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Frequent Infections – When to be Concerned

Frequent Infections in Your Child

You are noticing many infections in your child.  He gets over one infection and another one starts.  In many cases, the symptoms continue with new symptoms starting before the other symptoms went away.   You take him to the doctor and he has been diagnosed with another viral infection.  Is something wrong with his immune system? 

Why does this keep happening?

This is a scenario we frequently see at Four Seasons Pediatrics.  Many parents are frustrated with the frequent illnesses.  Let’s go through some of the factors that are leading to this, and give you direction about when it is ok, and when it might represent an immune problem.  

Prior to the pandemic, surveys [1] show that the average 1-3 year old gets up to 9 upper respiratory infections per year.  For ages 4-10 up to 6 viruses or upper respiratory infections (URI) per year.  Children just starting school or daycare [2] are more likely to have more infections in the very first year than in the second year.   The pandemic has resulted in a setback to exposure of illness, which is a glass half full and a glass half empty.  It has been wonderful (half full) to see less illness during the pandemic, however each illness is an education to the immune system – and that education simply has not been occurring (half empty).  For some pandemic children, they have never been exposed to illness outside the home.  Now that we have a much needed return to school, families and social circles, the small pockets of illness have exploded.  As families explore the want and the need for more human interaction, there is more spread of illness.  

What other factors make this so apparent?

Pre-pandemic – your child experienced these same illnesses.  They were more spread out through the year, though concentrated in the winter.  Currently they are compressed and many are making an unseasonal surge.  This includes illnesses like RSV  – which usually occurs from November to March in our area and has been occurring from July on; Coxsackie virus which usually occurs in the summer began during the fall and still is occurring.  Croup usually peaks in the fall and we are seeing a prolonged and higher level of this illness – usually caused by parainfluenza virus.  In MOST cases, children would either carry on in daycare or school, or stay home for a few days and then return.  With the current protocols, children are immediately pulled from school, or sent home to be tested.  This is placing a greater burden on parents, schools and doctors – as every illness is now “in your face” on day 1, demanding more of everyone’s time, loss of school and loss of work.  To add to the burden, later in the illness – there may be concerning symptoms that lead to another visit to check it out.  

My child has been sick since September – don’t I need an antibiotic?

Let’s do the math on these illnesses.  There are over 200 cold viruses. The rate of illnesses triples in the fall and winter when we are indoors and closer together.   Most illnesses last 9-10 days and some can last for weeks with symptoms slowly improving, but still lingering.  A typical viral upper respiratory illness will ramp up for the first 3 days, peak in the middle 3 days and start winding down in the last 3-4 days.   If there are 9 illnesses for 10 days – that will be 90 days of symptoms.  If most children are now getting to daycare or school for the first time in over a year (or some for the first time ever), and the upper respiratory infections (URI’s) are having a field day right now, it would seem like your child is constantly sick.  You would be correct about that!  The time off from work, from school and general loss of your time is very frustrating to parents.

Here is the good news.  Studies previously done have shown that a child in daycare will have less infections in the SECOND year of daycare.  Children in daycare will have less sick time when they get to school.  Up until this summer, children did not get their immune systems primed for illness and now they are all experiencing more illness. 

How do I know it is not a problem with my child’s immune system?

Most parents worry that a child who is ill repeatedly has some serious underlying disease. Children with immune system disease (inadequate antibody or white blood cell production) don’t get any more colds than the average child. Instead, they often have two or more bouts per year of unusual pneumonias, sinus infections that don’t clear up, draining lymph nodes, or boils and recover slowly from these infections. Moreover, children with serious disease do not gain weight adequately.

When your child gets sick, you have not neglected your child.  Viruses are an unavoidable part of growing up.  To put the problem in perspective, consider the findings of a pre-pandemic survey: On any given day 10% of children have colds, 8% have fevers, 5% have diarrhea, and 3% have ear infections.  Although you can reduce some of the symptoms, you cannot shorten the course of a cold.  Your child has to work through it and keep up the hydration.  A runny nose is natures way of washing out the virus.  When you are concerned, we are happy to evaluate and ensure no change in treatment is necessary.

When to return to activities?

Until we are able to see a decline in the pandemic (not elimination but down to acceptable levels), testing will continue to be part of the equation.  We have lobbied and will continue to advocate for different strategies that allow children to miss less time from school.  In the mean time and when appropriate, a negative test will allow a child to return when there is no fever and the symptoms are not excessively noisy or distracting for classmates.  Sports may need to be postponed until your child feels well enough to play.   Some illnesses such as RSV and Coxsackie virus have a contagious period for up to 6 weeks.   Most of the spread occurs in the first few days, while there is fever and or drooling in a young child.   It is just not practical or helpful to keep children out of daycare and school for the time a child might be contagious.  Daycares have sometimes asked us to write notes that state – this child is no longer contagious.  Such a note would not be truthful, so we instead focus on what is appropriate from a contagious point of view.  (e.g.  May return when fever free and symptoms not distracting).  The pandemic has created some well intentioned approaches that lead to frustration.  When appropriate, we will help you navigate these situations.   

There are no instant cures for recurrent colds and other viral illnesses. Antibiotics don’t help unless your child develops complications caused by a bacterial infection, such as an ear infection, sinus infection, or pneumonia. Having your child’s tonsils removed doesn’t help because colds are not caused by infected tonsils. Nor are they caused by poor diet. lack of vitamins, bad weather, air conditioners, or wet feet. Remember, the best time to have these inevitable infections and develop immunity is during childhood.

About sinus infections

It is mostly about duration of symptoms AND not improving.  We start to consider the possibility of a sinus infection when a child has a runny nose and cough for 10-14 days AND not improving.  Color does not matter.  You can have a clear runny nose with a sinus infection and a yellow green runny nose with a viral infection.  Sometimes this can seem like a sinus infection when a few illness are running back to back.  Look for the subtle clues.  (e.g. runny nose stopped for a few days, then seemed to come down with new symptoms and less eating or activity).  Certain infections need antibiotics immediately (e.g. pneumonia).  You can be patient with concerns over a runny nose signifying a sinus infection.  Some will get better and and not need antibiotics.