Posted tagged ‘snot’

A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis

October 8, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

 

We’re heading back into colder weather again, and along with the change in the leaves comes more people with miserable, congested noses. Today’s post is all about telling the difference. Next time, I’ll tell you how to treat them.

 

The common cold

Captain ColdAlso called an “acute upper respiratory infection”, a “cold” is far and away the most common cause of congestion and cough. It usually starts with a vague ill feeling, followed by a sore throat and then a congested or drippy nose. Sometimes, there’s a fever at the start of the illness (that’s more common in babies and younger children.) A few days later, a cough begins. On average, the symptoms of a cold last about 10 days, though often the cough lingers for 2 or 3 weeks.

Notice: the symptoms grow or develop over several days, and the fever is really only at the beginning. By day 7-10 things are starting to improve.

 

Influenza

“The flu” is a specific viral infection, and it’s not just a bad cold. Symptoms including fever, sore throat, body aches, nasal congestion or drip, and cough all pretty much start all at the same time, or within a few hours. Sometimes there are also gastrointestinal symptoms like abdominal pain or vomiting. Fever and aches are usually the worst symptoms – you feel, pretty much, like you’ve been hit by a truck. The worst symptoms last five days, but the congestion and cough often linger for another week or so.

Notice: the symptoms are sudden and severe.

 

Sinusitis

Most common colds, of course, go away on their own, with or without any kind of treatment. But rarely a common cold can turn into a sinus infection. That occurs when the persistent mucus becomes infected with bacteria, leading to worsening symptoms 7-10 days into an ordinary cold, or persistent symptoms 2 weeks after a cold begins. Very rarely, sinusitis can start suddenly and severely, but much more typically there is first a cold that turns into a sinus infection.

Notice: a sinus infection is like a cold, but the symptoms worsen after 7-10 days. A congested nose for less than 7-10 days is unlikely to be a sinus infection, even if it feels really stuffy.

 

Next up: treating colds, the flu, and sinus infections.

The whole series:

A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis

A cold, the flu, or sinusitis? Part 2: Treatment

A cold, the flu, or sinusitis? Part 3: Myths

 

To prevent ear infections, you have to prevent colds

February 25, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

“My toddler keeps getting ear infections. There’s got to be a way to help with this. What can we do to prevent them?”

It’s frustrating, I know. Ear infections—doctors call them “otitis media”, because we need fancy-pants names for ordinary things—are very common, and account more antibiotic prescriptions than any other pediatric infection. Why do kids get so many of them?

If you stick your finger in your ear, it won’t go very far. Which is probably a good thing. If your finger were oddly thin and pointy, though, you’d be able to reach down your own ear canal to touch your eardrum (doctor-speak: “tympanic membrane”), a little flimsy sheet of tissue that closes off the end of the outer ear parts and separates the ear canal from the middle ear. Ordinarily, on the other side of the eardrum is a small, open, air-filled space through which sound waves can be transmitted with the help of three interlocking little bones.  The important thing to remember is that this middle ear cavity is sealed off on all sides, and is supposed to be filled with ordinary air. There is a little drainage tube on the bottom which can allow tiny droplets of normal mucus to drain out of the middle ear into the nose. All of this works pretty well, most of the time.

Until the drainage tube (doctor-talk, “Eustacian tube” or “Auditory tube”) gets clogged up. Then the middle ear space fills with nice warm mucus. That sits there. And you can guess what happens: bacteria love warm, stagnant mucus. Party time = infection in the middle ear = Mommy, my ear hurts!

What causes congestion that clogs up the drainage tube? Usually, a common cold virus. Junior gets the dreaded yuck, gets all snotty, the tube clogs, and normal mucus can’t drain. That leads to ear infections.

Little kids get far more ear infections than adults. They get far more colds, especially if they’re enrolled in group care. They’re not very good at blowing their little noses and clearing out mucus. But most importantly, that drainage tube of theirs is oriented horizontally, and it’s thin—the net effect being, it doesn’t drain well. They’ve basically got lousy gutters, and the mucus builds up behind them, especially when there’s a lot of snot around.

Ear infections do run in families, probably because some families tend to have even worse middle ear anatomy that predisposes to more infections. Parental smoking is also a big-time contributor to ear infections, because that contributes to chronic congestion and poor drainage. Sometimes, chronic nasal allergy causes nasal congestion, poor drainage, and at least some ear infections. But by far, the biggest contributor to ear infections are ordinary common cold viruses. In fact, during an ordinary cold young children will develop an ear infection about half of the time.

So what can be done to prevent ear infections? The only really practical strategies are to try to prevent the spread of cold viruses:

  • Avoid group care, if possible
  • Stress the importance of handwashing
  • Practice good cough and sneeze hygiene—we should cough into our elbows, not our hands!

In addition, try to avoid second-hand smoke, and make sure that your children are up-to-date on their immunizations. Though there is no one immunization that will prevent all or even most ear infections, some infections can be prevented by making sure that your child has had the pneumococcal conjugate and influenza vaccines.

Related posts:

Weekend ear pain action plan—you do NOT have to rush to the ER, but you ought to help your child feel better when there’s a suspected ear infection

How many ear infections are too many?

Diagnosing ear infections requires an exam

What to do if your child seems to get too many colds

Out, damn’d snot

May 26, 2009

“Out, damn’d snot! out, I say!—One; two: why, then ’tis time to do’t.—Hell is murky.—Fie, my lord, fie, a soldier, and afeard? What need we fear who knows it, when none can call our pow’r to accompt?—Yet who would have thought the child to have had so much snot in him?”

Macbeth Act 5, scene 1, 26–40. Adapted.

One of the joys of being a pediatrician is that I can still make jokes about snot. I get all serious sometimes during the physical exam, asking a six year old to turn up their nose for a careful look. Then I make a concerned “Hmmmmm noise”—you know, create some comedic tension—then, a pause, followed by one of my best one-liners: “Ewww! Boogers!”

It cracks them up. Really.

Shannon asked me to write about whether the fancy-pants new high-tech nasal aspirators are any better than the old fashioned ones at de-snotting kids. The truth is, I have no idea. But there are plenty of other booger-tidbits I’d be happy to share—so join me for what promises to be the most revolting post of 2009, a journey of mucus and fun!

Snot is nasal mucus, made by specialized cells lining the nose, sinuses, and the entire respiratory tree. It’s mostly water, plus specialized proteins called mucins that help create its wonderfully sticky character. Mucus also contains disease-fighting antibodies and chemicals that can tear apart infectious particles. Not only does it help prevent and treat infections, but it also keeps the nasal linings happy and moist, and humidifies inhaled air. Its sticky surface traps pollens, infectious particles, and airborne pollutants, sort of like built-in fly paper. Under ordinary circumstances, a person makes—and swallows– about a quart of it a day.

The most common “chief complaint” for visits to a pediatric office is nasal congestion, most often caused by an upper respiratory infection, or “the common cold.” The snot, especially early on in the cold when it’s clear and watery, is loaded with infectious viral particles. That’s why colds are so common: they make your nose runny and irritated, so you rub it, then touch a doorknob, and then the virus can easily spread to the rest of the family and everyone else in the classroom. Towards the end of a cold, snot will get thick and dark and lovely yellow-green (especially the stuff in that first morning tissue.) By then, the mucus isn’t infectious anymore. Rather than being loaded with virus, it’s filled with dead and dying infection-fighting cells and sloughed debris from your nose. It’s a misconception (unfortunately perpetuated by many doctors, I know) that green snot at the end of a cold means that there’s some kind of infection that needs antibiotics. ‘Taint true, though if thick persistent all-day mucus lasts longer than 10-14 days at the end of a cold, you might have a sinus infection brewing. It’s the duration of symptoms that helps distinguish a cold from sinusitis, not the color of the boogers. And no, you don’t need to bring in a sample for your pediatrician to examine. Really. Thanks.

Excessive snot could be caused by other things. Allergies can make your nose run, though more commonly allergies cause swelling of the lining of the nose, causing a congested feeling without much actual extra mucus. When you cry or have irritated, teary eyes, the tears drain into your nose through little ducts, which makes your nose run too. And a three year old who shoves a lego up her nose is going to get one heck of a snotty discharge in a few days. About once a year I see a toddler with a “cold”—but a cold that oddly enough only leads to nasal discharge from one nostril. If your child has two nostrils, but only one of them is runny, take a look up there. You might just find a toy you thought was missing.

Too much snot causes a few problems. In the short-run, it might make it hard for your child to get comfortable, and can interfere with sleep. More importantly, nasal mucus that just sits there in the nasal cavity is a warm and inviting media for bacteria, and can eventually lead to secondary bacterial infections like ear infections and sinusitis. So both for symptom relief and for the prevention of these infections, it’s a good idea to at least try to get the boogers out of there.

What about cold medicines? The short answer: they don’t work. Some contain antihistamines that may make your child sleepy—that’s not a bad thing, as long as it’s safe—but none actually decrease mucus accumulation . Topical decongestants like Afrin do work, but are potentially addictive and shouldn’t routinely be used in children.

So a more creative approach is needed. Traditional, effective advice includes giving the child extra fluids, humidifying the air, and sitting in a steamy bathroom. These will all keep the mucus nice and runny rather than thick and sticky. You can also put a few drops of saline solution in the nostrils, or even better use a nasal saline irrigator to wash out the boogies. Loose, watery mucus can also be sucked out with a traditional bulb aspirator.

You say you want something fancy, something high-tech, something to casually whip out to the oooohs and aaaaahs of the envious playgroup crowd? This electronic marvel boasts twelve different tunes it can play to distract your honey while her nose is sucked out. (Got to be at least 12. Junior would certainly complain if the same tedious song were played during each episode of nose-sucking. I’m surprised there isn’t a built-in MP3 player.) Or the Nosefrida, manufactured in Sweden, which apparently lets you inflate your baby’s head much like a carnival balloon. I can’t believe I’m raising three kids without it!

I have no experience with these newer nose-suckers, so please, if you get one, post a review. Anyone who posts gets double points if you include a photo—of the kid, not the snot. I really can live without seeing that!