Written by Consultant Paediatrician Dr. Chitra Kailash
I have said this multiple times to my patients, but there still needs to be a better awareness among today’s parents on using OTC medicines for children. Do not give over the counter cold medicines to infants without consulting your doctor. Many over the counter medicines are not all that helpful, in fact some of them are really harmful. Here are some basic facts you must know.
Respiratory system plays a key role in maintaining life by undertaking oxygenation and excretory functions. Upper respiratory tract includes the structure above the larynx. Para nasal sinuses are groups of air cells lined with ciliated mucus secreting epithelium.
Common upper respiratory tract infection seen in children are
- Common cold
- Epistaxis
- Earaches
- Acute Pharyngitis
- Tonsilitis
- Pharyngo Tonsillitis
- Adeno Tonsilitis
- Sinusitis.
Common Cold:
Commonest infection among children. It is caused by respiratory viruses and para influenza viruses.
Symptoms-signs: Child will be suffering from runny, stuffy nose, sneezing, watery eyes, sore throat, cough, slight fever and cold. Cold is usually contagious especially during first 3-4 days.
Treatment: Since cold is caused by viruses it is not cured by antibiotics. Usually symptoms clear in few days. Some children may be sick for 1 week or cough for several weeks.
How to take care of children during cold attack ?
- Do not give ASPIRIN to children under 18 years of age. Use of Aspirin in children during viral infection has been linked to a potentially fatal disease- Reye’s Syndrome.
- Removing the mucus from your child’s nose may make sleep and feeding easier use a soft rubber bulb syringe to remove mucus. To loosen the mucus, make it easier to suction, you can use either warm water on SALINE DROPS from the pharmacy. Place 3 drops in each nostril before suctioning. Do one nostril at a time.
- Use a cool must humidifier to increase moisture in your child’s environment. Do not use steam humidifiers.
- Give extra clear fluid.
- Try to get your child to rest or do some quiet activities.
- Keep your child home from day care nurseries or school, until fever is gone usually 2-3 days.
- Consult your doctor if,
- Your child’s fever lasts more than 36 hours, your child’s complaints of earache, or sore throat, develops rashes, if nasal discharge lasts more than 2weeks.
- Take the child to emergency department, if the child refuses to drink fluids and has signs of dehydration such as
- restlessness
- no urination
- no tears
- if the child has laboured difficult breathing give only paracetamol for fever and rest the child.
- It is not uncommon to have 6-7 attacks of these minor respiratory infections during I year of life.
Ear ache:
It is a common finding in every paediatric clinic that a small baby is rushed into the doctor’s chamber with an incessant cry. The usual cause for this nonstop cry is earache, another reason may be abdominal colic.
How can this earache be prevented?
- Breast feeding- rather than formula feeding is one very important preventive measure. Breastfeeding for at least 4 months cuts the number of ear infection to half the incidence, exclusive breast feeding for 4-6months is recommended.
If bottle feeding is used, infants to be on her back while feeding, head should be always elevated so that the fluid from the mouth do not flow from upwards through the Eustachian tube into the ear.
- Pacifiers: can also increase ear infection. Constant sucking motion on pacifiers causes bacteria to flow upwards in to the Eustachian tube into the ear.
- Smoking and air quality : Smoking increases the risk of ear infection. Tobacco smoke can irritate the mucus membrane in nasal passages, causing them to swell. This increase the likelihood of fluid getting tapped in the middle ear. Even fragrance, cologne air fresheners can irritate mucus membrane
- Allergies and sensitivity: Food allergy like cow’s milk allergy , allergy to wheat, egg, peanut, corn, soy can also cause irritation of mucus membrane but allergy is always individualized.
Prevention:
Breast feeding is encouraged, No smoking , no pacifiers, No fragrance eliminating allergy, Encourage children to eat variety of fruits, vegetables to decrease the consumption of junk food, parents to quit smoking for their own health sake and for their wards’ sake.
Vitamin C helps to improve resistance. Vitamin A helps to increase the number of immune cells. Zinc To increase immunity. 90% of ear infection heal entirely on their own antibiotic ear drugs to be used only after consulting the doctor.
Epistaxis or Nose bleeding:
Can occur without apparent cause.
Causes: Nose picking, trauma, foreign body, adenoid hyperplasia, Sinusitis Polyps, Congenital vascular anamolies, thrombocyto penia, violent coughing etc.
Site of bleeding is often the vascular Kiesselbach plexus- Little’s area, on the anterior septum. Anterior turbinate is another site.
Children often swallow the blood from the nostril and can vomit it. It will mimic blood vomiting.
Treatment: Compression of the nose, application of ice on nasal bridge and packing of anterior nares. Child’s head is elevated .Severe bleeding may require cauterization blood transfusion. Any bleeding diathesis must be ruled out.
Sinusitis : Inflammation of sinuses causes severe cold, fever, Peri orbital oedema pain and cough. There may be pus in the middle in the maxillary. Frontal and anterior ethmoid Sinusitis, pus in the superior meatus in the sphenoid and posterior ethnoid Sinusitis. Post nasal discharge may cause nocturnal cough.
Treatment: Antibiotic for 14-21days along with decongesants and anti histamines. In chronic cases, sinus drainage and irrigation may be needed.
Acute Pharyngitis Tonsilitis:
Throat involvement occusr in viral infection, bacterial infection like streptococci, diptehria and mycoplasma.
Viral pharygitis: Presents with fever, anorexia, throat pain, drooling, cough, running nose and lymph node swelling on the neck. Exudates may be seen in the follicles. The illnesss clear in 1-5 days. Associated Conjunctivitis may be there.
Bacterial Pharyngitis : Usually due to Group A and b hemolytic streptococci. It presents with highgrade fever, tender lymphnode swelling, exudates in the tonsils. Throat swabs and blood counts are helpful.
Treatment: Warm saline gargle, anti pyretics. Penicillin or Erythromycin antibioticc for 10 days. Prompt treatment of streptococal infection ensures primary Prophylaxis against rheumatic fever as well as kidney infections.
Adenoids removal indicated for children with persistent mouth breathing, nasal speech, adenoid facies, repeated ear infections with deafness, recurrent naso pharyngitis.