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Winter Sneezes and Diseases
By Kenneth A. Alexander, MD, PhD and Dennis Clements, MD, PhD

Illnesses 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.

Influenza (“The flu”)
When most people think of winter illnesses, they think of the flu—and 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 season’s 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.

Gastroenteritis
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 child’s illness should call their child’s 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.

Kenneth 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

The 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.

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