By Jesse Hackell, MD
It is Normal?
Every day, parents bring their children to the pediatrician’s office with complaints that something about the child is not “normal,” whether in terms of temperature, sleep patterns, appetite and food intake, elimination of urine and stool, and a whole host of other bodily functions. I spend a good part of many visits helping parents understand just what is, and should be, meant by the word “normal.”
We have all grown up with the concept that the “normal” body temperature is 98.6 degrees Fahrenheit, right? Heck, it even says so on the old style glass thermometers, with a nice little arrow pointing right at 98.6—not that many of us use those glass thermometers any more (and no one should be using ones which contain silver-colored mercury) since ear and temporal thermometers have become so much more available and affordable in recent years.
In fact, the normal body temperature is not one number, but a range, generally felt to vary between 97 and 100.4 degrees. And it varies predictably with the time of day as well. Called a diurnal (from the Latin for day) variation, we reach our lowest temperature in the early pre-dawn hours, and our temperature peaks about twelve hours later, in the late afternoon. This variation is hormonally controlled, and while the times of the peaks and valleys can be altered (by changing sleep patterns, for example), this variation, and range of normal temperatures is characteristic of all humans.
So not only (as my colleagues have previously discussed) is fever not something to be feared, it is also something to be careful about even diagnosing. Consider that the temperature of a healthy, “normal” child might vary as much as three degrees Fahrenheit from the daily low to the daily high. And remember that, much more relevant that the number on the thermometer is the way that your child looks and acts.
What about sleeping patterns?
Is it “normal” for a baby to sleep eighteen hours out of twenty-four? Or for a toddler to seem as if he can get by on eight hours at night plus a couple of power naps during the day? The same answer applies to sleep as it does to fever—there is a wide range of what “normal” children require in order to function normally.
And therein lies the true answer: A child is getting enough sleep if he or she is able to be awake and functioning normally for blocks of time during the day, if he or she is not always yawning or drowsing off during activities, and if the mornings are not a struggle to get the child awake and moving in order to get the day started. Look at your child’s general alertness—that will give the best clue as to whether or not the amount of sheep he or she is getting is adequate.
Normal Food Intake
It is very hard to define a “normal” amount of food and nutrition intake. Different children have different metabolic rates and activity levels, and children do not grow at the same rate every day. No one—not the doctor, not the parent, not the grandmother—knows better than a child just how much nutrition a given child needs on a given day. And normal children will not starve themselves—they will choose and eat the foods that their bodies tell them are needed for growth.
Of course, they might naturally choose sweets or “junk” food, but I presume that, as parents, we will offer our children choices consistent with good nutrition, and allow then to choose types and amounts of foods from that selection. A parent’s job is NOT to get a child to eat; rather, it is to provide nutritionally sound choices from which the child can select those foods which his or her body needs at any given time.
Once again, the same thing holds for bowel movements, especially in the newborn and infant period.
There is no single “normal” frequency for an infant to have a bowel movement.
The pattern will depend on age, feeding and the infant’s own physiology, but, in general, as long as there are bowel movements at least every two to three days (although it can be longer in an exclusively breast fed infant), and most importantly, as long as they are soft and do not cause the baby discomfort when being passed, a baby will move his or her bowels when it becomes necessary. (This is not necessarily true as a child gets older, when some may hold their stools for prolonged periods, often out of fear of discomfort or out of hesitation to use a toilet; any signs of difficulty in defecation in an older child should be discussed with your child’s pediatrician.)
As in so much of pediatrics, what is “normal” can often best be defined by what is working for a particular child, and not by comparison to what other children are doing or experiencing. I cannot emphasize strongly enough that if your baby or child is happy, thriving, comfortable and growing, and is able to function normally, the chances are good that whatever he or she is doing with regard to temperature, sleeping, eating or eliminating is “normal” for him or her.
Listen to and watch your child—they are really good at letting you know if things are going well or not.
Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.