Prevention and control of common childhood diseases

The core of the prevention and control of common childhood diseases has never been the pursuit of "zero disease". Instead, it is through scientific graded protection and precise disease course intervention to reduce the risk of disease to a reasonable range, while avoiding severe illness and shortening the course of the disease to the greatest extent. This is a core principle generally recognized in the domestic pediatric clinical and health care fields.

Take respiratory infections, which are the most troublesome for everyone, as an example. When the autumn and winter school season comes, everyone has seen half the kindergarten class asking for leave. The debate on respiratory protection has not stopped in the past two years: one group of parents insists on "sterile protection" and sprays every corner of the house with disinfectant spray every day. Children must wear N95 when going out, and wipe their hands with no-rinse disinfectant gel immediately after touching public facilities. ； The other group advocates the "wild way of breeding", believing that only by being exposed to more germs can you develop resistance, and there is no need to do any protection. I have been working in a pediatric health clinic for nearly 7 years, and I have seen many extreme cases of both kinds: the year before last, there was a mother who sprayed disinfectant every day even on her child’s picture books. Her child had hardly been to public places before she was 3 years old. As a result, she contracted mycoplasma pneumonia in the first week of kindergarten and was hospitalized for a week. ； On the contrary, the child of the owner of the fruit shop downstairs touches the fruit basket at the door of the shop every day and plays with the cats and dogs in the community. Apart from washing hands before meals, he usually does not take any disinfection measures. He only gets colds two or three times a year, and each time lasts three to five days.

Oh, by the way, this is not to encourage everyone to not take protective measures at all, but to be careful: there is no need to disinfect the daily home environment every day. It is enough to boil toys and tableware once a week or wipe them with 75% alcohol. Changing coats when going out and washing hands with running water and soap are a must, but you don’t have to see your children touching the fitness equipment in the community as if you are facing a threat. After all, the human body's immune system requires appropriate stimulation by pathogens to develop and mature. An excessively sterile environment will make the immune system "unexperienced" and collapse after even the slightest contact with germs.

Following the scene in the kindergarten, in addition to the respiratory tract, digestive tract diseases are also the hardest hit areas among children. Norovirus and rotavirus infections, as well as "food accumulation" often mentioned by the elderly, are all high-frequency problems. There are a lot of controversies here: the older generation always believes that "children will grow stronger if they eat more", and it is common for them to chase after each other and feed them every meal. ； Young parents believe more in "feeding on demand" and don't feed their children if they don't want to eat. I once met a grandma who brought her grandson to the doctor. She said that the child was always constipated, had bad breath, and had a low-grade fever after tossing and turning at night. After asking, she found out that the grandma had to feed her child 4 meals of milk, 3 square meals, and stuffed two ham sausages and three small cakes as snacks every day. The child's delicate spleen and stomach simply couldn't bear it. This is not called "nutrition", it is called "feeding the child out of illness." There is also a period of high incidence of norovirus infection. Many parents panic when they see their children vomiting and immediately feed them antibiotics and antiemetics. In fact, it is completely unnecessary. Norovirus is a viral infection and antibiotics are useless. The most important thing is to replenish oral rehydration salt III in time to avoid dehydration. Most children can recover on their own in about 3 days. If they have persistent vomiting or no urine for more than 6 hours, it is not too late to go to the hospital.

There are also allergic diseases that have become more and more common in the past two years, such as eczema, allergic rhinitis, and asthma, which account for more than one-third of my outpatient visits. Regarding the treatment of allergies, two groups are quarreling fiercely: one group says that allergens must be completely avoided and cannot be touched at all. ； Another school of thought says to be more exposed to “exercise tolerance.” This really cannot be generalized: if you only have mild dust mite allergy or seasonal pollen allergy, and do not cause asthma or frequent coughing, you can indeed gradually develop a small amount of exposure under the guidance of a doctor and slowly build up immune tolerance. ； But if you have a severe allergic reaction, such as being out of breath when you come into contact with cat hair, or having a swollen throat after eating a mouthful of mango, you must strictly avoid it and don't make fun of your child's safety. There was a parent who thought that his child's allergic rhinitis was a "minor problem that you can just deal with." He delayed the treatment for more than half a year without intervention. As a result, it developed into chronic sinusitis and secretory otitis media, which affected his hearing. The gain outweighed the loss.

Many parents always ask me if there is any "universal prevention formula". To be honest, there is no such thing. My own 5-year-old child also gets colds and fevers. The last time she was infected with influenza A in kindergarten, I didn’t take her to the hospital when her fever reached 38.8 degrees Celsius. I just gave her warm salt water at home and fed her acetaminophen when her body temperature exceeded 38.5 degrees Celsius. When she was in good spirits, I even let her lie on the floor and play with building blocks. She returned to kindergarten alive and kicking in three days. You really don’t need to pursue being a “perfect parent”, nor do you need to try “preventive tips” on your children after seeing them on the Internet. If you really want to focus on the core, there are a few very simple points: ensure more than one hour of outdoor activities every day, and get more sunshine than how many vitamin D supplements you take. ； It’s enough to eat only 70% full. You don’t have to eat enough of the so-called “nutritional standards” for every meal.” ； Wash your hands with running water for more than 20 seconds, which is more effective than any disinfectant gel.

Oh, by the way, there are also principles for dealing with illness. Don’t believe in the extreme statements of “carry it if you can” or “go to the hospital as soon as you have a fever.” The most critical judgment indicator is the child’s mental state: if the child’s fever reaches 39 degrees and he can still get up and run after toys, then just observe him at home.； If your fever reaches 38 degrees Celsius and you become paralyzed, don’t even want to touch your favorite strawberries, or you experience shortness of breath, frequent vomiting, or an unexplained rash, don’t hesitate to go to the hospital immediately.

To put it bluntly, the prevention and control of common childhood diseases is essentially "cooperating" with the child's immune system. You don't have to block all enemies for it, nor can you completely let it go and let it fight alone. Finding the balance that suits your child is better than anything else.