Posted tagged ‘uri’

How long should coughs and runny noses last?

December 23, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

Many sick visits to primary care docs, like me, are driven by just a handful of complaints, all typically caused by viral upper respiratory infections (URIs): cough, congestion, and runny noses. How long should parents expect ordinary cold symptoms to last?

Longer than you’d think.

The British Medical Journal this month published a wonderful article, titled “Duration of symptoms of respiratory tract infections in children: systematic review.  They found 48 studies of the symptoms of URIs which included systematic tracking of system duration. Only placebos or over-the-counter remedies were included—they did not include any patients treated with antibiotics. From pooling the information from all of these studies, they found that:

  • Cough usually lasted at least 10 days (that is, 50% of kids with cough were still coughing after day 10). Cough resolved in 90% of patients by day 25—meaning that 1 in 10 children were still coughing at day 26, almost 4 weeks after the start of the cold.
  • Common cold nasal symptoms resolved by day 10 in 50% of children. 90% were better by day 15.

So: ordinary colds, just ordinary viruses we all get, cause symptoms that typically last a couple of weeks, with the cough often lingering even longer. The old joke ought to be rewritten: without this prescription, your cold will last two weeks. With it, it’ll only last 14 days.

If you or your child has an icky cold, you might be tempted to see your doctor after a few days or a week. It’s probably better to wait longer—save yourself a visit, and you’ll be less likely to end up on an antibiotic that won’t do you any good anyway.

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.

Idiotic attendance policies, part 2: The preschoolers

June 4, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

I’ve written about stupid school policies before—schools that set up carrots and sticks to prevent even genuinely sick kids from staying home. Dumb, dumb, dumb. But it did give me the opportunity to write, “If absences are outlawed, only outlaws will have absences.” I’m not sure exactly what that means, but it seems wise. Someone ought to put it on a bumper sticker.

Now I’m noticing more and more little kids being sent home (and often sent to my office) for equally dumb reasons. I don’t know why, but while the high schools seem to want to keep genuinely sick kids in the classrooms, child care centers for little ones want to send them home for next-to-nothing illnesses. Both extremes aren’t helping keep kids healthy.

The AmericanAcademyof Pediatrics has tried to offer guidance about sensible, science-based pre-school policies to protect the health of children. They’re summarized in this book, also available at Amazon. Owners and operators of preschools and government bodies that make health policies really ought to read that book, and keep it under their pillows at night to help absorb its wisdom. Instead, they seem to be making things up.

School exclusion rules ought to be designed to protect the health of children and staff. Children, in general, ought to stay home if:

  • They can’t comfortably participate
  • Their presence poses a health risk to themselves or others
  • Their presence requires more support than the staff can offer

The AAP has specific suggestions for certain health problems that may surprise you. They certainly run counter to what I’m seeing from day cares in my community. Some of their recommendations:

Kids with the common cold, even if there is green snot, don’t need to be excluded from school. This is because the period of highest infectivity is before symptoms become obvious. Once a child has obvious cold symptoms, they’re no longer very contagious anymore—no matter the color of their snot. As long as they’re comfortable, they can go to school.

Fever, itself, isn’t a reason to keep kids home. Now, most kids with fever are uncomfortable—those kids shouldn’t go to school, since they can’t participate. But some kids with fevers, especially those with viral infections, feel just fine after a dose of ibuprofen. Excluding these children is unlikely to reduce the spread of disease, since most viral infections are spread by children who have no symptoms at all.

Pink eye? This seems to be the biggest boogeyman at preschool. Like the common cold, pink eye is contagious, but there is no evidence that treatment of pink eye reduces the spread of the bacteria or viruses that cause this common infection. The symptoms are quite mild, and will resolve in 5-6 days with or without treatment. The schools freak out, but kids do not go blind from garden-variety pink-eye, and most of them feel fine. As with other illnesses, if the child really feels bad she ought to stay home. Note that there are rare, more-serious occasional outbreaks of more-serious pink eye caused by adenovirus, so a classroom with multiple cases of severe pink eye needs to be reported to public health authorities. But the vast majority of pink eye that’s referred “emergently” to my office are very mild, nearly symptom-free infections.

Infections that really ought to stay home are those that include diarrhea that can’t be contained in a diaper or requires frequent changes, or vomiting. These symptoms really can’t be managed safely or comfortably in a group care setting.

Wrongheaded day care policies probably drive a lot of my business. Many centers seem to require a “note from a doctor” to return to school. Still, wrong is wrong. What we need is a more sensible approach to group care and school illnesses, rather than knee-jerk policies that keep children and parents home or send them to my office. Sick kids ought to stay home, but most kids with mild illnesses who feel pretty well can go to school safely.

Preventing colds: Kids show us how it’s done

August 28, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Want to get fewer colds, skip the flu, and avoid using the toilet face-first? One of the most effective ways to prevent infectious diseases is to stay away from mucus. Other people’s mucus, that is—the infectious toxic goo that sick people can’t seem to avoid spreading all over the place.

Two recent studies illustrate that it really is possible to stay healthier thru goo avoidance. But the kids seem to be better at it than we are.

I wrote earlier about the first study, where adults were observed during, let’s say, events of mucus production. Surprise! The vast majority of adults did nothing to limit the spread of their sneezes, and even helped further spread their germs by wiping their snot-covered hands on doorknobs and other surfaces. Look around you. If you see adults, they’re trying to make you sick.

Compare that to a more recent study of children, summarized here. Danish schoolchildren underwent special training in hand washing, and were required to follow good hand hygiene while in school. Over the following months, compared with kids in other schools without the special training, the children in the handwashing groups had about 25% fewer illnesses and missed days of school. Even better—the following year, when the special training and requirements were dropped, those same children still continued to wash their hands, and continued to have a reduced rate of illnesses. The kids learned, and it worked, and it stuck! Take a lesson from these kids: good hand hygiene is a habit that we can learn, and a habit that really can keep us healthier.

If it makes you sick, it probably likes mucus. Try to keep your mucus to yourself, especially when you’re ill. When you’re sick, sneeze into your elbow and wash your hands! If you don’t want to become ill, wash your hands before eating or especially before touching your own face. In fact, you might be able to prevent many infections by developing a new habit: don’t touch your eyes, your nose, or your mouth without first washing your own hands. The germs on your skin won’t make you ill until you rub them in your eyes or up your nose. With the kids back in school and winter approaching, now’s a good time to work on those anti-mucus, staying-healthy habits. Let’s all keep our snot and germs to ourselves.

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