Understanding recurrent illness in babies and children

A very common question which any Pediatrician faces is why is my child suffering from recurrent illness? It is difficult to define what constitutes frequent illness.

Many parents over react to trivial problems and rush to a specialist with exaggerated accounts of the child’s illness.

As pointed out on the page about common childhood problems a child is not a miniature adult. There are many normal variations and it is often difficult to draw a line between normal and abnormal. But it is also true that children get frequent attacks of cough, cold, fever, diarrhea and vomiting. I shall try to explain this in simple language.

In the human body every organ has a unique function. The heart pumps blood to all the parts and the lungs absorb oxygen and eliminate carbon dioxide. Likewise there is another system in the body that is responsible for resisting infections.

This is called the Immune System. There are many causes of diseases in man and infections are a major cause of mortality and morbidity in children. Let us try to understand infections.

Those with even an elementary knowledge of biology are aware of the existence of microorganisms. There are different types of them-viruses and bacteria are important from the medical point of view. They are part of the nature and play an important role in ecology.

Man should learn to live in harmony with nature and has no business to treat it with contempt. Under certain circumstances these microorganisms can cause diseases in man.

As infectious diseases are quite common, a lot of research has been done in this field resulting in the development of many drugs- antivirals and antibiotics, which can kill these organisms.

But the fact is that these drugs can only help the body in overcoming the infections and are not of much use if the Immune System is not functioning properly. That is why it extremely difficult to treat infections in a person with an impaired Immune System.

While these drugs certainly have an important role to play in medical practice and have saved many lives, they have to be used with discretion.

Nature has its own mechanisms for restoring ecological balance and when man out of his arrogance tries to destroy a part of it, these mechanisms are automatically set in motion.

These organisms undergo a genetic transformation, which protects them against the drugs, which are used to destroy them. This is called drug resistance and has become a major problem in medical practice. Man tries to invent newer and more powerful drugs to counter this problem but cannot beat nature.

Hence we are encountering more and more organisms, which are resistant to many drugs. A common example is that of multi drug resistant tubercle bacillus that is responsible for causing tuberculosis.

The Immune System is not fully developed at birth. As the growing child gets exposed to different viruses and bacteria the Immune System responds to these infections in many ways and thus continues to mature. At times the immature system may not be able to overcome the infection and it becomes necessary to give drugs to contain the infection.

However unnecessary administration of antimicrobials may interfere with the development of natural immunity that is extremely important, at the same time resulting in the development of multi drug resistant organisms. In order to read more about how to prevent diseases please visit Childhood vaccination and Disease prevention

The treating doctor is the best person to decide whether an antimicrobial should be used or not. The purpose of this article is to educate the public so that they do not compel the doctor to produce quick cures. With this general introduction, I shall briefly discuss the most common symptoms with which children are brought to a clinic. Fever is discussed separately as people have many misconceptions about it and the topic requires more elaboration.

Cough and cold: It is quite common for infants and young children to be affected by cough and cold frequently. They may get up to 8 attacks in a year during the first two years of life. While most of these are self-limited sometimes complications like pneumonia can occur. Parents should have some patience and stop expecting miraculous cures for these minor conditions.

It may be difficult for parents to assess a small baby below three months and they should seek a doctor’s opinion. But after three months if the baby is feeding well and smiling there is no need to worry.

Many parents are over anxious about a trivial cold and often force a doctor to prescribe antibiotics unnecessarily. After some time the same people blame the doctor for prescribing too many drugs. It is better to allow the doctor to decide whether an antibiotic is essential.

After getting exposed to several infections the child’s immune system becomes stronger and the frequency of infections comes down. Later when the child starts attending the school he is exposed to newer infections and the frequency of cough and cold may increase for some time.

Often a smoker in the house is responsible for intractable cough in a child. Doctors conduct all sorts of tests and prescribe many medicines but without any result. Many people do not think of the consequences of passive smoking on other members of the family. Smoking is certainly harmful both to the person indulging in it and to other people around.

Diarrhea: A baby fed exclusively on breast milk is very unlikely to get any infection and suffer from diarrhea. After weaning is started he is at risk of contracting infections. Often diarrhea is due to viral infection and the most important aspect of treatment is to prevent dehydration by giving extra fluids.

Oral re-hydration solution can be prepared at home using clean water, sugar and salt. Add one level teaspoonful of sugar (approx. 5gm) and a pinch of salt to 250 ml of water. Be careful not to add too much of salt as it can be harmful. The prepared solution should not be saltier than tears

If the child vomits wait for a few minutes and then give small quantities. Often this is the only treatment required. If diarrhea persists or if you notice streaks of blood in the motion or if the child has high fever consult a doctor. Please remember that it takes some time for diarrhea to subside.

Drugs, which quickly stop diarrhea may be harmful in young children. The body tries to get rid of undesirable microorganisms in the intestine. Any attempt to prevent this may result in multiplication of such organisms and even invasion of blood.

Some infants may develop a condition called secondary lactose intolerance. This is due deficiency of an enzyme called lactase as a result of damage to the lining of small intestine. This enzyme is responsible for digestion of milk and the deficiency causes diarrhea whenever the affected infant is fed with milk.

If the condition is severe it will be necessary to give lactose-free diet for a few days. The condition resolves within a few days. Afterwards milk may be gradually reintroduced. Breast feeding need not be discontinued in case of mild lactose intolerance. If it is severe breast milk may be expressed and discarded for a few days till the condition resolves.

Vomiting: It is quite common for infants up to six months of age to vomit a few times everyday. If the baby is gaining weight normally there is no need to worry. After feeding the baby he should be put on the shoulders and the back gently tapped. This helps in bringing out the air, which a baby swallows while feeding. This slightly reduces vomiting. If vomiting is frequent or is associated with other symptoms like fever or excessive cry consult a doctor.

After this period vomiting can be due to many causes-some minor and some serious. Usually it is due to a minor and self-limited disease. If vomiting is frequent it is necessary to admit the child and give intravenous fluids. Unless you are living close to the hospital it is better to be prepared to admit the child. If the doctor says there is no serious problem you need not worry.

Please remember that no doctor can tell you when exactly vomiting will stop. Once the child is free of vomiting for a few hours you can start giving oral fluids. When the child tolerates fluids, start giving solid food. It is better to wait for some time after vomiting stops before leaving the hospital to make sure that there will not be any problem after going home. Follow the doctor’s advice regarding medication.

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