What you need to know about the coughs, sniffles, and sneezes of winter.
'Tis the season for giving and receiving, but the one thing you'd rather your baby not get this holiday season is a respiratory illness. The best defense is to stay clear of people who are coughing and sneezing -- especially if you've got a newborn or preemie. In addition, good hand washing will help your family avoid most infections, says Charles I. Shubin, MD, medical director of the Children's Health Center at Mercy FamilyCare, in Baltimore. Still, as kids play and explore, they'll pick up some germs that will make them sick. Here's how to recognize and remedy what may ail them.
About 100 different viruses (mainly rhinoviruses) cause the minor nose and throat infections that lead to the common cold. Newborns are typically protected by antibodies they get from Mom. But once that immunity wears off, at around 6 months, kids can get as many as 10 colds a year. The silver lining: "Colds help a child develop immune cells that prevent infections later on," says Jay Kolls, MD, chief of pediatric pulmonology at the Children's Hospital of Pittsburgh.
Colds come on slowly, usually with a runny nose, congestion, sneezing, sore throat, swollen glands, and coughs. Babies with a stuffy nose who haven't yet learned to breathe through their mouth may have trouble sleeping and eating. For most kids, colds are no big deal. But for asthmatic children, colds can be more severe and can trigger asthma attacks. Even after a cold has subsided, a cough may last for weeks.
Clean toys and teach older kids to wash their hands and to cover their mouth when they cough or sneeze, or tell them to bend their arm and sneeze into the crook of their elbow.
There is no cure, so don't pester your pediatrician for antibiotics, which don't kill viruses. And -- sorry, moms -- those infant over-the-counter cough and cold medications you've used in the past aren't available anymore. Those medications contain ingredients such as dextromethorphan (the DM in cough medicines), the decongestant pseudoephedrine, and antihistamines such as diphenhydramine that have been linked in children younger than age 2 with a variety of adverse effects -- including neurological problems, increased blood pressure, heart-rhythm problems, even death. That's why drug manufacturers voluntarily recalled infant cold and cough medicine in October. At that time, the FDA was also considering recommending that medicine with decongestants, cough suppressants, and/or antihistamines not be given to kids younger than age 6.
So do kids with colds have to tough it out? If yours has a fever, is uncomfortable, and is older than 6 months, give her acetaminophen or ibuprofen to lower her temperature. (Don't give kids aspirin because it can cause Reye's syndrome, which can lead to brain damage and death.) Drinking fluids can also loosen congestion and prevent dehydration. If your child refuses water, offer ice pops, diluted juice, or the age-old remedy -- chicken soup. You could also use a nasal aspirator on babies younger than 6 months or put saline drops (or use a spray) in an older child's nose. Or try a cool-mist humidifier, which thins mucus. (Clean the humidifier daily to prevent bacteria and mold growth.)
Kids with colds don't usually get high fevers, so if your child has a rectal temperature above 102 degrees F., check with your pediatrician to ensure that she doesn't have another type of infection, such as pneumonia, strep throat, or an ear infection. If your baby is under 3 months old, call your pediatrician at the very first sign of illness because even a mild cold can quickly develop into something more serious in these infants.
October to April, depending on where you live, is flu season. Flu is especially dangerous for newborns, but any child who catches it should be watched closely. If the infection works its way down into the lower respiratory tract, it can lead to bronchiolitis and pneumonia.
Flu is like a cold "with a kick," says C. Michael Bowman, MD, director of the division of pediatric pulmonology, allergy, and immunology at the Medical University of South Carolina. But what sets flu apart is its sudden onset, high fever (as high as 105 degrees F.), diarrhea, and general achiness. Babies with the flu will be extremely irritable and usually don't eat.
The flu vaccine. It becomes available in early October, but since flu season usually doesn't peak till January or February, December is still not too late to get one. It should be given to children starting at 6 months (plus a booster four to six weeks later) and then every flu season after that until age 5. Your child may still get the flu, but symptoms are likely to be milder if she's had her flu shot. The FDA also recently approved the nasal-spray vaccine FluMist for healthy children as young as age 2. If you have an infant who's younger than 6 months, you and any other caregivers should get immunized to lessen the chance of infecting your baby. (Note: You shouldn't receive FluMist if you're pregnant or have a depressed immune system or a chronic heart or lung condition.)
Give the same type of care you would if your child had a cold. Also ask your pediatrician about Tamiflu, which can be used starting at age 1 and can shave a day or two off a flu infection if it's given within the first 48 hours.
Call your doctor if high fever persists for more than a few days, or if your child has trouble breathing, has chest pain, or seems to get better but then relapses. These symptoms can signal another infection.
Most prevalent in early winter and spring, croup is most often caused by parainfluenza viruses, which inflame the area around the windpipe and voice box and narrow the airway. Croup can be alarming because it often comes on suddenly -- and in the middle of the night. Although it can cause serious breathing problems if the airway continues to swell, for the most part croup's barking cough "sounds more serious than it is," says Alfin G. Vicencio, MD, assistant professor of pediatrics at the division of pediatric respiratory and sleep medicine at the Children's Hospital at Montefiore and Albert Einstein College of Medicine, in New York City.
The cough's sound has been likened to a seal's bark.
Wash hands frequently, and avoid people with respiratory illnesses.
Fever reducers, cool-mist humidifiers, and fluids are your best medicine, along with sitting with your child in a steamy bathroom for 20 minutes. You might also bundle her up for a walk outside. "Some people think the cold air constricts blood vessels and diminishes the swelling, but that hasn't been proven," Dr. Vicencio says. Still, even if these things don't alleviate symptoms, they buy you time to calm your child down, which often allows the airway to relax on its own.
Most croup can be handled at home, but severe cases may require prescription steroids or emergency medical attention, particularly if your child was premature or has asthma. Signs of severe croup include a sleepy or distressed appearance, refusal to eat or drink, and a cough and breathing that get progressively worse. Listen for stridor, a high-pitched, creaky rattle when your child breathes in, and note if the skin around her ribs or the hollow at the base of her throat pulls in when she breathes. If you see a bluish tint around her mouth, she's not getting enough oxygen into her blood and needs immediate medical attention.
Bronchiolitis is an infection in the small breathing passages, called bronchioles, that lead to the lungs. It can be caused by many viruses, but in the winter and early spring, most bronchiolitis is the work of respiratory syncytial virus (RSV).
Of course, not every child who gets RSV will develop bronchiolitis. It typically affects children under age 2, probably because their airways are smaller and more easily blocked, and appears to be more common, Dr. Kolls says, among kids who were premature or exposed to cigarette smoke, or whose mothers have allergies or asthma. Indeed, RSV-related bronchiolitis may also set children up for asthma later on. "There's some evidence that the viruses destroy the cells that line the lungs, and when they regrow, it's thought that the new cells are more susceptible to changes in environmental conditions that make the lungs twitchy," Dr. Kolls says.
Bronchiolitis starts like a cold with a low-grade fever (below 102 degrees F.). Then it moves from the upper respiratory tract into the lower respiratory tract, the cough gets worse, and the wheezing starts.
Wash your hands and your child's, and keep him away from cigarette smoke and people with respiratory infections. If your baby was premature or has chronic lung disease or congenital heart disease, he should also get monthly injections of a medication called Synagis to prevent RSV until he's no longer at risk. Injections are given every RSV season (October to March or November to April, depending on where you live).
"One of the main reasons children end up in the hospital with bronchiolitis is because they're breathing so rapidly, they can't eat and get dehydrated," says Robert J. Giusti, MD, vice chairman of pediatrics at Long Island College Hospital, in Brooklyn, New York. That's why parents should focus on making kids feel comfortable, which in turn eases breathing. Nothing else is needed, because bronchiolitis typically clears up on its own.
Like many other respiratory ailments, bronchiolitis can lead to pneumonia, so watch your child's symptoms, and go to the ER if she has trouble breathing, seems dehydrated (cries without tears, has few wet diapers or a dry mouth), or has a bluish tint around her lips or nails.
Pneumonia is a lung infection in which the air sacs (alveoli) get blocked with pus and other fluids, making it hard for the alveoli to transfer oxygen into the blood. Pneumonia is usually caused by a virus, but it can be caused by bacteria, or a combination of bacteria and viruses. Kids with chronic illnesses have weaker immune systems and are at greater risk for pneumonia.
Rapid, labored breathing, coughing, and a fever (101 degrees F. to 104 degrees F.) are telltale signs. Viral pneumonia comes on with a lower fever, less fatigue, and more wheezing, but viral and bacterial pneumonia have similar symptoms. A minor but persistent cough may also signal "walking pneumonia," a milder infection that doesn't leave you bedridden.
Keeping your child up to date with his vaccines will help prevent the infections that often lead to pneumonia. In particular, make sure he receives the pneumococcal conjugate vaccine (typically given at 2, 4, and 6 months, as well as between 12 and 15 months), which protects against seven strains of pneumonia-causing bacteria.
Half the time, pneumonia is viral, so you'd treat it as you would a cold. But your pediatrician may prescribe antibiotics just in case it's bacterial.
Call 911 if you spot more than one alarming symptom -- if your baby is lethargic, has trouble breathing, and has a fever (above 100.4 degrees F. for babies younger than 6 months; above 102 degrees F. for older kids), or has a bluish tint around the lips and nails.
Beware of Whooping Cough
Since 2001, pertussis (or whooping cough) cases have tripled. (To hear what it sounds like, visit pkids.org, the Web site for Parents of Kids with Infectious Diseases.) That's why your baby should be immunized against it at 2, 4, and 6 months, then between 15 and 18 months and again between 4 and 6 years. Babies younger than 6 months have the highest risk of getting pertussis-related pneumonia and dying, and because unvaccinated infants are vulnerable to infection, their caregivers and everyone else in close contact with the baby (like teenage siblings) should get the shot even if they received it as children. Why? Immunity wanes over time.
Copyright © 2007. Used with permission from the December 2007 issue of American Baby magazine.
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