Clinical Reference Systems: Pediatric Advisor 10.0
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DESCRIPTION

Some children seem to have the constant sniffles. They get one cold after another. Many a parent wonders, "Isn't my child having too many colds?" Children start to get colds after about 6 months of age. During infancy and the preschool years they average seven or eight colds a year. During the school-age years they average five or six colds a year. During adolescence they finally reach an adult level of approximately four colds a year. Colds account for more than 50 percent of all acute illnesses with fever.

In addition, children can have diarrheal illnesses (with or without vomiting) two or three times per year. Some children are especially worrisome to their parents because they tend to get high fevers with most of their colds or they have sensitive gastrointestinal (GI) tracts and develop diarrhea with most of their colds.

SIMILAR CONDITION: ALLERGIES

If your child is over age 3 years, sneezes a lot, has a clear nasal discharge that lasts over a month, doesn't have a fever, and especially if these symptoms occur during pollen season, your child probably has a nasal allergy. Allergies are much easier to treat than frequent colds because medicines are effective at controlling symptoms.

CAUSES

The main reason your child is getting all these infections is that he or she is being exposed to new viruses. There are at least 200 different cold viruses. The younger the child, the less the previous exposure and subsequent protection. Your child is exposed more if he or she attends day care, play group, a church nursery, or a preschool. Your child has more indirect exposures if he has older siblings in school. Therefore, colds are more common in large families. The rate of colds triples in the winter when people spend more time crowded together indoors breathing recirculated air. In addition, smoking in the home increases your child's susceptibility to colds, coughs, ear infections, sinus infections, croup, wheezing, and asthma.

WHAT DOESN'T CAUSE FREQUENT INFECTIONS

Most parents are worried that their repeatedly ill child has some serious underlying disease. A child with immune system disease (inadequate antibody or white blood cell production) doesn't experience any more colds than the average child. Instead, the child has two or more bouts per year of pneumonia, sinus infection, draining lymph nodes, or boils and heals slowly from these infections. In addition, a child with a serious disease does not gain weight adequately nor appear well between bouts of infection. Tell your physician if your family is worried about a particular diagnosis so your physician can discuss this concern with you. Also, recurrent ear infections don't mean that your child has a serious health problem. They mean only that the eustachian tubes don't drain properly.

Some parents worry that they have in some way neglected their child or done something wrong to cause frequent colds. On the contrary, having all these colds is an unavoidable part of growing up. Colds are the one infection which can't be prevented. From a medical standpoint, colds are an unavoidable educational experience for your child's immune system.

DEALING WITH FREQUENT INFECTIONS

1. Look at your child's general health.

   If your child is vigorous and gaining weight, you don't have to worry about his or her basic health. Your child is no sicker than the average child of her age. Children get over colds by themselves. Although you can reduce the symptoms, you can't shorten the course of each cold. Your child will muddle through like every other child. The long-term outlook is good. The number of colds will decrease over the years as your child's body builds up a good antibody supply to the various viruses. For perspective, note the findings of a recent survey: On any given day 10 percent of children have colds, 8 percent have fevers, 5 percent have diarrhea, and 3 percent have ear infections.

2. Send your child back to school as soon as possible.

   The main requirement for returning your child to day care or school is that the fever is gone and the symptoms are not excessively noisy or distracting to classmates. It doesn't make sense to keep a child home until we can guarantee that he or she is no longer shedding any viruses because this could take 2 or 3 weeks. If isolation for respiratory infections were taken seriously, insufficient days would remain to educate children. Also the "germ warfare" that normally occurs in schools is fairly uncontrollable. Most children shed germs during the first days of their illness before they even look sick or have symptoms. In other words, contact with respiratory infections is unavoidable in group settings such as schools or day care.

   Also, as long as your child's fever has cleared, there is no reason he or she cannot attend parties, play with friends after school, and go on scheduled trips. Gym and team sports may need to be postponed for a few days.

3. Try not to miss work.

   When both parents work, these repeated colds are extremely inconvenient and costly. Since the complication rate is low and the improvement rate is slow, don't hesitate to leave your child with someone else at these times. Perhaps you have a baby sitter who is willing to care for a child with a fever. Because there are so many working mothers these days, "sick child" day care programs are starting to spring up around the country and can be another alternative to staying home with your child.

   If your child goes to day care or preschool, he or she can go back once the fever is gone. There is no reason to prolong the recovery at home if you need to return to work. Early return of a child with a respiratory illness won't increase the complication rate for your child or the exposure rate for other children. Likewise, you don't need to cancel an important social engagement because your child has a minor acute illness. In addition, you don't need to take your child out of preschool or day care permanently because of these repeated illnesses. Consider switching to a small home-based day care if your child is less than 2 years old. Also find another day care if someone on the day care staff smokes on-site.

WHAT DOESN'T HELP

There are no instant cures for recurrent colds and other viral illnesses. Antibiotics are not helpful unless your child develops complications such as an ear infection, sinus infection, or pneumonia. Having your child's tonsils removed is not helpful because colds are not caused by bad tonsils. Colds are not caused by poor diet or lack of vitamins. They are not caused by bad weather, air conditioners, or wet feet. Again, the best time to have these infections and develop immunity is during childhood.