Prevention and management of common childhood diseases

The core of the prevention and management of common childhood diseases has never been the pursuit of "zero disease" for children, but through scientific pre-protection and graded response, neither blind over-intervention with medication nor forced delay in treatment, ultimately minimizing the impact of the disease on the child's growth and development, while helping the child gradually establish a complete autoimmune barrier.

Last week, I met a mother who had just been sent to daycare for consultation. Her baby had fever three times in the 28 days after entering the kindergarten. The family had an immediate quarrel: Grandma wanted to give the baby a jar of "immune-enhancing colostrum" worth thousands of yuan per jar. Dad insisted on taking the baby for a full set of immune function tests. Mom was caught in the middle and shed tears. In fact, this kind of scene is too common in pediatric health clinics. Regarding how to "prevent illness", there are two mainstream directions in the industry. It is impossible to say who is right and who is wrong, but the family situations that are suitable for it are different.

One group is the nutritional support group, based on the "China Growth Guidelines for Children Under 7 Years Old" and related regulations on vitamin D supplementation. They believe that as long as they ensure a daily intake of 400-800IU of vitamin D and a balanced mix of meat, eggs, milk, fruits and vegetables, they do not need to take any additional health products that are said to "increase immunity". Spending money on food ingredients is much more cost-effective than paying an IQ tax.； The other school is the natural exercise school. The core basis is the "hygiene hypothesis", which believes that moderate exposure to microorganisms can help immune cells "recognize the enemy." Don't spray disinfectant at home every day, and don't let children play in the mud or touch pets. Usually, just wear clothes of the same thickness as adults. Running and jumping outdoors more is more effective than being tightly wrapped up. What’s interesting is that the views of these two groups are not conflicting at all. Previously, there was a 4-year-old boy whose grandmother always wore two extra layers for him. He would catch colds when he sweated every time he ran, and the plan we gave him was to take half from both sides: take 400IU vitamin D every day, the same amount as an adult, and play outdoors for an hour every day. After three months, his cold frequency dropped directly from three times a month to once every three months.

Don’t panic if you really get sick. Take the fever that worries parents the most. In the past, everyone stuck to the 38.5°C dosing line. Now the 2023 version of the "China Children’s Fever Diagnosis and Treatment Guidelines" has long since changed the rules: you don’t need to keep an eye on the temperature, just look at the child’s condition. If you have a fever of 38.8℃ and still run around building blocks, drinking more warm water and wiping your neck and armpits with a warm towel to cool down physically is enough. ； If the fever reaches 38°C and you are groaning in your arms and unable to eat, just give acetaminophen (for more than 3 months) or ibuprofen (for more than 6 months). There is no need to bear the pain. Of course, there is a red line here that you should not forget: as long as a baby under 3 months has a fever exceeding 38°C, do not hesitate to send it to the hospital directly, and do not give medicine at home.

There are also many old people who always say that diarrhea requires "an empty stomach", which is actually an old concept. The current clinical advice is that as long as the child does not vomit frequently, it is okay to drink porridge or steamed apples normally. However, being hungry will prolong the course of the disease. The most important thing to do is to drink oral rehydration salt III in a timely manner to avoid dehydration. Do not give your child antidiarrheal medicine casually - especially for diarrhea caused by norovirus and rotavirus infections. Antidiarrhea will hold toxins in the intestines, making recovery slower.

As for the most hotly debated issue about the use of antibiotics, I have seen two extremes: either feeding cephalosporin to a child when he catches a cold, or resolutely refusing antibiotics as soon as the doctor prescribes them. In fact, both are wrong. 90% of upper respiratory tract infections are caused by viruses, and antibiotics are useless. However, if the blood test shows that it is a bacterial infection, or you are diagnosed with bacterial otitis media or suppurative angina, you should take a full course of 7-10 days of treatment. Don't stop taking the medicine after two days, as drug resistance may easily develop.

The most common advice I give to parents I know well is to prepare two little valuable things at home: one is a small book with a date. Every time the child gets sick, write down the temperature, symptoms, medicines taken, and how long it takes to get better. You can directly show it to the doctor next time you visit. It is much more accurate than scrolling through your phone to recall it for half a day.； The other is a simple atomizer that costs tens of dollars. If your child has a history of asthma or wheezing bronchitis, you can atomize the baby with saline at home before going to the hospital when the attack occurs. This can avoid the danger of excessive suffocation on the road.

In fact, there is no perfect plan for raising a baby. It is all about crossing the river by feeling the stones. There is no need to blame yourself for a long time just because the baby has a minor illness. You treat your baby's immune system like a new mobile phone. Every time you have a minor illness, you download an anti-virus software corresponding to the virus. The more you download it, the system will naturally become smoother. If you keep putting it in a sterile environment and don't let anything touch it, one day it will freeze when you encounter a powerful virus. Do you think this is true?