Coughs and colds
The commonest affliction of childhood, some children may have 10-12 attacks per year (since 1 attack may last for 1 week or so, parents may feel that the child is falling sick every 2-3 weeks). To the parents of such children, it appears that the child is never all right. Hardly has one attack subsided that the child again starts having cough and cold. The infections may vary from common cold with nose block to high fever, severe cough and congestion of the chest.
Most of the respiratory infections are viral in nature, most common being common cold or flu. The best remedy for a blocked nose is frequent instillation of saline drops with intermittent cleaning of the mucus in the nose by buds or gentle suction. If some medicated nose drops is prescribed, it should not be used for more than 3-4 days as they can cause rebound congestion of the nose, because of which as soon as you stop the drops, the nose will again get blocked. If a common cold persists for more than 10 days, it indicates a sinus trouble (sinusitis) for which the doctor will prescribe some antibiotics.
Cough syrups should be used judiciously to suppress an irritating and hacking cough that disturbs the child much. Whatever syrup is given to the child should be well shaken, as omitting this step leads to diluted medicine being given first and concentrated doses when the bottle is finishing. The role of steam inhalation is questionable in treating respiratory infections. Of course the air that the child is breathing should not be dry.
The best way to liquefy the tenacious mucus inside the lungs and expectorate it out (remember child will swallow it and you won’t see him bringing it out) is to give plenty of fluids to the child. Tea, coffee, warm milk etc. may be quite beneficial. The purpose is to hydrate the child well so that the thick mucus present in the air passages, which is causing its irritation and hence coughing, becomes liquefied and thinned out so that the child can bring it out easily.
The expectoration of such mucus plugs causes a substantial relief of the coughing bout. Many children vomit at the end of a coughing bout. This vomiting is not due to stomach upset, but is a reflex vomiting secondary to gagging due to excessive coughing. In such cases the problem to be addressed is not the vomiting but the cough, and therefore anti-vomiting medicines are of limited value in such cases. Diarrhoea is also often associated with respiratory infections. Actually it is a part of the disease spectrum and not a separate illness. As such, it doesn’t require any specific treatment and starts subsiding as the respiratory infection starts improving.
Taking multivitamins cannot prevent colds, nor can swathing the child from head to toe in multiple wrappings of warm clothing prevent them. Colds are due to viruses, which are ubiquitously present in the air. How can one prevent a child from inhaling that air? The answer is simple: one cannot. So humans (both adults and children) had had and will have in future many episodes of colds and coughs. Vitamin C is quite popular as a preventive agent, but there is no scientific evidence to suggest that it is really effective.
Similarly there are no shots (vaccines) against cold. The only way of reducing the frequency of colds in a child is to keep him away from a person who is suffering from such an infection, because colds spread from person to person via air borne viruses. Again it is practically difficult to carry out this suggestion. How can one isolate a child from his parents and his playmates, who may be suffering from colds?
The use of steroids, a popular therapy for treating fevers, cold etc. is not justified and in fact may be harmful. Steroids can bring down fever and symptomatically improve the patient, sometimes dramatically, which makes parents very happy. This is the reason why steroids are a frequent component of multi-drug prescriptions. The truth is that fever etc. are manifestations of an infection that the steroids may suppress. This is all the more not desirable, because now nobody knows whether the infection has worsened.
In fact by the regression of symptoms like fever, one is lulled into a false sense of security that the patient is improving, whereas actually the infection may have worsened. It doesn’t require much common sense to understand that fever, cough etc. are manifestations of some disease and if you cure the disease, the symptoms will automatically be cured.
Unfortunately, because these symptoms are so obvious and because they are the cause of discomfort to the child, the parents want them to be relieved fast and once some improvement of the symptoms occurs, parents think that the child is on the road to recovery. Surely he is on the road to recovery provided the symptoms are not being suppressed by artificial means like steroids, but rather are getting better in the natural course of the disease. So remember the wise old adage: when you want to remove a problem permanently, strike at its roots (though sometimes it may be time consuming).
Sore throat: (Tonsillitis & Pharyngitis)
Both of them co-exist closely. The chief manifestations are sore throat, pain in swallowing and fever. The glands around the neck may become enlarged and painful. Again, viral aetiology is most common, so no antibiotics are warranted. Warm saline gargling may provide symptomatic relief. Usually in a matter of 3-4 days, the patient will be relieved even without medicines.
In some cases, a bacterium called “streptococcus” can cause sore throat (pharyngitis). Rarely, these bacteria after an interval of few weeks (particularly in the age group of 5-15 years) may cause problems to the heart, joints etc. called “rheumatic fever/rheumatic heart disease”. The only way of knowing that the throat problem is due to streptococcus and not due to viruses, is by means of throat culture (report takes 2-3 days to be ready). Streptococcal sore throat requires antibiotic treatment.
A common dilemma of parents is “Enlarged Tonsils”. Remember that tonsils may be physiologically enlarged to an extent that they might seem to meet in the midline of the throat on gagging. However if the child is having no problems and the area around the tonsils is normal i.e. not red and inflamed, then no treatment is required.
Tonsils have been blamed for respiratory problems, particularly recurrent respiratory infections. Parents believe that removal of tonsils is a permanent cure for frequently occurring cough, cold, nose block etc. Nothing is farther from the truth. Tonsils and adenoids are lymphoid tissues, which have been provided by nature to protect against infections. Any infection that threatens to enter through the nose or mouth meets as a first line of defence, the tonsils and adenoids. As is obvious, they protect against infections rather than being the culprits causing recurrent infections.
Nasal allergy: (hay fever/hives)
The patient is bothered by persistent running nose (clear, watery discharge which if examined under the microscope shows eosinophils), sneezing, itching of the nose/throat and stuffiness of the nose. If this problem is seasonal and keeps on recurring during fixed months of a year, it is called “seasonal hay fever” and is usually due to allergy to pollens. If the problem is around the year, it is called “perennial hay fever.” Common allergens are dust, mites, feathers, pets, moulds (fungal spores) etc.
Some preventive measures recommended are that the floor should be wet mopped daily; curtains, bedcovers, carpets, furniture coverings, linen etc. should be laundered at least once a week and then exposed to bright sunshine; woollen articles and stuffed toys should be removed from the bedroom. The environment should not be too humid as it favours the growth of fungal moulds.
The room and the air inside should be kept as clean as possible, particularly of air suspended particles like dust. Furniture coverings, bed sheets etc. may harbour mites and thus should be periodically laundered. All these measures will reduce the incidence of allergic attacks though not eliminate them completely, as it is very difficult to remove all allergens from the environment. Persistent nose problems like watering, sneezing etc. are often attributed to a deviation of the midline nasal septum.
A slight deviation to one side is normal and is not responsible for these nasal problems. Surgical correction of this “deviation” is advocated as a permanent cure for persistent nose problems, but the results post operatively are mostly disappointing, if this is done without a careful and critical evaluation. In fact you should go for it only if it is certain that it is indeed the culprit. Since nasal allergy is a chronic, life long problem, the helpless patient accepts any sort of treatment including surgery (which in most cases is not required as it is of no benefit).
Treatment of nasal allergy: During the acute phase oral antihistamines/ decongestants work well (nowadays there are non-sedating single daily dose antihistamines available). Your doctor may also prescribe decongestant nasal drops. Once the attack is controlled, for prevention, prophylactic nasal drops (sodium chromoglycate drops or steroid nasal sprays) can be used.