Guidance on prevention of common childhood diseases

Differentiate protection that matches the developmental characteristics of different age groups, avoid unnecessary medical intervention that disrupts autoimmune rhythms, and find a dynamic balance between exposure to a small amount of pathogens and active protection. This is the most practical conclusion I have come to after 12 years of clinical experience in pediatrics and exposure to nearly 30,000 common cases in children.

I just treated a 3-year-old girl last week. My grandma was in so much pain that she wouldn’t even touch the public seats in the community when she went out. She would wipe her hands with disinfectant wipes immediately if she touched a toy. She spent a small amount of 2,000 yuan on various supplements every month. As a result, she contracted mycoplasma pneumonia in the first week of kindergarten. The fever lasted for 5 days and she couldn’t recover. The grandma held the child in the clinic and shed tears, saying, “I’m protecting her so well, how can I still get sick?” Don’t tell me, I’ve seen this happen too many times. Nowadays, the parenting circle is naturally divided into two groups. One group is the “sterile people” who wish they could turn on ultraviolet disinfection lights at home 24 hours a day, and everything the children put in their mouths must be steamed for 15 minutes. The other group is the “rough care people” who say that they need to be exposed to more “dirty things” to develop their immunity. They have to bear colds and fevers without taking any medicine. In fact, both of these two misconceptions are based on prevention.

Let’s talk about small-month-old babies first. Children under 6 months old have not yet metabolized the antibodies they brought from their mothers, so the probability of getting sick is actually very low. Many parents panic when they see some eczema on their children’s faces, looking for “hormone-free miracle drugs”, or even stop breastfeeding at will. In fact, there are slight differences in the recommendations of different diagnosis and treatment guidelines: some domestic primary hospitals will recommend postponing vaccination during the onset of eczema, but the American Academy of Pediatrics and my country's latest children's eczema diagnosis and treatment guidelines both make it clear that mild eczema does not affect routine vaccination at all. As long as it is not severe eczema with ulceration and infection, there is no need to postpone it. As for ointments, mild eczema can be relieved by moisturizing. Only moderate to severe eczema requires the use of weak glucocorticoids. Follow the doctor's advice and you don't have to worry about side effects. On the contrary, those Internet celebrity ointments that claim to be "all natural and hormone-free" secretly add powerful hormones, which may harm children if used for a long time.

A while ago, a mother came to ask if it would be a problem if her child was given antibiotics as soon as the fever reached 38°C. Her reason is that she is "fearful of having a fever that is too high and may cause pneumonia." In fact, this is a very common misunderstanding - pneumonia is caused by pathogens such as bacteria and viruses that infect the lungs, and is not "burned" by a fever. If there is no pathogenic infection, a fever of 40°C will not cause pneumonia. And whether you need to take antipyretics or not, you don’t have to stick to the 38.5°C line. If the child is in good spirits and runs and jumps like no one else, you can also physically cool down to 39°C for observation. If the child is too weak to open his eyes, you can take acetaminophen or ibuprofen to relieve discomfort even at 38°C. Just adjust flexibly and don’t have to stick to the standard.

Oh, by the way, talking about daily protection, my daughter just entered the first grade last year, which happened to coincide with the outbreak of influenza A. Half of the children in the class asked for leave, but she didn't get infected. I didn’t give her any special supplements. I just prepared ordinary medical surgical masks for her. I told her to wash her hands first thing after school and not to touch her face or mouth before washing her hands. I didn’t even let her wear an N95. Children’s airways are narrower than adults, and their cardiopulmonary function is not fully developed. Wearing an N95 for a long time will increase the respiratory burden, which is not worth the gain.

There is also the issue of diet. Many parents firmly believe that "eating cold foods will cause diarrhea" and "cold fruits cannot be eaten by children." There is indeed a difference in the views of traditional Chinese medicine and Western medicine on this point: Traditional Chinese medicine pays attention to the maintenance of the spleen and stomach and recommends avoiding exposure to cold and cold foods. Western medicine pays more attention to individual tolerance. As long as the child does not have any uncomfortable reactions when drinking cold milk or eating cold yogurt, there is no need to restrict food at all. I have friends’ children who have grown up eating room-temperature fruits and drinking iced milk from adults, and they have grown very strong. On the contrary, those children who have to steam and heat even room-temperature fruits will occasionally suffer from diarrhea after taking a bite of cold food. To put it bluntly, their stomachs have been raised too "delicately", and their adaptability is poor.

After all, there is really no standard answer to the prevention of common childhood diseases, and there is no need to make the whole family fall on their feet. I have been in the clinic for so many years, but I feel that those children who play around in the community every day and get covered in mud have the least number of trips to the clinic. The immune system is like a child learning to walk. You have to let it fall a few times before it learns how to balance. If you keep holding it, it will never learn to walk. Of course, the vaccines that should be administered must be administered according to the regulations. This is the bottom line. There is really no need to be too tight about the rest.