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How to Manage Childhood Infections

Author: DR PAULA ROBERTSON, MBBS, FRCPCH PAEDIATRICIAN

Scenario: It is the start of the July/August vacation period, which usually gives some respite from common childhood conditions, but these tend to flare up once more with the start of the new school term in September. It’s a good time therefore to review some common childhood conditions and how to manage them:

1.The common cold:

According to the US Centre for Disease Control (CDC), more than 200 viruses can cause the common cold; rhinovirus is one of the most common of these viruses.  The cold can spread from person to person through the air and close personal contact. As this is caused by a virus, antibiotics do not work and do not help you feel better if you have a cold.

Signs and Symptoms:

When viruses that cause colds first infect the nose and sinuses, clear mucous is produced; this helps wash the germs from the nose and sinuses. The mucous fills your nose, and can cause a runny nose, congestion and a post-nasal drip (when mucous drips down the back of your throat, causing symptoms like a sore throat and cough). After two or three days, mucus may change to a white, yellow, or green color. This is normal and does not necessarily mean you or your child needs antibiotics.

Other signs and symptoms of the common cold can include:

    • Sneezing
    • Stuffy nose
    • Sore throat
    • Coughing
    • Post-nasal drip (mucus dripping down your throat)
    • Watery eyes
    • Mild headache
    • Mild body aches

These symptoms usually peak within 2-3 days but can last for up to 10-14 days.

General advice and symptom relief:

    • Get lots of rest.
    • Drink plenty of fluids.
    • Use a clean humidifier or cool mist vaporizer, for example a Vicks vaporizer or one that allows you to put in menthol and/or eucalyptus oil.
    • Turn off the airconditioning if possible – this tend to make nasal congestion worse.
    • Avoid smoking, secondhand smoke, and other pollutants (airborne chemicals or irritants).
    • Use saline nasal spray or drops as needed.
    • You can give simple anti-fever medications such as paracetamol if needed, using the recommended dose on the bottle.
    • Please note that over the counter (OTC) cough and cold preparations have not been adequately studied in young children and can be associated with side effects. The American Academy of Paediatrics and the Food and Drug Administration (FDA) in the US have both ruled that they should not be given to young children less than 4 years old. In fact, supportive care measures such as those outlined above can often work just as well, and are much safer!

When to seek medical care:

Consult your doctor if:

    • Symptoms last for more than 1 week without improvement.
    • Symptoms are severe or unusual – for example fever not responding to paracetamol, or not tolerating fluids.

If your child is younger than three months of age and has a fever, it’s important to call your doctor right away.

Common cold symptoms. Picture from the CDC: Common Cold and Runny Nose (www.cdc.gov)

 Prevention:

There are steps you can take to help prevent getting a cold, including:

    • Practice good hand hygiene – for eg, washing hands regularly, coughing and sneezing into a tissue, using a hand sanitizer.
    • Avoid close contact with people who have colds or other upper respiratory infections.
    • Avoid sending your child to daycare or school until they are better.

2.Hand, Foot and Mouth Disease:

Hand, Foot, and Mouth Disease (HFMD) is a contagious illness caused by different viruses, but most commonly a group of viruses known as enteroviruses. It is common in infants and children younger than 5 years old, because they do not yet have immunity to the viruses that cause HFMD.

HFMD is usually not serious in the majority of cases, and nearly all people recover in 7 to 10 days without medical treatment. However, there can be rare complications such as a viral meningitis or encephalitis (types of brain infections), which can be more severe.

People with HFMD are most contagious during the first week of their illness. However, they may sometimes remain contagious for weeks after symptoms go away. Some people, especially adults, may not develop any symptoms, but they can still spread the viruses to others.

HFMD spreads from an infected person to others from:

    • Close contact, such as kissing, hugging, or sharing cups and eating utensils.
    • Coughing and sneezing.
    • Contact with faeces, for example when changing a diaper.
    • Contact with blister fluid.
    • Touching objects or surfaces that have the virus on them.

It is important to maintain good hygiene, like washing hands often with soap and water, to reduce your chances of getting and spreading HFMD.

Symptoms of hand, foot, and mouth disease often include:

    • Fever
    • Reduced appetite
    • Sore throat
    • Feeling unwell
    • Painful mouth sores that usually begin as flat red spots
    • Rash of flat red spots that may blister on the palms of the hands, soles of the feet, and sometimes the knees, elbows, buttocks, and/or genital area

These symptoms usually appear in stages, not all at once. Some people may show no symptoms, but it is possible that they can still pass the virus to others – this is why good hand hygiene is so important.

Typical rash of HFMD, found on the palms and soles of the feet

(Picture from https://www.cdc.gov/features/handfootmouthdisease/index.html)

Treatment:

There is no specific treatment for HFMD. Fever and pain can be managed with simple pain and fever medications like paracetamol or ibuprofen. It is important to get lots of rest and drink enough fluids to prevent dehydration.

When to seek medical care:

Consult your doctor if:

    • Your child is unable to tolerate fluids or is showing signs of dehydration (eg reduced number of wet pampers, sunken eyes, lethargy).
    • Symptoms that are severe or unusual – for example fever not responding to paracetamol,  excessive drowsiness, sleepiness, headaches, irritability or seizures.

If your child is younger than three months of age and has a fever, it’s important to call your doctor right away.

Prevention:

You can reduce the risk of getting infected with the viruses that cause HFMD by following a few simple steps:

    • Wash your hands often with soap and water for 20 seconds, especially after changing diapers, and help young children do the same.
    • Avoid touching your eyes, nose, and mouth with unwashed hands.
    • Avoid close contact such as kissing, hugging, and sharing cups and eating utensils with people who have HFMD.
    • Disinfect frequently touched surfaces and objects, such as toys and doorknobs, especially if someone is sick.

Keep affected children off school until all the blisters have dried up (usually this takes 7 days), and the fever has resolved.

Is it possible to get HFMD again?

Yes. A child can have repeat infections with the same type of virus or different viruses that cause hand, foot, and mouth disease.

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