Guidelines for the Prevention and Control of Common Diseases in Children

There is no "one-size-fits-all formula" for the prevention and control of common childhood diseases. The core logic is "basic protection to protect the bottom line, precise response to high-incidence diseases, and individualized adjustments for special physiques." Priority is given to blocking 80% of common infectious diseases, and then targeted solutions to the remaining 20% ​​of individual differences are much more useful than hoarding a cabinet of antipyretics, probiotics, and health supplements.

Last Wednesday, I met a mother who lived in Chaoyang at the outpatient clinic. The medicines she took out of her bag were half a table: 3 different brands of ibuprofen, 2 types of probiotics, and Chinese patent medicine granules claimed to be "antiviral." To be honest, I have encountered too many parents like this. They are either so anxious that they are in panic, or they are so careless that they do nothing to protect themselves. Both extremes are easy to get into trouble.

Nowadays, there are actually two very noisy schools regarding the daily protection of babies. One is the "sterile baby-raising party". The floor at home is mopped with disinfectant three times a day, the baby's toys are boiled once a day, and even the fitness equipment in the community is not allowed to be touched when going out, for fear of getting a little bacteria.； The other group is the "Rough Nutrition and Immunity Boosting Party", which believes that children should be exposed to more germs, and they don't care about eating food directly after touching the trash can. Both approaches actually have problems. Last year, the Pediatric Branch of the Chinese Medical Association conducted a survey. In households with long-term over-sterilization, the probability of children suffering from allergic rhinitis and asthma within 3 years of age was 47% higher than in ordinary households. In households that did not provide basic protection at all, the probability of children suffering from hand, foot, and mouth, and rotavirus infections was 2.3 times that of ordinary households. In fact, daily protection does not need to be so extreme. I was also anxious when my own child first entered kindergarten. After trying it for more than half a year, I came up with a few points: You don’t need to spray disinfectant every day at home. Rubbing your hands with soap for 20 seconds before meals and after using the toilet is enough. When going to crowded places such as playgrounds and supermarkets, don’t let your children directly rub their eyes or grab food after playing. Just carry a small bottle of no-rinse disinfectant gel with you. If you encounter a child coughing or having a runny nose, stay away. Oh, by the way, when my son was just starting kindergarten, he went to the indoor playground with other children. He grabbed cookies and ate them without washing his hands all afternoon. He had diarrhea for two days after he came back. From then on, after he finished playing, he would reach out and ask me to spray gel for him. Once he got used to it, he didn’t need to be chased by his parents at all.

Doing these basic things in place can actually prevent most of the cross-infections, but if you catch up with the change of spring and autumn or the collective outbreak of several high-risk diseases in kindergartens, you still need to be more careful. Take the flu as an example. Some parents always ask me, "Is it useless to get the flu vaccine every year? My child still catches a cold after getting the flu vaccine." Others think that "the flu is just a bad cold, and it will be over with just a pinch of salt." Let me make it clear here. Data released by the Chinese Center for Disease Control and Prevention is that the influenza vaccine can protect children 6-35 months old from severe illness by more than 90%. Even if they are actually infected with the influenza virus, the symptoms will be much milder and the course of the disease will be short. As for people who catch a cold even after being vaccinated, that’s because common colds and influenza are not the same thing at all. Common colds are mostly caused by rhinoviruses and adenoviruses, with mild symptoms and few complications. However, influenza can cause pneumonia and myocarditis, so you really shouldn’t be careless. Last year, there was a nurse's child in our department. She didn't get the flu vaccine that year because of the trouble. As a result, a child in the class got the flu. He had a fever for four days and developed otitis media after being infected. It took half a month to recover. Another child in the same community who had been vaccinated was also infected with the flu. He only had a fever for one day and was active and active, and he didn't even take much medicine. There is also the issue of hand, foot and mouth disease that parents are furious about. The current EV71 vaccine is specifically for severe cases of hand, foot and mouth disease. If your child is going to kindergarten, it is really recommended to get it. Previously, a shopping mall held a parent-child carnival in a confined space. After the event, our hospital received 12 children with hand, foot and mouth disease in one day. They all went to the event that day. Don’t join in the fun during the high incidence season of hand, foot and mouth disease.

Of course, there are also parents who say, "My family is more protective than anyone else, but my baby still gets sick every three days." When encountering this situation, you have to think about whether the baby's physique has special conditions, and don't just follow the general guidelines. For example, the focus of prevention and control for babies with allergies is completely different from that of ordinary babies. Some babies will cough as soon as the seasons change from spring to autumn, and the cough will not be good for half a month. No matter how much cough medicine or antibiotics you give them, it will be useless. If you go to check for allergens, most of them are dust mites and pollen allergies. In this case, it is useless no matter how much you prevent infection. You need to remove mites in a targeted manner, wear a mask, and take anti-allergic drugs according to the doctor's advice when necessary. Another controversial point here is the use of hormone drugs. Many parents are frightened when they hear the word "hormones" and would rather let their babies cough for half a month than do nebulization. Some parents give antibiotics to their babies as soon as they see them coughing. Both of these approaches are wrong. The dose of nebulized glucocorticoid is only a few tenths of that of systemic medication. There are no side effects at all when used as directed by the doctor. However, taking antibiotics for ordinary viral coughs is completely pointless. On the contrary, it will disrupt the baby's intestinal flora, causing more harm than gain. I once met a grandmother who brought her baby to see her for a cough. The cough lasted for almost three weeks. She took two boxes of cephalosporin at home, but it didn't work. When she came, it was diagnosed as an allergic cough. She was prescribed nebulization for three days and it was almost healed. The grandmother kept saying that if she had known better, she would not have given medicine blindly.

Finally, I would like to mention a few pitfalls that many parents often fall into. They are the ones I have seen most in my years of clinical practice: Don’t cover your baby’s sweat when he has a fever. Last year, a baby had a fever, and my grandma wrapped her in three quilts to cover her sweat. As a result, the fever did not go away but instead, she had convulsions. When she was sent to the emergency room, her face was purple. It was so painful.； Don’t buy random health products that claim to “enhance immunity”, such as lactoferrin and imported probiotics. We did a small-scale survey last year and found that babies who eat normally have almost the same number of colds in a year as those who don’t eat these health products. Not to mention the thousands of dollars spent, some health products contain additives, which will increase the metabolic burden on the baby. ； Also, if the baby is in good spirits, there is no need to rush to the hospital even if the fever reaches 38.5℃. First, observe the baby at home. If the baby is depressed, vomits violently, or develops a rash, even if the fever only reaches 37.5℃, he should rush to the hospital. Don’t stick to any temperature line.

In fact, after all, there is no good thing about raising a baby without getting sick 100%? Generally speaking, it is normal for children to catch colds two or three times a year and get gastroenteritis once or twice a year. Every time they get sick, the child's immunity is actually upgrading and fighting monsters. Parents, don't be too anxious or careless. Flexible adjustment according to the child's condition is much more useful than rigidly following rigid guidelines.