Infections

Two categories of germs – bacteria and viruses – cause most infections. Illnesses like strep throat, urinary tract infections and some types of ear infections are examples of bacterial infections. Bacterial infections can be cured with antibiotics. Antibiotics are prescribed in office by your provider.

Viruses, not bacteria, are the primary source of infections in children. Viral infections, such as colds and most cases of diarrhea and vomiting, cannot be cured with antibiotics. Your child will recover from viral infections when the illness has run its course.

Aside from not curing the disease, there are three other major downsides of treating viral infections with antibiotics:

• • Your child may have an adverse reaction to the antibiotic. These reactions can be as simple as developing an itchy rash and as serious as causing swelling and closing of the throat.
  • Bacteria may become more resistant each time you give antibiotics to your child. If you child becomes infected with antibiotic-resistant bacteria, it may be necessary to use more powerful medicines, which may need to be given intravenously in the hospital. Even then, some antibiotic-resistant bacteria are very difficult to treat. Antibiotic-resistant bacteria can also spread to others in the family and community.
  • At the end of viral illnesses, children can frequently break out in a red, widespread rash. If a rash occurs while your child is taking antibiotics, we are left with a difficult question: is the rash from an allergy to the medication or is it unrelated to the antibiotic and caused by the virus instead? Sometimes it is difficult to know the answer, and your child may end up labeled as allergic to a family of antibiotics. For your child’s future, a potentially useful and safe antibiotic might not be used when your child really needs it.

Viral infections may sometimes lead to bacterial infections. Keep us informed if the illness gets worse or lasts for a long time, so that treatment can be given as necessary.

My child seems to be sick all the time with a cold. Is that a sign that he or she is less capable of fighting infections as compared to other children?
It may sound a bit impersonal, but it’s been shown that, on average, the number of colds per year is anywhere from 3-10 colds. If each cold lasts the usual 10-14 days, this translates to up to 140 days (or 4-5 months) of cold symptoms per year! Therefore, it’s possible for children to be sick almost continuously for periods of time during the year, especially during the winter. In the wintertime, cold viruses are 3 times more common, and children tend to stay indoors for prolonged periods and can spread viruses more easily.
Children tend to get sick more often in part because they probably shed viruses for longer periods of time; because they tend to share nasal secretions and saliva more easily through toys and shared objects; because they do not wash their hands as often; and because their immune system is encountering sources of infection that are that are new to them.
Finally, there are some causes for cold-like symptoms, such as allergies, that are not caused by viruses. Allergies tend to flare up in the spring and summer months with the surge of pollen, grass and ragweed. If your child is over 3 years of age; sneezes a lot; has a clear nasal discharge that lasts over a month; doesn’t have a fever; and, especially, if these symptoms occur during pollen season, your child could have a nasal allergy. Some children are sensitive to indoor allergens and irritants such as molds, dust mites, pet dander and smoke. Talk to your doctor or nurse practitioner if you suspect allergies, as there might be medications or changes you can make in the home environment that might help your child.

Since antibiotics are not helpful for viral infections, how about over-the-counter remedies?
Perhaps a few children might benefit from the nose-drying and cough-suppressive effects of cold medicine. However, these preparations are not useful for the majority of kids. They certainly do not shorten the duration of a cold.  Children are also susceptible to the side effects of these medications such as jitteriness, racing heart rate and behavioral changes. If you are planning to give these products a try, it’s probably better to avoid drugs that have multiple ingredients because they increase the risk of side effects. Similarly, it is actually better not to use combination cold medicines with fever reducers (e.g. Tylenol or Motrin/Advil and decongestants/cough suppressants). Give the fever reducer separate from the cold medicine. That way you can give the maximum safe dose of the fever reducer without overdoing it with the cold medications.
In cases of vomiting and diarrhea, practically none of the medications used for adults are indicated and can be actually dangerous for children. Do not use them.

What can I do to help my baby with a cold?
In cases of young children with colds, remember that children cannot breath through the mouth and suck at the same time. If your child is breast or bottle-feeding, you must clear the nose so he or she can breathe while sucking. Clearing the nasal passages is also important before putting the child down to sleep. The best remedy you can use to help with dry nasal mucus is to put a few drops of warm clean water or saline solution in to each nostril. Then, after waiting a few seconds, you can wipe the nose gently with a soft facial tissue paper.
Click here to review other supportive care measures for cold/cough.

How soon can my child return to daycare or school after an infection?
The main requirement for returning your child to daycare or school is that the fever is gone for at least 24 hours and the symptoms are not excessively noisy or distracting to classmates and staff or teachers. It does not make sense to keep a child home until we can guarantee that he or she is not contagious because viral shedding can last 2 to 3 weeks!

How about alternative medicine approaches to preventing or treating infections?
Although alternative medicines are becoming more and more popular for use in adults, they have not been studied very carefully in children. Besides, some of the therapies that have been studied, such as the use of Echinacea and vitamin C for the common cold, have no proven benefit for children. We also know that “lack of vitamins” is not the cause of common infections, and too much vitamin C (more than 2 grams) can cause diarrhea.
It may be that, in the future, more and more of the homeopathic remedies will be scientifically shown to help. Research is being directed into the role of dietary supplements in treating childhood diseases. But, for the meantime, the jury is still out on most alternative remedies. Until then, the most helpful thing to remember is that “natural” may not necessarily mean “safe” or “effective”.

What is the best way to prevent the spread of infections?
Hand washing helps to prevent the spread of gastrointestinal and upper respiratory infections better than all other methods. Hand washing (with running water and soap or a waterless antibacterial cleanser) is especially important after using the toilet; changing diapers; coming in contact with pets; handling foods, especially raw meats; and, before and after touching your nose, eyes and mouth.
Infectious diseases that were killers or causes of life-long disabilities in children, such as polio, measles or tetanus, have been practically eliminated thanks to vaccinations. Therefore, we encourage you to make sure your child is up to date with immunizations.

Fevers and Infections:
Fever is common in both viral and bacterial infections. (Please click here for more information about proper ways to check a temperature in children, dosing charts for fever reducers, instructions on when to call your pediatrician if your child has a fever and other topics about fever).

Flu
Please click here to review information on flu.

References:

• • Gardiner, Paula, etc al. Supplement Use Growing Among Children and Adolescents, Pediatric Annals, Volume 33, Number 4, pp. 227-240.
  • Gorman, Christine. Is it Strep Throat?, Time Magazine, April 19, 2004.
  • Schmidt, Barton D. Instructions for Pediatric Patients, W.B. Saunders and Company, Philadelphia, Pennsylvania, 1999, pp. 69, 76.
  • Your Child and Antibiotics (Brochure), American Academy of Pediatrics.