Duke Medicine: Winter sneezes and diseases

Illnesses in children are as much a part of winter as cold weather. Among the most common seasonal illnesses we see are viral respiratory infections (influenza and respiratory syncytial virus), streptococcal pharyngitis (strep throat), and viral gastroenteritis. While many of these diseases are unavoidable, there are things we can do to help keep them at bay and make our children a bit less miserable when they are sick.

Winter is the season for respiratory syncytial virus (RSV). While it infects people of all ages, typically causing sore throats and nasal congestion in adults and older children, RSV can cause considerable coughing and wheezing in young children.

Infants with RSV infection may also develop pneumonia requiring hospitalization.

Fortunately, an RSV preventive antibody is available for children at highest risk of severe RSV infection (former premature infants and infants with congenital heart disease). No effective therapy for RSV infection is available for outpatient use, but symptoms can be treated.

Strep throat is most common in children of late preschool and elementary school age. While many parents expect physicians to prescribe antibiotics for sore throats, streptococcal bacteria cause only about 15 to 25 percent of sore throats; the remainder are caused by respiratory viruses, which are unresponsive to antibiotics.

No physician can consistently distinguish between streptococcal pharyngitis and sore throats caused by viruses based on physical examination alone. As such, all children suspected of having strep throat should have their throats swabbed to determine if streptococcal bacteria are present.

Children with streptococci in their throats are appropriately treated with antibiotics to reduce transmission of the illness and prevent rheumatic fever.

Outbreaks of vomiting and diarrhea caused by gastroenteritis (inflammation of the gastrointestinal tract) typically occur in late winter or early spring. While most episodes of gastroenteritis in young children are attributable to rotavirus, many other viruses can cause vomiting and/or diarrhea.

Gastroenteritis generally gets better on its own, however, young children are at particular risk for dehydration. For this reason, it is especially important for parents of infants and young toddlers to keep on hand a supply of oral rehydration solution (e.g., Pedialyte).

While earlier generations of pediatricians advocated delaying the reintroduction of breast milk (or formula) and solid foods, recent studies suggest the child can return to a normal diet as soon as it can be tolerated.

New vaccines for prevention of rotavirus gastroenteritis are currently in clinical trials.