American Medical Association Family Medical Guide - American Medical Association [161]
Age Permanent Teeth
6-8 years First incisors
6-7 years First molars
7-9 years Second incisors
9-12 years Canines
10-12 years First and second premolars
11-13 years Second molars
17-20 years (or never) Third molars (wisdom teeth)
Health Concerns of Newborns and Infants
Most health problems in infants are not life-threatening. Many conditions in infants, such as cradle cap, diaper rash, and colic, are common and are easy to treat at home. As you get to know your child and are familiar with his or her habits and moods, you will quickly recognize any signs or symptoms of possible problems. Serious health problems, such as asphyxia and respiratory distress syndrome, are more likely to occur in babies who are born preterm than in full-term babies.
Asphyxia in the Newborn
Asphyxia is a life-threatening lack of oxygen and carbon dioxide exchange in the lungs that results from poor or absent breathing. The brain controls breathing, and if a baby’s brain does not function normally at birth, his or her breathing may be impaired, which can lead to asphyxia. In some cases, a newborn’s brain does not function normally because the supply of oxygen from the placenta to the baby during labor was inadequate. This problem may develop when a baby is small for the length of the pregnancy, if delivery is significantly early or overdue, or if the umbilical cord becomes flattened or twisted during labor. In asphyxia, brain damage may occur either before or after the baby is delivered. Infants born to women who smoked during pregnancy are more likely to be small and prone to asphyxia and other respiratory problems.
In hospital deliveries, doctors are prepared to treat babies with asphyxia immediately after birth. For this reason, the risk of brain damage (which can occur after about 4 to 5 minutes without oxygen) or death (which can occur after about 7 to 10 minutes without oxygen) is minimal. In a home birth, the risks of serious complications from asphyxia are significantly greater, even when a doctor is present, because of the lack of special equipment and trained personnel to deal with this medical emergency.
Symptoms
A baby with asphyxia does not breathe or cry at birth. In mild cases, the baby’s skin looks blue and his or her arms and legs may feel stiff when you move them. In severe cases, the baby’s skin looks gray and he or she is limp and immobile.
Diagnosis
A diagnosis of asphyxia in a newborn is based on the baby’s symptoms. In some cases, an obstetrician can identify a baby who is at risk for asphyxia during pregnancy, before labor begins, and can arrange in advance to deliver the baby in a hospital neonatal intensive care unit. However, in most cases, an inadequate supply of oxygen from the placenta is detected during labor, and asphyxia is handled by emergency delivery, sometimes by forceps or cesarean section (see page 534).
Treatment
To treat asphyxia in a newborn, the doctor uses a special tube to quickly suck secretions and other substances that may be blocking the airways—such as amniotic fluid (the fluid that surrounds a fetus during pregnancy) or meconium (the first bowel movement of a newborn)—from the baby’s nose, mouth, and throat. In mild cases of asphyxia, as the airways are cleared, the baby will gasp and inhale oxygen, which stimulates the brain to initiate breathing. If the baby does not begin breathing, the doctor maintains an open airway and uses a special bag and mask to breathe for the child. The mask fits over the baby’s nose and mouth, and the doctor squeezes the bag to force oxygen into the child’s lungs. If the baby does not respond, the doctor threads a tube into his or her airway, and the child is placed on a ventilator (an artificial breathing machine) until he or she can breathe alone and the underlying cause of asphyxia has been treated. The possibility of resulting brain damage depends on the underlying cause of the asphyxia and the length of time the baby’s brain has been deprived of oxygen. If the brain has not been deprived of oxygen for more than about