The Bug Decoder (the germy kind)

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Winter is the season of the cough, the wheeze, the whoop, the bark, and the rattle, sniffle, and honk.

Copyright Jessica Snyder Sachs, as first published in PARENTING magazine

We spend so much more time indoors, where it's easier for respiratory infections to spread from person to person. Children, with more immature immune systems, get colds and the flu more often than grown-ups. And they have their very own diseases, like croup.


That's why millions of moms (and dads) will be awake tonight, trying to figure out how to relieve their kids' coughing and congestion and fretting over whether to call the doctor or even make a midnight run to the emergency room.

Most of the time, all our kids need is a little symptom relief and comforting -- even when they sound terrible. Sometimes, a parent's wisdom lies in not giving her child medication. But some symptoms do warrant immediate medical attention, while others linger long enough to make you wonder if they signal asthma.

Art by Courtney

What you need to know:

The very common cold
Babies and kids get six to eight colds a year, but sometimes they sound sicker than they are. "What parents usually hear are the random snorts and sniffles of air passing through mucus and secretions in the nose and throat," says pediatric pulmonologist Peter Scott, M.D., of Children's Healthcare of Atlanta. There's no need to worry as long as your child seems reasonably comfortable and active, continues to eat and drink, and starts to get better after a few days. In the meantime:

Try saline drops to loosen nasal congestion. They're especially helpful for babies too young to blow their noses. Use three or four times a day.

To relieve a nighttime cough, elevate your child's head with a wedge beneath the mattress.

Offer liquids to lubricate an irritated, cough-prone throat. For babies, nurse or bottle-feed more frequently. For children, give water or diluted juice (semi-frozen if you want, for its pain-soothing chill). "But there's no need to push fluids -- normal intake is fine," says Dr. Scott.

Go easy on cold preparations. Never give babies under 6 months decongestants or cough suppressants, says Dr. Scott. Some decongestants can act as stimulants and keep an older child (and you) awake if taken within four hours of bedtime. Some moms find that over-the-counter cough suppressants help their kids, although studies haven't shown them to be effective. If coughing interferes with your child's sleep for four or five nights, talk to your doctor, who may prescribe a stronger prescription cough suppressant.

See the doctor if your baby is under 3 months and has a fever over 100.5 degrees. And call if a child of any age has symptoms -- cough, congestion, mild sore throat -- that linger for longer than a week.


RSV: a risk for infants

Respiratory syncytial virus (RSV) is either a minor nuisance or an emergency. Most kids get it by age 1, but parents usually think it's just a cold. But around 2 percent of the time, the virus causes bronchiolitis, an inflammation of the small tubes of the lungs. Even this condition is not usually life-threatening, but it can be in some babies under 6 months, and in preemies up to 1 year.

Maribelle Lewis, a medical technologist in Palisades Park, New Jersey, suspected RSV when her 3-month-old daughter, Aiyannah, developed a persistent wheezy cough but no fever. "Her extreme lethargy tipped me off," says Lewis.

Aiyannah's pediatrician gave her an inhaler with medication to open her airways. But over the next two days, Aiyannah stopped nursing and became even more listless. When Lewis took her baby back, the pediatrician sent her to the hospital, where Aiyannah received intravenous fluids and intensive respiratory therapy (inhaled steroids). Today Aiyannah is a healthy, happy 3-year-old.

Some babies with severe RSV do spike a high fever, but others never get hot at all. Always call your pediatrician if your child's wheezing or coughing makes it difficult to breathe, or if there's a loss of appetite and unusual lethargy.

Flu fears

Anxiety over avian flu may be dominating the news, but even the old-fashioned kind can prove severe, with symptoms that often begin like a cold but become more debilitating and long-lasting.

It often hits more abruptly, with a sudden high fever, dry cough, and a headache. There can also be muscle aches, sore throat, and a runny nose. Kids -- but rarely adults -- sometimes also have stomach problems, like diarrhea or belly pain.

For most babies (6 months and up) and children, treat flu-related cough and congestion much like those of a cold (with acetaminophen or ibuprofen, but never aspirin). Just expect more lethargy and feverishness. One exception: If you suspect flu in an infant under 2 months, go to the doctor right away; from 3 to 6 months, call.

And for a child of any age, watch out for that sore throat. If it's severe, there's a fever over 101, and it lasts more than a day, see the doctor to rule out strep. Also bring your kid in if his ear hurts (flu can cause ear infections), if a fever doesn't go away in three or four days, or if a cough persists more than a week. But it's fine to call earlier.

Sinusitis and pneumonia

Around 10 percent of the time, a child's cold or flu will progress to sinus inflammation, or sinusitis, which may include a wet, or phlegmy, cough, bad breath, and thick yellow or green mucus. Sinusitis may also bring headache and fever.

The underlying cause is a bacterial infection, so it always warrants a trip to the doctor, who will likely prescribe antibiotics to clear it. Once you're back home, you can help your child breathe better by letting her inhale steam over a hot (but no longer boiling) pot or cup of water.

"We were a bit too sanguine," admits Marina Budhos, a mom in Maplewood, New Jersey. Last February, her son Sasha, 4, had been coughing for nearly two weeks, though he never had a fever. Then, in the middle of one night, he woke up crying inconsolably. His breathing was labored, and he looked exhausted. "We brought him in the next morning, and the nurse took one look at him and said, 'He's a mess.'"

Sasha had pneumonia, which occurs when a respiratory virus settles into the chest and causes an inflammation of the lung's air sacs. Sometimes the cause is bacterial, typically as a secondary infection after a cold or flu.

Unfortunately, figuring out whether a child's congestion is in the lungs is maddeningly difficult, even for doctors. "That's why we spend so much time with our stethoscopes on your child's chest," says Joshua Needleman, M.D., a pediatric pulmonologist at Children's Hospital at Montefiore, in New York City. Three red flags:

Coughing that lasts two weeks or more

Coughing plus fast breathing and a high, persistent fever

Coughing that returns a few days after a cold appears to go away

Pneumonia can come on quickly, with fever, shaking, and chest pain, or slowly, with fatigue, weakness, and headache. See your pediatrician, who'll examine your child and most likely have her chest x-rayed. If he sends you home, treat symptoms with rest, fluids, and children's pain relievers (but not cough suppressants, which may interfere with your child's ability to clear congestion out of the lungs). But don't be surprised if the doctor hospitalizes your child to make sure she's getting enough oxygen and to bring the infection under control.


Croup, an infection of the larynx (the voice box) is a rite of early childhood for millions of families. When Jennifer Lopez's son Noah, 3, woke up barking one night, she turned on the hot shower and sat with him upright on her lap in the steamy bathroom. "He was coughing so deep in his chest, we could just feel his pain," says the Gainesville, Florida, mom. When Noah's breathing became more labored -- his nostrils flaring and his belly and chest heaving -- his parents called the pediatrician, who sent them to the emergency room. There, Noah got an injection of steroids -- a standard treatment that's safe in kids as young as 3 months -- and was given an inhaler with medication to help open his airways. He went home three hours later.

"The family did everything right," says pediatrician Ari Brown, M.D., author of Baby 411. They elevated their child's head and headed for a steamy bathroom. (The opposite -- going out into the cool night air -- can also ease croup for many children.) Even more important, the Lopezes sought immediate medical care when they saw signs that Noah was struggling for breath.

Another sign of extreme airway narrowing is when croup's classic bark turns into a high-pitched squeal, called "stridor." If a steamy bathroom or a whiff of chilly air doesn't make the squeal disappear in 20 minutes, head to the emergency room, says Dr. Brown.


Whooping cough

Sandy Knight thought she knew what to expect when her 3-month-old son Luke got his third cold: "It always started the same, with a runny nose. Then toward the end, he'd get a nighttime cough."

But this cough sounded different. Instead of a little "cough-cough," Luke would hack on and on and then pause, as if gagging. "My husband and I would sit there on edge, just waiting for Luke to take a breath." Somewhat sheepishly, Knight, of Austin, Texas, took Luke to his pediatrician the next morning. "I'm probably being a silly mom," she began. Far from it, given what Knight described -- prolonged coughing followed by a gag or gasp. The doctor swabbed Luke's nose and throat for analysis. The diagnosis: pertussis, a.k.a. whooping cough, a serious bacterial infection that can lead to pneumonia, seizures, even death. Luke and both of his parents got a five-day course of antibiotics, and everyone was fine.

This highly contagious disease has been making a disturbing comeback across North America. It's the only vaccine-preventable disease that's on the increase, with more than 18,000 reported cases in 2004, up from around 10,000 in 2003. Babies are especially vulnerable until they get the third of four diphtheria-tetanus-pertussis (DtP) vaccinations, usually at 6 months. Those under 3 months are at special risk of pertussis-related apnea, in which they stop breathing altogether and need emergency help.

Pertussis starts like a common cold, with a runny nose, sneezing, and cough, with or without fever. After a week or two, the cough tends to worsen, with severe and prolonged coughing jags punctuated by gags and gasps and, occasionally, vomiting. In spite of its name, babies under 1 rarely "whoop." Nor do adults (kids do). Any suspected case of pertussis warrants a trip to the doctor, as antibiotics may be needed.

The best prevention: Stay on schedule with baby shots and remain vigilant for signs of pertussis until full protection kicks in around 6 months. Though your baby's first DtP shot may produce a spike in temperature, studies have shown it does not cause lasting harm -- and certainly nothing to compare with the disease's dangerous symptoms.

By the time your child becomes a teenager, though, his immunity will start to wane. That's why the Centers for Disease Control and Prevention now recommends that all kids at age 11 or 12 get the new Food and Drug Administration- approved Tdap vaccine (Boostrix), which adds pertussis to the tetanus-diphtheria booster -- and that adults get it every ten years (sooner if you're around an infant). This should help curb the spread of whooping cough to young children.

Coughs and congestion may always be a part of early childhood. They'll become less frequent as our kids strengthen their immunity through regular vaccinations and, inevitably, a touch of actual sickness. In the meantime, your watchful vigilance protects them from serious dangers, and your TLC eases these rites of passage.

When to call 911
Pneumonia, croup, whooping cough (pertussis), RSV, and asthma can each make a baby or child struggle to breathe. This is an emergency. Call 911 if your child:

pauses more than 10 seconds between breaths

breathes very rapidly for more than a minute

turns gray or blue

Or if:

his nostrils are flaring

the muscles between or below the ribs (or the chin) are moving inward, a phenomenon called retraction

PARENTING contributing editor Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World (Hill&Wang/FSG)

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This page contains a single entry by JSS published on May 28, 2008 8:01 PM.

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