‘Tis the season to be snotty…

Colds, Flu, Nasty Sick Bugs…They’re Doing The Rounds Mamas & Here’s What You Need To Know About Them

Does your child have the ‘eternal’ runny nose that never seems to stop? Or that rattly ‘smoker’s’ cough that you hear mainly at night or first thing in the morning? Have you had to make more trips to the doctor in the past few weeks that in the past few years combined? Then you can take strength and comfort from knowing that YOU ARE NOT ALONE MAMAS! For, ’tis the season to be snotty…

My patients are constantly wondering why they have to bring their kids to see me so often these days, and whether or not their kids get sick more frequently than other kids do. Some are even convinced that their children must have some immunological reason or deficit causing them to fall sick so many times. It is a fact: we get sick more frequently in cooler weather. Recent studies have shown a few reasons for this:

– In cooler, drier weather, the mucous membranes in our nose dry out, and the protection of that mucous layer decreases, and viruses can then easily enter our system.

– Virus particles are more hardy in winter because their external viral envelope is stronger in cooler temperatures and the virus is less susceptible to damage.

– In dry weather conditions, viral particles spend more time airborne and are hence more likely to be inhaled and cause infection.

Here is a list of a few of the most common illnesses I see at the clinic these days:

– RSV (respiratory syncytial virus) causing colds and bronchiolitis

– Hand, Foot and Mouth disease

– Influenza

– common cold

RSV

RSV is one of the most common causes of cold-like symptoms, and also leads to bronchitis, croup, bronchiolitis and even pneumonia. 25 to 40% of infants with RSV infection develop bronchiolitis. If your child has RSV, they’ll have a runny nose, poor appetite, fever, they’ll start coughing 1 to 3 days later and will often wheeze. The cough and wheeze are signs of bronchiolitis.

What is bronchiolitis? It is the infection and inflammation of the bronchioles, which are the smallest airways at the periphery of the lungs. This leads to cough, shortness of breath and wheezing. RSV causes over 70% of cases of bronchiolitis. Premature and very young infants are at increased risk of developing complications, as are those with chronic lung disease, cardiac disease and immunocompromise.

RSV can be easily diagnosed with rapid testing. This is a test done using a swab of nasal secretions, gives us a result in a few minutes and is around 90% sensitive. I often do this at the clinic when I suspect the diagnosis is RSV.

Treatment of RSV is mainly supportive, in the form of anti-fever medications and TLC. Try to kee p your child’s fluids up and treat it as you would any cold. If your child has signs of breathing difficulty, such as significant shortness of breath or wheeze, they may require care in a hospital setting, mainly for oxygen and saline nebulisation. In children with underlying asthma-like symptoms, they may need further treatment with asthma medications.

For those children with increased risk of hospitalisation due to a history of prematurity and chronic lung disease or cardiac disease, prophylaxis with an RSV vaccine (palivizumab) can be considered. This is given as a monthly injectable vaccine over the 5 months of the RSV season in the baby’s first year of life. There are specific and detailed guidelines that determine who should get this vaccine.

HAND, FOOT AND MOUTH DISEASE (HFMD)

How many of you have had a child with HFMD or have received a letter from their nursery/school about another case in their class? We certainly make this diagnosis several times a week and almost daily.

HFMD is an illness caused by different viruses, most common in children less than 5 years old. It is very common in the childcare setting due to frequent nappy changes. It causes fever, reduced appetite, sore throat, and 2 days later, painful sores develop in the mouth, as well as a rash on the palms of the hands and soles of the feet and lower arms and legs. The rash often looks blister-like and doesn’t itch. The clinical presentation is very variable, with some children getting just a few of the symptoms and others getting them all. It is highly contagious, with the virus present in their nose and throat secretions, blister fluid and feces. It is rare for adults to catch it, but they can often carry it to others. It is useful to note that due to the fact that many different viruses can cause HFMD, a child can get it more than once.

Treatment of HFMD supportive with the focus being on relief of the symptoms with anti-pain and anti-fever medication, lots of fluids and soft, soothing easy-to-swallow foods. The child will also need to be off nursery/school and avoid other children for one week from the appearance of the rash.

INFLUENZA

We often hear people saying, “I have the ‘flu’” when they’re actually referring to a regular common cold. When you actually have influenza, or the “flu” you are extremely unwell and practically bed-bound with high fever, chills and body aches. It feels like you’ve been hit by a bus!

Influenza is a viral infection that causes an abrupt onset of muscle pain, fever, runny nose, headache, malaise, cough and sore throat. It can also cause nausea, vomiting otitis media and febrile convulsions can be seen in up to 20% of cases. It is transmitted by droplet spread (by coughing or sneezing) and is highly contagious with an incubation period of 1 to 4 days and infectivity that can last for 10 days after the onset of symptoms. It leads to several days off school and work and has the potential to cause serious complications requiring hospitalisation and has an associated significant mortality rate.

Influenza can be diagnosed using rapid testing with a swab of nasal secretions. This gives us a diagnosis within a few minutes. If I’m presented with a patient who is unwell with a high fever and very runny nose, I will always test for influenza. Diagnosing it in the first 2 to 3 days allows us to treat it with an oral anti-viral medication (oseltamivir or tamiflu). This reduces the intensity of the symptoms and shortens the disease duration dramatically, as well as decreases how contagious the child is to others. Those of you who have been to see me and have been diagnosed with influenza, would’ve also left the clinic with a handful of tamiflu prescriptions for other family and household members in case they became symptomatic.

Have you and your children had the influenza vaccine? If the answer is yes, then well done! If not, then you’re at increased risk of all the symptoms and complications mentioned above, as well as at risk of passing influenza to those around you. The nature of our lives here in Dubai seems to increase our risk if catching viruses in general, of which influenza is a major player. Frequent travel, guests from overseas, play areas and so on, all increase our risk of infection.

The influenza vaccine becomes available every September and protects us against the most common strains of influenza prevalent during this season. It has lead to a significant drop in the number of cases of influenza worldwide and a subsequent drop in the associated complications and fatality rates. As many of you know, I strongly recommend that anyone over 6 months old should receive an annual dose of the influenza vaccine, and this is especially important for children with other conditions such as asthma, history of chronic lung disease or who simply attend nursery and have high exposure to viral infections.

COMMON COLD

Of course, not every snotty nose is a sign of the three conditions I described above. What’s common is common, and the aptly-named ‘common cold’ is exactly that. This is the basic runny nose and sore throat, occurring with or without a fever, often with a cough and the illness lasts for a week. It is caused by countless different viruses and is otherwise known as a viral URTI (upper respiratory tract infection).

If your child has a runny nose and mild fever, that seems to settle after a couple of days, then their diagnosis is the common cold. This is treated with anti-fever medication, the occasional honey-based cough syrup, warm drinks and lots of love and cuddles.

To help prevent all of these conditions, get your kids (and yourselves) to wash hands regularly, to cough or sneeze into a tissue or into their elbow if a tissue isn’t available, to throw dirty tissues in the bin and to try and avoid close contact with others who are symptomatic.

Wishing you a happy, healthy and snot-free season!