Most common questions

Is there any way to prevent RSV?

The season for respiratory syncytial virus (RSV) infection in the United States is usually October to April. It's wise to take precautions to help prevent it. The main thing to do is wash your hands often and thoroughly with soap and water. Make sure everyone who touches your baby has clean hands. Keep your baby away from crowds of people. Do not allow anyone to smoke around your baby. Cover your mouth when you cough or sneeze and don't share cups, spoons and forks with others. RSV is very contagious. Almost all babies get it before the age of 2. Talk to your baby's health care provider about ways to prevent RSV.

What is diphtheria?

Diphtheria is a disease caused by a bacteria. The disease causes a thick coating in the nose, throat and airway. It can lead to breathing problems, heart failure, paralysis or even death.

Diphtheria can be spread by coughing and sneezing. Symptoms may include a slow onset of a sore throat and low-grade fever.

The DTaP (for children) and Tdap (for adults) vaccines can protect against diphtheria, and . Your baby gets the DTaP vaccine in four doses: at 2 months, 4 months, 6 months and between 15 and 18 months.

If you’re thinking about getting pregnant, make sure you’re protected against diphtheria. If you need to get vaccinated, get the adult vaccine before pregnancy.

What is Haemophilus influenzae type b?

Hib is a serious disease caused by bacteria. It usually affects young children.

Hib is spread from person to person through coughing or sneezing. Hib can cause , and other serious health problems.

The Hib vaccine protects against this disease. Your baby gets the Hib vaccine in three to four doses: at 2 months, 4 months, 6 months (some brands of the vaccine require a shot at 6 months, but others don’t) and between 12 and 15 months.

What is hepatitis B?

Hepatitis B is caused by the hepatitis B virus. It can lead to serious liver disease. Signs of hepatitis B infection include belly pain, joint pain, dark urine, loss of appetite, nausea, fatigue and . However, most people who have hepatitis B infection never show any signs.

You can catch hepatitis B if you’re in contact with bodily fluids of someone who has it. For example, you can get the virus from kissing or having sex with an infected person. You also can get it if you share needles with someone who has the virus. During pregnancy, a mom with hepatitis B can pass the infection on to her baby during childbirth. Pregnant women are tested for hepatitis B at a .

Most people with hepatitis B get better and may not need treatment. However, if you have chronic (long-lasting) hepatitis B infection, you may need treatment with medicines called antivirals that fight the virus. If the liver is badly damaged, you may need a liver transplant. Babies and children are much more likely than adults to get chronic hepatitis B infection.

The hepatitis B vaccine can prevent infection in babies and adults. Your baby gets three doses of hepatitis B vaccine: at birth, 2 months and between 6 and 18 months.

What is measles?

Measles is a disease that is easily spread and causes rash, cough and fever. In some cases, it can lead to diarrhea, ear infection, pneumonia, brain damage or even death. Measles can cause serious health problems in young children. It also can be especially harmful to pregnant women and can cause miscarriage.

The measles,  and  (MMR) vaccine protects against these three diseases. Your baby gets the MMR vaccine in two doses: the first between 12 and 15 months, the second between 4 and 6 years.

If you’re thinking about getting pregnant, make sure you’re protected against measles. If you need to get vaccinated, get the MMR vaccine before pregnancy. Wait at least 1 month before trying to get pregnant after getting the shot.

What is meningitis?

Meningitis is an infection that causes swelling in the brain and spinal cord. It’s usually caused by a virus or bacteria. The infection can spread from person to person through coughing, sneezing, kissing or sharing drinks.

Most people get meningitis from a virus. If you get this kind of meningitis, you’ll probably get better in a few days without treatment. But the meningitis caused by bacteria can lead to brain damage and even death.

Adults may have symptoms like headache, fever and a stiff neck. These symptoms are sometimes mistaken for the flu. Babies may show different symptoms, like high fever, constant crying or even seizures.

If you think anyone if your family has meningitis, see your health care provider right away.

The vaccine can protect against bacteria that cause meningitis. Your baby gets the Hib vaccine in three to four doses: at 2 months, 4 months, 6 months and between 12 and 15 months. Some brands of the vaccine require a shot at 6 months, but others don’t. Ask your provider if you have questions about when your baby gets the vaccine.

What is mumps?

Mumps is a disease that spreads easily from person to person, usually through coughing or sneezing.

It causes fever, headache and swollen glands around the jaw. It can lead to hearing loss, meningitis and painful, swollen testicles in men.

The , mumps and (MMR) vaccine prevents against these diseases. Your baby gets the MMR vaccine in two doses: the first between 12 and 15 months, the second between 4 and 6 years.

If you’re thinking about getting pregnant, make sure you’re protected against mumps. If you need to get vaccinated, get the MMR vaccine before pregnancy. Wait 1 month before trying to get pregnant after getting the shot.

What is pertussis?

Pertussis (whooping cough) is a disease caused by bacteria. Pertussis leads to coughing and choking that can last for several weeks. Babies who catch pertussis can get very sick, and some may die. Most deaths from pertussis happen in babies less than 4 months old.

The number of pertussis cases in this country has more than doubled since 2000. This may be because protection from the childhood vaccine fades over time. In the last few years, there have been several large pertussis outbreaks. Outbreaks are common in places like schools and hospitals. The disease spreads easily from person to person, usually by coughing or sneezing. Most infants who get pertussis catch it from someone in their family, often a parent.

The DTaP vaccine for children and the Tdap vaccine for adults can protect you and your children from pertussis, diphtheria and tetanus. Your baby gets the DTaP vaccine in four doses: at 2 months, 4 months, 6 months and between 15 and 18 months. The pertussis part of the vaccine may weaken as your child gets older. So for the best protection, she gets a fifth shot before she starts school, around 4 to 6 years old.

All new parents need the pertussis vaccine. Until your baby gets her first pertussis shot at 2 months, the best way to protect her is for you to get the adult vaccine before pregnancy or soon after you have your baby. The vaccine prevents you from getting pertussis and passing it along to your baby. Caregivers, close friends and relatives who spend time with your baby should get vaccinated, too.

What is pneumonia?

Pneumonia is an infection in the lungs caused by bacteria or viruses.

Pneumonia can cause coughing, shortness of breath and chest pain. You can catch it from another person, even if he doesn’t look or feel sick.

Several vaccines can protect you from pneumonia by preventing infection from certain bacteria or viruses. One vaccine that protects against pneumonia is pneumococcal conjugate vaccine (PCV). Your baby gets the PCV vaccine in four doses: at 2 months, 4 months, 6 months and between 12 and 15 months.

Other vaccines that help protect against pneumonia include:

• (Hib)
• (flu)
• , mumps, rubella (MMR)
• , and (DTaP for children and Tdap for adults)
• (chickenpox)

If you’re thinking about getting pregnant and are at risk for pneumonia, your provider may recommend that you get vaccinated before pregnancy. Talk to your provider if you think you may be at risk for pneumonia.

What is tetanus?

Tetanus (also called lockjaw) is a disease caused by bacteria that attacks the nervous system (that includes the brain, spinal cord and nerves).

Stiffness in the neck or stomach muscles may be early symptoms of tetanus. Tetanus also can cause the jaw to “lock,” so that a person can’t open his mouth or swallow. It also can cause serious, painful spasms of all muscles. It sometimes causes death.

Tetanus is not passed from one person to another. Instead, the bacteria that causes tetanus can enter your body through a break in your skin and cause infection. For example, if you step on a nail, cut your skin in an accident, or get a splinter, you may be at risk of tetanus infection.

The DTaP (for children) and Tdap (for adults) vaccines can protect you from tetanus, and . Your baby gets the DTaP vaccine in four doses: at 2 months, 4 months, 6 months and between 15 and 18 months.

If you’re thinking about getting pregnant, make sure you’re protected against tetanus. If you need to get vaccinated, get the adult vaccine before pregnancy.

What’s an umbilical hernia?

This common hernia in infants usually appears as a soft lump or bulge beneath the belly button. You may see it most clearly when your baby is crying, pushing her belly outward. It happens when a portion of the intestine bulges through the abdominal wall. This happens when the muscles in the area fail to close around the belly button after the umbilical cord falls off. It's more common in girls, particularly African Americans, or premature babies.

Umbilical hernias usually aren't serious or painful to the baby and they go away without treatment by the fifth birthday - often much sooner. If you suspect your baby has a hernia, call your child's health care provider. It’ll be important to watch it for changes over time. If it enlarges or swells, or if you baby has severe pain, vomiting or weakness, call your child's health provider right away, as a serious complication could exist. If surgery is required, it’s usually a quick fix.

Colds

Most babies have 8-10 colds by the time they are 2 years old. Colds are caused by viruses. They are highly contagious and easily spread through the air and by touching contaminated surfaces.

For example, you can touch another person's hands who has a cold and then touch your own nose or eyes. If a cold virus is on the person's hands, you may then get a cold.

Unfortunately, colds are a part of life. The symptoms last about a week and are all too familiar: runny or stuffy nose, sneezing, sore throat, cough and slight fever.

These symptoms can be more uncomfortable for a baby than for an older child or adult. A baby can't blow her nose. She also has a hard time breathing through her mouth. A stuffy nose can make it difficult for a baby to suck, interfering with feeding.

Call your baby's health care provider if your baby is less than 3 months old and:

• Develops any fever (more than 100.4° F) or cold symptoms. The provider will probably want to examine her to make sure she is not developing a more serious illness.
• Refuses several feedings.
• Is more irritable than usual or especially sleepy.

Also call if your older baby or child:

• Develops a fever above 102° F
• Has a cough that worsens or doesn't get better after a week. Do not give over-the-counter cough and cold products to infants and children younger than 4 years of age. According to the U.S. Food and Drug Administration, these medications can have serious and life-threatening side effects.
• Has a stuffy nose that doesn't go away after 10-14 days
• Has a sore throat that gets worse
• Has difficulty breathing
• Develops ear or face pain

Although there's no cure for the common cold, you can make your baby more comfortable. If your baby is having trouble sucking, try using a rubber suction bulb to help clear her nose before each feeding. Your provider may recommend nasal saline (salt water) drops to ease stuffiness. Putting a cool-mist humidifier in her room may also help her breathe more easily.

You can try to protect your baby from colds by keeping her away from people who are sneezing or coughing. This is especially important when your baby is less than 3 months old.

July 2006 (R 1/08)

Croup

Croup is a common childhood illness that affects the voice box (larynx) and windpipe (trachea). Children between 3 months and 3 years of age are most likely to get croup. Their airways are small, and any swelling can make it difficult to breathe. Most cases of croup are mild and last less than a week.

Croup is caused by viruses that are contagious. The viruses can spread through the air or by touching a contaminated surface. Less frequently, allergies may cause croup. Your baby can get croup at any time of year, but it is most common between October and March.

Croup often starts with mild cold-like symptoms. As the airway swells, the child develops noisy breathing and a cough that sounds like the barking of a seal. Often a child's symptoms get worse or come on suddenly at night. The symptoms tend to repeat over the next two to three nights.

Do not give over-the-counter cough and cold products to infants and children younger than 2 years of age. According to the U.S. Food and Drug Administration, these medications can have serious and even life-threating side effects.

Antibiotics won't help croup. Health care providers sometimes prescribe medications called corticosteroids that reduce swelling in the airways and make breathing easier. Rarely, a child with serious breathing problems may need to be treated with oxygen and medications in the hospital.

Call your baby's health care provider right away if your child develops a barking cough or noisy breathing. She may also be hoarse and have fever.

Call for emergency medical assistance if your baby:

• Appears to be struggling to get a breath
• Looks blue around the mouth
• Drools and has a lot of trouble swallowing
• Makes louder and louder noises as she inhales (called stridor), especially when resting

Steam often helps children with mild cases of croup to breathe easier. You can steam up the bathroom with hot shower water and sit there with your child for 15 to 20 minutes. If this doesn't help, try taking your child outside to breathe cool night air. The cool air helps reduce airway swelling. A cool-water humidifier (vaporizer) in your baby's room also may help. While your baby has the croup, check on her frequently during the night to make sure the symptoms don't get worse.

July 2006 (R 1-08)

Cytomegalovirus and your baby

Cytomegalovirus (CMV) is a herpes virus. This is a large group of viruses that can cause different kinds of diseases and health problems. Most people get CMV at some point in their lives, most often during childhood.

CMV is the most common congenital infection in the United States. Congenital means that it’s something a baby’s born with. Each year about 1 in 150 babies (less than 1 percent) is born with CMV. About 8,000 children each year develop lasting health problems caused by CMV.

You can pass CMV to your baby at any time during pregnancy. It’s more likely to cause problems for your baby if it happens in the early part of pregnancy. You also can pass CMV to your baby during labor and birth and during breastfeeding. If your baby gets the virus during these times, he’s less likely to have health problems than if he gets the virus during pregnancy.

What problems can CMV cause in babies?

Most babies born with CMV don’t have serious health problems from the virus. Eight in 10 babies born with CMV (80 percent) never have symptoms or problems caused by the infection.

About 15 in 100 babies born with CMV (15 percent) develop one or more disabilities during the first few years of life. These disabilities can include:

• Hearing loss
• Intellectual disabilities (problems with how the brain works that can cause a person to have trouble learning, communicating, taking care of himself and getting along with others)
• Vision loss

How do you know if your baby has CMV?

If you’re pregnant and have CMV, you can have prenatal tests to see if your baby has CMV.

After birth, your baby’s health care provider can test your baby’s body fluids within 3 weeks of birth to check for CMV. Body fluids include urine, saliva and blood.
Most babies born with CMV appear healthy. But about 1 in 10 infected newborns (10 percent) have signs and symptoms of CMV at birth. These include:

• Enlarged liver or spleen
• Jaundice (yellowing of the skin and eyes) or liver problems
• Low birthweight (when a baby weighs less than 5 pounds, 8 ounces)
• Premature birth (birth that happens too early, before 37 completed weeks of pregnancy)
• Feeding problems
• Rash
• Seizures
• Small size
• Swollen lymph nodes

Older babies and children usually don’t have CMV symptoms. But some may have:

• A sore throat
• Fever that lasts for a few days
• Swollen glands
• Fatigue (extreme tiredness)

Call your baby’s health care provider if you think your baby may have CMV.

How are babies born with CMV treated?

Even though most babies aren’t harmed by CMV, all babies born with the virus need regular hearing and vision tests.

Babies born with CMV may be treated with antiviral medicines. These medicines kill infections caused by viruses. This treatment usually happens in a hospital.

For more information
cmvfoundation.org

stopcmv.org

Last reviewed June 2012

See also: Cytomegalovirus and pregnancy

Ear infection

Otitis media is an infection behind the eardrum (middle ear). In most cases, ear infections develop in a child who has had a cold. Your child can't catch an ear infection from another child who has one. But he can catch the cold that caused the child's ear infection. About two out of every three children have at least one ear infection before their second birthday.

Ear infection is caused by viruses and bacteria. Babies and preschool-aged children are especially likely to get ear infections for several reasons, including:

• The tubes that connect the back of their throats and middle ear are small. (These tubes are called the eustachian tubes). The position of these tubes also increases the risk of infection.
• Their immune systems are still developing.

Your child may have an ear infection if she:

• Complains of ear pain
• Does not seem to hear normally
• Pulls on her ear
• Has a fever (above 100.4° F)
• Cries during feeding

Call your child's health care provider if you suspect an ear infection. Providers can diagnose an ear infection by looking inside a child's ear canal. They do this with an instrument called an otoscope.

Some ear infections clear up without treatment within a few days. Others require antibiotics. Providers usually treat babies under 6 months of age with antibiotics. If the child is older and has mild symptoms, the provider may suggest waiting a few days before starting antibiotics to see if the infection clears up by itself.

If your child's provider recommends antibiotics, be sure your child takes them for the recommended length of time (even if she feels better sooner). If antibiotics are stopped too soon, the ear infection could come back, and then require stronger antibiotics.

The provider also will suggest treatment for ear pain, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil), and sometimes ear drops.

After treatment, some children may have fluid in the ear that can affect hearing for three weeks or more. Hearing should return to normal when the fluid clears.

Some children are prone to repeated ear infections. In these cases, the provider may recommend low-dose antibiotic treatment to help prevent the infections. If this doesn't work, some providers recommend inserting tiny tubes in the eardrums to help drain the middle ear. The tubes may help prevent speech and language problems that may result from hearing loss from repeated or long-lasting ear infection.

You may be able to help prevent some ear infections in your baby by:

• Breastfeeding your baby. Breast milk has antibodies that help protect a baby from many infections, including those that can cause ear infections.
• Holding your baby in a partially upright position during bottle-feeding. This helps prevent formula from dripping into the eustachian tubes. Avoid keeping your baby's bottle in the crib after feeding.
• Keeping your baby or young child away from cigarette smoke. Smoke appears to increase the risk of ear, as well as respiratory, infections. Minimizing dust in the home also may help.
• Making sure your baby gets all the recommended immunizations. The pneumococcal vaccine may help prevent ear infections caused by certain bacteria.

July 2006

 

Fever-related seizures

A seizure, also called a convulsion, can be triggered by a fever. This is called a febrile seizure. Febrile seizures usually won't harm a child, but they can be very frightening for parents.

A child who is having a febrile seizure may roll his eyes, stiffen, and not respond when you speak to him. Sometimes the child may fall to the floor. His arms and legs may twitch violently.

About 2 to 5 out of every 100 children have at least one febrile seizure. These seizures are most common between 6 months and 5 years of age.

Febrile seizures usually occur early in an illness when the fever rises quickly. Examples of such illnesses are roseola, colds and stomach infection.

Most febrile seizures last less than one minute, though they may occasionally last up to 15 minutes. They usually occur only once during a 24-hour period and involve both the left and right sides of the body.

Other kinds of seizures (such as those associated with epilepsy) may last longer, happen more often, or affect only certain parts of the body. A child who has febrile seizures does not have epilepsy. But he may be at slightly higher risk of developing it than a child who has never had a febrile seizure.

Febrile seizures seem to run in families. Children who are under 12 months of age when they have their first febrile seizure have about a 50 percent chance of having another one with a future fever. In some cases, the health care provider may recommend medications to prevent additional febrile seizures.

If your child has a seizure:

• Lay him on the bed or on the floor. Remove any hard or sharp objects from the area so he doesn't hurt himself.
• Place him on his side or turn his head to the side. This will help prevent choking if the child vomits.
• Do not place anything in the child's mouth.
• Call your child's health care provider after the seizure ends. The provider will want to examine your child to rule out serious infections and other causes of seizures. If your provider isn't available, take your child to the emergency room.

Have someone call for emergency medical assistance while you stay with the child if:

• The seizure lasts longer than two or three minutes
• The child is having trouble breathing

To help prevent another seizure, keep your child's temperature down during an illness. Your child's provider may recommend infant's or children's acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) and sponge baths with lukewarm water.

If your child is sick or has a fever, avoid overdressing him. Your child's temperature may rise even more if he is wearing layers of warm clothes.

July 2006

Influenza (flu) and your baby

Influenza is a serious disease. It’s more than just a runny nose and sore throat. Instead, it can cause a person to be very sick.

Influenza is commonly called the “flu.” Many people say they have the flu when they really have just a cold or a cough. If your baby gets influenza, it can cause serious illness. And for some, it can be life-threatening. It’s really important for babies and young children to be protected from the flu.

Influenza is easily spread from person to person. When someone with influenza coughs, sneezes or speaks, the virus spreads through the air. Your baby can get infected with influenza if she breathes it in. She also can get infected if she touches something (like a toy) that has the influenza virus on it and then she touches her nose, eyes or mouth.

The best way to protect your baby from influenza is to get her the influenza vaccine (flu shot) each year before flu season starts in October. She can get the shot from her health care provider. Many pharmacies and work places also offer it each fall. Even though your baby is more likely to get influenza during flu season (October through May), she can get it any time of year.

What are the symptoms of flu?
Flu symptoms include:

• Fever
• Chills
• Cough (Don’t give over-the-counter cough and cold products to your baby or young child. According to the American Academy of Pediatrics, these medicines can cause serious health problems for children.)
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headache
• Being tired
• Vomiting and diarrhea

Fever and most other symptoms can last a week or longer.

Does your child need the influenza vaccine?
Yes. The Centers for Disease Control and Prevention (CDC) recommends that everyone older than 6 months get the influenza vaccine each year. The 2012-2013 influenza vaccine protects your child against seasonal flu and the 2009 H1N1 flu (a kind of flu that spread around the world in 2009). It’s important to get your child vaccinated each year because flu viruses are always changing and protection from the vaccine only lasts about 1 year.

It’s important for children younger than 5 to get the vaccine because they’re more likely than older kids to have health problems caused by influenza. Some children younger than age 9 need two doses of the vaccine. Ask your child’s provider if one dose is enough.

The influenza vaccine is safe for most children. But check with your child’s provider to make sure the vaccine is safe if your child:

• Is allergic to eggs. The influenza vaccine is made with eggs.
• Has had the influenza vaccine before and had a serious reaction to it
• Has had Guillain-Barré syndrome after getting the influenza vaccine. This is an illness that can cause paralysis (being unable to move).

Having influenza can be really dangerous for children with chronic health problems, like asthma, heart disease, sickle cell disease, diabetes, cancer and HIV. If your child has these or other health conditions and she is older than 6 months, be sure she gets the influenza vaccine each fall. Flu season lasts from October through May.

If you take care of a child younger than 5 years old, get the influenza vaccine yourself. This is really important if you take care of a baby younger than 6 months old. Babies this age are too young to get the influenza vaccine. Getting the vaccine yourself can help prevent you from spreading influenza.

How is the influenza vaccine given?
The influenza vaccine is given in two ways:

1. Flu shot
2. Flu mist. This is a nasal spray. Children older than 2 years can get the flu mist unless they have certain health conditions, like asthma or heart and lung problems.

If you’re not sure which vaccine is best for your child, ask his health care provider or visit flu.gov.

How is flu treated?
If your child has flu symptoms, call his health care provider right away. His provider may recommend medicine that kills infections caused by viruses.

Be sure your child gets lots of rest and drinks plenty of fluids. She may not want to eat much. Try giving her small meals to help her body get better.

If your child seems uncomfortable from a fever, ask the provider if you can give your child infant's or children's acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®). Never give aspirin to a child who has a fever without checking with his health care provider. Aspirin can cause a rare but life-threatening liver disorder called Reye syndrome in children with certain illnesses, such as , flu and chickenpox.

How can you stop influenza from spreading?
If your child has influenza, he can spread it to others. Take the following steps to help prevent influenza from spreading:

• Don’t kiss your child on or around the mouth. But a hug is a good thing!
• Teach your child to cough or sneeze into a tissue or his arm. Throw used tissues in the trash.
• Wash your hands with soap and water before and after caring for your child. You also can use alcohol-based hand rubs.
• Use hot, soapy water or a dishwasher to clean your child’s dishes and utensils.
• Don’t share any of your child’s dishes, glasses, utensils or his toothbrush.
• Limit your child’s contact with others.

When should you call your child’s health care provider?
Contact your child's health care provider right away if your child has any of these signs:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that she doesn’t want to be held
• Flu symptoms that improve but return with fever and worse cough
• Fever with a rash

For more information
Flu.gov

Lastreviewed October 2012

See also: Flu and pregnancy, Your baby’s vaccinations

MRSA

MRSA (pronounced "mersa") is a skin infection that is resistant to some commonly used drugs. "Resistant" means that the infection does not get better once a specific drug is given. MRSA stands for "methicillin-resistant Staphylococcus aureus."
Staphylococcus aureus, also called Staph, is a type of bacteria. It is a common cause of skin infections. Some Staph bacteria, including MRSA, are resistant to certain antibiotics.

About 9 out of 10 MRSA infections are related to health care. Examples: Surgery, kidney dialysis.

Other MRSA infections occur as people go about their daily lives. Examples:

• A towel infected with MRSA touches a scrape on a person's arm.
• An open cut on one person's leg touches a surface (like a weight-training bench) that has the MRSA bacteria on it.

MRSA infections often occur:

• Where there is a cut or scrape
• On a part of the body that is covered by hair, such as the back of the neck

Crowded conditions can help spread MRSA. Examples: School athletic facilities, day care facilities.

Staph infections like MRSA can sometimes cause serious problems. Examples: Pneumonia, infections of the bloodstream.

What can my children and I do to reduce the spread of MRSA?

• Wash your hands often with soap and water. Or use a hand sanitizer that contains alcohol.
• Shower after you exercise.
• Keep cuts and scrapes clean.
• Cover cuts and scrapes with clean, dry bandages until they heal.
• If you have a cut, always put dirty bandages in the trash. Wash your hands after handling dirty bandages.
• Do not touch the cuts or skin infections of other people. Also, do not touch their bandages.
• Do not share personal items that come into contact with skin. Examples: Towels, razors.

When should I be concerned about a skin infection?
Most Staph skin infections are minor and are easily treated. The skin may be red, swollen, painful, or have pus or oozing. The infection may look like a pimple, a boil or a bite.

Important: If a skin infection doesn't get better, call your health care provider. The infection may be MRSA.

How is MRSA treated?

• Most MRSA infections can be treated with antibiotics taken by mouth. If your child has been given an antibiotic, be sure she takes all the doses, unless her health care provider tells her to stop.
• When treating a MRSA infection, the health care provider sometimes cuts open the infected area of the skin, cleans it and drains it.

December 2007

Neonatal abstinence syndrome (NAS)

Neonatal abstinence syndrome (also called NAS) is a group of conditions a newborn can have if his mother is addicted to drugs during pregnancy. NAS happens when a baby gets addicted to a drug before birth and then goes through drug withdrawal after birth. NAS can last from 1 week to 6 months after birth.

If you’re pregnant and you use street (illegal) drugs or abuse prescription drugs, tell your health care provider right away. She can help you get treatment to quit using these drugs and help prevent NAS in your baby. If you’re not pregnant, quit using drugs before you get pregnant. This is the best way to prevent NAS.

What causes NAS?
If you take drugs during pregnancy, they can pass through the placenta to your baby in the womb. The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord. If your baby’s body starts to depend on a drug during pregnancy, he may have withdrawal symptoms after birth.

Using drugs like these during pregnancy can cause NAS:

• Marijuana (pot)
• Cocaine
• Amphetamines (like speed, Adderall® and Dexedrine®)
• Opioids (like heroin, oxycodone, Oxycontin®, Vicodin®, Percocet®, morphine and codeine)
• Barbiturates (like phennies, yellow jackets and Amytal®)
• Benzodiazepines (like sleeping pills, Valium® and Xanax®)

Some of these drugs, like cocaine and heroin, are street drugs and illegal to use. Some, though, like Oxycontin and Valium, are prescription drugs. Prescription drugs are medicines that a health care provider has prescribed for you to treat a certain health condition. If you abuse prescription drugs, it means you take more than has been prescribed for you, you take someone else’s prescription drug, or you get the drug from someone without a prescription. Just like street drugs, some prescription drugs can hurt your baby during pregnancy and cause NAS after birth..

In most cases, it’s best to stop using street drugs immediately to give your baby the best chance to be born healthy. But if you’re pregnant and using opioids, like heroin or oxycodone, don’t stop taking them without treatment from your health care provider. Quitting suddenly (sometimes called cold turkey) can cause severe problems for your baby, including death. Talk to your health care provider or a drug-treatment center about treatment with drugs like methadone or buprenorphine. Getting treatment can help you stop using drugs and is safer for your baby than getting no treatment at all.

What are the symptoms of NAS?

Babies with NAS may show these symptoms in the first 10 days following birth:

• Body shakes (tremors) or seizures (convulsions)
• Being very fussy, excessive crying or having a high-pitched cry
• Poor feeding, poor sucking or slow weight gain
• Breathing really fast
• Fever
• Sweating
• Trouble sleeping
• Patchy or uneven skin color
• Diarrhea or throwing up
• Hyperactive reflexes
• Tight muscle tone
• Stuffy nose or sneezing

Call your baby’s health care provider if your baby has any of these symptoms. Not all babies with NAS have the same symptoms. Symptoms depend on:

• What drug you used during pregnancy, how much you used and how long you took it
• How your own body breaks down the drug
• If your baby was born prematurely (before 37 completed weeks of pregnancy)

How do you know if your baby has NAS?

Your baby’s provider can use these tests to see if he has NAS:

• Neonatal abstinence scoring system. This system gives points for each NAS symptom depending on how severe it symptom is. Your baby’s provider uses the score to decide what kind of treatment your baby needs.
• Test of your baby’s first bowel movements (also called meconium)
• Test of your baby’s urine

How is NAS treated?

Your baby’s treatment may include:

• Taking medicines to treat or manage severe withdrawal symptoms. Your baby’s provider may give her a medicine that’s similar to the drug you used during pregnancy. This can help relieve your baby’s withdrawal symptoms. Once these symptoms are under control, your baby gets smaller doses of the medicine over time so her body can adjust to being off the medicine. Medicines used to treat severe withdrawal symptoms include morphine, methadone and buprenorphine.
• Getting fluids through a needle into a vein (also called intravenous or IV). Babies with NAS can get very dehydrated from having diarrhea or throwing up a lot. If a baby’s dehydrated, she doesn’t have enough water in her body. Getting fluids through an IV helps keep your baby from getting dehydrated.
• Drinking higher-calorie baby formula. Some babies with NAS need extra calories to help them grow because they have trouble feeding or slow growth.

While your baby’s being treated for NAS, he may be fussy and hard to soothe. Doing these things can help calm him:

• Swaddle your baby in a blanket.
• Gently rock your baby.
• Keep your baby in a quiet, dimly lit room.

For more information

National Council on Alcoholism and Drug Dependence
Substance Abuse Treatment Facility Locator
Organization of Teratology Information Specialists

Last reviewed January 2013

See also: Drugs and pregnancy, Alcohol during pregnancy

Newborn jaundice

Jaundice is a yellow discoloration of the skin and the whites of the eyes. It is caused by a build-up in the blood of a yellow pigment called bilirubin. Jaundice occurs in about 60 percent of all newborns (1, 2).

Skin usually starts to turn yellow a few days after birth. In most cases, jaundice goes away without treatment and does not harm the baby or cause any discomfort. However, babies with severe jaundice can have high bilirubin levels, which can pose a risk of brain damage.

The American Academy of Pediatrics (AAP) recommends that all babies be checked for jaundice before they leave the hospital (3, 4). Babies should be examined again by a health care provider at 3 to 5 days of age because this is the time when bilirubin levels are highest (3, 4). When necessary, a baby can be treated to prevent bilirubin levels from getting too high.

How are babies checked for jaundice?
A health care provider examines the baby for signs of jaundice before being discharged from the hospital. If the baby's skin looks yellow or if the baby has certain risk factors that make jaundice more likely (see below), the provider may measure the level of bilirubin with a skin sensor or a blood test. The blood test is the most accurate way to determine the level of bilirubin. Providers may recommend one of these tests for some babies with darker skin because it may be difficult to tell if a baby has jaundice by examining the skin.

What causes jaundice in newborns?
Jaundice occurs when bilirubin builds up in the blood. Each day some red blood cells in the body die. As they break down, an oxygen-carrying substance called hemoglobin is changed to bilirubin.

Normally, the liver removes bilirubin from the blood and changes it into a form that can be passed from the body in bowel movements. In the newborn period, more red blood cells can break down than at most other times, creating more bilirubin to handle.

The liver of a newborn may be too immature to keep up with bilirubin removal, causing bilirubin to build up in the blood. This build-up turns skin and, sometimes, the white part of eyes yellow. Premature babies have especially immature livers, making jaundice more likely.

Jaundice caused by a maturing liver is called physiologic jaundice. This is the most common type of jaundice in newborns, occurring in both breastfed and formula-fed infants. Physiologic jaundice usually clears up within two weeks in formula-fed babies, though it may last for more than two to three weeks in breastfed infants (3).

Certain health problems in the baby can contribute to jaundice. In these cases, jaundice may begin in the first 24 hours of life and become more serious. A small number of babies have different blood types from their mothers (such as ABO or Rh incompatibility that can lead to an especially rapid breakdown of red blood cells and jaundice.

Certain newborn digestive system disorders, infections and genetic disorders also can contribute to jaundice, as can severe bruising at birth. Babies with these conditions are more likely than babies with physiologic jaundice to require treatment to reduce the levels of bilirubin in their blood.

When bilirubin levels get too high, bilirubin can enter the brain and cause brain damage.

Are breastfed babies more likely to develop jaundice?
Breastfed babies are more likely than formula-fed infants to develop jaundice (3). However, jaundice occurs mainly in babies who are not nursing well (3, 4). These babies may not get enough calories and may become dehydrated, both of which may contribute to jaundice. Breastfeeding mothers should nurse their babies at least 8 to 12 times a day for the first several days of life to help keep their baby’s bilirubin level down (4).

The AAP recommends that all healthy full-term and near-term babies be breastfed (4). Breast milk is the ideal food for babies and provides many health benefits, including reducing the risk of infections.

What are the signs of jaundice?
Yellow discoloration usually first appears on the face and in the whites of the eyes. A parent often can tell if a baby has jaundice by looking at the baby under natural daylight or in a room that has fluorescent lights. If a parent thinks there is a yellowish color, he should contact the baby's health care provider.

Most babies with jaundice are alert and eat and sleep normally. However, a parent should call the baby's health care provider immediately or seek emergency medical care if a baby with jaundice (1, 4):

• Appears very yellow
• Is hard to wake
• Sucks or nurses poorly
• Appears floppy or stiff (or alternates between both)
• Arches the neck or back backwards
• Develops a high-pitched cry or fever
• Has unusual eye movements

These may be warning signs of dangerously high levels of bilirubin that require prompt treatment to prevent a rare form of brain damage called kernicterus.

What is kernicterus?
Kernicterus is a type of brain damage caused by high levels of bilirubin. It can cause athetoid cerebral palsy (characterized by uncontrollable tremors or writhing movements of the limbs, body and face), hearing loss, problems with vision and, sometimes, intellectual disabilities.

No baby should develop kernicterus because there are effective treatments that can lower bilirubin levels before they become dangerous. While kernicterus is rare, the exact incidence in the United States is unknown. About 125 babies with kernicterus were reported to a kernicterus registry from 1984-2002 (5). The number of affected children may be rising, possibly due in part to early hospital discharge of babies before jaundice is recognized or diagnosed.

How is jaundice treated?
Most babies with jaundice do not need treatment. Health care providers sometimes suggest steps parents can take at home to help clear up mild to moderate jaundice. The provider may recommend increasing the number of feedings to encourage more bowel movements, which helps eliminate bilirubin.

However, if a baby has moderate to severe jaundice that does not clear up on its own, treatment is recommended:

Phototherapy: The baby, wearing only a small diaper, is placed under special white or blue lights called bili-lights. The baby wears shields to protect the eyes. The lights help change bilirubin in the blood to a form that can be easily eliminated in urine.

Some babies receive phototherapy before discharge from the newborn nursery or are admitted to the hospital for a few days for phototherapy, while others are treated at home. A baby's health care provider can discuss with the parents which treatment is appropriate for their baby.

Phototherapy is safe. A few babies develop a mild skin rash that goes away when treatment is completed. Special fiber-optic blankets also can be used to treat some babies.

Exchange transfusions: Babies who do not respond to phototherapy and continue to have rising or dangerously high bilirubin levels may need to be treated with a special kind of blood transfusion. In this procedure, the baby's blood is removed little by little and replaced with donor blood.

Exchange transfusion is effective at lowering bilirubin levels. However, it can pose a risk of infection and other complications, so it is recommended only when bilirubin levels are very high. It is done in a newborn intensive care unit.

Who is at increased risk for serious jaundice that requires treatment?
Some babies are at increased risk for serious jaundice, including (3, 4):

• Babies with signs of jaundice in the first 24 hours of life. A health care provider can check to see if the baby has an underlying disorder (such as a blood-group incompatibility or genetic disease) contributing to the jaundice.
• Premature babies (born before 37 completed weeks of pregnancy)
• Babies who have a sibling who was treated for jaundice
• Babies of East Asian descent
• Babies who have high bilirubin levels before leaving the hospital
• Breastfed babies, especially those who are not nursing well
• Babies with large bruises or a cephalohematoma (bleeding under the scalp related to labor and delivery)
• Family history of a genetic disorder called G6PD deficiency

Does the March of Dimes support research on newborn jaundice?
The March of Dimes has long supported research aimed at improving prevention and treatment of newborn jaundice. In 2003, the March of Dimes cosponsored a conference with the AAP, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health, aimed at identifying areas where research is needed to improve the diagnosis and treatment of newborn jaundice (6).

The March of Dimes also is collaborating with these and other health organizations in the Kernicterus Prevention Partnership, which aims to prevent all new cases of kernicterus in any full-term or near-term baby born in this country by educating health care providers, as well as families, about the potential hazards of newborn jaundice.

Where can families get more information on jaundice and kernicterus?
For additional information, contact:

• American Academy of Pediatrics (AAP)
• Centers for Disease Control and Prevention
• Parents of Infants and Children with Kernicterus (PICK), (312) 274-9695

References

1. Centers for Disease Control and Prevention (CDC). Frequently Asked Questions about Jaundice and Kernicterus. Updated 3/28/07.
2. Maisels, M.J. and McDonagh, A.F. Phototherapy for Neonatal Jaundice. New England Journal of Medicine, volume 358, number 9, February 28, 2008, pages 920-928.
3. American Academy of Pediatrics (AAP). Questions and Answers: Jaundice and Your Newborn. Posted 6/25/04, accessed 4/21/08.
4. American Academy of Pediatrics (AAP). Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation: Clinical Practice Guideline. Pediatrics, volume 114, number 1, July 2004, pages 297-316.
5. Springer, S.C. Kernicterus. EMedicine, updated 7/31/06.
6. Blackmon, L.R., et al. Research on Prevention of Bilirubin-Induced Brain Injury and Kernicterus: National Institute of Child Health and Human Development Conference Summary. Pediatrics, volume 114, number 1, July 2004, pages 229-233.

May 2008

Reflux

All babies spit up or throw up now and then. But some do so more often than usual. This is called reflux. Reflux is short for gastroesophageal reflux or GER.

Reflux is common among premature babies. Most babies outgrow it after a few months. Only 1 percent of babies are still spitting up after their first birthday.

Here's what happens with reflux:

1. Food first passes through the mouth and the esophagus into the stomach. (The esophagus is the tube that connects the mouth and the stomach.
2. Once the food is in the stomach, it comes back up the esophagus and out of the mouth.
3. Most babies with reflux are less bothered by it than their parents. They grow and develop normally. But for a few babies, reflux is more serious. The baby needs medication to make sure reflux is not dangerous.

Feeding tips
If your baby had reflux in the NICU, the nurses may have shown you how to feed and position your baby to minimize spit up. These tips may help:

• Hold your baby upright during feeding.
• Try smaller, more frequent feedings.
• Burp your baby often, especially if you are feeding him with a bottle.
• Try a different nipple on your baby's bottle so he swallows less air.
• Ask your baby's health care provider if you can thicken the formula or expressed breast milk with a small amount of rice cereal.
• Keep your baby still after feeding.
• Raise the head of your baby's bed 30 degrees or so.
• Keep a stack of cloth diapers or burp cloths handy. Use them to protect your clothes, your baby's clothes and your furniture.

When to call your baby's health care provider
These symptoms may mean that your baby has other problems digesting food:

• The spit-up is bright yellow or green.
• There is a large amount of spit-up.
• Your baby arches his back or cries during feeding.
• Your baby vomits with great force (projectile vomiting).

August 2009

Roseola

Roseola is a childhood illness caused by a virus. It is most common in babies and children under 2 years of age. Roseola usually starts with a slight cold. The child then gets a high fever (between 102° and 105° F) that usually lasts between three and seven days.

Although roseola is rarely serious, there is a small risk of . The risk is highest early in the illness when the fever is rising quickly. Some children with roseola have a slight cough, reduced appetite and mild diarrhea.

After the child's temperature returns to normal, she develops a rash. The rash usually starts on the back, stomach or back and then spreads to the upper arms and neck. It usually clears up in about one day. Once the rash is gone, the child can resume normal activities.

Roseola is contagious, but you probably can't protect your child from it. It is usually spread by respiratory droplets or saliva from a child who has no obvious symptoms of the illness.

Call your child's health care provider right away if your child:

• Develops any fever of more than 100.4° F in the first 3 months of life, 101° F or greater between 3 and 6 months, or 103° F after 6 months of age
• Has a seizure

Your child should feel better within a week. In the meantime, you can make her more comfortable if you:

• Dress your child in light clothing.
• Encourage her to get extra rest and drink plenty of fluids.
• Ask your child's health care provider if you should give her infant's or children's acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) for the fever. Never give aspirin to a child or teenager with a fever without checking with a health care provider. Aspirin can cause a rare, but life-threatening disorder called Reye syndrome in children with certain viral illnesses (including colds, flu and chickenpox).
• Give her sponge baths using lukewarm water to lower his temperature.

July 2006

Rotavirus

Rotavirus is the most common cause of severe diarrhea in infants and young children. It is highly contagious. Almost all children get infected by the age of 3. Your baby can catch rotavirus at any time of year, but it is most common from November to May. A child usually picks up this virus by putting her fingers in her mouth after touching something contaminated with the stool of an infected person.
The child may develop watery diarrhea, fever, nausea and vomiting. Nausea and fever usually go away in about two days, but diarrhea can last up to eight days. Antibiotics do not work against rotavirus infection.

The main concern with rotavirus is preventing dehydration. Dehydration is a large loss of water from body tissues. It can occur when a person loses lots of fluid from diarrhea.

A child can get rotavirus infection more than once. But repeat bouts of the illness tend to be milder than the first.

Call your baby's health care provider right away if the baby:

• Has watery diarrhea
• Has nausea and vomiting
• Develops any fever of more than 100.4° F in the first 3 months of life, 101° F or greater between 3 and 6 months, or 103° F after 6 months of age

Follow the provider's instructions about what your child should eat and drink. The provider probably will advise you to give your child a solution to replace the salts and water that are lost with diarrhea. Common ones include Pedialyte, Infalyte and ReVital.

Call your provider immediately or take your baby to the emergency room if she has any signs of dehydration including:

• No wet diapers for several hours
• Dry mouth
• Lack of tears when crying
• Increased thirst
• Sunken soft spot on top of the head or sunken eyes
• Irritability or lethargy

Some children who become dehydrated need to have fluids replaced through a vein (intravenously) in the hospital.

Teach your child to wash her hands thoroughly after using the bathroom and before eating. This may help prevent rotavirus and other infections that can cause diarrhea. Make sure everyone who touches your baby has washed his or her hands.

Vaccine for Rotavirus

Until recently, there was little you could do to prevent rotavirus infection in your baby or toddler. In 2006, the Food and Drug Administration (FDA) approved a new vaccine called RotaTeq to help prevent rotavirus infections. The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices has recommended that this vaccine be added to the schedule of immunizations for all babies. RotaTeq is not the same rotavirus vaccine that was withdrawn from the market in 1999 because it appeared to contribute to rare intestinal blockages.

RotaTeq vaccine is given to babies at 2, 4 and 6 months of age. Ask your baby's health care provider whether your baby should be vaccinated.

If your baby receives the RotaTeq vaccine, contact your her health care provider if she has any of these symptoms after being vaccinated:

• Stomach pain
• Vomiting
• Diarrhea
• Blood in the stool
• Change in bowel movements

February 2007

RSV

Respiratory syncytial virus (RSV) commonly causes infection in childhood. RSV is very contagious. Almost all babies get it before the age of 2. Many babies (and most older children) get only a cold from RSV.

Some babies with RSV develop potentially serious lower respiratory infections. Examples are:

• Bronchiolitis, an infection of the small breathing tubes in the lungs
• Pneumonia

These infections are especially dangerous in babies who were born prematurely, have lung or heart problems, or have certain other chronic illnesses. Your baby can get RSV at any time of year, but it is most common from October to March.

Symptoms of RSV usually last between 8-15 days. Most babies with RSV do not become seriously ill. But a few become very sick. They may need to be treated in the hospital with oxygen. In some cases, the baby will need bronchodilators (drugs that help open up breathing tubes) and antiviral drugs.

Call your baby's health care provider right away if your baby:

• Develops fast breathing or breathing problems
• Wheezes (makes a whistling sound when exhaling)
• Develops a worsening cough (Do not give over-the-counter cough and cold products to infants and children younger than 4 years of age. According to the U.S. Food and Drug Administration, these medications can have serious and life-threatening side effects.)
• Looks blue around the mouth or fingertips
• Has difficulty sucking and swallowing
• Develops any fever of more than 100.4° F in the first 3 months of life, 101° F or greater between 3 and 6 months, or 103° F after 6 months of age

If your baby has RSV, be sure she gets extra rest and drinks lots of fluids. You also can use a rubber suction bulb to help clear mucus from your baby's nose, especially before feedings.

If your baby was born prematurely (too early), or has lung or heart disease, talk to your health care provider about ways to help prevent RSV.

Babies who are at highest risk from RSV (including babies born at or before 32 weeks of pregnancy) may benefit from medication that helps prevent the infection. This medication is called palivizumab (Synagis). It is given in monthly injections during the fall and winter months.

You can help protect your baby from RSV by:

• Keeping him away from people who are sneezing or coughing
• Making sure everyone who touches the baby has clean hands
• Keeping your baby away from crowds of people
• Not allowing anyone to smoke near your baby

For more information, visit RSV Protection.

Note: The March of Dimes does not endorse specific brands or products.

July 2006 (R 1-8, 7-9)

Rubella and your baby

Rubella, also called German measles, is an infection that causes mild flu-like symptoms and a rash on the skin. Only about half of children infected with rubella have these symptoms. Others have no symptoms and parents may not even know they’re infected.

Rubella has been eliminated in the United States because of routine vaccination of children. Vaccination protects a person against rubella for life. Only five cases of rubella were reported in this country between 2001 and 2004.

Rubella is common in other countries. Travelers can bring it into the United States, or you can get it when travelling outside the country.

It’s important to get your baby vaccinated for rubella. The vaccine is called MMR and protects your baby from measles, mumps and rubella. Your baby can get the MMR vaccine at 1 year of age.

What are signs and symptoms of rubella?
Children generally have few signs or symptoms. Rubella is usually mild with flu-like symptoms followed by a rash. The rash is often the first sign a parent notices. The rash often lasts about 3 days.

Flu-like symptoms include:

• Low-grade fever
• Headache
• Runny nose
• Red eyes
• Swollen glands
• Muscle or joint pain

What causes rubella?
Rubella is caused by a virus (a tiny organism that can make you sick). It’s very contagious and is spread through the air from an infected person’s cough or sneeze.

How is rubella diagnosed and treated?
Your baby’s health care provider takes a swab of your baby’s nose or throat and tests it for rubella.

There is no treatment for rubella. The illness usually goes away on its own. Try to keep him comfortable. Give him fluids and try to get him to rest if he’s tired. If your baby has a fever, his health care provider may recommend a fever reducer, like acetaminophen (Tylenol®).

How can you prevent your baby from getting rubella?
Make sure your baby gets the MMR vaccine. Your baby gets the vaccine in two doses: the first between 12 and 15 months, and the second between 4 and 6 years.

Until your baby gets her first MMR vaccine:

• Keep your baby away from anyone who has rubella.
• Tell your baby’s health care provider right away if your baby has been in contact with someone who has rubella.
• Make sure you’re vaccinated and immune to rubella. Immune means being protected from an infection. If you're immune to an infection, it means you can't get the infection. You being immune to rubella can help protect your baby from the illness until she gets her MMR vaccinations. It also means you’re immune from the disease during any future pregnancies.

Last reviewed April 2012

See also: Rubella and pregnancy, Vaccinations and your baby, Vaccinations and pregnancy

Thrush

Thrush is an infection in the mouth. It is caused by a yeast-like organism called Candida albicans. This condition is common in infants up to about 5 months of age. Because this organism is frequently found in the vagina, infants may get this infection from their mothers during delivery.

Your baby may develop white spots that look like milk curd on the insides of the cheeks or on the tongue. This may be thrush. The spots often bleed if you try to scrape them off. Thrush can make your baby's mouth sore and may cause feeding problems.

The same yeast infection can cause persistent diaper rash. Some babies have the infection both in their mouth and on their bottom. Thrush also can spread to your breasts if you breastfeed your baby. Rarely, a yeast infection can spread and cause a dangerous, widespread infection in babies who are very premature or have weakened immune systems.

Call your child's health care provider if you think your baby has thrush. Although mild cases often clear up on their own, many babies need antifungal medications. You usually apply these medications to the infected areas with a dropper or with your finger after a feeding. A baby with an infection in the diaper area can be treated with an antifungal ointment when a diaper is changed.

If your baby develops thrush and you are breastfeeding, ask your child's provider if you should use the same antifungal ointment on your breasts. This may help prevent passing the infection back and forth between your breast and your baby's mouth. You can continue breastfeeding during treatment. If you are bottle-feeding, be sure to sterilize or replace bottle nipples, as well as pacifiers, when your baby's infection starts to clear up.

July 2006