February 22, 2024
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February 22, 2024
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The First Rule of Pediatrics: Do No Harm

Fall is upon us. The High Holidays are over and the kids are all back in school. Huddling together in crowded lunch rooms and working together in their classrooms for hours on end makes spreading colds and illness easier. That’s right, we’re getting ready for the cold and flu season. It’s not that illness stops in the summer. We see plenty of Coxsackie virus causing sores on the hands, feet and mouth during these months. Strep throat and swimmer’s ear seem to keep us busy. But here comes Rhinovirus, Enterovirus and Coronavirus. None of us look forward to the dreaded Respiratory Syncytial Virus (RSV) and the wheezing it brings to infants or the Influenza viruses heading our way (get your flu vaccine!).

With these viruses come the runny noses, fevers, coughs from post nasal drip and, of course, the sleepless nights. This ultimately leads to the numerous phone calls and office visits which try to deal with these illnesses and their unwanted symptoms. On average, a child may encounter six to eight different upper respiratory infections during the year with most happening between September and May. If the average length of each illness is 10 days or so, that accounts for a large part of winter!

Many are the fathers who come to the office hoping they will leave with an antibiotic for their child so that the wife or worried grandparent has something to try to use and shalom bayit can return to the house. Many are the mothers who hate hearing the dreaded “V” word from the lips of the pediatrician, “Your child has a virus…It will take a few more days for him to get better.” Unfortunately, there are just too many different viruses out there that make us sick for us to come up with one simple solution..

This frequently leads to the latter part of the conversation: What can be done to make the sick child feel better? How do we get my child healthy before his bar mitzvah this weekend? There is company coming for Shabbos. Isn’t there anything we can give my daughter to make her less contagious so I don’t have to change our plans? The answer (like many in our religion) is not so straightforward. For every parent or study which claims benefit using a certain treatment, there is another family or study ready to refute these conclusions. This, as expected, leads to confusion and frustration. Ask 10 pediatricians what their thoughts are on humidifiers and you will likely get 20 different opinions. Join a Facebook mommy group and you will get overwhelmed with “home remedies” and “foolproof” cures that are given with such conviction that you feel foolish to doubt their efficacy.

While there are a lot of treatment options out there, most provide limited benefit. Many companies are selling similar products and fighting for shelf space in order to capture your hard-earned dollars. Just take a look at how many versions of Dimetapp or Mucinex are out there. These products all contain the same basic ingredients, but in various combinations—so read those labels closely. Homeopathic or “natural” treatments are not FDA regulated. Unsubstantiated claims go unchecked in these products. Inaccurate ingredient listings are not uncommon. Multiple formulations of a product without standardization makes it difficult to study the effectiveness of these products.

While I never want to totally dismiss a treatment option with a family, I oftentimes also want to make sure the expectations of success or improvement are realistic. Most important, however, is following a basic tenet of medicine: “Do No Harm.” Onions in the socks for a chest cold—go for it and good luck! Hot salt put in a sock and placed next to an ear for an ear infection—NOT a good idea. Want to try Sudafed PE for that stuffy nose in your eight-year-old? Let’s see if it works (not usually)! Prescribing codeine for a cough in a young child—sorry, just not done anymore. There is a basic urge we all have to try and do something to help another person, especially if that person is our child and they are sick. I have to bring that fever down (well, not really). That lingering cough tells me there must be something serious going on and I need to make it stop (actually, bring that phlegm up!). There is a lot of power in placebo and that may be why some of what we try seems to work. Sometimes, however, less is more.

The following are some tips to help battle through the upcoming winter.

-Wash your hands! Limit the sharing of food and toys among siblings in the house. Wiping down their favorite toys after play time may help as well.

-Saline drops or spray followed by gentle suctioning can cause temporary relief of congestion in infants, especially before a feeding. Humidifiers claim to help thin out mucus. Most recommend cool air, ultrasonic humidifiers. Benefit, however, is questionable especially since a baby will still have a hard time clearing out the “thinner” congestion. If you decide to use a humidifier, make sure you clean it routinely. Avoid vapor rubs in infants, they can irritate airways and make the symptoms worse.

-Over the counter (OTC) cough and cold medicines have NOT been proven to be safe or consistently effective in young children. The FDA does not recommend these products in children under four years old for the treatment of colds. Some even argue that they are not beneficial in children under 12 years old. Proper dosing of these products in children has not been accurately studied, even though these products have been on the market for over 40 years! This includes expectorants, cough suppressants, decongestants and antihistamines. Buckwheat honey used in syrup may have some benefit to reduce cough in children over 1 year of age (NEVER give honey to a child under the age of 1).

-Fever is a normal response to fighting a cold. The height of the fever does NOT correlate to the severity of the illness. It will not cause brain damage. Make sure you have an accurate thermometer (rectal in infants and temporal scanning or oral in older kids). Ear thermometers frequently give inconsistent readings. Acetaminophen (Tylenol) or ibuprofen (Motrin/Advil) can help reduce the fever and make your child feel better, but it will not necessarily eliminate the fever. There is much misinformation, confusion and improper use of alternating between these products. Alternating has not shown to be any more beneficial than using just one product.

-Linus Pauling was a brilliant man and a two-time Nobel Prize winner. He strongly believed in the power of high doses of vitamin C to help fight infection. Unfortunately, his theories have not been validated on a consistent basis. Large doses of vitamin C do not appear to protect against getting a cold, nor do they reduce the length or severity of the illness. Taking more than 500 milligrams (mg) of vitamin C at any one time is not helpful. More than that amount is simply lost by our body through urination.

-Sambucol—an elderberry extract, may help reduce the course of influenza by a few days. It does NOT prevent you from getting the flu. Proper dosing in children is still uncertain. Antiviral prescriptions such as Tamiflu don’t fare much better. If the medicine is started in the first few days of illness, it may reduce the course of illness by a few days. It could also have some unwanted side effects in children including vomiting, behavior changes and hallucinations. It can be used, in some circumstances, as a preventive medication to reduce the risk of getting the flu from sick family members.

-Echinacea contains active substances that may boost immune function, reduce inflammation and provide antiviral effects. It comes in many forms, however, and some products use more than one species of the plant. It is also frequently combined with other homeopathic products. This makes measuring true effectiveness and establishing accurate dosing difficult.

-Zinc is theorized to slow down viral replication in our bodies. A 2014 study in JAMA showed that Zinc shortened the duration of a cold by one day, but did not affect symptom severity. Zinc nasal sprays have been reported to cause some people to lose their ability to smell (sometimes permanently). Bad taste and nausea, as well as the risk of zinc toxicity, are all good reasons to avoid zinc products.

You can always contact your pediatrician with any questions or concerns, especially if fever has persisted for a few days or your child seems to be getting worse. Wishing you all a wonderful fall season and a healthy winter!

By Dr. Joshua D. Menasha, Tenafly Pediatrics

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