BABY AND CHILDHOOD RESPIRATORY DISORDERS: THE COMMON COLD

Posted by admin on May 8, 2009 under General health | Be the First to Comment

‘David isn’t too happy,’ Jean said, as she hauled her unhappy-looking five-year-old into my surgery. ‘It all started yesterday when he was caught in the rain, no doubt got a chill, and now he is sneezing and coughing, has a runny nose, and is off his food and running a bit of a fever.’

Master David, usually a happy little fellow, was certainly not at his sparkling best. He slumped in the chair, looked morose and kept dabbing at his nose. Intermittently he gave a violent bark, which seemed to cause him some degree of pain in the chest.

‘I’ve got a sore throat too,’ David ventured, as I started to check him out, ‘And my skin feels all sore too.’ David was a sensible little lad, determined that I should know all the facts of his case. Very helpful.

There was little doubt about the diagnosis: an upper respiratory tract infection. Germs had obviously become established the day before, following his exposure and chilling, a common starting point. His nose was running and looked red and sore around the outer nostrils. Breathing through the nose was obviously difficult. His throat was a little inflamed, and the harsh cough had already started. As I listened to his chest with my stethoscope, I could hear a few abnormal sounds (called rales), indicating fluid was already starting to accumulate in the airways of the lungs.

‘What is the verdict?’ Jean asked as I completed my examination.

‘A straightforward case of acute coryza,’ I replied. ‘But don’t be alarmed. Its more popular name is the common cold. It is a simple upper respiratory tract infection, no doubt caused by viruses which he probably picked up yesterday when he got cold. The germs become rapidly embedded in the nasal passageways, in the linings, where they quickly multiply. This has caused a swelling of the lining and made normal nasal breathing more difficult. Against this the body’s reinforcements have been called, and the start of a mighty campaign is underway—the goodies versus the baddies. So, fluid is being secreted by the cells, and before long this turns to a pussy material as germs are killed and discharged.’

‘Sounds very gruesome,’ Jean commented. ‘What else is happening?’

‘Almost invariably the germs manage to penetrate further into the respiratory canals. So more swelling and discharges. Finally they reach the back of the nose and reach the pharynx, and track down to the next part, the larynx and voice box. Frequently a croaky voice occurs. Then they race on down the trachea into the bronchi and frequently into the lungs also. All this occurs with amazing rapidity, and before long there is a sore throat and a cough.’

‘You’re so right. It is incredible how quickly it happened,’ Jean replied. ‘David started coughing this morning, not much more than 24 hours after his drenching. Those bugs move fast,’ she continued.

‘Right,’ I answered.

‘Then, what to do? What is the advice we should follow?’

Treatment

‘First of all, he will do quite well within a few days, I feel sure,’ I started, giving a note of reassurance.

‘There are several simple measures to take which will help. We don’t have a specific mixture that will immediately kill the germs, for these are usually viruses which do not respond to antibiotics. If serious chest infections or other infections and complications occur, then we will use them. But we’ll commence with simple measures.

‘I’d suggest you put David to bed for a day or two. He’s already complaining of feeling off-colour and tingly all over, and he is running a mild fever. Bed at least gives the body a rest and helps the body to conquer the invading germs. I think he is feeling sufficiently off-colour to be happy with this for a short time. What do you say, David?’ I asked my youthful patient.

‘I’ll go to bed for a day or two. But only while I’m feeling sick,’ he replied, giving himself the opportunity to opt out early. (How typical of youngsters. I love ‘em all.)

‘Plenty of liquids is a good idea,’ I said. ‘Water, fresh fruit juices (the best, in my opinion), aerated beverages such as lemonade— although I’m not keen on fizzy sugary drinks, as you know. But for a day or two they are all right. Flavoured ice-blocks are also good, and I’m sure David would like those.’

‘That’s beaut!’ David said, listening from the sidelines.

‘A quick warm bath each morning is also a good idea. It will get rid of the sweat that accumulates and dries on the skin and makes his skin feel sore. Use a soft towel and dab his body dry afterwards. And make sure he doesn’t get a fresh chill whilst you are doing this.’

‘What about his temperature?’ Jean asked.

‘Simple paracetamol elixir is a good mixture to take. The usual dose for five-year-olds is five to ten millilitres every four hours, ideally after food. It tastes reasonable.

‘We don’t like giving aspirin to children under six years, for it is a severe gastric irritant and can cause stomach bleeding. For any colds that David catches when he is a couple of years older either paracetamol or aspirin tablets can be used for reducing fevers and relieving aches and pain, which are often severe; they can also reduce the tingly skin sensitivity which is often quite unpleasant. But in the meantime, try paracetamol elixir for David’s cold.’

‘Should I give him something for the cough?’ Jean queried.

‘Yes. Simple pholcodine elixir is good, and may be repeated if and when the cough troubles him. There are plenty of brands around. Personally I like a nice red one—it looks like raspberry, and most children love it. But use it only when necessary, for the cough is there to rid the lungs of phlegm, dead germs and unwanted fluids which could otherwise be damaging.

Home remedies

‘An easy do-it-yourself one is to squeeze a lemon into a glass. Then add half the volume of honey. Let David sip this as often as he likes. Lemon cuts back the phlegm and irritation in the back of the throat. The honey is very soothing. It is a simple old-fashioned remedy which many people still use with good effect. It is cheap too. How’s that in this overpriced world of inflation?’

‘Great, simply great,’ Jean answered, with a grin.

‘How about his blocked-up nose?’ she continued.

‘Simple steam inhalations are a good idea,’ I replied. ‘You might find that adding 15 drops of friar’s balsam to a pint of boiling water will work wonders. But if David finds it a bit messy, an alternative is simple blowing plus the use of some vasoconstrictor drops. They will reduce swelling in the nasal linings. Use the drops two to three times a day but only when necessary.’

‘Should I starve his cold?’ Jean queried.

‘No. Let David have what food he likes. Small meals attractively served is the best advice I can offer. Simply prepared foods, stewed fruits, mashed vegetables, soup, toast, eggs lightly cooked, jelly, ice-cream, that sort of thing. There is plenty to choose from. For a few days he might not be keen on food at all, so stick to fluids. Add some powdered glucose D, a teaspoon per glass, for this equals food and is an easy way of sustaining nutrition. Very soon he will come back to normal food intake, I am certain. Ideally his room is best kept warm and free from cigarette smoke—but then, of course, you don’t smoke. Great!’

‘That all sounds pretty straightforward,’ Jean said. She had been writing a few notes on a pad whilst I spoke, an excellent idea. I am happy to see parents writing down suggestions so they will not forget.

‘Anything else I should know?’

‘If there are any complications, please contact me. The germs may spread to other areas, and this could need extra treatment, such as antibiotics.’

‘How would I know when complications are setting in?’ Jean asked.

‘If pain develops in David’s ears, it could mean infected ears; under the eyes behind the cheeks, infected sinuses; a very sore throat, tonsillitis or pharyngitis or laryngitis; pains in the chest, pneumonia or pleurisy. If breathing becomes difficult or the cough really gets worse and causes distress, let me know promptly, and I’ll pop around and give you the next lot of instructions.’

‘Fine,’ said Jean.

‘Thanks, Doctor,’ echoed David, in his unhappy little voice. ‘See you round some time,’ he continued, as the pair prepared to leave.

Nice little bloke, I thought to myself … I really do like kids. So uninhibited, so honest with everybody.

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