet nappies a day, the colour of the bowel movements changes from dark green to yellow, and he seems satisfied after feeding.
- Phototherapy (“light” therapy) This is the most common medical treatment for jaundice in newborns, and in most cases, is the only treatment required. It consists of exposing an infant’s skin to blue light, which breaks bilirubin down into parts that are easier to eliminate in the stool and urine.
- Exchange transfusion A procedure that is done urgently to prevent or minimise bilirubin-related brain damage. It may be performed in infants who have not responded to other treatments and who have signs of or at significant neurologic risk of bilirubin toxicity.
Seek immediate medical assistance if:
- The yellow colouring intensifies
- Your baby has any difficulty feeding
- It’s hard to wake up your baby
- Your baby is irritable and difficult to console
- Your baby arches her neck or body backwards.
Acne is often confused with infantile eczema, but is easily distinguished by its distribution around the nose, upper cheeks and on the chin, explains Dr Sinclair. “It’s far more common in boys and is generally associated with early hormonal sensitivity from being in-utero and breastfeeding. Though usually self-limiting, it can lead to scarring, as blackheads (comedones) can become blocked and infected, leading to pustular acne. A non-comedogenic moisturiser is important, but specific acne therapies may be required to prevent pustular formations and scars. A gentle approach is essential, as are regular follow-ups with your healthcare provider,” he adds.
Blocked tear ducts
A blocked tear duct is a common condition in babies that causes the eyes to tear more than usual. Babies who have a blocked tear duct are usually born with it, says Dr Padayachee-Govender.
Symptoms of a blocked tear duct include:
- Increased tearing – some or all of the time
- Crusty eyelids
- Redness in the whites of the eyes
- A blue area of swelling between the eye and nose (which only happens if both ends of the tear duct are blocked).
A blocked tear duct can become infected. Symptoms include redness, swelling, warmth, pain and pus.
“Most babies don’t need treatment unless their tear ducts become infected,” explains Dr Padayachee-Govender. “Most blocked tear ducts open up on their own by the time the baby is six months old. However, to help this happen, your healthcare provider may recommend gently massaging the area and will show you how to do so. If the tear duct remains closed, your baby may be referred to an ophthalmologist to perform a procedure to open the duct.”