Prevention and care of common childhood diseases

The core logic of prevention and care of common children's diseases has never been "all poisons are immune", but "seize the key points and respond individually" - there is no universal care formula that can be applied to all children, and over-protection or hard work is not advisable. The core principle is "prioritize the child's condition over indicators, and evidence-based decision-making over folk prescription experience."

Last week, I found out that my baby just turned 3 years old and was sent to kindergarten for the first time. She had fever twice in a week. She was so anxious that she tried more than 20 "child care tips" collected by Xiaohongshu: she would cover the baby's sweat and feed her rock sugar and snow pears. As a result, the baby's fever did not go away and she had diarrhea for three days. When she came to my clinic, her eyes were swollen and she said, "Why don't all the tricks they use on my baby work?" ”

Don't tell me, this is really a common problem among many parents. They always want to find a once-and-for-all standard of care, but the most taboo thing about raising children is "one size fits all." Take the most common fever as an example. There are currently two factions quarreling fiercely on the Internet: One faction is purely evidence-based and insists on physically cooling the temperature below 38.5°C and only giving antipyretics when the temperature is above 38.5°C. They will never go to the hospital within 3 days. ； The other group is the empirical group. They think that if the fever is high, it will easily lead to burnout. As soon as the temperature reaches 38°C, they will quickly take medicine or even run to the emergency room. I have been in pediatric clinical practice for almost 9 years. To be honest, both of these statements are too absolute. Last month, I met a 4-year-old child who had a fever of 39.2 degrees Celsius and was still sitting at the door of the clinic playing Lego. She was in better spirits than the parents waiting for the doctor. I asked her mother to go back and give her more warm salt water and put on an antipyretic patch to make her feel more comfortable. No need to take medicine. ； However, I have also encountered babies with fevers of 37.8°C who lay in their arms unable to open their eyes and even vomited twice. It was found that it was a bacterial infection and antibiotics were used as needed, and they could not wait until the temperature reached 38.5°C.

Oh, by the way, don’t believe in the old method of rubbing alcohol on the body to cool down. Children’s skin is thin, and alcohol can easily penetrate into the bloodstream through the skin. I once met a 2-year-old child whose parents used 75-degree alcohol to rub the armpits and neck. As a result, the child was directly poisoned by alcohol and was sent to the rescue. It is really not a mistake. For physical cooling, just use a warm towel to wipe the neck, groin and other places with large blood vessels. If you find it troublesome, put on an antipyretic patch. If the baby resists, don't do it. It's already uncomfortable, so don't torment him any more.

When it comes to prevention, the first reaction of many parents is to "keep it clean". They use 84 to wipe the floor at home every day, spray disinfectant spray on everything their children touch, and they don't even let them touch the slide when they go out. What's the result? Many children are raised so "squeamish" that they get a rash if they touch a public seat when they go out, or catch a cold after going to an amusement park. There is actually a "hygiene hypothesis" that has been proposed by academic circles for many years, which means that moderate exposure of children to common microorganisms in the environment during childhood can actually help them build a more complete immune system and reduce the probability of allergies and autoimmune diseases. Of course, this statement is also controversial. Many parents say what should I do if I touch the norovirus? In fact, you don’t have to go to extremes. Clean water is enough for daily household cleaning. There is no need to disinfect every day. Just wash your hands carefully with the seven-step hand washing method before meals, after using the toilet, and when you come back from outside. Don’t let your baby rub his eyes or chew his hands after touching public toys. There is really no need to raise your baby in a “sterile box”.

Let’s talk about the cough that parents are most afraid of. Many people rush to give cough medicine as soon as they hear their baby cough, fearing that the cough will lead to pneumonia. There are also two mainstream views here: The mainstream of Western medicine is that it is not recommended to use central antitussives for children under 6 years old, because coughing itself is the body’s phlegm reflex. If you stop the cough, the phlegm blocked in the trachea will easily turn into pneumonia. ； However, the view of traditional Chinese medicine is that prolonged coughing damages Qi, especially since babies have a weak spleen and stomach. Prolonged coughing can easily affect appetite and sleep, so appropriate intervention is required. My own experience is that you should first look at the condition of your baby’s cough: if he coughs twice occasionally during the day and is able to eat and sleep, then drink more warm honey water (you can only drink it if you are over 1 year old), or boil some pear water, and you don’t need to take medicine. ； If you cough so much that you can't sleep at night, or you hear phlegm but can't cough it up, go to the hospital for a blood test first to see if it's a viral or bacterial infection. Do you need to use nebulizer? Don't give cough medicine to yourself. A parent once gave a 3-year-old child an adult cough medicine for three days. The child's cough stopped, but the phlegm blocked his lungs and almost developed into severe pneumonia. He couldn't breathe when he came, which was really dangerous.

The recently popular hand, foot and mouth disease, herpangina, and norovirus are all self-limiting diseases. Most babies will recover on their own within a week or so, without the need for frequent infusions. My baby had hand, foot and mouth disease last fall and had a fever for two days, with the highest temperature reaching 39°C. I gave him antipyretic medicine twice and sprayed some Throat Sword to relieve the sore throat. After the fever subsided, a rash broke out. He stayed at home for a week and was cured without going to the hospital at all. Of course, here’s the key point: If your baby develops persistent high fever, poor energy, convulsions, vomiting, or shortness of breath, don’t hesitate to go to the hospital immediately. These are signs of serious illness and should not be tolerated.

In fact, the biggest feeling that I have been doing in pediatrics for so many years is that there is really no standard answer to raising a baby. Every baby has a different physique. Some babies have strong firepower and can be fine with less clothing. Some babies are born with a cold body and catch a cold when exposed to the slightest breeze. Don’t always apply other people’s experiences to your own baby. Paying more attention to your baby's condition is more useful than memorizing 100 care rules. If you are really unsure, go to a pediatrician in a regular hospital and don't try random remedies on the Internet. This is better than anything else.