Cough-Cold & a child with DS

Cough-cold & child with DS
Running nose, noisy breathing, disturbed sleep, nasal block, irritability, fever, watering of eyes....I know these are the major concerns of all the parents reading this article.
Let us first understand the 'WHY?'
Why our children are prone to Respiratory Tract Infection?


1.     Small nose & low nasal bridge leads to smaller & narrower nasal cavity. As there is less space for inhaled air to flow freely, child learns to breathe through mouth. This eventually results in poor clearance of dust particles & germs.

High arched palate


2.     Macroglossia (big tongue), high arched palate & weak oral muscles lead to tongue protrusion that further adds to mouth breathing & its disadvantages.

Mouth breathing


3.     The disadvantages of mouth breathing are;
·        Dryness of upper respiratory tract: The entire respiratory tract has an outer most layer that produces mucus & keeps the entire tract moist. Mucus is our friend. 


     Dryness created by mouth breathing makes the tract vulnerable to infection.
·        Mouth breathing allows dust particles & germs to settle down in oral cavity & upper respiratory tract.
·        Mouth breathing leads to poor oral hygiene which proves to be a home for harmful bacteria.
·        Overcrowding of teeth, misaligned teeth & delayed dentition further adds to poor oral hygiene.

Misalignment


Overcrowding


·        As the oral cavity & upper respiratory tract is constantly exposed to harmful elements, adenoids & tonsils catch infections frequently.
·        The swollen adenoids & tonsils further narrow down the passage & the vicious cycle sets in.


4.     The organisms responsible for cough & cold are around us in abundance. As our children have low immunity power, they catch infections readily.
5.     The outer most moist layer of respiratory tract has hair like cilia throughout. These cilia help removing germs & drain mucus. Unfortunately our children have lesser & weaker ciliary movement. This results in poor clearance of mucus even during healthy periods.

Click the link below to understand function of cilia.




6.     Our children have weak cough reflex so it becomes difficult for them to expel the excess mucus. Mucus as I said is our friend but when infected it becomes thick, sticky & a good nourishing media for germs. Uncleared,  infected mucus leads to lower respiratory tract infection. Remained untreated can eventually leads to pneumonia.
7.     Dry atmosphere (long hours in air-conditioned room), exposure to smoke (vehicular, industrial or house-hold), passive smoking (someone in vicinity is smoking & the smoke goes in child's lungs passively), low fluid intake, certain medicines & consumption of  cold beverages results into dryness of the moist layer of the respiratory system which leads to thicker mucus. This uncleared thick mucus will serve as a media for germs to grow. 
What to do?
Prevention is better than cure. Let's see how we can prevent or reduce the frequency of our children getting cough & cold.
·        We cannot increase the space of nasal cavity but can teach some breathing exercises. Here are some cards. You can get them online for free.

·        To get rid of mouth breathing, we need to encourage the child for oromotor exercises. Strong oral muscles can hold the tongue inside the oral cavity & keep the mouth close. You can get help regarding the same from my blog on speech.
·        Inculcate a habit of proper brushing twice a day. In the morning & before going to bed. There are many fun videos for brushing teeth available on YouTube, download & get started.
·        Consult a good dentist for a better oral hygiene, teeth alignment & treat overcrowding of teeth timely.
·        To improve on expelling power, encourage the child to exercise on respirometer, if possible daily.


·        We cannot improve the ciliary movement but can prevent stagnation of mucus by keeping it thin. Healthy mucus is thin like water & gets cleared easily. Make your child drink plenty of water routinely.
·   Inculcate a habit of doing salt water (lukewarm water) gargling daily. This reduces inflammation of upper respiratory tract & makes mucus thin.
·        Avoid long hours in air-conditioned room (when unavoidable give plenty of fluids), avoid exposure to smoke, increase fluid intake, avoid medicines as long as possible & stop consumption of  cold beverages.
·        Food plays major role in healthy mucus production & food can be a culprit in producing unhealthy mucus.



·         Include food rich in vitamin C in your child's diet as a routine. Vitamin C boosts immunity.



·        Make your child eat plenty of green leafy vegetables, garlic, onions, ginger, berries, walnut, yogurt etc. All these food items improve immunity.

The treatment
1.     Give plenty of fluid
2.     Rest
3.     Use nasal bulb to clear the mucus


4.     Hot water therapies
·        Inhalation of water vapor


·        Water vapor bath: 
     We made a small cabin in our bathroom using thermocol sheets. In outer corner of that cabin a hole was made. An insulated rubber tube was passed through that hole so that one end remained in the cabin & the other end was fitted on the outlet of cooker whistle. The steam produced in pressure cooker traveled through insulated tube & used to fill the cabin with vapor. My daughter Palak used to sit on a stool in that cabin for 10-15 minutes. This therapy reduced the episodes of cold & cough to a great extent. Make sure to hydrate the child very well before sitting in the cabin. 
·        Hot water dry compress:
     Pour hot water in a hot water bag or bottle, cover it with a napkin. Put it on the chest of the child & compress gently. Check the temperature & cork of the bag carefully before putting it on child's chest. Repeat similarly on the back of the chest. There are varieties of hot water bags available in market. 


5.     Local application
·        On chest & nose
     There are cold rubs available in market. Select the one made for kids and is a proper combination of Eucalyptus, Menthol & Camphor. 


     Apply on front & back of chest, nose & front & back of ears.
·        Instillation of nasal drops
     Saline nasal drops to be instilled twice a day to clear the air passage & drain the mucus. 

     Nasal irrigation with saline is very good. One can consult an ENT expert & the irrigation is done using saline water & syringe. Usually child does not cooperate & it becomes difficult to perform the procedure.
     Neti is another way of doing saline irrgation. There are varieties of Neti pots available in market. If taught, a grown up child can do Neti on his/her own.


·        Cotton plugs in ears
      Apply cotton ball dipped in cold rub in both ears.


6.     Physiotherapy to ease mucus drainage: This is very important & effective method that helps clearing mucus.
·        Tapping (young children): 
     After giving hot water dry compress or vapor bath, gently tap with the tips of your fingers on the chest of the child. 

     Repeat the procedure in different positions as shown.


·        Percussion (Older children)
     This is performed in older children. The positions & science behind is same as tapping but as the surface area is bigger & chest wall is thicker the procedure is carried a bit differently.
     For percussion one need to form a cup with palm as shown.


     You need to tap the cupped hand on the chest of the child keeping the child in different positions.


7.     Medication
·        Nebulizer: This is not habit forming, needs less dose of medicine & acts locally. One should prefer nebulizing the child to oral drugs.


·        Anti-cold drugs, cough suppressants & cough expectorants as per the advice of the treating paediatrician. One should be sure about giving antibiotics as in most cases antibiotics has no role. Anti-cold & cough suppressants induces dryness of the tract. This results into thicker mucus & hard stools. When your child is on such medicines make sure to give plenty of fluids.

It is important to read carefully because frequent cough & cold may lead to; 

·       Impaired hearing
·       Pneumonia
·       Weak immune system
·       Slow down growth & development
·       Irritability & behavioral issues  

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