Dr. Barry Dworkin

Originally published in The Ottawa Citizen October 1, 2002
Original Title: Daycare Part I: The Valley of the Nose Pickers

Part II – Children’s eye diseases spread quickly
Part III – Childhood rashes hard to diagnose at first

The beginning of school or daycare normally exposes children to a collection of infectious diseases. With colder weather, most people tend to stay indoors thereby increasing the chance to spread disease. What are the more common afflictions that breed in the daycare and school settings? What can you do to prevent or treat them? This next series of columns will review many of these common childhood illnesses.

The number one affliction especially in young children is the common cold. The groups of viruses responsible for these upper respiratory infections (URIs) are rhinoviruses, coronaviruses, and the respiratory syncytial virus (RSV). Commonly the virus transfers via hand-to-hand contact and coughing or sneezing at close range. In fact, the real culprit is the finger-in-the-nose! The virus sitting on the fingers and hands is transmitted into the body predominantly by the nasal route.

One study found that rhinovirus can be recovered from 40 to 90 percent of hands of persons with colds, and from six to 15 percent of objects in the immediate environment of cold sufferers. Unless you wash a child’s hands and face every five minutes or prevent ‘nose-picking’ (Ha!), preventing colds is nearly impossible.

The most common comment from parents is that their child has had a cold for months at a time. Indeed, what is really happening is that the child is catching another cold virus just after successfully fighting off the last one.

It takes the body’s immune system five days to destroy the cold virus. The damage to the throat, the skin lining inside the nose and the large air passages/tubes can take ten to 14 days to heal. Symptoms like sore throat, runny nose, blocked ears and cough will continue even after the virus’ destruction and only stop after the tissue completely heals and the fluid reabsorbed.

During the healing phase, the damage to the lining of the respiratory tract impairs its ability to remove a new virus before it causes the next cold. The body becomes more prone to catch another cold. Since the symptoms seem to persist, the perception is that the child never recovers from their cold. Indeed, they do recover but catch another virus during their healing phase.

Another comment is “there must be something wrong with their immune system” if they are so prone to colds. Their symptoms and fever are signs that their immune system is working. Indeed, a cold can be serious for children with damaged immune systems due to leukemia, HIV, or chemotherapy.

With over 100 rhinoviruses in circulation, children will experience about five to seven colds per year in preschool children. They develop immunity to each of these viruses. As they reach adulthood, they have fewer colds because of this immunity. Colds account for 40 percent of all time lost from jobs among employed people.

Ear pain can occur because of swelling of the tube that runs between the back of the nose and the middle ear (Eustachian tube). Since fluid is no longer able to drain out of the middle ear, it accumulates behind the eardrum (tympanic membrane). The fluid pressure stretches the eardrum causing pain.

The bacteria that normally exist in the middle ear usually do not cause infections as long as there is oxygen. These bacteria grow best when there is a lack of oxygen. Once the Eustachian tube blocks, oxygen can no longer reach the middle ear. The bacteria can better reproduce and cause middle ear infections (otitis media). The Eustachian tube in younger children is curved which hinders the drainage process. As the child grows, the tube straightens out and drains more easily leading to fewer ear infections.

Most of the common illnesses have similar basic treatment measures. Children should drink as much as they can to prevent dehydration. Solid food is not as important for the first few days in any of these illnesses. Children can survive for over a week without solids but can dehydrate only after a few days of meager fluid intake.

I tend not to recommend combination cold preparations. It is best to treat the child’s specific troublesome symptoms with single ingredient syrups or tablets. It is preferable to use as little medication as possible. Treatment consists of acetaminophen (Tylenol or Tempra) and/or Ibuprofen (Advil or Motrin) to control fever and sooth a sore throat or ears. Despite the dosing schedule on the bottle based on the child’s age, it is best to calculate the dose based on the child’s weight. Using age often leads to underdosing. Antibiotics are not effective against viruses.

Dextromethorphan (DM) found in many preparations will control cough to a certain extent. Pseudoephedrine (Sudafed) will help unblock those stuffy noses but use it with caution since it can put your child into hyperdrive. An expectorant’s purpose is to irritate the lung passages to produce more secretions that the body eliminates through coughing. There is no proof that expectorants are of any benefit. Anti-histamines have no role at all. In fact, they can cause drowsiness making it unclear if the child’s illness is worsening. . It is best to avoid this side effect since drowsiness in the face of high fever (39 to 40°C) could mean meningitis. The signs of meningitis also include headache, a stiff neck and in some cases a spotty rash.

The treatment for ear infections varies around the world. In Europe, pain management is the first step because most ear infections spontaneously heal. If there is evidence of worsening otitis media, antibiotic therapy follows.

In North America, antibiotic use is greater partly because of the child’s distress and parental desire for an antibiotic. Indeed the antibiotic will eliminate the infection but the cost may lead to ever increasing resistant strains of bacteria. The fear is when we most need to use them they will be ineffective.