I had the privilege of seeing 5 newborns in clinic yesterday. As I found myself repeatedly talking about some of the quirky, lesser known, normal activities of newborns, I realized that there are things parents didn’t warn each other about. These are all NORMAL things in the newborn stage.
- Skin peeling. Babies have been swimming in “water” for 9 months. Being in so much fluid for so long, will make the skin peel in the first couple of weeks. Treat it by using a good, thick, hypoallergenic lotion a couple of times a day until it stops.
- Twitchy movements. Babies have a reflex called a Moro reflex. When startled, moved rapidly, or rolled to their backs, babies’ arms will quickly outstretch to the side and the hands will open wide. Their other muscles can randomly contract and twitch on occasion. Any persistent, rhythmic movement (like a seizure) should be seen by your doctor. Tip: Record with your phone those sorts of movements in case your baby doesn’t do it while you’re at the doctor’s office (that way your doctor can see if the movements are something to be concerned about).
- Funky breathing. Babies do something called periodic breathing. This is due to an immature nervous system. It goes away with time (first couple of months). In the beginning your baby may have short bouts where he/she breathes fast and then appears to stop breathing. These pauses can be many seconds long (think 10-20 seconds). If you aren’t aware of this quirky breathing pattern, it may make you think that your baby has stopped breathing.
- Gagging and spitting up. Gagging is especially true in the first couple of days of life if the baby was C-Section or a fast delivery. The baby may have remaining fluid in his/her lungs (from prior to birth) or have swallowed some of the amniotic fluid. It can take a couple of days for the baby to get all that junk out. Usually, the baby is still in the hospital during this period and the medical staff can help determine if steps (like sucking out the gunk) need to be taken to help the baby with the transition. After you get home with your baby, some spitting up is still normal. If it seems like a lot (every feed and most of the bottle), talk to your doctor.
- Eye rolling/crossing. Newborns have weak, eye muscles that aren’t very coordinated. It often takes a couple of months for the eyes to consistently start tracking properly. You will likely notice, more eye rolling, crossing, and wandering when the baby is tired.
As always, if there is anything you are particularly worried about, don’t be afraid to see your doctor. Hopefully knowing these normal things can save you time and co-pays. Enjoy your newborn!
Cough and cold season is officially upon us, and I am starting to see lots of kids who are wheezing. Now everyone knows that people with asthma can have wheezing, but not all that wheezes is asthma. There are plenty of other reasons that kids have wheezing, so be careful not to jump to premature conclusions (a.k.a., don’t freak out that your child has asthma just because your pediatrician says that your child is wheezing for the first time).
What is wheezing?
Wheezing is an abnormal breath sound. It is characterized by a high pitched whistling sort of sound. The sound is usually heard on expiration (breathing out). Wheezing is usually heard in the lungs with a stethoscope. Technically speaking, wheezing is not just noisy breathing (although they often get lumped together). There are all sorts of different causes of noisy breathing including airway and nose issues that are not wheezing.
Causes of wheezing
While asthma is probably the number one reason that kids wheeze, this article is exploring other causes of wheezing. It is also worth noting that when kids have wheezing for the first time, they are not diagnosed with asthma. While the child may eventually end up with a diagnosis of asthma, first time wheezing never gets diagnosed as asthma (because of the other possible causes). Let’s look at the other possible causes:
- Viral infections. Many common viruses that infect the lungs can cause inflammation. When the airways get inflamed, wheezing results. RSV (respiratory syncytial virus) is one of the most common viruses that cause wheezing.
- Bacterial infections. Similar to viral infections, bacterial infections can also cause inflammation of the lungs and subsequent wheezing. Bacteria, like pertussis, can cause wheezing. Sometimes pneumonia develops and the patient will also develop wheezing.
- Foreign body aspiration. If your child has inhaled something into his/her airway, then localized wheezing will often develop. The lungs will be irritated by the foreign object and create inflammation around the object. When that happens, the child will develop wheezing. Foreign body inhalation/aspiration happens almost exclusively in the very young child.
- Genetic causes. Conditions like cystic fibrosis may cause wheezing.
- Lung malformations. If the lungs are not formed properly (either from prematurity or otherwise), then children can have wheezing.
- Upper airway problems. This is a tricky cause. Technically “wheezing” heard from these causes are not truly wheezing, but commonly misdiagnosed as such. These include reasons like vocal cord dysfunction or laryngomalacia.
- Heart problems. There are few (much less common) heart conditions that will cause a “wheeze.” A very skilled physician will be able to help distinguish the cardiac wheeze from a lung wheeze. Cardiac wheezing warrants a referral to a pediatric cardiologist (specialist).
How to treat the child who has wheezing entirely depends upon the cause of the wheeze. You certainly wouldn’t give inhalers (designed for inflamed lungs) to a kid who had a cardiac (heart) wheeze. Many of the causes of wheezing (including asthma and infections) get treated similarly, with inhalers. There are essentially two different types of inhalers:
- Preventative inhalers. These deal with the problem of inflammation in the lungs. The medication class is inhaled corticosteroids.
- Rescue inhalers. These deal with the problem of the muscles in the airways getting tight. The medication is a form of albuterol. Inhaled meds can be given through a nebulizer machine or inhalers (used with a spacer).
When to worry
Because wheezing is a finding discovered on auscultation (listening with a stethoscope), most parents won’t realize their child is wheezing until they are already at the doctor. The doctor will then help determine the scope of concern based on severity of symptoms. If by chance your child is having enough trouble breathing to be actually audible without a stethoscope, you should seek immediate medical attention. Generally speaking, wheezing is not normal. If it is happening, you should have your child seen by his or her pediatrician.