In over two decades as a pediatrician, I’ve seen numerous standards in parenting advice change due to fads or improved medical knowledge. As a result, parents from different generations can have very different ideas on the do’s and don’ts of caring for children who are sick. Myths, old wives’ tales and out-of-date information can cause a lot of confusion between new parents and grandparents.
In my last articles, I addressed certain fads and facts regarding general baby and child care as well as changes in disciplinary measures. In this article, I will look at the different views on treating and preventing certain types of illness.
To vaccinate or not to vaccinate?
The “short list” vaccines you remember from the ’60s were all against diseases that used to kill and maim children by thousands. The Salk and Sabin polio vaccines sent hundreds of iron lungs and child-size crutches to the junkyard; whooping cough and diphtheria vaccines caused the old children’s cemeteries to overgrow with weeds; measles vaccine sent SSPE (subacute sclerosing panencephalitis) into the “diseases that only Dr. House ever heard of” category. The newer vaccines are generally against diseases that were never as common or as deadly as the “old guard” illnesses. Some important new vaccines:
- The three major meningitis vaccines (HiB, pneumococcal, meningococcal) that cover the three major causes of postneonatal meningitis.
- The chickenpox vaccine covers a common disease with rare complications, but one person dying of it is one too many.
- The HPV shot covers cervical cancer, which is actually a sexually transmitted disease. Now it’s largely vaccine-preventable (5- to 20-fold reduction in vaccinated individuals.)
Can you catch cold from the cold?
It was once believed that malaria was caused by bad air around swamps. However, mosquitoes, also plentiful in swampy areas, were actually what carried the disease. In a similar way, cold air and respiratory disease are related, but the connection is much more complicated than just “cold causes colds.”
While simply being exposed to cold weather doesn’t directly cause colds, the immune system is stressed when the body’s core temperature drops, which might cause you to get sick. In addition, cold can cause vasoconstriction – when blood vessels such as those found in the nose narrow – which can lead to dryness. This dryness compromises the nose’s ability to filter infections. On returning to warm air, rebound vasodilation occurs, where your hands get pink and your nose starts running as blood returns to the vessels. The resulting sniffles cause people to breathe through their mouths, which bypasses the nose’s air filtration capabilities. As a result, it becomes easier to inhale the virus-bearing mucus that can cause colds and lower respiratory infections.
Treat fevers or let them run their course?
Dangerous fevers begin over 106 degrees Fahrenheit or so. Below that, the only reason to treat fevers is that they cause discomfort. Acetaminophen or ibuprofen should be used in moderation, and never overdosed (too large a dose or too frequent).
A real danger of fevers is the dehydration that they cause; also, a dehydrated child can’t make enough sweat to cool herself. Fluids are about the only “definite yes” in fever management. The saying “Starve a fever, feed a cold” should really be “Hydrate a fever and hydrate a cold.” People with fever generally won’t want to eat, nor should they be forced to, but fluid intake should be strongly encouraged.
As for fever being useful in fighting the disease – if you’ve taken a microbiology course, you know that if you let the incubator go over 101 degrees Fahrenheit, your cultures won’t grow in the Petri dishes, so, yes, it is one of the ways the body slows down infectious processes. High fever is actually a positive prognostic indicator in bacterial meningitis – the chances of survival are higher if there was fever at presentation.
Avoid dairy or “Got Milk?”
Some people believe that giving children milk or other dairy products when they’re sick will increase their mucus. Although milk may coat the back of a child’s throat or cause a reaction if he’s lactose intolerant, dairy does not increase mucus production. When a child is sick, he should eat his usual diet so as to reduce stress on his body. If that diet includes dairy, then give him dairy. If he can’t stomach anything, then make sure he gets a lot of fluids. You can also try the typical BRAT diet (bananas, rice, applesauce and toast).
The chicken soup cure or a spoonful of medicine?
While chicken soup isn’t a miracle cure, it actually does help with a cold in a way. Soup is mostly water, tends to be more palatable to a sick child, and thus is a good way to hydrate at a time when hydration is especially important.
Cold medicines don’t work very well at all, but a recent study showed that honey did a better job of cough suppression than actual cough suppressants [however, don't give honey to infants younger than 1 year]. And good old saline (0.9% salt water) nose drops work better for most nasal problems than actual medicated drops.
Antibiotics for green or yellow snot?
It can’t be accurately determined from the color of her nasal discharge whether a child has a viral infection or a bacterial infection. Before determining whether it’s time to prescribe antibiotics, we look at other signs such as fever, headache, tooth pain, nasal congestion and how the child looks. If the runny nose is one-sided, consider the possibility that there is a foreign body in the nose – beads tend to be a favorite, as do pencil-tip erasers.
Keep kids active when they have a cold or keep them in bed?
Bed rest is certainly overkill for a cold, and the activity level should depend on the child’s tolerance. If a child has been tiring much easier than usual, though, it may be time to go see the doctor because it may be more serious than a cold, even without fever.
Editor’s note: Have you changed how you care for sick kids since you were a young parent? If so, GRAND would like to hear from you at firstname.lastname@example.org.
This article is part 3 of Dr. Belilovsky’s three-part series for GRAND Magazine on “Fact vs. Fad: Changes in Parenting Advice Across the Generations.”
Anatoly Belilovsky, M.D., is medical director of Belilovsky Pediatrics in Brooklyn, New York, and has more than 20 years of experience in treating children and advising parents. He is a Princeton graduate, a former clinical instructor at Cornell University and a recipient of the Americhoice Quality of Care Award for his groundbreaking work with pediatric asthma patients.