CHILDREN’S HEALTH

Dr. Tara Forcier

Even though Florida is more temperate than the cold weather states of the North, we still see our fair share of seasonal infectious diseases.  Winter respiratory viruses create a heavy burden for families in terms of medical office visits and loss of school and work. The following are common and important questions from parents about these pesky infections:

Q: How can I keep my kids from getting sick?

A: Many families want to know what they can do to prevent colds, flu, sinus infections, pneumonia, bronchitis, and asthma exacerbations. Truthfully, no amount of good hygiene, vitamins, herbal supplements, antibiotics, or avoidance of sick people will completely protect you from infection.  We all must accept that sometimes people get sick and that is a natural consequence of living.

Nevertheless, there are things that you can do to minimize contact with infections and to support your immune system.  Frequent hand washing is extremely important in stopping the spread of contagious diseases.  Avoiding sick people is a good idea, especially for newborns, but is not always possible for older children and adults who will be in contact with others all day long at school or work.  Since it really isn’t reasonable for people to stay home the entire time they may be sick with a cold, contact with others is inevitable.

INFLUENZA, or “The Flu,” causes an illness characterized by fever, body aches, cough, runny nose, sore throat, chills, fatigue and headache. Influenza vaccine is recommended for all children aged 6 months to 18 years of age, but especially for those under 5 years and for those with asthma or underlying health problems.

Your immune system functions best when your body is healthy.  Good nutrition, exercise, and adequate sleep are vital.  There are also many herbs and vitamins, such as Vitamin C and Echinacea, that have been promoted as immune boosters.  While there is scientific data to support some of these claims, the studies have not been consistent and more research is necessary.  Please use caution if choosing these complementary therapies.  Because these products are sold as food items rather than medications in the United States, they do not need to meet as many federal guidelines and therefore may not be examined as carefully for their dosages, safety, or side effects.  Also remember that just because something is “natural,” it does not mean that it is harmless.

Q: What can I do for colds and sinus infections?

A: The “common cold” is an illness that can be caused by one of a large number of viruses.  Symptoms may include sneezing, runny nose or eyes, congestion, fever, or cough.  Symptoms frequently last for 5 to 10 days, but may last up to 2 weeks.  In children under 2 years of age, treatment is limited to saline sprays or drops to the nose, humidifier use, and fever reducers.  Elevating the head while sleeping may assist with cough and nasal drainage.  Over the counter cough and cold remedies are not recommended under 2 years of age and are probably of limited helpfulness in children up to age 5.  Older children may use antihistamines, decongestants, and cough suppressants for symptomatic care.

Studies in children have shown that the vast majority of these infections in the first 7 days of illness are caused by viruses and do not require antibiotics.  If the child’s symptoms worsen after a week or continue after 10 to 14 days, the child may have acquired a bacterial sinus infection that would benefit from antibiotics.

Q:  Why does my child always seem to be sick?

A: It is not uncommon for healthy, normal young children to have as many as 10 colds a year.  For many parents, it sometimes seems as though their child is just getting better when they get sick again.  This is particularly true for children who have just entered daycare or school for the first time because their immune systems are encountering many new infections.  Young children are also more likely to develop ear infections whenever they have an upper respiratory infection.  Allergies and asthma may also contribute to chronic symptoms.

Although immune deficiencies are relatively uncommon, if your child has recurrent infections, especially if they are severe or require multiple hospitalizations, you should discuss with your child’s doctor whether further evaluation for underlying medical problems is warranted.

CHILDREN with uncomplicated respiratory infections can return to normal activity when they no longer have fever, have minimal cough, and are feeling well enough to participate in activities.

Q: What is RSV Bronchiolitis?

A: Respiratory Syncytial Virus (RSV) causes an illness that resembles a cold in older children and adults.  In infants, especially newborns and premature babies, RSV can cause a more severe, potentially life-threatening illness involving the bronchioles (smaller airways) of the lungs.  The infection causes debris and mucus to build up in the bronchioles, resulting in difficulty moving air through these small airways.  The child may show runny nose, nasal congestion, fever, cough, wheezing, rapid or difficult breathing, and sometimes retractions (pulling or tugging of ribcage muscles to assist with breathing).

Rarely a young baby may become apneic (stop breathing).  When children have any signs of respiratory distress (difficulty breathing), they should receive prompt medical attention.  They may require hospitalization to offer oxygen or other types of respiratory support.  Breathing treatments are helpful in only about 25% of children with bronchiolitis, but may be recommended by your health care provider.

Certain premature infants or those with significant underlying health problems (e.g. congenital heart disease) are recommended to receive monthly injections of palivizumab, an antibody that helps to prevent infection with RSV, during the RSV season.

Q: How do I keep my asthmatic child healthy?

A: Asthma is a chronic lung condition characterized by airway muscle spasm and inflammation in response to specific triggers (e.g. viruses, allergies, smoke, and exercise) that causes airway obstruction leading to cough, wheeze, and breathing difficulty.  There is a strong genetic predisposition for asthma, so there is frequently a family history of asthma also.  When young children wheeze with viral respiratory infections, they are usually diagnosed with “reactive airway disease”.  That is because sometimes these children will outgrow the condition.  However, the process in the lungs and the treatment of these two conditions are basically the same.

Every child with a history of asthma or reactive airway disease should have a “rescue” medicine, such as albuterol, prescribed to them.  This is usually given either as an inhaler or by a nebulizer, and will immediately relieve some of the symptoms.  Some children will also require “controller” medicines, such as inhaled steroids, which help to prevent symptoms or to improve symptoms during an acute exacerbation.

Children with asthma or reactive airway disease should see their health care provider at least twice a year to be sure this condition is well controlled using  prescribed medications.  Ask your child’s health care provider for an Asthma Action Plan so that you know what medicines to give your child when they develop symptoms and at what point your child should seek medical attention.  With this condition, recognizing and understanding the early signs of illness and acting promptly will greatly impact the severity of an exacerbation.

Dr. Forcier is a native of Brevard County and is a graduate of Satellite High School.  She attended college and medical school at the University of North Carolina at Chapel Hill.  She then completed her pediatric training at the University of Minnesota.  Dr. Forcier returned to Brevard County, Florida with her family in 2004 and practices medicine with Pediatrics in Brevard at the Rockledge location.  She resides in Satellite Beach with her husband, Joel Wilson, and their three sons.

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