Friday, September 5, 2014

Cold/Congestion review



Please see the updated post February 2017

With school back in session we often see an increase in colds and congestion, so I am brushing off an earlier post with some updates. It is important to have some guidelines to help you figure out when a trip to the doctor's office is indicated. On the other hand, often there is nothing to do but wait it out, so below are some tips to help you and your child get through the illness as comfortably as possible.

Colds and coughs are a common issue for all of us with or without kids. Studies say that most children will have an average of EIGHT colds within the first 18 months of life. Most of the time the congestion is caused by a viral syndrome. Allergies and teething* can also be culprits causing you to be congested. All that mucous is the perfect breeding ground for bacteria, which is why something that starts as a virus can turn into an ear infection, sinus infection, or lower respiratory infection fairly quickly. Be warned,  
we can see a patient one day with clear lungs and no ear issues, and the very next day they can seem a lot worse and have a raging infection.

When to come in:  
If you are dealing with a congested family member, here are the questions to consider:

*Do they seem to be having any labored breathing?  Babies with labored breathing will look like their little tummies are going in and out more than usual. Respiration will be more rapid (I am more concerned with the lungs than a stuffy nose.) Noisy breathing alone is not a very good indicator as it may be caused by upper airway issues that we aren't too worried about.

*How is their mood?

*Do they have a fever?

*How is the appetite? If your baby is nursing well, that is very reassuring

*Are they sleeping well at night?

* What color is the mucous?

*How long has this been going on?

Many colds and coughs can last between 7-10 days. Some coughs can linger for a few weeks.  

IF
we have a reasonable consolable child with clear mucous who is eating and sleeping  well, whose breathing isn't alarming and who has no significant fever,  

THEN I am okay playing the "wait and see" game. Of course if the symptoms show no signs of improvement, please check in with your doctor's office.
IF
you have any labored breathing, wheezing, a child who is much grumpier or fussier than usual, and/or a fever that is hard to control or has lasted more than 3 days with  mucous that is getting thicker and greener,  

THEN that person needs to be seen. Green mucous does not automatically signal a problem. It is just one more clue.

Try sticking your ear up to their lungs and see if you can hear anything. If you can hear nice clear air noises, that is great. If you hear whistles or squeaky noises, that may mean the lungs are involved. More than half the time this won't work and you won't be able to hear anything, but once in a while parents are able to get some important clues from the "ear to chest" evaluation.

Any baby less then 2 months old is probably worth a visit to the office with their first cold, unless they are eating really well and seem completely happy. It is certainly at least worth a call to the nurse.

Management tips:

The best way to manage congestion at home is to make sure your little patient is getting plenty of fluids (this will help to keep the mucous thinner.) Breast milk is perfect if you are lucky enough to have it.

With some older kids, cows milk may not be the best choice because it can increase the amount of mucous (it doesn't impact everyone the same way.)

Steam is great. Hang out in the bathroom when anyone takes a shower. Running a humidifier or vaporizer at night is a good idea. Turn it off during the day and give the room a chance to dry out so that you don't grow mold. Make sure you change the water daily. As long as you follow those rules, I don't have a preference between warm or cool mist.

Keeping the head elevated makes a huge difference. Some of the younger babies will do best sleeping in their car seats, bouncy seat or swing (make sure it is safe.) Otherwise try a crib wedge or place a towel underneath the mattress to raise it up a bit.

You can put saline drops or breast milk into the nose (and then suck it out with a Nose Frida or snot sucker). This is the most natural way to clear the nose. Your baby will no doubt hate this, but if you can manage to do it about ten minutes before a feeding, it may clear the nose up enough to make eating much easier. Do not torture your baby with the nasal irrigation if they are managing just fine.

For patients over 6 months of age, ask your doctor about Windbreaker (a Chinese herb that we use to dry up congestion) Many of our families swear by it. It is sold at the Chinese medicine works on 25th and Noe. For convenience our office tries to also keep it in stock.

For older kids don't minimize the value of chicken soup!

For night coughs try a bit of  Vicks Vaporub on the feet!

Prevention:
For parents and big kids I really like Sambucol and zinc lozenges. This may be placebo, but in my case I say " bring it on" because they seem to work. Remember that I work in the germ factory and (knock wood) I manage to avoid many of the things I tend to be exposed to. The second I feel that little tickle in my throat or any tell tale signs of an illness I take a zinc cold therapy lozenge (Walgreen's generic taste better and are cheaper) and a Sambucol lozenge twice a day.

Another very good thing to do for folks who are old enough is to use a Neti Pot or sinus irrigation

11/15 new tip!!! One of my moms swears by the Oogiebear nose and ear cleaners. These are safe, soft little plastic scoops that allow you to remove stubborn little boogies

Good hand washing is of course essential.

Wishing you a back to school season that is kind and gentle.
*Most medical literature disputes whether or not teething is connected to any symptoms, but I have been at my job for many years, and I see what I see



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