Category: News

As I approach my 17^th winter as a pediatrician, I find that many patients with familiar symptoms and equally familiar diagnoses are filling my schedule. While examining the patients and counseling the parents, I am pleasantly surprised about my continued interested in these illnesses despite having seen them thousands of times. I am interested in hearing the illness history and trying to formulate a diagnosis based on what I am hearing and what I have heard over many years of practicing pediatrics. I am interested in the exam and seeing how each child presents differently…….same illness but Charlie has bigger tonsils and lots of snoring while Rebecca is wheezing and Jake has yet another ear infection. I am intrigued by the uniqueness of each child and family and happy that at this point in my career, all does not seem mundane or boring or standard.

The following is my pediatrician version of a primer on common winter illnesses (installment #1):

URI: Upper Respiratory Infection. The common cold. Most commonly caused by a virus called rhinovirus of which there are 100+ serologically distinct viruses. However, there are 200+ serologically different viral agents responsible for the common cold. It thus makes sense that most children (especially those around any other child on a regular or semi-regular basis) get 8-12 colds per year. Most of these occur during the winter months from mid-October until April. Each cold usually lasts 7-10 days but a post-viral cough can persist for 2-3 weeks.   Therefore, in that 5-month period: 8-12 colds each about 2 weeks = 16-24 weeks which means almost non-stop symptoms. Definitely familiar to a parent with a child in any kind of childcare.   A fact to remember with all viral illness is that they worsen before they get better.   The first symptoms are usually profuse clear runny nose sometimes associated with fussiness or fatigue. Fever is not always present, but if so it is usually low grade, noted day #1-3 of illness and usually lasting 24-48 hours. Most of the time, there is a peak in symptom severity 3-4 days into the illness. This includes cough and more fussiness and often a thickening of the secretions (day #5-8 – nose not as runny but if the child sneezes – lots of stuff is coming out!). This is expected during the course of the illness and does mean there is a secondary bacterial infection (despite what grandmothers and the Urgent Care Center may say).   Cough comes later (day 4+) and lasts longer.   By day #5, symptoms should be improving with most parents being able to definitively say there is some improvement (even if not 100%) by day #7-10 of illness. Complications from URIs such as ear infections (children < 3 years old), sinus infections (children >8 years old) and pneumonia occur late in the course of illness and a late fever or increased fussiness after several days of seeming better should prompt a visit to the office. The American Academy of Pediatrics does not recommend any over the counter (OTC) cold medicine for children less than 2 years of age and most OTC cold remedies cause more side effects than benefits in children less than 6 years of age. My recommended treatment is symptomatic only and includes cool mist humidifier, nasal saline spray, increased fluids and rest. It is OK if the child does not want to eat as long as they are drinking. Most of us do not want to eat when we are sick. They will make up for it when they are well and eat double! Fever reducers can also be used as needed.

A quick note on fever. Fever is not an emergency. It is protective and the body’s way of fighting off the infection. There are many studies that recommend against treating a fever as this may hamper the body’s immune response. If the fever is less than 102.5 – treat with fever reducer only if the child is uncomfortable. If the fever is greater than 102.5, treat as most children will be uncomfortable with this temperature. However, never wake a sleeping child to give fever medicine. If they are uncomfortable, they will awaken on their own.  

Croup: Most commonly caused by parainfluenza virus. Another viral infection with no medication (ie antibiotics) to cure the illness. Symptoms again peak in severity 3-4 days into the illness. The symptoms include fever, nasal congestion, hoarse voice/cry and a barky, seal like cough. The symptom usually worsen at night and may include stridor. Stridor is a very scary gasping for air kind of noise which the affected child will make when they inhale. This should be distinguished from wheezing which occurs when children exhale and is a high pitch whistle like sound. The stridor is the result of viral induced swelling of the airway. While many parent advice sites and books talk about putting a child with croup in a steamy shower, I feel cool air is much better to ease stridor. It makes intuitive sense. If something is swollen, you want to put cold on it to help reduce the swelling. My recommendations to parents who are awakened in the middle of the night with this heart stopping experience: put the shower on at hot temperatures, then wrap your child up and go outside. If after 15 minutes outside, the child is not better go into the now steamy hot bathroom. Call the pediatrician on call if the child is no better after 15 minutes in the steamy bathroom. Ideally, you can get through the night without a trip to the emergency room and contact the pediatrician in the morning. While there is no cure other than a tincture of time for this illness, oral steroids to help with the symptom of airway swelling are sometimes indicated. This is dependent on the age of the child, where he/she is in the course of the illness and the severity of the symptoms. Your pediatrician can help decide if this is warranted for your child and I recommend an office visit to evaluate and discuss treatment recommendations.

Coming next up: Respiratory Syncytial Virus (RSV) and Influenza Virus (FLU). FLU season is fast approaching and I recommend the influenza vaccine for all children (> 6 months of age) and adults unless medical contraindications are present.

Finally, I want to remind all about the resiliency of children. You can do a lot to a child and they are still running around playing and laughing and for the most part happy.   Whenever I say this to families, I always think of one of my patients from residency. A healthy 2 year old who underwent a bone marrow aspiration for her sibling affected with leukemia. Less than 15 minutes after the procedure, she was running around the ward excited to be just be living. This is the reason I went into pediatrics. So remember this general rule of thumb: if the symptoms are bothering you more than the child, try not to worry. Easier said than done I know….but just look away from the endless runny nose and listen for the laughter.

Nowadays, many parents are reluctant to vaccinate their children, having been told, incorrectly, that vaccines are too dangerous.  This is far different from when vaccines were first developed.  When the Salk vaccine for polio first came out in the 1950s, parents would endure long lines for a chance to avoid a disease that crippled or killed hundreds of thousands of children yearly in this country alone.

The first major anti-vaccine thrust came courtesy of a television show, 20/20, over 30 years ago.  Someone noticed that crib deaths (SIDS) and receiving whooping cough (pertussis) vaccines happened at around the same time, and the producers of the show advertised for parents whose children had received the vaccine and then died of SIDS soon thereafter.  They found plenty of them, and went on the air announcing their discovery.  The problem is that what they found was merely a coincidence.  Had they advertised for parents whose babies had the vaccine and then soon thereafter started to eat cereal, or had their first laugh, or even who had missed their whooping cough vaccine, they would have found plenty of those, and been able to ‘prove’ that cereal, or laughing, or missing vaccines, caused SIDS.  As subsequently shown by numerous actual studies, there was no association between the vaccine and SIDS.

Unfortunately, the damage was done.  England in particular took this to heart, and the vaccination rate fell. The outcome was easily predictable.  Pertussis cases rose, a few children died, and that in turn convinced parents to start vaccinating again, and the number of cases dropped once again.

The next big controversy, which still lingers, was with autism and the MMR vaccine.  Autism is often diagnosed around the age when the MMR is given, leading people to assume the two are related.  This is not so.  Numerous studies, in various countries, with various designs, involving tens of thousands of children, have shown that this is a coincidence; the chance of developing autism is the same whether one is vaccinated or not.

This controversy was fueled by an article Andrew Wakefield published in the prestigious journal Lancet in 1998, showing a link between the MMR vaccine and autism.  No scientist has ever been able to replicate his findings, with good reason; the study was fraudulent.  You are probably aware that the article was later retracted by the journal, and disavowed by Wakefield’s co-authors.  You may not be aware of how the article came to be written.  Lawyers in England were looking to sue the manufacturer of the MMR vaccine, but in England, you need scientific proof, not just speculation, to do so.  Therefore, a group of lawyers hired Mr. Wakefield to find some proof, which he subsequently did, in the now discredited article.  For an excellent report on this, go to www.bmj.com/content/342/bmj.c5347.

After the article, MMR vaccination rates naturally fell, and England had its first death from measles in 14 years.  Mr. Wakefield subsequently lost his license to practice medicine, and moved to the United States, where he has earned a living advocating against vaccines.