Sneezes and Diseases
By Kenneth A. Alexander, MD, PhD and Dennis Clements, MD, PhD
in children are as much a part of winter as cold weather. Among
the most common seasonal illnesses we see are viral respiratory
infections (influenza and respiratory syncytial virus), streptococcal
pharyngitis (strep throat), and viral gastroenteritis. While many
of these diseases are unavoidable, there are things we can do to
help keep them at bay and make our children a bit less miserable
when they are sick.
When most people think of winter illnesses, they think of the fluand
with good reason. Flu is a very common cause of both mild and severe
childhood illness in the winter. Influenza activity typically peaks
in the U.S. between late December and mid-February. The good news
is that almost all cases of influenza are preventable. The bad news
(at least for the 2004-2005 winter) is that, while the most effective
means of prevention is the influenza vaccine, flu vaccine supplies
have come up short. The current seasons lack of influenza
vaccine has been a concern to health officials, a headache to pediatricians,
and a worry to many parents. Fortunately, while vaccine supplies
have been curtailed, there has been a sufficient supply to immunize
high-risk children (all children aged 6 months to two years, and
older children with risk factors for severe influenza, including
asthma, congenital heart disease and immune deficiencies) and their
parents. For healthy children who have not been immunized, influenza
can lead to a week of missed school and a lot of coughing and vomiting,
but is rarely life-threatening. While antiviral agents are available
to treat influenza, they are of modest benefit and are not often
used in children.
Respiratory syncytial virus (RSV)
Winter is also the season for respiratory syncytial virus (RSV).
While it infects people of all ages, typically causing sore throats
and nasal congestion in adults and older children, RSV can cause
considerable coughing and wheezing in young children. Infants with
RSV infection may also develop pneumonia requiring hospitalization.
Fortunately, an RSV preventive antibody is available for children
at highest risk of severe RSV infection (former premature infants
and infants with congenital heart disease). No effective therapy
for RSV infection is available for outpatient use, but symptoms
can be treated.
Streptococcal pharyngitis (strep throat)
Strep throat is most common in children of late preschool and elementary
school age. While many parents expect physicians to prescribe antibiotics
for sore throats, streptococcal bacteria cause only about 15 to
25 percent of sore throats; the remainder are caused by respiratory
viruses, which are unresponsive to antibiotics. No physician can
consistently distinguish between streptococcal pharyngitis and sore
throats caused by viruses based on physical examination alone. As
such, all children suspected of having strep throat should have
their throats swabbed to determine if streptococcal bacteria are
present. Children with streptococci in their throats are appropriately
treated with antibiotics to reduce transmission of the illness and
prevent rheumatic fever.
Outbreaks of vomiting and diarrhea caused by gastroenteritis (inflammation
of the gastrointestinal tract) typically occur in late winter or
early spring. While most episodes of gastroenteritis in young children
are attributable to rotavirus, many other viruses can cause vomiting
and/or diarrhea. Gastroenteritis generally gets better on its own,
however, young children are at particular risk for dehydration.
For this reason, it is especially important for parents of infants
and young toddlers to keep on hand a supply of oral rehydration
solution (e.g. Pedialyte). While earlier generations of pediatricians
advocated delaying the reintroduction of breast milk (or formula)
and solid foods, recent studies suggest the child can return to
a normal diet as soon as it can be tolerated. New vaccines for prevention
of rotavirus gastroenteritis are currently in clinical trials.
Preparing for winter illnesses
Winter illnesses are an inevitable part of childhood. While immunizations
and good hand-washing can prevent some illnesses, winter illnesses
should be expected in all children. To be prepared, parents should
keep on hand acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Motrin)
for treatment of fevers, a large box of soft tissues for runny noses,
and, for young children, a stock of oral rehydration solution. Parents
with children in daycare should also make plans for picking up children
should they become ill on a weekday, and plan ahead for alternative
childcare arrangements if needed. Parents with questions or concerns
about their childs illness should call their childs
health care provider.
Seasonal illnesses in children can be stressful for families, but
most of these illnesses are mild and will resolve spontaneously.
Parents and children should make the best of their times together,
even when children are sick. Use sick days as opportunities to read
together, listen to music, and talk with your children. Love and
attention are powerful medicines. While at times an inconvenience,
sick days well spent can result in lasting memories for children
and their parents.
A. Alexander, MD, PhD, is an associate professor in the Division
of Infectious Diseases, Department of Pediatrics at Duke. Dennis
Clements, MD, PhD, is interim chair of the Department of Pediatrics
at Duke University Medical Center. For more information, visit www.dukehealth.org
information presented on this site is intended solely as a general
educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.