Edna Pytlak, MD

For years researchers have been trying to find ways to prevent and treat the common cold. Given the wide array of common respiratory viruses and the way we live modern life, however, complete prevention is not practical.

Preventing a virus from infecting a young child or an infant is a particular challenge; their immune systems are new and they are surrounded by germs. Here I will share a few observations on how the little ones get sick, how they share what they catch, and what parents can do to protect the whole family. 

Young children who go to nursery school or other indoor play centers typically contract 8 to 12 respiratory illnesses per year. Most of the colds, fortunately, will be limited to the upper airway. How sick a child becomes each time is determined by factors such as age, nutritional reserve, and immune resilience. Some common viruses, such as respiratory syncytial virus, cause cellular injury to the lower respiratory tract lining in infants. Influenza weakens local tissue defenses, allowing increased adhesion to respiratory epithelial cells of pathogenic bacteria such as pneumococci.  
 


  
The size of the viral “inoculum” also plays a role. The greater the exposure, the sicker the child is likely to be. The germs in a cough will travel about an arm's length and then drop to the floor. If someone inhales while another person coughs directly into his or her face, the respiratory air stream will carry germs deep into the lungs. When a few germs land on a person's hands, however, or are inhaled in a large spacious room or outdoors, the immune system starts to process the pathogen in the tonsils and adenoids. This immune surveillance system can be effective enough that a person exposed to a bug doesn't get sick. In the days before the chickenpox vaccine, some children suffered milder cases than others. The kids who were exposed to the virus in small doses over several days (ie, in a well-ventilated classroom with all the desks facing forward) tended to have a milder version than those whose first contact was more intense, ie, with an affectionate sibling during the most contagious phase of the virus when the spots were just beginning to appear.


One reason children in nursery school or daycare are so prone to getting colds is that they run around an indoor space all day with other children of the same size, coughing into each other's faces. When the children head home, they freely cough into their parents' faces and pass on the newest circulating virus. As the months go by, a new preschooler gradually builds up an elaborate library of antibodies. Often, by the time kids start grammar school, they get sick only rarely. In the 1950s a study reported that kindergarteners missed an average of 30 school days a year. The reason was their vulnerability to modern-day vaccine preventable illnesses: measles, mumps, rubella, and chickenpox.
 



The preschooler with a newborn sibling at home is a particular challenge. Parents can’t, and shouldn’t, keep the older sibling away from the newborn. The easiest way to protect the infant is to have the child wash his hands with an alcohol-based hand sanitizer as soon as he is picked up at school or when he enters the house. Have the affectionate older child learn to kiss the baby on the feet (or top of the head or hands) instead of the face. At family gatherings, infants should be kept out of the coughing and touching range of other partygoers. Infant carriers are particularly helpful because they help keep the baby in the respiratory air zone of the parent and less likely to be passed around the room, from person to person.

 
There are many over-the-counter products from A (Airborne) to Z (zinc tablets) that are marketed as adjuncts in the prevention of common colds. Some alleviate symptoms, others enhance resistance. The human immune system is elaborate and many of the processes behind the immune response are still unclear. I don’t have the magic potion for prevention or cure, but here I offer some nutritional approaches and home treatments I’ve found helpful.  



 contains catechins which have been shown in studies of nursing home residents to help decrease the adhesion of influenza virus to receptors on the back of the throat. Green tea gargles were proposed as a possible preventive measure for nursing home staff and patients. 
 


, and several other fruits contain proanthocyanidins, which inhibit several viruses and also help block the viral receptor hemagglutinin.
 


 has been shown to increase the efficacy of monocytes. Widespread vitamin D deficiency during the early years of the industrial revolution is now thought to have helped propel the spread of tuberculosis in city dwellers. 
 


 help reduce the viscosity of respiratory secretions and improve immune resistance within the mucous layer. 
 


 Sleep deprivation reduces human resistance.

 Include fruits, vegetables, and proteins; all help optimize immunity.

Walking outdoors, and particularly in the cold, makes the nasal passages produce a wave of protective clear mucus that helps clear away germs.

 It’s also important to stay warm during the cold months. Prolonged sitting/standing in cold temperatures can weaken immune defense. We have all heard people complain of a cold getting worse after they’ve been “chilled.” The influenza virus prefers a cooler nostril and prolonged cold can even promote replication. Drinking warm liquids after exercising in the cold helps prevent the virus from settling in.   
 

Articles

Dr Pytlak offers tips on what parents can do to protect the whole family from colds and flu this season with some seasoned home remedies.

Warding Off the Common Cold in Young Children

Over the years grandmothers from around the world have come to Brooklyn where I practice to help their daughters adjust during the newborn period. Here are some of the functional foods I have learned about that are used to help improve breast milk and help general healing for infant and mother.  
 


Functional foods to help improve breast milk

: “Black” beer (ie, Guiness-like dark beers)
 


Fennugreek tea and/or fennugreek pudding  (in Sudan, it is served to mothers as a porridge; in the United States, it is available in capsule form) 
 
 


 can be used to wipe the eyes of a baby with newborn conjunctivitis. A small amount of chamomile tea (1 ounce/day) also can be given to babies with colic to quiet symptoms. A soft cloth soaked in chamomile tea and placed on the sore nipples is also soothing for the mother.

 is also helpful for an infant with colic. From 1 cup of brewed tea, 1 ounce/day can be given to the baby and the mother can drink the rest.

 is used as an ablution for the perineal area after childbirth. A tea leaf is allowed to soak in hot water which is then poured over the perineum to help the healing process. Guava leaves are also used to soothe older boys after circumcision. The leaf is wrapped around the penis after the procedure and rinsed off after 1 or 2 days.

For a mother who is overdue (also from Germany) 

will help induce uterine contractions. It is thought the tea might help bring on labor and mothers who are not ready to go into labor should not drink it at all.

Functional foods for post-partum mothers include galactagogues to enhance breast feeding and teas to soothe colic.

Postpartum Remedies for Better Breast Milk

Pediatricians, during residency, will learn how to manage acute diarrhea and rehydration in young patients. However, once in practice, they will probably see many children whose parents have brought them to the office only after 1 or 2 days of diarrhea. These children aren’t usually dangerously dehydrated but can become so if fluid intake doesn’t keep up with ongoing loss.

There are quite a few dietary tactics you can recommend that are simple for most parents to use and provide replenishment and comfort for the child. 
 
First, remind the parent that diarrhea often takes about a week and a half to resolve. This is because the intestinal tract needs time to replace the many cells lost during the acute illness. During the recuperation phase, nutrients will not be as well absorbed so careful attention to a child’s diet is helpful. Partially digested foods, particularly sugars, will act like osmotic stool softeners so should be avoided. On the other hand, an overly restrictive diet that avoids, for example, fats and protein, can prolong recovery. Without fat in the intestinal lumen, it will take much longer for the intestinal brush border to reestablish its enzymatic machinery.


A recipe for homemade rehydration fluid: 
• 1 liter of water
• One-half teaspoon of salt
• 8 teaspoons of sugar

This solution lacks potassium, so the child should have some banana, potato, or carrots. Some parents turn this into an orange smoothie by mixing the salt/sugar/water solution in a blender with a quarter cup of orange juice and half a banana.

Homemade chicken or vegetable soup makes excellent rehydration fluid: 
• Place unboned chicken thighs in a pot of water; bring to a boil.    
• Add one-third teaspoon of salt per 1 liter of water (some of the water will evaporate). 
• Add carrots, peas, or squash; all contain natural sugar and potassium.

Dietary tricks to help support gut recuperation 



. Taken as a soup, helps by “blotting” up bacterial by-products and cellular debris. Rice bran has a spiral structure that acts like a cotton mop as it travels down the GI tract.


Has the same beneficial effect of mopping up cellular debris. It can be cooked to a soupy consistency and bananas can be added for flavor, texture, and potassium. 


. Their fibrous structure also is a good bacterial “blotter” and will help decrease the osmotic load of contents in the lower intestine. 


. Another good blotter for extra bacteria and their toxins.


. The yellow vegetables are thought to be good for intestinal healing. 


. All are great sources of potassium and trace elements and can be sprinkled with salt.

Remember to add some fat to the broths and the vegetable dishes.

 a “friendly” bacteria added to some commercial yogurt products, is thought to be particularly helpful in children with diarrhea because it competes with other intestinal bacteria. It is thought to float to the periphery of the intestinal stream and help crowd away the more pathogenic 

As long as an infant can tolerate cow’s milk protein, he or she can be given yogurt as early as 6 months of age. It’s not necessary to purchase the commercial “baby yogurt” brands; any reputable pasteurized brand that claims on the label to contain “active cultures” can be used.

For children who don't like yogurt or milk, there are several pediatric probiotic products available without a doctor’s prescription (ie, pediatric Culturelle and Florastor). The products are made to be sprinkled on and mixed into cold soft foods.

Prolonged diarrhea causes dehydration and cellular depletion in the gastrointestinal lumen. Sodium-rich liquids and functional foods help restore gut balance.

Diarrhea: Home Remedies to Help Rehydrate and to Soothe the Gut

Here, I offer a few old-fashioned and time-tested home remedies to relieve ear pain that typically follows a respiratory infection. I've found it helpful to share these tips with parents of my young patients.  



 Place a few drops of ice water into the affected ear. Be sure to forewarn the child that it’s going to feel “super cold” and maybe tell him/her that you are putting some melted snow into the ear to make the pain go away. Then have the child lie against your shoulder or sit propped up and gently stroke the side of the neck. The brief pulse of ice water causes the blood vessels of the inflamed tympanic membrane to constrict, and does bring some relief.
 
This trick works best if you administer ibuprofen first and try not to drip ice water on the external ear or down the child's neck.  



 Gentle warmth around the ear can also alleviate infection-associated pain and a homemade “salt sock” can serve as a natural heating pad for infants and young children. Put a cup of uncooked rice or other grain into a thick cotton sock. Add a tablespoon of Kosher or sea salt. Shake. Then tie the sock closed and put it into a microwave oven for 30 to 60 seconds. To minimize the chance of accidental burning, parents should place the heating pad on their chest and hold the child on his/her lap. The child can then gently lean against the salt sock rather than lying flat against it while prone.     




A young child who has a cold and must travel by air will be very prone to ear pain, especially when the airplane begins its initial descent. On a mid-winter flight to Florida, the cry of a young child is often heard about 20 minutes before landing-when intraocular pressure starts to shift. A warm moist poultice placed in the bottom of a cup can help. Parents will need to do a bit of advanced planning to make this tactic work. 

Tell them to bring along a plastic bag full of cotton balls and/or makeup pads and an insulated pack in their carry-on luggage. Once airborne and settled, moisten some of the cotton balls/pads with hot water from the beverage cart and put them in the insulated bag. By the time the flight is approaching its destination, the cotton should be sufficiently warm. Press a few of the warm moist, but not dripping, cotton balls or pads into the bottom of a small paper or plastic cup. Place the cup over the child’s affected ear to create a change in local barometric pressure that will help reduce the pain. The warm moist cotton can also be placed under the earpiece of a set of headphones.   
 
 

Pain from ear infections can be reduced at home and during plane travel using ibuprofen and home remedies: cold water, warm compresses, and paper cups

Home Remedies for Ear Pain on the Ground and in the Air

Pediatricians see waves of patients with influenza coming through their offices each year -- but many of the illnesses are so mild that they are indistinguishable from other febrile respiratory viruses. For every child who has a raging fever, marked myalgias, dry cough, and headache, there are a handful of children who have been exposed to the same virus and who have a simple runny nose or cold/cough. Such was frequently the case during the nh1n1 epidemic of 2009. Many family members or classroom contacts of a documented case did not "get sick" or simply had a mild cough/cold.  
 
What distinguishes influenza from other respiratory viruses?
 


 The fever from influenza is often high and sustained. During the novel nh1n1 epidemic in 2009, many older kids were having fevers of 103°F to 104°F. For many of today’s parents who never experienced the prolonged fevers of measles, this was very scary.

Muscle fatigue can make infants and toddlers act “limp”.... toddlers sit quietly on their parent’s laps in the waiting room. Older kids will flop on the couch, and then feel dizzy when they try to get up and walk. Many people will feel “achy” muscles -- hence the term “grippe.”

A distinguishing feature of influenza is its rapid onset. Older children will remember the exact hour they started to feel sick. Often a child will go to school feeling fine, only to develop a high fever in the afternoon. Younger children often vomit before the onset of fever. 
 


 The cough of influenza usually gets wetter and more productive as the days go on and the viral-induced cell debris begins to be coughed up. At the onset of the illness, the cough tends to be dry and irritating in older kids and croupy in younger kids. In a child with the flu, rhonchi sound more moist.

Influenza is potentially more pathogenic than so many of the other respiratory viruses because it can attach itself to the surfactant producing alveolar type II cells. This can lead to alveolar collapse and respiratory distress syndromes. During the nh1n1 epidemic, pregnant women were more prone to this form of pneumonia.

Capillary leakage is another type of pulmonary injury from influenza. One of my colleagues remembers a bad influenza season when he was a resident in the 1970s in which an otherwise healthy 3-year-old boy with influenza ended up being admitted to the PICU after coughing up blood with his cough in the ED.  
 


The potential for secondary bacterial infections. 

Influenza increases bacterial adhesion, particularly pneumococcus, to the respiratory epithelium. Before l995 and the widespread use of the Prevnar vaccine, there were many more hospitalizations for pneumococcal bacteremia and pneumococcal pneumonia than there are now. The other big pediatric pathogen, Haemophilus influenza, induced more serious illnesses (ie, meningitis, preseptal cellulitis, epiglottis) during the winter months when influenza causes microscopic injury to children’s respiratory linings.
 
Bacterial secondary infections usually develop several days after what seems to be classic viral symptoms of a clear runny nose. Infants and toddlers can be up all night with ear pain. A a raging strep throat can develop in a child who had been exposed to strep at school. Typically, the child has been starting to look a little better when the fever returns. If a secondary bacterial pneumonia is starting to develop, a very high fever and tachypnea will develop.    

. Fortunately, this complication is rare, but most pediatricians know of a patient who has had subclinical myocarditis. Besides homing onto to the respiratory lining, influenza can also infect muscles cells. When teenagers or athletes have what looks like influenza with myalgias, we recommend that they not push themselves with drills in sports teams. We advise them to take it easy until they are back to full strength and completely symptom free. For a teenager who has been running fevers for days, the “recovery phase” (ie, when they're not back to normal) might be 2 weeks or so.
 


Sometimes older toddlers and preschoolers experience a febrile seizure with the initial wallop of the immune response. Also, during the nh1n1 epidemic there were a few reports of infants with symptoms of encephalitis.
 


 Patients with juvenile onset diabetes often have a flu-like or enteroviral syndrome before the onset of diabetes.    

Many people have an extensive library of memory antibodies to flu. This is why many teachers, pediatricians, dentists, shop owners don’t get sick often after the initial few years of training.   Everyone else in their family might get sick, but they have only mild cold symptoms, or one day of achiness/fatigue. People who grow up in large families usually experience lots of “sibling sprinkles” throughout early childhood. By the time they go to college, they're more “immune” than a classmate who grew up in the country, didn't go to day care, or was home schooled. A child who has attended day care for 2 or 3 years has already developed lots of immunity to influenza.

Also, children who have received the influenza vaccine during the first couple of years of life and during the preschool years have much more resistance to influenza. Young children have a developing immune system and more “photographic” memory for flu vaccines. A vaccine given in 2010 can cause memory antibodies to activate years later.
 
Many people think that flu vaccines are not important. Some think it’s better to get the “natural illness.” The antigens to 3 different strains in each year’s flu vaccine might not completely “match” and the person might still get sick. However, a vaccine given to a child isn't wasted, because 1 of the 3 strains present in the vaccine can later appear.
 
Other people expect a flu vaccine to do more than it is capable of. They think the flu vaccine will prevent them from getting sick during the winter. This, of course, is not so. They can still get strep throat,  the Norwalk 'vomiting' illnesses, respiratory adenovirus, etc. Younger children are still at risk for respiratory syncytial virus, and human metapneumovirus, and parainfluenza viruses. They can still be back and forth to the doctor's office with one cold after another and an ear infection or croup, even though they had a flu shot.
 

High fevers; more fatigue; rapid onset of illness distinguish influenza from colds and other viral conditions. Here, more diagnostic pearls here from Dr. Pytlak's blog.

What Distinguishes Influenza From Other Respiratory Viruses?

There are very good reasons why persistent cough is so common among toddlers. In fact, bronchial cough is one of the most common diagnosis codes for pediatric outpatient visits. Parents need to know that not all coughs are bad, and that there are many effective home remedies for persistent cough, some of which I describe below.

Their behavior sets toddlers up for persistent cough. Toddlers and older infants who are crawling normally cough more than youngsters of any other age. They are mobile, and as they explore, they are on the receiving end of many sneezes and coughs from other children their own size. As a child plays in a room full of other children the same size, he or she is likely to inhale a respiratory air stream that is sneezed or coughed out by other children.

Hand contact also plays a role--especially with respiratory syncytial virus. But if a toddler inhales when face to face with a sneezing child, a much larger viral innoculum lands in the upper airway and trachea. Also, the distance from the upper airway to the trachea and bronchial tree of a toddler is much less than that of an adult, so a sneeze in the face is nearly a direct hit to the bronchial air passages.




It is normal for children to have a mucousy cough. Nevertheless, many parents think a child who has a wet mucousy cough is sick. As long as the child is not wheezing or febrile, a wet loose cough does not indicate any problem with lung function; it is actually a natural protective response. Mucus is "good stuff." It is loaded with antibacterial and antiviral properties, including anti-adhesins that impair the ability of bacteria to adhere to the airway. 
 
Many parents also think that cold air is "bad" and that it can make a child sick. It is true that dry/cold air can cause some reactive wheezing in some children and adults. For most children, however, being properly dressed and spending time outdoors actually cuts down on upper respiratory tract infections. In Sweden, preschool children take naps outdoors in sleeping bags. Exercising outdoors is particularly good because is causes the sinus passages to drain and helps mobilize mucus. The beneficial effects of exercising in cold weather accrue to children with cystic fibrosis. (Cold "brisk" air was also used to combat tuberculosis in the sanitariums of the Alps and the Adirondacks.)
 
Hypothermia is another matter. Getting "chilled" after sitting around in wet clothes or being exposed to prolonged cold while underdressed, seems to worsen pulmonary immune defenses (probably related to ciliary clearance or anti-adhesin activity.) One can become "chilled" in the warm weather as well, by (for example) getting soaked in a rain storm and then sitting in air conditioning. 
 



Here are some home remedies I have recommended for children with persistent cough due to bronchitis:



have been used throughout northern Europe and Siberia as cough remedies, because they are a source of vitamin C. Rose hips are high in bioflavinoids, which help "loosen mucus." Rose hips are widely available in the United States in many decaffeinated fruit-flavored teas. One of the most well known are the "Zinger" teas from Celestial Seasonings. They have very kid-friendly flavors (Wild Berry Zinger tastes like grape Koolaid, while Lemon Zinger tastes like lemonade). Unlike juice, these teas have no calories, but can be sweeted with sugar or (for older children) with honey.  
 


 has been shown to help defend against viral infections by impairing the ability of viruses to adhere to the cell. This effect is in addition to its Vitamin C content, and its well known protective role against urinary tract infections (by decreasing the ability of gram negative bacteria to cling to the bladder wall). An ounce of cranberry juice can be added to rose hips tea or lemonade, or mixed with apple sauce and served with a spoon.
 


 are believed to share the antiviral property of cranberries. An ounce of concord grape juice can be added to rose hip or other drink.  

 is widely used in Scandinavia and Israel. It probably shares the same properties as the grape and cranberry.
 


 is packed with the bioflavinoids that improve the antibacterial/antiviral properties of the mucus layer. Many people tell me their child doesn't like tea, but will drink it if an ounce is mixed with lemonade.    
 


 is available in middle Eastern specialty stores. Licorice is also used in cough remedies in Israel.

 The pediatric literature recently reported the results of a controlled study at a hospital in Pennsylvania that showed a teaspoon of buckwheat honey helped calm a cough.

 However, only children older than a year of age can be given honey because of the risk of botulism spores being able to germinate in the GI tracts of younger children.

There was an interesting article in

 To the surprise of many, there are receptors in the lungs for both sweet and bitter; sweet induces bronchodilation and bitter induces bronchoconstriction.
 


 In many European countries, going to the shore was a treatment for bronchitis and asthma. Studies in Australia involving patients with cystic fibrosis showed that those with asthma who surfed had better lung function than those who did not. This led to the discovery that salt mist helped increase the efficiency of the "brushing" action of cilia. Three-percent nNormal saline inhalation treatments are being incorporated into the regimens of many children with cystic fibrosis.
 
No need to go to the shore: This can be another one of the home remedies.Parents who want to make their own salt mis can sprinkle a couple of tablespoons of kosher or sea salt in the bottom of the bath tub and turn on the hot water shower tap while the bathroom door is closed. As the water hits the salt, a nice mist will start to form. You can then put the stopper in and begin to fill the bath with warm water. 
 


 Throughout the world, there are various forms of chest rubs that contain eucalyptus or camphor compound that give a sensation of warmth on the skin. Parents report that chest rubs seem to help with persistent cough, but evidence-based studies are sparse. The most likely mechanism of action is relaxation and bronchodilation. These compounds can be toxic if ingested, and should never be left where a child might eat or play with them. If a child is asthmatic, the smell might be asthma-inducing. For the vast majority of children, however, a small amount rubbed on the chest at bedtime would not seem to be hazardous.   

The Germans make an infusion of 

. They put 1 tsp of thyme in a tea ball, and add hot water to make a tea. When sufficiently cool, they drink the tea with honey. Another one of the German cough remedies is

 which is available in some health food stores.



Before World War II, mustard plasters were widely used in the United States. They are still available in Russian specialty stores. Mustard plaster recipes vary  from family to family. One from an elderly neighbor from upstate New York is as follows:

Mix a tablespoon of dry mustard with a tablespoon of flour, add enough water to make a paste the consistency of peanut butter. Next, spread the mixture it (like peanut butter) on a 4-6 inch square of material cut from an old undershirt. Put another smaller layer of cotton cloth on top of the mustard paste and try to fold the edges so the mustard paste is sealed in. Place the cloth "sandwich" in the middle of the child's chest for only a minute or two - - until the child stays it is starting to feel warm.

An Italian woman I know in Brooklyn uses the same basic recipe, but instead of using cotton jersey, she uses newspapers to sandwich in the paste.
 
There are many stories of children and adults who sustained thermochemical burns with mustard plasters. Not surprisingly, this has caused mustard plasters to fall out of favor among home remedies. They have largely been replaced by the more child-friendly chest rubs, which are much easier to apply.
   

1.Paul IM. Therapeutic options for acute cough due to upper respiratory infections in children. 

http://www.ncbi.nlm.nih.gov/pubmed/21892785

2. Finger TE, Kinnamon SC. Matters of taste. 

http://the-scientist.com/2011/12/01/matters-of-taste/

Persistent cough and bronchitis are common, and normal, among children. Here are some home treatments I have recommended.