Prevention and management of common childhood diseases

Prioritize prevention over cure, hierarchical management of severity, and individualized adaptation of plans. There is no universal formula, and there is no need to be overly anxious.

Last week, I met a mother in the outpatient clinic. Her 3-year-old baby had just entered kindergarten. She had fever three times in the first month of school. Each time, she went to the emergency room in the middle of the night. Her bag was stuffed with seven or eight kinds of medicine, including antipyretics, anti-inflammatory drugs, and cough syrup. As soon as she entered the door, she asked if there was any "magic medicine" that could make her baby never get sick again. To be honest, I am very familiar with this kind of anxiety. After working in the pediatric care department for 6 years, I have seen too many parents raising their babies like porcelain dolls. They wish they could cover them in a sterile cover. On the contrary, the more careful they are, the more likely they are to get sick. There used to be a grandmother who wiped the floor with 84 three times a day and steamed her child's tableware. As a result, her 2 and a half year old child caught a cold whenever she went out and came into contact with children. After investigation, she found out that over-sterilization destroyed the intestinal flora and made her immunity even lower. Of course, there are also parenting schools that advocate that babies born prematurely or with a history of severe allergies should minimize their exposure to pathogens in the first 6 months. There is no absolute right or wrong between the two ideas. The core is to match the basic physical constitution of your baby.

Speaking of this, we have to mention the fever issue that parents are most concerned about, and this is also the area with the most controversy. The current mainstream Chinese and American pediatric guidelines clearly recommend that when the temperature is above 38.5°C and the child is in a bad mental state, then use antipyretics, such as ibuprofen or acetaminophen. Routine use of warm water baths and alcohol baths for physical cooling is not recommended, as it can easily cause discomfort or even alcohol poisoning in the baby. But I have also encountered many elders who insist on wiping their babies to cool down. In fact, if the baby’s temperature cannot be lowered after taking antipyretic medicine, but the baby is still in good spirits, it is not impossible to wipe the large blood vessels such as the neck, armpits, and groin with a warm towel. It does not need to be completely one-size-fits-all. After all, raising a baby is not an experiment. There is no need to impose hard guidelines and conflict with the elderly. But remember, the body temperature number is never as important as the baby's mental state. A baby that is still jumping when the temperature reaches 39°C is much less risky than a baby that languishes in the arms when the temperature reaches 38°C.

In addition to respiratory diseases, digestive tract problems are also the most frequently asked questions by parents. When kindergartens send mass messages to Noru in autumn and winter, I can receive more than a dozen inquiries in a morning. Most parents panic and ask for antibiotics and fluids as soon as they see their babies vomiting. In fact, norovirus and whorls are viral infections, and antibiotics are completely useless. The core of care is to prevent dehydration: do not give water or food immediately after vomiting, rest for 10 to 15 minutes, and feed 1 to 2 spoons of oral rehydration salt each time, and slowly increase the amount. As long as the baby can drink it, has normal urine output, and is not depressed, the baby can be cared for at home. But if you vomit for more than 12 hours, have bloody stools, and complain of stomachache and can’t stand up, don’t hesitate to go to the hospital immediately. The most important thing is to rule out acute abdominal diseases such as intussusception. Oh, by the way, there is another common misunderstanding: giving your baby cough medicine when he coughs. The U.S. FDA clearly recommends that children under 4 years old not use over-the-counter cough medicines casually. Coughing itself is a self-protective reaction to expel phlegm. If you try to stop the cough and block the phlegm in the airway, it will easily develop into pneumonia. Of course, some Chinese medicine practitioners believe that if a child has a dry cough that affects his sleep, he can use some mild traditional Chinese medicine cough preparations. This can be chosen based on the actual situation and the doctor's advice, and there is no need to completely reject a certain school's solution.

When my own baby got herpetic angina last year, her fever reached 39.8°C. My mother was anxious to give her cephalosporins, so I just gave her antipyretic medicine. I gave her more cold porridge and milk, and sprayed some Throat Sword to relieve the sore throat. The fever subsided in three days, and she was completely healed in a week. But I’m not encouraging everyone to carry it on. I barely slept in those two days, and I would touch her head every half an hour. If she had convulsions, drowsiness, or couldn’t even drink water, I would definitely send her to the hospital as soon as possible.

Another question that gets asked a lot: Should I give my baby immunity-boosting supplements like spleen aminopeptides and lactoferrin? The current mainstream research conclusion of Western medicine is that there is no clear evidence that such products are effective for healthy children. Only children with confirmed immune deficiency and recurrent respiratory infections more than 10 times a year need to use them under the guidance of a doctor. But I have also encountered feedback from many clinical colleagues that some babies with really weak constitutions have indeed become less sick after taking it. There is no absolute right or wrong in this matter. Everyone can choose according to their own financial situation and the doctor's advice. There is no need to worry about this. After all, 2 hours of outdoor activities a day, a balanced diet, and getting enough sleep are recognized as the golden rules for improving immunity, and they are much more effective than supplements costing thousands of dollars.

To be honest, the longer I stay in the pediatric department, the more I realize that there is really no need to pursue "zero illness" when raising a baby. The baby's immune system is like a new mobile phone you just bought. You have to install a few more normal apps (exposed to a small amount of pathogens) so that it can run more smoothly. If you always turn on airplane mode (completely isolating the outside world and over-sterilizing), the baby's immune system will freeze whenever it comes into contact with viruses. Understand more common sense, be less anxious, don't use medicine indiscriminately, and don't take it too hard. The best solution is the one that suits your child.