Natasha: Why do you think that respiratory tract infections (RTIs) especially viral are such an important topic of discussion in children?
Dr Mane: RTIs are very common. Most RTIs are viral and they spread very easily by simple contact with droplets. RTIs have high morbidity; it leads to loss of work/school for at least 2-3 days. The rapid spread of these infections is due to its easy communicability and also people are not aware of measures to protect themselves from such infections. Also each RTI need not be treated with antibiotics. The misuse and overuse of antibiotics in treatment of RTIs is rampant. Every individual should know how RTIs occur, what one should do when it occurs and how one can prevent them.
Charu: What are the symptoms of RTIs in children and when should parents seek medical advice?
Dr Mane: Cough is the most common symptom. It is important for parents to know that not all children with cough have a RTI. A normal healthy child coughs 10-11 times a day. The cough is of concern if it’s disturbing the sleep or disrupting the daily routine of the child and affecting the growth. Another important symptom is wheezing. It is important to understand if your child actually has a wheeze or no. Often other respiratory sounds may mimic a wheeze, hence its best if your physician decides whether or not it’s a wheeze. The presence of fever indicates infection and your child must visit a doctor. Other symptoms of RTI include cyanosis (bluish discoloration), sneezing, chest tightness/ heaviness and child not growing adequately for which you must pay a visit to your doctor.
Charu: So Dr Mane, what exactly is common cold? Is there any cure for it yet? When does one use antibiotics?
Dr Mane: (laughs) Good question Charu! I know it is so common, even then, we do not know much about it. Common cold as the name suggests is quite common. It is not to be taken as a serious illness. Most times colds are viral origin (80%) and rest of times its bacterial (20%). There are numerous viruses in the environment that cause common cold. A child having 1 episode of an upper RTI is considered normal. Hence 8 to 12 episodes a year are considered normal. It is not imperative to vaccinate your child against the influenza virus as it is not a serious infection, and mortality is seen only when influenza occurs in people with co morbid illnesses such as diabetes, chronic kidney/liver disease or kids with low immunity. Since most common colds are due to viruses, using antibiotics is of no use. It may do more harm than good.
Natasha: Are all respiratory infections a potential cause for pneumonia?
Dr Mane: No. There are certain predisposing factors that increase the risk of pneumonia in a child. Few of them are: 1) Poor nutrition 2). Low immunity 3). Infants who are not exclusively breast fed
4). Living in crowded and unhygienic conditions 5). A highly dangerous bug.
Natasha: My child has been recently diagnosed with asthma. I really do not understand this. What exactly is asthma?
Dr Mane: Natasha, keeping it short and exact: Asthma is a disease of the small airways. In simple terms, it is considered as the inflammation of the airways. Asthma is a heterogeneous disease with reversible airway obstruction with recurrent respiratory symptoms such as wheezing, cough, breathlessness or chest tightness which is variable in time and intensity. A child can have any one of the above four symptoms persistently in asthma.
Charu: Why does my child have asthma even if no one in my family has a similar problem?
Dr Mane: Asthma can be caused because of both genetic causes and environmental triggers. Not all children have a genetic predisposition to asthma, but the ones who have it develop asthma at an earlier age with the disease process being more severe and difficult to control. Just like we never expect a plant to grow from a building made of concrete, but still see a small sapling grow from the crevices of a wall when the conditions are conducive. Similarly, in children with genetic predisposition when exposed to environmental triggers the asthma sets off. Environmental triggers can be outdoor pollutants like car exhaust, smoke or fuel gases or indoor pollutants like dust, pet hair, mites, incense sticks, mosquito coils, liquid mosquito repellent solutions, perfumes/ deodorant sprays, damp walls with growth of fungi or even chalk dust. A detailed history by your physician will help you identify the triggers and one should avoid itat all times.
Charu: Doctor, are medications the only answer to control asthma?
Dr Mane: I will say yes, if your child has been diagnosed with asthma, then he definitely needs medications. These medications not only help in preventing any successive exacerbating acute attacks, but also help in preventing the “remodelling” and “fibrotic” changes inside the respiratory system as a long-term result of asthma.
Natasha: I get really worried when my child goes to school, when I am not around. Is there anything I could do?
Dr Mane: I understand the anxiety what parents face in such a situation. I personally recommend informing the school authorities/school-clinic about the medications if your child is on a regular prescription. Although most of the episodes of acute asthma attacks occur during late night and early morning, the teachers and friends should be aware of the medications your child is taking. Do not forget to inform the teacher in-charge at the time of your child’s promotion to the next grade. Also, an emergency dosage of medications should always be present in your child’s school bag.
Charu: Do I need to take care of my child’s diet for his betterment? Should we avoid any particular types of food?
Dr Mane: Anything under the sun can trigger asthma. So, it is a very subjective question. We have evidence to prove that cold items can trigger a reactive response, and thus, I recommend parents to avoid giving chilled food items like ice-creams to their kids. The cold temperature and the added food colors/preservatives can also trigger a response. Just warm the ice-cream a little bit, bring it to the room temperature and you can serve it to your child. Secondly, there are a whole bunch of allergic diseases associated with asthma, hence, keep a check on the plate of your child. Avoid giving regular allergens like peanut, soy milk, tree nuts, fish, etc. But keeping the medications regular is what matters the most.
Natasha: We have been using the inhaler for the control of asthma as advised by the doctor, but my child isn’t getting any better. Why is it so?
Dr Mane: We see a lot of cases having recurrent episodes of asthma even on medications. The four most important reasons of having recurrent attacks are non compliance, improper dosage, wrong technique of administration and timing. For the fact that propellant, being heavy settles down and the drug, being light, stays up in the mixture, I recommend using a spacer device for kids because it gives better results and appropriate dosage delivery. Take note of not skipping any doses or jumping the time table of the medications.
Natasha: My child has had 3 attacks of asthma in the recent past. Can asthma be a fatal condition?
Dr Mane: The fact that your child had three attacks in the recent past means that his disease is not controlled. He needs to be put on a regularised and strict medication schedule. Every attack of asthma can predispose to another, so be diligent and yes, it can be fatal. Only medications can control it.
Charu: How important is the role of immunisation in my child?
Dr Mane: Vaccines, in general, are as important as food for children. To make them stronger and protected against common infections, these vaccines play an inevitable role. They are a definite “must do” for every child. For a child having asthma, certain vaccines like pneumococcal, influenza, rotavirus, varicella and annual flu shots are very important as they help preventing the long term sequel of asthma like lower respiratory infections and pneumonia.
Natasha: My doctor has prescribed steroids for my child. Is it safe?
Dr Mane: Yes Natasha, steroids given for asthma is very much safe for your child. Steroids are given in a local inhalational manner for the treatment of asthma which does not cause any kind of stunting or decrease in immunity in children. Their levels are kept minimum and appropriate the control the disease and not lead to any serious adverse effects.
Charu: What will be your final message to our parents, Dr Mane?
Dr Mane: Video!