How to protect your child from winter cough, cold and flu and how to beat the bugs
The We Can How This Help Winter? Them Bugs Beat
The season of sneezes, wheezes, bugs and flu has arrived and in full swing wherever children congregate.
“We’re flooded with kids with sniffles, coughs, colds, sore ears and throats, for about a month now," says Cork-based GP Dr Phil Kieran.
Dublin-based pharmacist Sheena Mitchell, creator of family healthcare platform wonderbaba.ie, adds: “Parents are saying their children are going from one cold to another.”
So what winter ailments – Covid apart – should we watch out for in children? How can we help them beat the bugs? And when should we call the doctor?
Often starting with a sore throat, symptoms include sniffles, runny nose, congestion and some fatigue. “Nothing too serious and there’s never really a fever with a cold,” says Mitchell.
Colds spread in colder weather when everybody’s indoors. “There’s more around this year because children have no strong immunity after the lockdowns.”
Colds can usually be treated at home without visiting the GP. Give liquid paracetamol/ibuprofen if they’re in pain or have fever.
For congestion, don’t under-rate the value of steam, says Mitchell. “Read their bedtime story or do the last feed in the steamed-up bathroom after their shower. Putting a damp towel on a warm radiator adds humidity to dry air. If the air’s too dry, mucus in nasal passageways thickens.”
To prevent runny nose from developing into a bacterial chest infection, she suggests using a saline nasal spray. “Use before bed and, for young babies, before their feed.”
Mucus trickling down back of the throat often causes children to cough during a cold. If they’re feeding/drinking/eating/breathing normally and there's no wheezing, a cough is usually nothing to worry about ( www2.hse.ie/conditions/colds-coughs-children). If the child is over six years, the pharmacist might suggest over-the-counter cough medicine.
CarePlus Pharmacy owner Tomás Conefrey, based on Dublin’s Pearse Street, says parents – worried about a child’s cough – usually start by saying they’ve done an antigen test and ‘it’s not Covid’.
Conefrey then asks a number of questions: How long has the child had the cough? What remedy have they already tried?
“I get them to describe it. Is it a dry cough in their throat, unproductive (no phlegm), and their throat is sore? Or is it a cough from the chest, where their chest feels tight and they want to cough something off it? This helps decide the best product.”
Dr Kieran says it’s normal for a post-viral cough to linger. “It can easily go on for three weeks after an infection.” His go-to remedy when his children have a cough is honey and lemon in warm water. “A 2007 Australian study found this as effective as any cough bottle.”
With symptoms including high temperature, muscle pains, headache and extreme tiredness, Mitchell says people often dismiss flu – not realising it can lead to serious complications, such as pneumonia and bronchitis, in some children. Very young children especially are more likely than adults to get severe complications of flu.
Between 2009 and 2019, the HSE Health Protection Surveillance Centre reported 4,750 children needed hospitalisation for flu complications, 183 were admitted to ICU and 41 died.
“Children with respiratory health conditions, premature babies, those with weak immune systems or who have Down syndrome or neurological or heart conditions are more susceptible to flu complications,” says Mitchell.
At the National Immunisation Office Dr Aparna Keegan says children are twice as likely as adults to catch flu. They also carry the virus longer in their systems. The strong recommendation is that children get the flu vaccine – a non-invasive nasal spray, free for two to 17-year-olds.
“Every child should get the flu vaccine, not only for their self-interest and their family’s but for the community,” says Mitchell.
She says no vaccine is 100% effective but, at 70% effectiveness, flu vaccine is the best protection against influenza.
If your child gets flu, keep them warm, make sure they rest and sleep. Give paracetamol/ibuprofen to lower temperature and for aches/pains. They should drink plenty of water to avoid dehydration.
The last two years have seen extremely high levels of Respiratory Syncytial Virus (RSV). In the three weeks up to mid-October, 462 cases were detected – compared to about 90 for the same period in pre-Covid years.
Mitchell explains that pre-pandemic, two-year-old children would typically have had RSV. Now it’s also occurring in slightly older children and is the leading cause of hospitalisation in children up to four-year-olds at this time of year. “With lockdowns, that age group wasn’t mixing normally so didn’t develop natural immunity to RSV,” says Mitchell.
RSV can be mild. “A child mightn’t be too badly affected. Most commonly it starts with a runny nose and looks like a cold. If there’s fever, it’s usually mild – you wouldn’t be thinking flu.”
But RSV is the leading cause of bronchiolitis, which Mitchell describes as “a relatively frightening condition causing inflammation of the child’s airways”.
Explaining that the condition peaks at three to five days, she says: “You could be thinking you’re dealing with a cold, a bit of a dry cough. And then the cough becomes more difficult – the child starts struggling with their breathing.”
Mild bronchiolitis cases can be treated at home, similarly to normal viral infections. Moderate to severe cases need hospitalisation ( www2.hse.ie/conditions/bronchiolitis).
“Remember all the respiratory hygiene and coughing etiquette we learned through Covid? Cover your mouth/nose when you cough/sneeze. Sneeze into your elbow, wash your hands – great advice, regardless of Covid,” says Dr Kieran.
Mitchell is back to placing 500ml jars of hand gel just inside the door when her children – aged 10, nine and seven – come in. “So if they’ve picked up anything, it’s not going on every surface around the house. I keep tissues in the living room and kitchen.
“And it’s understandable we want playdates for our children, but we should stay away from symptomatic people and symptomatic people should stay away from us. A minor cough for one four-year-old could be hospitalisation for the one-year-old who visits them.”
Children using inhalers to treat asthma/suspected asthma should stay on top of their asthma action plan and take their preventative inhalers. “Having asthma symptoms under control before contracting a virus can really improve outcome.”
Another strategy to stop flare-ups in children with respiratory conditions is to ensure they pull a light snood over their mouth/nose to break cold air – triggering for anyone with asthmatic symptoms.
Sleep is important. A 2009-published study found poorer sleep and shorter sleep duration during weeks before exposure to rhinovirus were associated with lower resistance to illness. “You won’t keep viruses away but you’ll optimise your child’s chance of fighting them,” says Mitchell.
A varied diet is protective too. “Ensure they’re eating vegetables – lots of different colours – it’s where they’ll get their vitamins,” says Dr Kieran, who emphasises the importance of vitamin D: studies show people with chronically low vitamin D levels suffer worst from viral illnesses.
“Ensure children are getting the vitamin either through a supplement or in fortified cereal/milk.”
*Under three-month-olds have temperature of over 38°C, or three to six-month-olds have temperature of over 39°C.
*Child’s rapidly deteriorating – symptoms worsening by half-hour/hour. This could be a sign of meningitis, a quick-onset disease ( https://actformeningitis.ie/).
*There’s difficulty breathing, wheezing, rapid breathing, baby/young child’s drawing in their chest a lot.
*Colour is off – pale/mottled skin, blue lip.
*They’re hard to wake or keep awake.
*They’re not responding to normal tickles or laughter.
*They’re dehydrated - less frequent wet nappies, no tears when crying, drinking less than half normal volume, skin on back of hand doesn’t bounce back after three seconds if you pinch it.
Sheena Mitchell’s WonderBaba podcast is in its second season, which covers respiratory health ( www.instagram.com/WonderBabacare/).
