| Upper Respiratory Infections | ||||
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Emergencies |
Upper
respiratory tract infections (URI's) are one of the most common of
pediatric illnesses. By the time a child is seven years old, he will have
experienced 100 infections most of which are mainly viruses. Many of these
will be asymptomatic and you may never know the child is ill (unless a
viral rash appears) or the child's crankiness from such an infection may
be passed off as being overly tired or teething. Upper respiratory
infections are the most common of these 100 infections An average child
may have 5 or 6 upper respiratory infections per year and up to 10 or 12 a
year is not unusual (i.e. one a month). There are certain times of the
year when these are more likely to be present (October through March);
certain times of a child's life when they are more susceptible (6 to 24
months and again on entry to school); and certain settings where they are
more likely to occur (exposure to large number of children, day care, and
travel between two localities). Many of the common problems of childhood
such as ear infections or sinus infections are bacterial complications of
viral upper respiratory infections, hence it is important to know the
typical course of a URI since deviation from this may mean your child
needs to see his pediatrician. Often viral upper respiratory symptoms
begin with fever and runny nose which may be soon followed by cough.
Occasionally drainage may make a cough precede a runny nose by a day or
two. The fever with a new onset of runny nose is frequently from the viral
infection and lasts a day or two. Fever persisting into the fourth day or
fever which returns several days into an upper respiratory infection may
signal a bacterial complication such as an ear infection. Similarly
children are often cranky the first day or two of an illness. Crankiness
and night awakening that persists several days into an illness, crankiness
that is of new onset days into a URI, or that is progressively worse may
also represent a complication such as an ear infection even if there is no
fever. The runny nose that's present in a viral upper respiratory
infection is often initially clear and thin. Commonly this changes to
yellow-green or becomes thicker on the fourth or fifth day. In years past,
it was thought that a green runny nose represented bacterial infection and
a need to be on antibiotics whereas a clear runny nose represented a virus
or an allergy. Nowadays, we know that's not true, and the color of the
runny nose is less significant than the length of time it persists.
Typical viral upper respiratory infections and colds last about seven days
or at least should have obvious improvement by then (a night time cough or
one present for a few minutes upon arising however may persist two weeks
after the runny nose leaves). A child who is not improving 10 days into a
URI or who is feeling progressively worse may have a complication of the
URI such as an ear infection or sinusitis. In fact, studies of children
have revealed that the presence of a runny nose--be it clear, yellow,
green or orange-when persisting for over 10 days and accompanied by both
day and nighttime cough will represent a sinus infection about 70 % of the
time. Hence, it is not the color, but the length of time and associated
cough that separates a cold from sinusitis. Even then about two thirds of
these will resolve without any treatment but they may improve quicker with
antibiotics. Recent studies, however have questioned whether antibiotics
really hasten the resolution of sinusitis.
Unless there is a complication, most upper respiratory infections are from viruses and no antibiotic, decongestant, antihistamine or cough medicine will shorten the illness or make your child well any sooner. Antibiotics are not useful in viral respiratory infection and unless there is bacterial complication will not shorten nor make your child well any sooner. All antibiotics will add are complications and resistant bugs making true bacterial illnesses more difficult to treat. While there may be very special situations when preventative antibiotics are used in hopes of preventing bacterial complications--they will not shorten a viral URI and because of the problem with antibiotic resistance this is being done less and less and most colds should be allowed to run their course with only medicines for fever or discomfort. In fact, it is currently difficult to show any benefit using common cold medicines. On the other hand, they have been used for years and probably--but not certainly--are safe.
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Thus in the
early stages of a viral URI the most important treatments are 1) TYLENOL
or MOTRIN for headaches, aches or other discomfort 2) Keep the child
comfortable 3) Expect loss of appetite but offer plenty of fluids 4) In
some cases a humidifier or vaporizer may help 5) Elevating the head of the
bed may help with cough and drainage
In treating head congestion in infants and children there are several basic questions to be asked: Does the congestion make the child uncomfortable or interfere with activities, eating, or sleeping? Do the temporary benefits of the medicine outweigh side effects (such as irritability or not sleeping from medicines)? Can you get the child to take medicine without a wrestling match and a head lock? I f the answer is NO to any of these questions there is no need to give any medicine (even antipyretics such as TYLENOL) because the child will not get well any sooner giving a cold medicine and the only reason to give any cold medicines is if you feel it makes a child feel or sleep a little bit better. Young infants are particularly more prone to side effects of medicines, and in the very young infant it may be prudent to avoid medicines whenever possible. Coughs can often be made better by elevating the head of the bed and increasing the humidity. Nasal secretions can be removed by bulb syringe to make eating easier when the nose is clogged. Salt water nose drops (Ayr, Ocean, Nasal) may be added to loosen thick secretions. At a conference on upper respiratory infections, Dr. Rodney Lusk, then chief of the ENT department at St. Louis Children's Hospital, stated that many saline solutions contain preservatives. He recommended that parents make up their own for each illness by adding one fourth teaspoon of table salt and one fourth teaspoon of baking soda to one cup of water, mix well and make up a new supply daily. Bulb suction should be used in moderation--too vigorous or too frequent may cause swelling and irritation. As with medicines, however, if this is done with great difficulty or causes quite a disturbance, you should ask yourself if it is really worthwhile. If the congestion doesn't interrupt your child's sleep or interfere with eating, do your child a favor and don't pick up the bulb syringe and don't give cold medicines. Despite the many products and advertising, all "cold medicines"--whether they are prescription or over the counter--are all very similar with various combinations of the same basic ingredients. There is usually a decongestant which is pseudo-ephedrine. Often there is an expectorant which may be only theoretically effective; there may be an anti-histamine; and there may be a cough suppressant. Prescription drugs consist of essentially the same ingredients with the exception of sometimes having a narcotic cough suppressant, perhaps combining two antihistamines, or increasing the concentration of components found in over the counter medicines.
SEE ALSO
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