Keep well this winter

Parents are often made to feel inadequate if they don’t administer some sort of medication to prevent, treat or alleviate their children’s illnesses. Annette Binger asks the experts for their advice on maintaining family health throughout the winter months. 

If it didn’t seem as though children became sick more often during winter, the cold temperatures and shorter days might be easier to endure. But the facts are, everyone is at greater risk of contracting influenza – the flu – during winter, and certain diseases and viruses are more prevalent throughout the colder months. Some of these illnesses can be immunised against, or if contracted do require medication. But is treatment always necessary or possible?

Colds: an inevitable evil?

Because up to 200 different viruses cause colds, immunisation is unavailable so contracting a cold, particularly over winter, is almost inevitable. Dr Colin Robertson, respiratory physician at the Royal Children’s Hospital in Melbourne, says that it’s reasonable to expect children will contract between eight and ten colds a year.

And, he adds, for some children the virus that causes the cold can lead to ear infections and tonsillitis, or provoke other illnesses like croup and asthma. His recommendation is that the most parents can hope for is minimisation of a virus’ spread and effect.

According to information put out by the Melbourne Royal Children’s Hospital, there are things that may help to prevent a cold. Eating healthy food is a good start and will maintain general health – plenty of fresh fruit and vegetables; wholegrain cereals; legumes; lean meat, chicken and fish or alternative proteins; and calcium rich foods like milk, cheese and yoghurt. And preventative treatments like Vitamin C, extra zinc and Echinacea might shorten a cold’s duration, but are not proven.

Pam Stone is a practicing naturopath and consultant to a leading natural health products company. Her advice to parents considering natural therapies is to be aware of dosages when treating a child, and check with a pharmacy assistant or health food retailer if you’re uncertain about a product.

‘Echinacea can be used preventatively to stimulate the immune system, but the key is to use small to moderate doses for children and to have a one to two week break every eight weeks…long-term use will reduce its effect.'

‘Vitamin C will be better absorbed if taken in a formula that includes bioflavonoids and can be used preventatively in conjunction with Echinacea,’ she adds. ‘And while a children’s formula multi-vitamin will be beneficial for the general boost it gives, extra zinc assists with healing, and Vitamin A (in carrots and cod-liver oil) builds the mucous membranes’ defences.’

Because colds are commonly spread in two ways – by small drops in the air from a sick person’s cough or sneeze, or on hands that have come in contact with a virus, the Royal Children’s Hospital suggests a number of good-sense measures that may minimise the spread of cold viruses.

Try to keep a reasonable distance from people with colds; teach children to cover their nose and mouth when coughing or sneezing; wash your hands after nose-blowing and sneezing, and before eating; and use disposable tissues rather than handkerchiefs.

If the worst does eventuate, medical practitioners agree that there is no cure for a cold but you can at least make your young patient more comfortable. The age-old treatments of rest, reassurance, fluids and paracetamol for a fever or sore throat are still the best means of treating a cold. A persistently stuffy nose will temporarily clear with saline drops or a children’s formula nose spray, and decongestant medicines may ease the symptoms.

Is it cold or flu?

Influenza, or the flu, is caught in the same way as a cold but is very different. It comes on more quickly than a cold, and is associated with more extreme headaches, body aches, shivering and feelings of hot and cold. According to Dr Rosemary Lester, the Victorian Department of Human Services’ immunisation expert, only children in high-risk categories, people over 65, and those in contact with high-risk people need to immunise against it.

‘The flu is extremely unpleasant for anyone,’ she says, ‘but it generally tends to result in short-lived illnesses in children and for that reason we don’t recommend they’re immunised. But if your child has a chronic illness, lung disease or immune deficiency then immunisation is essential.

‘It’s important that people with the flu don’t try to ‘soldier on’,’ she adds. ‘They will only spread the illness further and take longer to recover themselves.’

Treating a child with the flu is similar to a cold; however, if you’re concerned a doctor’s check-up may be beneficial. But as with a cold, your doctor will only prescribe antibiotics if your child has developed another infection – for example an ear infection or pneumonia.

That’s a terrible cough

‘Cold viruses can be responsible for a number of different respiratory illnesses,’ says respiratory physician Dr Colin Robertson. ‘They can provoke croup and asthma in susceptible children, and cause coughs often described as bronchitis (that we now classify as post-infective cough), which can last up to four weeks after a cold.’

Croup, the bark-like cough that affects children, generally peaks between April and August according to Dr Robertson. ‘Most children will only get it once,’ he says. ‘But unfortunately, for those with recurrent croup there’s not a lot we can offer. We’ve pretty much discounted the benefits of steam these days and have found the most beneficial treatment for a croupy child to be comfort and reassurance.’

Dr Robertson divides asthma into two camps: intermittent and persistent. ‘Children with intermittent asthma tend to only get it in conjunction with a virus and require aggressive treatment when it occurs,’ he says. ‘These children don’t benefit from asthma preventers but it is important for parents to have an asthma management plan written by their doctor and appropriate treatment at home…asthma doesn’t limit itself to doctors’ business hours!

‘Children with persistent or ongoing asthma, which will be made worse by a cold, should be controlling their asthma with regular preventers. They’ll then have a strong base-line and the effects of a virus on their asthma will be minimised.’

When asthma has been ruled out in the diagnosis of an ongoing cough, it will generally be a post-infective cough hanging around after a cold. ‘There’s no magical cure and asthma therapy won’t help, although some do benefit from pharmacy brand cough suppressants,’ he says.

Is vaccination worthwhile?

‘You only need to look at track records from the last hundred years and you can see the overwhelming benefits of immunisation – to society as a whole and for the individual protection it offers from disease,’ says Dr Lester. ‘There is a very small percentage of the population who refuse to immunise their children for a variety of reasons; however, recent fears, for instance, about autism related to MMR (Measles, Mumps and Rubella) vaccination have been proven unfounded.’

The standard schedule of free immunisation offered to children has recently changed. Children now receive free immunisation to guard against Hepatitis B, meningitis (Hib vaccination), diphtheria, tetanus, pertussis (whooping cough), polio, measles, mumps, rubella, and meningococcal C – a catch-up programme for children and young adults not already immunised against meningitis and meningococcal C is now in place and available through schools and local councils.

Aboriginal and Torres Strait Islanders, as well as individual children at risk, are offered free access to pneumococcal vaccinations; and although not subsidised, the department does recommend that children are immunised against chickenpox (VZV at 18 months) and pneumococcal (7vPCV for under two-year-olds).

‘Because of the amount of inter-country travel that occurs, it’s vital we maintain our vigilance, or diseases that are now considered virtually eradicated will take off in the non-immunised population,’ says Dr Lester.

Recent changes to the schedule also include an adolescent booster for whooping cough given to 15 to17-year-olds, which is now included in the diphtheria and tetanus booster provided free-of-charge to this age group. This is because young adults can get a persistent, lingering cough, which they can pass on to their children if they’re parents.

Over the counter remedies

It’s wrong to assume that an over-the-counter medication is harmless just because it’s not regulated by a doctor’s prescription, says Dr Noel Cranswick, clinical pharmacologist at the Royal Children’s Hospital in Melbourne. His findings suggest that many preparations available in chemists and supermarkets have unproven benefits, and in some cases may do more harm than good.

‘Oral decongestants may be helpful for relieving the symptoms of a viral infection; however, many of these preparations have age restrictions and should not be given to children under two,’ he says. ‘A decongestant nasal spray will temporarily clear a blocked nose, but should not be used long-term because rebound nasal congestion will occur after stopping use.

And because coughing is a common symptom related to viral infections – and it actually serves a purpose in clearing infection – cough medicines should only be used if a cough is particularly troublesome, and after other causes (like asthma) have been ruled out. ‘If a child experiences pain or fever at home, only use paracetamol or ibuprofen based pain-killers, as aspirin is not recommended for children under 12 because of its link with Reye’s syndrome*’

Using the Internet to self-diagnose

The combination of accessibility to the Internet plus the huge number of Internet sites devoted to health issues has made home-diagnosis more common. And although it’s been known to cause unnecessary panic, the Internet can be helpful for finding out more information on an illness or drug, so long as the information is reliable. The trouble is, how do you know if you’ve landed on a reputable site that offers sensible, unbiased advice? It can sometimes be difficult judge.

by Annette Binger

The following trustworthy websites offer unbiased information on ailments and medications:

Australian Prescriber is an independent publication with website that provides readily accessible information about drugs and therapeutics.

Better Health Victoria - Reliable health information and services that are quality assured by the Victorian Government.

Centers for Disease Control and Prevention - An American website set up by the Department of Health and Human Services.

Quack Watch website - Exposes unreliable health advisors and information.

Home Doctor - a practical Australian guide to treating common complaints at home by Dr Michael Peters, Published by Dorling Kindersley

A handy reference book which lists over 150 common conditions. General symptoms, prevalent infectious diseases and common conditions affecting specific parts of the body are addressed. Within each of these sections, there is a brief overview, a medical rider, what can be done at home to help treatment and any useful pharmacy medications that might alleviate symptoms.

*Reyes Syndrome (pronounced ‘rye’) syndrome is a disease which is believed to be caused by the ingestion of medicines (such as aspirin) that contain salicylate that affects all organs of the body, but affects the liver and brain most lethally. Although the exact cause of this rare syndrome remains unknown, research has shown that the ingestion of aspirin during and after a viral illness, such as chicken pox, flu or other respiratory tract illness, significantly increases the chance of Reye's syndrome.

The information provided in this article is intended as a guide only. Always consult your doctor if you or your child is suffering any medical complaint. Any websites referred to by Australian Family contain information moderated by government and medical institutions or organisations.
 

This article was first published in Australian Family Magazine, June 2004. Updated July 2009.