Posted tagged ‘common cold’

Can getting cold give you a cold? A win for Grandma!

January 29, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

Grandma says, “Bundle up or you’ll catch cold!”

Research just published in the Proceedings of the National Academy of Sciences explains why Grandma may have been right.

A team from Yale University looked at rhinovirus–the most common of the common cold viruses—and the immune response in mice. They found some solid science:

Mouse airway cells infected with mouse-adapted rhinovirus 1B exhibited a striking enrichment in expression of antiviral defense response genes at 37 °C relative to 33 °C, which correlated with significantly higher expression levels of type I and type III IFN genes and IFN-stimulated genes (ISGs) at 37 °C.

In other words, when the nose is at the ordinary body temperature (37 C = 98.6 F), there is a more-robust immune response than when the nose is cold (33 C = 91.4 F). Cold temperatures allow the rhinovirus to replicate and spread more easily.

Does this mean you ought to put a muffler on your pet mouse this winter? Maybe so. And maybe your children, too!

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How to treat congestion in babies

February 27, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

Life isn’t easy for babies. You can’t talk, and to get anywhere you have to wave your arms around and hope someone carries you. Perhaps worst of all, when you’ve got a cold your little nose gets so stuffy, it’s miserable.

Face it: no matter how smart your baby is, she probably hasn’t figured out how to blow her nose. Are there any practical ways to help unstuff congested baby?

  • Keep the room humid, using a cool-mist humidifier or a warm vaporizer. Moist air prevents mucus from getting stick and sticky and harder to move.
  • Try using a few drops of nasal saline. You can buy a little bottle at the drug store, or make it yourself.  Squirt or drip a few drops of this up each nostril to loosen mucus. You can repeat this as often as you’d like.
  • A nasal bulb aspirator can help pull out at least some of the mucus. Remember, first squeeze it, then gently press the tip against the nose opening, then let go so it sucks out the yuck.
  • Gently inclining the bed can help, but it’s not a good idea to routinely let babies sleep in a car seat, bouncy seat, or other device that holds them upright.
  • Vapor-rubs like “Vicks” might help some with congestion, though good studies haven’t been done, especially in young babies. If you want to try a product like this, it’s essential that your baby NOT be able to eat or lick any of the rub. It’s very toxic if ingested.

Fortunately, even the most congestion baby usually feels much better in a day or two. If your congested baby is acting ill, having trouble nursing, having any trouble breathing, or isn’t improving in a few days it’s a good idea to head to the doctor.

Infections now, or infections later: Does day care keep children healthier in the long run?

March 6, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Tracy has a good question: “My 4 year old is not in day care – he stays with Granny. I heard that once you get a cold, you never get that cold again, and I am worried he isn’t exposed to enough germs now to keep him healthy later. Should we be trying to infect him with more colds now that he has the luxury of staying in PJs all day instead of hitting him with all these new viruses when he does start school?”

For many viral infections, it’s true: you get it once, you won’t get it again. Think about chicken pox, measles, or hepatitis A—suffer through the infection, or get the vaccine, and you’re pretty much protected for life. Second infections or breakthrough disease after vaccination can happen, but it’s uncommon. This doesn’t hold true for bacterial infections like pneumonia, whooping cough, or ear infections, but for many viruses immunity can last the rest of your life.

But the common cold isn’t caused by one virus, or even one family of viruses. Common cold symptoms occur with hundreds of kinds of rhinoviruses, coronaviruses, and the recently-discovered metapneumovirus, to name just a few. Each cold may earn you immunity from one variety of one virus, but there are plenty more of them lurking out there.

What about the cumulative effect of the dozens or hundreds of viruses kids in day care? Do day-care kids earn lasting protection from enough viruses to keep them healthier once they’re in school? And does that mean that kids who spent more time in their PJs with Granny will get sicker once they start kindergarten?

A study published in December 2010 tried to figure that out. Researchers followed about 1300 families in Canada over eight years to record the frequency of infections in children through their years of day care and school. They looked at upper respiratory infections, ear infections, and “tummy bugs” that caused vomiting and diarrhea. Their conclusion was actually quite satisfying: children, whether or not they attended day care, suffered through approximately the same number of infections over the course of the study. But day-care kids got more of their infections when they were younger, especially when they first started in group care, while kids who didn’t attend day care got more infections later when they started school. The piper gets paid, either way: get your infections over with early, or get them later.

It’s reassuring to know that overall, neither group of children was really sicker than the other. Whether or not children attend group care when they’re young doesn’t seem to affect the total number of infections, but rather only the timing of their infections. Parents can choose whether their children will get more infections now or later, but the total number of infections is going to be about the same either way.

Zinc supplements for the common cold

February 18, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

The Cochrane Collaboration is a very well-respected international non-profit whose 28,000 volunteers review the best, solid evidence to help determine if medications or other health interventions really work. They are, in short, da bomb.

When Cochrane speaks, people listen.

Cochrane last week released a review of studies examining the effectiveness of zinc supplementation on preventing and treating the common cold. They found that there was good evidence that zinc taken early, during the first symptoms of a cold, can lessen the duration and severity of illness; furthermore, zinc taken daily during cold season can reduce the frequency of these annoying infections.

There were only 15 good quality studies to look at, involving a total of about 1400 patients. Because the studies varied in how much zinc was given, in what form, and how often, no conclusion could be drawn about the best dosing strategy. Nor could any conclusions be drawn about using zinc in children. Still, the evidence tantalizing, and more research is needed to pin down these details.

Zinc is fairly well-tolerated and safe. The most common side effects reported were an unpleasant taste and nausea. There is no particular reason to think zinc in reasonable doses would be unsafe in children or adults.

If you want to try zinc, there are drops, lozenges, and pills to choose from of varying strength and composition. Follow label directions for dosing. For these products to work to treat the cold, you have to start them quickly, and take them frequently throughout the day.

One other warning: the Cochrane review was looking at genuine, therapeutic doses of zinc. Many other zinc products are produced and marketed as “homeopathic”—meaning there isn’t any actual zinc in the bottle. Homeopathy is literally nothing. It’s a kind of witchcraft that relies on the nonexistent magical memory of water. Don’t waste your money on anything labeled “homeopathic.” If you want to try zinc, choose a genuine zinc product that measures the dose in milligrams, not in magic memories.

Humidifier versus dehumidifier smackdown!

December 5, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

Shannon wrote in, “I just recently read in a magazine that a humid environment as opposed to a dry environment is more hostile to viruses. It sounds a little counter-intuitive to me, however, if it’s true would it be best to run my children’s humidifiers all winter long to stave off the flu and other viruses as this article recommended? I tend to run them more in the winter anyway because my kids tend to have more runny noses or their nasal passages are drier and bloodier. What are your thoughts?”

I’m not sure the viruses, themselves, would even care. Viruses are just little teeny packets of genetic material, with a small handful of protein. They’re not cells, so they won’t “dry out”, and I doubt that their survival would depend much on humidity.

I would guess, though, that a dry environment might make it easier for viruses to invade the nasal lining to make your children sick. Viruses can’t penetrate normal intact skin, and even moist surfaces like the lining of a mouth or nose does a pretty good job repelling these little monsters (the viruses, I mean, not the children.) But once the lining of a nose gets dried out and develops cracks and fissures, the viruses can grab hold and jump right in.

By preventing dry air with a humidifier, you’ll also keep whatever mucus is around nicely wet and runny—that’s good, because thin and runny mucus is less likely to plug up noses and sinuses and get infected with bacteria. Thick and sticky mucus just sits there, an inviting bacterial playground. Thin and runny mucus drains, carrying infection away.

If you do run a humidifier all winter, you’ve got to keep it clean. That warm, moist environment can also become a playground for mold. Once a week, take the humidifier apart, wipe it down with diluted bleach (1 capful per gallon) and let the pieces dry before re-assembling.

What kind of humidifier is best? The ultrasonic ones are easiest to clean, so those get my vote. The kind with the big fabric wicks are just about impossible to clean well, and the ones that use a heating coil could cause burns when Junior pulls it over onto her head.

More articles about mucus, which has apparently become a favorite topic at my blog. Momma would be proud:

Out, Damn’d Snot

Control your mucus

Too many colds

A cold lasts longer than you think

Cough and cold medicines don’t work, updated here

Great study, but wrong conclusion: The Vapo Rub fail

November 9, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

A study due for publication in December, 2010 claims to show that Vick’s Vapo Rub can help your child fight through the common cold. Though it was funded by the manufacturer (Procter and Gamble), it’s a good study—but if you read it carefully, there are some big red flags that say “Beware!” I don’t agree with the author’s conclusions, and I don’t agree with headlines in the media extolling the virtues of Vick’s. The study was well-designed, but the authors themselves found a fatal flaw that renders their results meaningless.

The study design was solid, and cleverly tried to prevent parents from being able to skew the results. 138 kids from age 2-11 years with at least moderate coughs were recruited. Children with more-specific causes of cough, like asthma, were excluded; and the children were not allowed to take other kinds of medication that might suppress a cough. The group was divided into thirds: one group received no treatment at all, one group received plain petrolatum (similar to Vaseline), and one group received Vick’s Vapo Rub. The parents were given a glass jar in an opaque bag with their study drug (or an empty jar, if they were in the no treatment group), along with a second jar that contained Vapo Rub in all three groups. When the families began treatment, they were instructed to first rub Vapo Rub under their own noses—then rub the study medication on their child’s chest. By putting Vapo Rub on the parents, the hope was that parents would not be able to tell whether they had put plain petrolatum or Vapo Rub on their child’s chest.

The next day, parents filled out a questionnaire, recording how well, or how poorly, their child did. The kids who received Vapo Rub did the best, especially when their ability to sleep was judged. That’s what the mainstream and medical press are reporting. But sometimes it pays to read the study a little bit further.

Thought the authors tried to prevent the parents from knowing what treatment group they were in, 90% of the parents correctly “guessed” what their child had been treated with the night before. I don’t know if the parents were able to smell past the Vick’s on their own noses, or if they didn’t follow directions, or if the approximately 50% of children in the Vapo Rub group who developed skin irritation gave it away—but in any case, this was essentially an unblinded study. Almost all of the parents knew whether their child was treated with Vick’s or the placebo—and that could certainly account for the observed differences in how the children did.

It’s human nature. The placebo effect has been documented in almost every clinical study that’s been done. People who are given what they think is medicine expect to get better, or expect their kids to get better, and will honestly judge that they did get better. Even if the “medicine” is itself just a placebo. Our own expectations influence our perceptions. If study participants are aware of whether they’re taking placebo or the study drug, clinical studies of medications are worthless.

There are other reasons to think twice before using Vick’s Vapo Rub. It can be quite toxic—according to the discussion section of this new study, an 8 tsp dose can kill a child. Much smaller doses are probably safe, but have occasionally been linked to seizures (children with seizures were excluded from the study.) In children less than two, Vick’s can cause serious lung irritation and breathing troubles.

When deciding whether to try a treatment, parents and physicians ought to weight the risks and the benefits. This study, in which the participants were inadvertently unblinded, allows us to draw no conclusions about whether Vick’s actually works. We do know that there are genuine risks. I’d stay away from Vicks, especially in younger children, until there is better proof that it actually works.

If you do want to try Vick’s Vapo Rub, follow the directions carefully. Do not put any near your child’s mouth, and do not use it in children less than two. Keep it way out of the reach of children and pets.

Short questions on cramps, SIDS, lumps, spatulas, and suckers

October 6, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

A quick-fire post! Time to clear out the inbox…

Michelle: “Is it possible for girls to have cramps before (about a year or so) they start their period?”

I don’t think that’s likely, at least not that far beforehand. Constipation, stress, poor diet (too much processed food, not enough fresh fruits/vegs/water), not enough exercise, and lactose intolerance would be far more likely.

L asked: “Why do some children develop knots in the leg after immunization injections?”

They’re called “sterile abscesses”, which isn’t a great name—they’re not really abscesses at all. The knots are caused by a local inflammatory reaction, and they’re more likely to occur if the needle was too short or if the child jerked away. The knots don’t really mean anything, and don’t interfere with the way the vaccine works. Expect them to gradually go away in a few months.

Sheri: “My 6 1/2 month old recently started sleeping on his stomach. I put him down on his back half swaddled with his arms out for every sleep. He cries, moves around and eventually rolls over on his stomach for the rest of the night. I know this increases his risk of SIDS but I can’t stop him from rolling over. Can I stop worrying?”

Yes. Stop worrying. The “back to sleep” campaign, which has reduced SIDS by about 50%, encourages parents to put babies on their backs to sleep—but never included any instructions to keep babies on their backs. Once your child can roll to him stomach, leave him there. You don’t have to stand aside his crib all night with a spatula, flipping him back over.

Melissa: “Hi- I was wondering what your opinion was on all of the antibacterial products that are available now and so widely used.”

No good studies have been able to confirm that antibacterial-coated products have been able to reduce infections. I doubt they could have any net effect on the germs that children are exposed to, with the single exception of alcohol-based hand sanitizers. Those have been shown to reduce infections among health care works and in day cares. You want to avoid infections? Try:

  • Good handwashing
  • Frequent use of alcohol-based hand sanitizers
  • Vaccines against preventable illnesses like influenza
  • Keeping your children away from sick children
  • A good night’s sleep

Antibacterial surfaces, special vitamin supplements (including those “developed by a teacher” or sold by olympians), herbs, wands, sprays, magic air ionizers, and plenty of other gizmos and elixirs are big money-makers for some, and big money-wasters for others. Don’t be a sucker.