Orz in children: symptoms and treatment

Acute respiratory diseases (ARI), according to medical statistics, account for about a third of all types of diseases requiring treatment.
Children suffer especially often from acute respiratory infections: if for an adult patient there are two cases a year, then for school-age children there are three or more, and children attending kindergarten get sick even more often - on average six times a year. It also happens in infants, for whom parents are especially worried - most medications are contraindicated for babies, and besides, they still don’t know how to explain their condition or complain about it.

What it is?

Viral and bacterial, as well as viral-bacterial diseases are included in a group of diseases called acute respiratory infections. Acute respiratory infections affect the upper respiratory tract: nasopharynx, bronchi, lungs. The infection is transmitted by airborne droplets. The causative agents of the disease are streptococci, staphylococci, viruses A, B, C (influenza), enteroviruses and some others.

The time of greatest spread of these diseases is autumn, winter, and early spring.

Causes

The cause of acute respiratory infections can be either direct contact with an already ill person who coughs and sneezes, or objects touched by the infected person (viruses and bacteria can survive for three hours even outside the human body on various surfaces). Particularly dangerous:

• handrails in different types of public transport;
• towels that are used by more than one person;
• telephone handsets;
• door handles;
• toys that different children play with.

Due to weakened immunity, some children get sick very often; doctors even identified them as a special group of frequently ill children (FIC) . You can find out whether your child belongs to it by comparing your baby’s medical history with the average statistical data. ChBD includes those who are ill during the year:

• 4 or more times infants,
• 6 or more times – children from 1 to 3 years old,
• 5 times – children from 3 to 5 years old,
• 4 or more times – children over 5 years old.

For the children included in this list, any draft is dangerous; visiting a kindergarten is a big problem. The situation can be corrected by asking the pediatrician to carefully understand the causes of frequent acute respiratory infections in the child and select effective preventive treatment.

Acute respiratory diseases (ARI) in children - treatment and prevention

The significance of acute respiratory infections Acute respiratory infections are a group of diseases with similar epidemiological and many clinical features, but extremely diverse etiology: respiratory viral (ARVI, influenza), entero-, corono-virus, bacterial, incl. chlamydial and mycoplasma. The high frequency of acute respiratory infections in childhood is due to the abundance of viruses; every year all children suffer several infections, most often mild and subclinical, which do not require treatment and do not leave any consequences. Influenza and adenovirus infection are more severe, and in the 1st year also infection with the RS virus; There is a risk of complications with all bacterial infections. But even a mild acute respiratory infection can cause an exacerbation of chronic suffering. ARI is a serious health problem and due to the economic damage they cause, which in Russia is estimated at an amount equivalent to 1.6 billion US dollars: 1 case of ARI costs the state 100-150, and the patient - 15-100 dollars [1]. ARVI occurs more often in the cold season - from October to April with a peak in February, infections caused by mycoplasma become more frequent in early autumn, and pneumococcal and streptococcal group A infections sometimes become more frequent in the spring months. ARIs are more often recorded in cold and temperate climates, but epidemics and pandemics are ubiquitous. The main mechanism of transmission of viral infection is airborne, however, infection through contaminated hands, and for adenoviruses, through care items plays a significant role. For bacterial acute respiratory infections, close and prolonged contact plays a more significant role. High susceptibility to acute respiratory infections pathogens in children aged 6 months to 3 years is due, first of all, to the lack of previous contact with viruses; With age, antibodies to an increasing number of viruses appear, which is accompanied by a decrease in morbidity [2]. Therefore, frequent acute respiratory infections cannot be considered a sign of immunodeficiency - they most often reflect a high level of contact with the source of infection. In a group of children, group immunity to a number of pathogens is formed, as evidenced by a high percentage of carriage in the absence of diseases [2]. Active immunization against influenza reduces the incidence of both influenza and acute respiratory infections in general. Carriage of viruses, mycoplasmas and opportunistic bacterial flora of the respiratory tract is an important reservoir of infection, especially in the inter-epidemic period. Frequent morbidity in children is facilitated by the instability of immunity to a number of viruses (RS and parainfluenza), the diversity of sero- and biotypes of pneumotropic bacteria (pneumococci, staphylococci, Haemophilus influenzae), rhino- and adenoviruses, as well as the variability of influenza viruses. The high susceptibility of children with allergies is obviously associated with the predominance of type 2 T-helper cells in them. Difference between viral and bacterial acute respiratory infections Most (90% or more) acute respiratory infections are caused by respiratory viruses and influenza.
Bacterial acute respiratory infections are few in number; unfortunately, it is difficult to distinguish them from viral ones, much less identify the pathogen at the patient’s bedside (there are practically no express methods, and identifying the pathogen does not yet indicate its etiological role; they often grow in the respiratory tract). Therefore, the first contact doctor tends to overestimate the possible role of bacterial flora and prescribe antibiotics more often than necessary. Domestic recommendations [3], as well as most foreign ones [4, 5], indicate that uncomplicated ARVI is characterized by manifestations, the presence of which does not require the prescription of antibiotics. Antibiotics are indicated for children with recurrent otitis media, severe malnutrition, congenital defects, or signs of immunodeficiency. A bacterial infection is obvious or highly likely in the presence of: Syndrome General disorders Respiratory symptoms Rhinitis, nasopharyngitis T below 38 degrees Cough Conjunctivitis T above 38 degrees Less than 3 days Runny nose Tonsillitis (viral) Febrile convulsions Redness of the pharynx Bronchitis, tracheitis Loss of appetite Hoarseness of voice Bronchiolitis Headache Disseminated wheezing Darkening of the sinuses Myalgia Bronchial obstruction Laryngitis, croup Herpes Difficulty breathing swelling of the face or orbital, lymphadenitis, abscess in the pharynx; tonsillitis - streptococcal group A or anaerobic (putrefactive odor); acute otitis media, confirmed otoscopically (or with suppuration); sinusitis - with symptoms on the 10-14th day from the onset of ARVI; pneumonia, pleurisy.
Indirect symptoms of bacterial pneumonia are highly specific - temperature >38 degrees C for 3 days or more; increased respiration rate up to 60 or more per minute in children 0-2 months old, up to 50 or more in children 3-12 months old, up to 40 or more in children 1-3 years old; asymmetry of moist rales and retractions of the compliant areas of the chest, grunting breathing in the absence of bronchial obstruction. For these signs, an antibiotic can be prescribed; if the diagnosis is not confirmed, it should be canceled immediately. Symptomatic treatment of acute respiratory infections acute respiratory infections are not only the most common pathology, but also the main reason for treating children. There are an endless number of drugs and methods for treating acute respiratory infections, most of them, if they have any, have a weak effect, as a rule, not strictly proven; But side effects of these drugs are common. Mild and moderate acute respiratory viral infections, as a rule, do not require treatment; WHO recommends relieving symptoms with “home” remedies [6]. On the other hand, severe forms require emergency treatment, and bacterial acute respiratory infections require antibiotics. The data below corresponds to the main recommendations on this topic issued in different countries and WHO [3-8]. Fever accompanies most acute respiratory infections, which is a protective reaction; reducing its level is not always justified; the use of antipyretics is justified only in the following situations:

previously healthy children over 3 months of age: with a temperature >39.0 degrees C, and/or with discomfort, muscle aches and headaches. children with a history of febrile convulsions, with severe heart and lung diseases, as well as children 0-3 months of life: at a temperature >38-38.5 degrees C.

The safest antipyretic for children is paracetamol, its single dose is 10-15 mg/kg, daily dose is 60 mg/kg. Ibuprofen 5-10 mg/kg per dose is also effective, but it has more side effects than paracetamol. For acute respiratory infections in children, acetylsalicylic acid (Aspirin) is not used due to its connection with the development of Reye's syndrome, metamizole (Analgin) orally (danger of agranulocytosis and collaptoid state), amidopyrine, antipyrine, phenacetin. A course of taking an antipyretic should be avoided, because this can make it difficult to diagnose a bacterial infection and start treatment in a timely manner. A repeat dose should be given only after a new increase in temperature to the above level; simultaneous prescription of an antibiotic and an antipyretic makes it difficult to assess the effectiveness of the latter. For febrile seizures (they are usually short-lived with a good prognosis), an antipyretic is administered. Prolonged (more than 15 minutes), repeated or focal convulsions require the administration of a lytic mixture (or Analgin IM), as well as diazepam (0.5% solution IM or IV 0.1-0.2 mg/kg repeated, maximum 0.6 mg/kg in 8 hours). Laryngeal stenosis (croup) with viral laryngitis most often goes away on its own; Breathing with humidified air is beneficial; administration of 0.6 mg/kg dexamethasone (IV, IM) or inhaled steroid prevents progression. The main goal of treating a runny nose is to improve nasal breathing. Vasoconstrictor drops are used for the first 1-3 days; with longer use, they can worsen a runny nose and also cause side effects. At an early age, due to pain, 0.01% and 0.025% solutions are used. Convenient (after 6 years) nasal sprays, which allow the drug to be evenly distributed at a smaller dose (Fervex spray for the runny nose, Dlynos, Vibrocil). But the most effective way to cleanse the nose and nasopharynx, especially with thick exudate, is saline solution - 2-3 pipettes in each nostril 3-4 times a day - lying on your back with your head hanging down and back. For oral remedies for the common cold, you should use drugs that do not contain sympathomimetics (phenylephrine, pseudoephedrine), for example, Fervex for children. Antihistamines, incl. the second generation, effective for allergic rhinitis, is not recommended by WHO for use in acute respiratory infections [6]. Bronchial obstruction occurs in infants on the 2-4th day of acute respiratory viral infection with a picture of bronchiolitis or obstructive bronchitis.
Urgent measures are required by patients in whom obstruction is accompanied by increased breathing up to 70 per minute or higher, anxiety, tension of the intercostal muscles during exhalation, difficulty in inhaling, central cyanosis, decreased PO2 and increased PCO2. The drugs of choice for relieving severe obstruction are b2-agonists - via a nebulizer or metered dose inhaler (2 doses without a spacer or, better, 4-5 doses through a 0.7-1 L spacer), parenterally or orally. Together with a b-agonist, a corticosteroid can be administered - intramuscularly or inhaled; O2 is given through a nasal catheter or cannulas. The use of aminophylline orally and intramuscularly is less reliable and often causes side effects. Table 1 Therapy of otitis media, sinusitis, tonsillitis ARI Pathogens Antibiotics Otitis media, sinusitis (first episode, did not receive antibiotics) Sensitive: Pneumococcus - 75% H. influenzae acapsular - 20% Streptococcus - 5% Orally amoxicillin, Ospen syrup, macrolide (with allergies to penicillins) Otitis media, sinusitis (repeated episode, previously treated with antibiotics) Probably resistant: Pneumococcus, H. influenzae acapsular, Moraxella catarrhalis, less often staphylococcus, other flora Oral co-amoxiclav, cefuroxime-axetil i.v., i.m. cefuroxime, Ceftriaxone, vaccomycin Tonsillitis Hemolytic streptococcus group AA Amoxicillin, macrolides
In most patients with acute respiratory infections antitussives are not indicated; strictly speaking, the indication for their use is a dry cough, which usually quickly turns into a wet one. Non-narcotic antitussive drugs of central action are used (glaucine, butamirate, oxeladin, etc.). Expectorants are designed to have a cough-stimulating effect similar to an emetic; their effectiveness is questionable; in young children they can cause vomiting, as well as allergic reactions including anaphylaxis. Their purpose is more of a tradition than a necessity; expensive remedies from this group have no advantages over conventional herbal remedies. Among the mucolytics , acetylcysteine ​​and carbocysteine ​​are the most active, but in acute bronchitis in children there is practically no need for their use; They are used mainly for chronic processes. WHO also does not recommend drugs such as bromhexine and ambroxol for children with acute respiratory infections. For long-lasting cough (whooping cough, persistent tracheitis), anti-inflammatory drugs are indicated: fenspiride (Erespal), inhaled steroids, for pharyngitis and nasopharyngitis - local antibiotic fusafyungin, produced in an aerosol (Bioparox) and used both nasally and orally from the age of 30 months . Emollient lozenges and sprays for pharyngitis also have a bactericidal effect; they are used from 6 years of age [9]. Aerosol inhalations of water, saline, etc. are not indicated for acute respiratory infections. Mustard plasters, cupping, and burning patches that are still popular in Russia should not be used in children; in acute respiratory infections there are rarely indications for physiotherapy. Antiviral drugs The choice of antiviral chemotherapy drugs acceptable in pediatric practice is limited; they are indicated only in more severe cases, provided they are used in the first 24-36 hours of illness. For the treatment (and prevention) of influenza A2, a 5-day course of Remantadine is used: children 3-7 years old 1.5 mg/kg/day in 2 doses, 7-10 years old - 50 mg 2 times a day, over 10 years old - 3 times a day day [10]. At an early age, it is used in the form of Algirem (0.2% syrup): in children 1-3 years old, 10 ml, 3-7 years old - 15 ml: 1st day 3 times, 2nd-3rd days - 2 times, 4th – 1 time per day. Arbidol with a similar antiviral effect; is also an interferon inducer. It is prescribed to children 7-10 years old, 100 mg 2 times, over 10 years old - 3 times a day [10]. Both Remantadine and Arbidol reduce the febrile period both in influenza A2 and in mixed infections, and in non-influenza ARVI [11]. Ribavirin in the USA is used for MS viral bronchiolitis in the most severe patients (20 mg/kg/day in an aerosol); due to its high price and side effects, it is practically not used in Europe. The neuraminidase inhibitor oseltamivir - Tamiflu and zanamivir - Relenza shorten the duration of fever by 24-36 hours and have a preventive effect, but there is little experience with their use in Russia. The drugs Florenal 0.5%, oxolinic ointment 1-2%, Bonafton, Lokferon, etc., used locally (in the nose, in the eyes), are indicated, for example, for adenovirus infection, but their effect is difficult to assess. To treat influenza and other acute respiratory viral infections, native leukocyte interferon is used (1000 units/ml - 4-6 times a day in the nose in a total dose of 2 ml on the 1st-2nd day of illness), but it is less effective than. recombinant a-interferon (Reaferon, Grippferon -10,000 units/ml - 5 days, 2 drops 3-4 times a day (single dose 2,000 units, daily 6,000-8,000 units), Viferon (Reaferon + vitamins E and C - rectal suppositories) for influenza and ARVI, 150 thousand IU are prescribed 2 times a day for 5 days [11]. Of the interferon inducers, Amiksin (Teloron) is most often used - at the first symptoms of acute respiratory infection or flu, 250 mg orally after meals for the first 2 days, and then 125 mg per day for another 3-4 days Antibacterial therapy There are few main pathogens of bacterial acute respiratory infections, most often pneumococci, group A hemolytic streptococcus, non-capsular hemophilus influenzae (H. influenzae), less often staphylococcus. Carriage of each of They are observed in 5-50% of children, but during acute respiratory viral infections in the nasal cavity, pharynx and bronchi, a non-invasive multiplication of pneumococcus and Haemophilus influenzae (but not staphylococcus) occurs, which does not affect the clinical manifestations of the disease. protection (flu, ARVI, hypothermia, aspiration of food), the bacterial process develops in usually sterile parts of the respiratory tract - the middle ear, paranasal sinuses, tonsil lacunae, lungs.
H. influenzae type b colonizes the respiratory tract in 3-5% of children; it causes epiglottitis and about 10% of pneumonia complicated by pleurisy in children under 6 years of age [12]. In children who received antibiotics shortly before illness, the inoculation of staphylococci and Moraxella catarrhalis (they are b-lactamase resistant), E. coli, Klebsiella pneumoniae, enterococci, pseudomonas (pseudomonas aeruginosa) increases more often. Mycoplasma pneumoniae causes bronchitis, conjunctivitis, and at school age - up to half of all pneumonia, Chl. pneumoniae - pharyngitis, lymphadenitis, pneumonia [13]. In Russia, 95% of strains of pneumococcus and group A streptococci that are sensitive to penicillin, cephalosporins and macrolides circulate, which makes it possible to use these drugs in the treatment of community-acquired infections. More than 90% of H. influenzae strains are sensitive to amoxicillin, amoxicillin/clavulanate, 2-3 generation cephalosporins, aminoglycosides, chloramphenicol; but of the macrolides, this microorganism retained sensitivity only to azithromycin. But these pathogens have become resistant to co-trimoxazole (Biseptol, Bactrim), which makes it unsuitable for the treatment of acute respiratory infections [14]. Community-acquired strains of staphylococci remain sensitive to oxacillin, protected penicillins, lincomycin, cefazolin, ceftriaxone, Moraxella catarrhalis - to macrolides, protected penicillins, ceftriaxone, aminoglycosides. M. pneumoniae, chlamydia are sensitive to macrolides and tetracyclines. In nosocomial diseases and in previously treated children, the sensitivity of pathogens usually depends on which antibiotic was administered before the disease [12]. For the treatment of acute respiratory infections in children, oral medications are most often used, since community-acquired acute respiratory infections are caused by sensitive flora; first-choice drugs are used as starting drugs, but children previously treated with antibiotics (approximately within 1-2 months before the development of the present process) should select drugs that also effective against resistant strains. Combinations of drugs are used to expand the antibacterial spectrum in the absence of data on the causative agent of severe acute disease. It is extremely important to note signs of the drug's effectiveness in the first 24-48 hours, in the absence of which it is changed. The main sign of the effect is a decrease in temperature below 380; simultaneous administration of an antipyretic with an antibiotic may obscure the signs of ineffectiveness. Consensus recommendations for the treatment of bacterial acute respiratory infections are presented in Tables 1–3 [3]. In the treatment of otitis media, sinusitis, tonsillitis and mild pneumonia, preference is given to penicillins, of which amoxicillin is almost universal. Unfortunately, pediatricians still often use ampicillin, although amoxicillin is absorbed in the intestines much better (capsules, tablets - by 70-75%, syrup and other children's forms - by 80-85%, Flemoxin-Solutab - by 95%), it taken regardless of food intake. In young children, the use of phenoxymethylpenicillin-benzathine (Ospen syrup) is justified. Oxacillin, cephalexin and cefadroxil act on streptococci and staphylococci, but given the rarity of the latter in acute respiratory infections, they have no advantages over oral penicillins. Macrolides are active against intracellular pathogens - mycoplasmas and chlamydia, as well as cocci, but do not act (with the exception of azithromycin) on Haemophilus influenzae, which should be kept in mind when treating acute respiratory infections. Azithromycin, used in short (3-5 days) courses, does not have this drawback. In children over 8 years of age, doxycycline, which is active against pneumococci, mycoplasmas and chlamydia, and H. influenzae, can be used instead of macrolides. Of the 2nd choice drugs, the most reliable are protected penicillins (coamoxiclav) and cefuroxime-axetil. Oral cephalosporins of the 3rd generation are not recommended for acute respiratory infections due to unstable activity against cocci. Duration of treatment for tonsillitis – 10 days, otitis – 7-10 days, sinusitis – 10-14 days; with a smooth course of pneumonia, shorter courses are possible (2 days against a background of normal temperature). Table 2 Therapy of pneumonia in children 1-6 months Age, form Etiology Starting drug Replacement if ineffective 1-6 months, typical (febrile, with infiltrate or focus) E.
coli, other enterobacteria, staphylococcus, less commonly pneumococcus and H. influenzae type b Oral co-amoxiclav, IV, IM ampicillin + oxacillin, or cefazolin + aminoglycoside IV, IM cephalosporin 2-3 generations, lincomycin , vancomycin, carbapenem 1-6 months, atypical (afebrile, diffuse) Chl. trachomatis, less commonly P. Carinii., U. urealyticum, Macrolide Co-trimoxazole Prevention of acute respiratory infections A child cannot help but suffer from acute respiratory infections, but it is important that they do not occur too often and are mild.
In this regard, it is important to fully reduce the contacts of infants and young children, especially during seasons of increased respiratory morbidity: reducing the use of public transport, extending walking time, wearing masks and washing hands by family members with acute respiratory infections. Hardening children, even if it does not completely prevent acute respiratory infections, contributes to their easier progression. Prevention of ARVI with interferon (Grippferon 5 drops 2 times a day for 7-10 days) or Remantadine (the above doses 1 time a day for 10-15 days) is especially indicated for chronically ill patients, children just starting to attend child care institutions, as well as for everyone children during an influenza outbreak. Vaccine prevention of influenza reduces the incidence of not only influenza, but also ARVI; According to our data, during the influenza season, the frequency of ARVI episodes per vaccinated child was 0.69 compared to 0.89 for unvaccinated children [15]. For recurrent acute respiratory infections, bacterial vaccines—lysates or cellular components of capsular microorganisms—are used as immune stimulants. It is unlikely that the effect of these drugs is associated with the formation of antibodies in response to their administration, since we are talking about the prevention, first of all, of ARVI. But they stimulate a more mature Th-1 type immune response, increasing the production of IgA, SigA, the concentration of g-interferon and interleukin-2, including in children with allergic pathology. These are drugs KP-4, IRS-19, Imudon, Ribomunil, Bronchomunal, which can reduce the respiratory morbidity of children by 2-4 times over the next 1-2 years [16-19]. Prevention of bacterial complications with antibiotics, which is sometimes used to justify their unjustified use in acute respiratory viral infections, is ineffective. Moreover, by suppressing the growth of sensitive microflora, they open the way for the colonization of the respiratory tract with resistant flora, increasing by 2.5 times the frequency of complications such as otitis media and pneumonia. Table 3. Therapy of pneumonia in children 6 months - 15 years Age, form Etiology Starting drug Replacement if ineffective 6 months - 15 years, typical uncomplicated (homogeneous) Pneumococcus (+ H. influenzae non-capsular). Oral amoxicillin, Ospen syrup, azithromycin, macrolide (for lactam intolerance). Orally co-amoxiclav, IM, IV cephalosporin I-III generation, penicillin, lincomycin 6-15 years, atypical (non-homogeneous) M. pneumoniae, Chl. pneumoniae Oral azithromycin, macrolide Other macrolides, doxycycline (>8 years) 6 months-15 years, complicated (pleurisy, destruction) Pneumococcus, in children under 5 years old H. influenzae type b, rarely streptococcus IM, IV penicillin, ampicillin, cefazolin . Up to 5 years - cefuroxime, co-amoxiclav IV, IM cephalosporin I-III generation V.K. Tatochenko, Doctor of Medical Sciences, Professor, Honored Scientist. Department of Diagnostics, Research Institute of Pediatrics, Scientific Center for Diagnostics of the Russian Academy of Medical Sciences, Moscow

Signs and diagnosis

The disease begins with an incubation period that lasts an average of 5 days. After this, symptoms characteristic of an acute respiratory disease appear (the whole “package” or only part of the painful manifestations):

• runny nose, sneezing, breathing problems due to nasal congestion;
• cough, sore throat;
• heat;
• mild eye irritation;
• muscle pain and headaches;
• poor appetite, loss of taste;
• lethargy and drowsiness, and sometimes, on the contrary, too much activity.

The little patient feels worst in the first days of the disease. Experts explain this by saying that the pathogenic virus is especially active at this time, it multiplies, and the immune system is not yet ready to give an appropriate response. The duration of symptoms in the youngest children is up to 14 days, in older children - an average of a week.
When making a diagnosis, the pediatrician focuses on the clinical picture of the disease, laboratory data, and also takes into account the general epidemiological situation in the locality where the small patient lives. If necessary, a modern express method can be used for diagnosis, in which laboratory test data already in the first hours of illness provide the doctor with answers to the questions posed.

Symptoms of acute respiratory infections in a child

A cold (common cold) can lead to nasal congestion, followed by a runny nose, sneezing, sore throat and cough. Symptoms of acute respiratory infections in young children can last up to two weeks, while older children, as a rule, are ill for no more than one week, of course there are exceptions.

The first symptom of a cold is usually a sore or irritated throat. Following the first symptom, others follow, which include:

• Nasal congestion - caused by an accumulation of phlegm or mucus;
• Pain and irritation in the nose;
• Sneezing;
• Runny nose (nasal discharge) - the discharge at the beginning of the disease is usually clear, but over time it can become thicker and darker;
• Cough - this symptom manifests itself in 30% of cases;
• Hoarse voice;
• Poor general health.

Less common symptoms of a cold in a child include:

• Increased body temperature (fever) to approximately 38-39 ° C;
• Headache (see Headache in a child);
• Ear pain—severe ear pain may be a sign of a middle ear infection (otitis media);
• Muscle pain;
• Loss of taste and smell;
• Mild eye irritation;
• Feeling of pressure in the ears.

The most unpleasant and severe symptoms of a cold in a child occur in the first 2–3 days of illness, after which a gradual improvement occurs. In older children, colds usually last about a week, but in young children (under 5 years old) colds can last 10 to 14 days. However, if your child has a cough, it may last up to three weeks. If a child develops symptoms of an acute respiratory infection, it is necessary to adhere to special actions in order not only to help him recover, but also not to harm him through incorrect actions.

What is the difference between acute respiratory infections and acute respiratory viral infections?

ARI is the general name for respiratory tract diseases caused by viruses, fungi, bacteria, and in some cases, protozoan pathogens (parasites). The exact pathogen is usually unknown; laboratory tests help identify it.

As for ARVI, the “circle of suspects” is narrowed - the doctor is convinced that he is dealing with a viral infection, and his conclusions can be confirmed by a patient’s blood test. By the way, during seasonal outbreaks of diseases, doctors most often deal with ARVI, since it is viruses that usually become the impetus for the outbreak of epidemics: they quickly increase the number of victims, spreading by airborne droplets.

Causes of acute respiratory infections in a child

Colds are spread through the air (by inhaling viral particles) when there is an infected person nearby who sneezes, coughs, talks, or blows their nose into a tissue. Your child can also catch the virus by touching a contaminated surface that an infected person has touched.

The most common objects from which you can pick up viruses or bacteria include:

• Door handles
• Phones
• Kids toys
• Towels
• Handrails in public transport

According to the National Institute of Allergy and Infectious Diseases, rhinoviruses (which cause the largest number of upper respiratory infections) can live for up to three hours on hard surfaces and hands.

Of the known viruses, most can be classified and divided into several groups:

• Rhinoviruses
• Coronaviruses
• Parainfluenza viruses
• Adenoviruses

There are also some other common culprits that provoke acute respiratory infections, for example, respiratory syncytial virus. Modern science has not yet identified some of the causative agents of acute respiratory infections and scientists are still working on it.

In countries with temperate climates, colds occur most often in autumn and winter. Factors such as the start of the school year for schoolchildren and students play a big role here, and this often occurs due to the fact that children are indoors for long periods of time and are in contact with infected peers and other people. Indoor air is usually drier. This causes the nasal passages to dry out, leading to an increased risk of infection. Humidity levels are generally lower in winter, and bacteria and viruses that cause acute respiratory infections survive better in low humidity conditions.

How to treat the disease?

The first thing to do is to create the necessary comfortable environment for the patient: the room should not be hot (suitable temperature - 20-21 degrees) and too dry (optimal humidity - from 50 to 70 percent). The baby also needs to drink more, since during viral and cold infections the body loses a lot of fluid.

Medications

Prescribing medications is the prerogative of the doctor. Typically, he recommends:

• anti-inflammatory drugs and, if the temperature is very high, antipyretics - Paracetamol, Nurofer (taken after 4 hours, not more often);
• for a runny nose - drops Nazivin, Vibrocil (reducing swelling and making breathing easier), Collargol and Protargol (antibacterial drugs), nasal rinses Humer, Aquamaris or regular saline;
• for cough – Bronchikum lozenges, Ingalipt sprays, Tantum Verde;
• for dry mouth - Humana Electrolyte, Regidron solutions.

It is especially dangerous to give antibiotics to children without a doctor's instructions. As for nasal drops, the dosage is important (it depends on the age of the child) and the duration of treatment (there is a danger of addiction to the drug).

It is also impossible to choose the right cough remedy without the help of a doctor - you need to take into account the type of cough (dry or wet) and the age of the small patient - for children under two years of age, medications that dilute sputum are strictly prohibited, since the baby simply does not yet know how to cough it up.

Folk remedies

Folk remedies can be effective, but their use should also be agreed with a doctor in order to avoid allergic reactions or any other deterioration in the health of a small patient (special care is required when treating infants).

Here are some folk remedies that can be used for acute respiratory infections from cough:

• viburnum berries, ground with granulated sugar;
• black radish juice with honey (honey is placed in a hollow hollowed out in the root vegetable);
• rinsing with water with sea salt or iodine added to it.

If a child with acute respiratory infections has a high temperature, then to relieve the condition, use a solution of propolis in water (ratio - 1:10). Using this liquid, they rub down the little body: do not use a towel, wait until the skin dries itself, and dress the child in clean, dry underwear. Linden tea or chamomile infusion also help fight fever. And as an anti-inflammatory and immune-strengthening remedy, they give the child tea made from rose hips, raspberries or lingonberry leaves.

Treatment in children under one year of age

For children under one year of age, symptoms are relieved with rubbing, baths, enemas, and compresses.
All these procedures are possible if the baby’s temperature does not exceed 38 degrees, when drug treatment is no longer possible. Rubbing is done using Bronchium balm, Doctor MOM ointment, and other pharmaceutical preparations intended for very young children.
Modern medicine does not recommend using a vinegar solution, as was previously the case. Enemas filled with cool water (recommended volume - from 20 to 30 ml), and baths with some healing drug (for example, eucabal balsam) help to alleviate the baby’s condition But drops, elixirs, lozenges and lozenges are not prescribed to the youngest children. Cough syrup can be given to children from the age of six months: Bronchicum, Doctor Theiss, Doctor MOM.

And a couple more tips. To make your baby's breathing easier, you can drop some eucalyptus oil on a napkin and put it in the crib. To cope with a cough, coarse salt is heated in a frying pan, poured onto a diaper, wrapped in several layers and applied to the patient’s chest.

Acute respiratory infections in children

The abbreviation ARZ hides a group of acute respiratory diseases that affect the upper respiratory tract of a person. As a rule, a sharp increase in the number of people falling ill with acute respiratory infections is observed in the off-season, as well as during periods when people tend to concentrate in enclosed spaces with not the most favorable atmospheric conditions (the dry air of offices and apartments heated in winter is an excellent example of such rooms).

A lot of different articles and scientific studies are devoted to the prevention and treatment of acute respiratory infections in adults. In this article, we will talk about acute respiratory infections and acute respiratory viral infections in children, we will tell you about the signs of acute respiratory infections in children, and, in particular, the symptoms of acute respiratory infections in children under one year old, we will consider the main methods of preventing acute respiratory infections in children, we will describe the treatment of acute respiratory infections in infants children and older children, we will analyze whether it is worth using antibiotics for children with acute respiratory infections.

Acute respiratory infections: symptoms in children

As already mentioned, acute respiratory infections and acute respiratory viral infections are diseases of the respiratory tract. The symptoms of these diseases are similar:

• cough;
• runny nose;
• sneezing;
• general weakness;
• headache;
• a sore throat;
• increased body temperature;
• change in behavior – irritability, unstable mood;
• sleep and appetite disturbances.

Despite the fact that the symptoms of acute respiratory viral infections and acute respiratory infections in children are the same, the treatment used is different: for acute respiratory viral infections it is antiviral therapy, and for acute respiratory infections it is antibacterial drugs. At the same time, you need to remember that it is undesirable to immediately prescribe antibiotics for acute respiratory infections, and, of course, it is completely contraindicated to treat the baby yourself, without first consulting a pediatrician.

Acute respiratory infections in children: treatment

Treatment of acute respiratory infections in infants consists, first of all, in creating favorable conditions for the normal functioning of the respiratory system. This means that the air in the children's room should be clean, humid and cool. Too dry, hot air irritates the mucous membranes, provokes a runny nose and cough, and aggravates coughing attacks. At the same time, the baby himself should be dressed warmly (but not too much so that he doesn’t feel hot). Of course, you should not forget about drinking - a lot of warm liquid will help the child’s body cope with the disease faster. But you should not overfeed a sick baby; it is better to slightly reduce the usual amount of food portions. To get rid of a runny nose, it is better to use isotonic solutions rather than vasoconstrictor drops. If your baby’s cough is very severe, the pediatrician will prescribe a drug that effectively relieves it. This takes into account both the age of the baby and the type of cough (dry or wet).

An increase in the child’s body temperature, which worries all mothers, is, on the contrary, a normal phenomenon during acute respiratory infections. As long as the baby's temperature does not exceed 38.5°C, NO means should be given to lower it. A slight increase in body temperature indicates that the body is fighting an infection, but if there is no elevated temperature at all, this is already a bad sign.

To alleviate the baby’s condition at elevated temperatures, you can wipe him with warm water (no vodka, vinegar, or anything else needs to be added to it), often give the baby water (a little at a time), and under no circumstances wrap him up (after all, the baby is already too hot). If your baby wants to play, don’t force him to bed, let him play. The most important thing in the treatment of acute respiratory infections is not to overfeed, give water often, and do not skip bathing (at a temperature, the child sweats, and you should regularly cleanse the skin, wash off dirt and sweat from it).

The choice of medications for the treatment of acute respiratory infections rests entirely with the pediatrician. You cannot prescribe or use medications without medical prescription and supervision.

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Treatment tips from Dr. Komarovsky

Famous pediatrician Evgeny Komarovsky debunks myths that seemed unshakable for many generations of mothers. It was believed that bed rest, warmth in the room and plentiful, even “forced” food were important for the baby’s recovery. According to Komarovsky, if a child is placed in such conditions, his recovery will be delayed.

It is vital for the human body to move; in too warm a room, pathogenic viruses multiply rapidly, and as for eating “for dad, for mom,” too much food eaten leads to the fact that the body’s forces, which could be aimed at fighting Acute respiratory infections are spent on the process of digesting food.

If these problems are solved correctly, there is a high probability that it will be possible to do without medications. It is advisable, for example, to install an air humidifier in the nursery (any kind - ultrasonic or steam), which would evaporate from 3 to 4 liters of water during the day (if the room is very large, then the power of the device should be higher). In a room that is too dry, the mucus that forms in the child’s nose dries out and no longer blocks viruses from entering the body.

Komarovsky, of course, does not completely refuse medications: in his opinion, drugs that reduce pain and help the baby breathe normally should be used. And the necessary prescriptions should be made by the attending physician, and not by mom and dad.

Treatment of acute respiratory infections and acute respiratory viral infections in infants with folk remedies

Acute respiratory diseases (ARI), known as colds, account for more than half of all childhood illnesses. Two thirds of visits to the pediatrician are related to colds. This is due, firstly, to the infectious nature of acute respiratory infections, which can quickly spread in a community, and secondly, to the diversity of disease-causing microorganisms: most acute respiratory infections are caused by viruses. Acute respiratory infections caused by viruses are called acute respiratory viral infections (ARVI). These include influenza, parainfluenza, adenovirus, enterovirus and other infections. In children of the first year of life, colds are caused with equal frequency by influenza viruses, parainfluenza viruses, and adenoviruses.

There is an opinion that newborns and children in the first two to three months of life, especially those who are breastfed, are less susceptible to colds due to the presence of immune protection transmitted by the mother. However, it is necessary to take into account that hereditary and congenital respiratory diseases, unfavorable environmental factors, insufficient child care, violation of feeding regime and rules, and the presence of colds in family members increase the risk of a child’s illness.

It must be remembered that a pregnant woman with ARVI can infect her unborn child, since viruses easily penetrate the placenta to the fetus. Therefore, it is very important to take measures to prevent the development of acute respiratory diseases in pregnant women.

Manifestations of acute respiratory infections in children of the first year of life, regardless of the type of virus, have common features. As a rule, health worsens: anxiety appears, the child cries more often, he loses interest in his surroundings, sleep is disturbed, appetite disappears - all this is due to the development of viral intoxication, swelling of the mucous membrane and nasal congestion, “stuffed” ears and painful sensations in them. The child's temperature rises, often quite significantly. Against this background, lethargy, adynamia, and possible seizures may develop. Frequent signs of acute respiratory infections are rapid breathing (shortness of breath), runny nose, sore throat and chest, sore throat, cough. All these manifestations of colds are due to the fact that viruses penetrate the cells lining the respiratory tract, causing irritation of the mucous membrane and the development of inflammation in different parts of the respiratory tract.

In young children, acute respiratory viral infections, especially influenza, are more severe and more often cause severe complications. There is a very high risk of developing inflammation of the ear (otitis media), maxillary sinuses (sinusitis), inflammation of the bronchi and lungs (bronchitis, pneumonia). These diseases, in turn, determine the formation of a contingent of so-called frequently ill children.

Prevention of ARVI in infants

In order to prevent such complications, it is important to begin proper treatment as early as possible, when the first signs of a cold appear. However, parents’ independent choice of over-the-counter drugs is a big tactical mistake. Only a doctor can correctly assess the child’s condition, make a diagnosis and prescribe the necessary treatment, taking into account the characteristics of infancy, the course of the disease and the effects of recommended medications. Every mother needs to remember that an increase in temperature, a change in the child’s behavior, refusal to eat, or the appearance of signs of a cold are reasons to consult a doctor.

Herbal preparations for the treatment of ARVI in children

After consulting with a doctor, you can begin treating your child with safe and at the same time quite effective measures. These include the use of plant substances (herbal medicines). Pharmacies offer a wide selection of simple herbal preparations made from the herb thermopsis and thyme; ipecac roots, licorice, marshmallow; pine, linden buds; eucalyptus leaves, coltsfoot, plantain, etc. Modern combined herbal preparations are very popular: bronchicum (cough syrup, balm, inhalate, bath extract), “Doctor Theiss” (cough syrup, balm), “Doctor MOM” (cough syrup, ointment), Tussamag (balm , cough syrup) and others. Combined preparations, which include simple plant substances, are more effective, have optimal healing properties and are well tolerated. They can be used in the form of rubbing (rubbing), baths, inhalations, and also taken orally in the form of cough syrup. Dosage forms such as decoctions, drops, elixirs, lozenges, lozenges, capsules are not prescribed to young children.

In addition to the use of medications, there are a number of measures that can alleviate the condition of a sick child. Every mother should be able to carry out this or that procedure at home. First of all, in case of acute respiratory infections, it is necessary to raise the head end of the bed or place a pillow under the child’s head, as regurgitation, increased salivation may occur, and with a cough and runny nose, separation of sputum and mucus from the respiratory tract may occur. With a low head position, there is a risk of aspiration (inhalation) of discharge and the development of suffocation. In addition, an elevated position of the head facilitates breathing that is difficult during a cold. The air in the room should be moderately humid and warm.

Rubbing and compresses for ARVI in children

When the first signs of a cold appear in young children, you can begin treatment with rubbing, medicinal baths and compresses. It must be remembered that these procedures can only be carried out at temperatures below 38 ° C and in the absence of damage and skin diseases. A temperature that does not reach this limit does not require special treatment: it indicates that the body is fighting the infection on its own. At temperatures above 38 °C, non-drug treatments can be used. You need to undress the child for 5-10 minutes and rub him with a solution of vinegar or alcohol diluted in half with water. Small enemas with cool water (20-30 ml) are also effective.

Rubbing the skin of the chest, back, neck, legs and feet can be done using bronchicum balm, Doctor Theiss eucalyptus balm, Doctor MOM ointment, tussamag balm and others. Rubbing into the skin is carried out for 5-7 minutes 2-3 times a day and always at night; at the end of the procedure, the child should be wrapped in flannel or soft wool. Rubbing is recommended for children of any age, starting from birth.

Baths for ARVI in infants

Therapeutic herbal baths are also recommended for children of any age. For children under one year old, the water temperature is recommended to be about 38° C; this temperature must be maintained throughout the entire bath, that is, 10-15 minutes. The required volume of herbal preparation is dissolved in water: bronchicum-bath with thyme (20-30 ml), eucabal-balm (a strip of balm 10-20 cm long is squeezed out of the tube). If necessary, the bath is repeated daily. After the bath, the child should be wrapped up and put to bed. In case of excessive sweating, it is necessary to carefully change the child into warm, dry clothes some time after taking a bath.

Compresses for ARVI in infants

Compresses on the chest are made using any vegetable oil: the child is wrapped in a soft cloth soaked in oil heated in a water bath, after which thin polyethylene is applied, then a cotton or wool pad, and all this is secured to the chest with a bandage or scarf. Compresses are made for a period of at least 2 hours, they can be repeated up to 2-3 times a day.

The therapeutic effect of rubbing, medicinal baths and compresses is due to the content of aromatic (essential) oils in herbal preparations. During the procedure, they freely penetrate through the skin into the blood and lymph and have a healing and calming effect: the child’s general well-being and heart function improve. In addition, when taking herbal baths, aromatic vapors penetrate the respiratory tract, helping to restore normal breathing.

Bronchicum balm, eucalyptus balm "Doctor Theiss", ointment "Doctor MOM", tussamag balm for colds contain eucalyptus, camphor, coniferous (pine) and nutmeg oils. They relieve inflammation, thin mucus, remove obstacles to its elimination, improve breathing, and reduce cough. In addition, when heated to body temperature, essential oils become volatile and have a therapeutic effect also when inhaled. Thanks to the double effect, rubbing in balms and ointments is an emollient for colds.

Inhalations for the treatment of ARVI in an infant

To reduce runny nose and cough, it is advisable to use inhalation - inhalation of vapors of plant substances containing aromatic oils; they enter directly into the respiratory tract, envelop and moisturize them, relieve irritation and cough. For inhalations the following are used: bronchicum inhalate containing aromatic oils of eucalyptus, pine needles, thyme; ointment "Doctor MOM", eucalyptus balm "Doctor Theiss", tussamag balm and other products. For newborns and infants, inhalations are carried out in a special way: using evaporation from an open container (pan) of hot water with a plant substance dissolved in it. In this case, the windows and doors of the kitchen (or other room where an awake or sleeping child is located) must be tightly closed. Proportions of the solution for inhalation: for 2-2.5 liters of hot water, 2-3 teaspoons of balm, inhalation or ointment. The child should stay in this room and inhale the vapors for 1-1.5 hours.

The combination of baths, rubbing and inhalations leads to a speedy recovery. Proper rubbing, baths, compresses and inhalations with herbal substances cannot harm the child’s health. However, these procedures must be coordinated with your doctor, just like taking cough syrups orally.

Herbal cough syrups for infants

Herbal cough syrups are prescribed to infants from 6 months. Syrups must be shaken before use. They should be stored in a dark, cool place. Here are the characteristics of some syrups:

Bronchicum is a cough syrup (contains thyme, rose hips, honey and other substances), administered orally 0.5 teaspoon 2-4 times a day. It is undesirable to use syrup in the first months of life, since it contains honey. When taking bronchicum syrup on the 3-5th day, the cough softens and becomes less frequent.

"Doctor Theiss" - syrup with plantain for cough, applied orally 0.5 teaspoon every 2-3 hours (with a night break). Recommended for use when coughing with difficulty releasing sputum.

“Doctor MOM” is a herbal cough syrup (contains licorice, basil, saffron), applied orally 0.5-1 teaspoon 3 times a day. It is especially recommended for sore, irritable, convulsive cough.

Tussamag - cough syrup (contains thyme extract), used from 9-12 months, 0.5-1 teaspoon 3 times a day. Especially indicated for dry cough.

All herbal substances are used at home as prescribed by a doctor and only for the treatment of mild colds in young children. Severe ARVI and suspected complications require hospital treatment.

What is not recommended to do?

It is impossible to lower the temperature until it exceeds 38 degrees in children who are under two months old, and 38.5 in older children.
A high temperature means that the body is fighting viruses, and this process should not be disrupted. Of course, there are exceptions to the general rule - for example, congenital diseases or the danger of seizures, which the doctor and parents should be aware of. In these cases, reducing the temperature is necessary.

It is forbidden to give antibiotics to a child unless the pediatrician has made the appropriate prescriptions. Warming compresses are prohibited if the baby’s temperature is elevated. They will only complicate the situation and may cause respiratory arrest. You should also not do steam inhalation: for a child this is a very risky procedure that can result in a burn to the mucous membranes.

It is very dangerous to overheat a baby by wrapping him in warm clothes at home: his body temperature is already above normal, and we are aggravating the situation with the “greenhouse effect.” For the same reason, it is advisable to remove diapers from the baby - this will make it easier for the body to cope with excess heat and regulate heat exchange processes.

Orz in a baby: treatment

The younger the child, the more susceptible he is to various diseases. Most often, young children suffer from colds. Treatment of acute respiratory infections in infants requires special attention and is never carried out independently, only under the supervision of a pediatrician.

How to get rid of a runny nose?

A runny nose is the most common symptom of respiratory diseases. Occurs in case of damage to the upper respiratory tract.

When treating a runny nose in a baby, you need to follow the pediatrician's prescriptions. Under no circumstances should you use dubious folk recipes. For example, putting breast milk in your nose.

Milk is very nutritious and is an excellent breeding ground for pathogenic microorganisms. In addition, when it dries out in the nose, it makes breathing difficult.

Therefore, if parents want to protect their child from complications (most often otitis media develops), it is unacceptable to use any traditional medicine recipes without a doctor’s permission.

It is very important to clean the nasal passages of babies. The procedure is very unpleasant; newborn babies need to be swaddled tightly before it is performed.

To soften and remove mucus, you need to drip your nose with saline or saline solution (sold in pharmacies). After 2-3 minutes, the mucus is sucked out using an aspirator. Young mothers who have no experience in carrying out such a procedure can ask their pediatrician to show them how to do it correctly.

After cleaning the nose, medications are used. Your doctor will tell you what drops you will need. As a rule, antiviral drugs are used at the onset of the disease. Silver-based drops are very effective; they not only disinfect, but also dry out the mucous membrane, which significantly reduces the amount of discharge.

If there is a significant accumulation of mucus, which makes breathing difficult, vasoconstrictor drops are prescribed. The product reduces swelling, which allows the baby to breathe calmly. It is best to use them before feeding or bedtime, but no more than 3 times a day. This ensures good breastfeeding and falling asleep without whims.

It is worth remembering that vasoconstrictor drugs are not used, especially when treating infants, for longer than 7 days. Otherwise, side effects from the nervous and cardiovascular systems may occur.

In case of severe swelling of the mucous membrane, the pediatrician may prescribe antiallergic drugs. They have anti-edematous properties.

Cough in infants

Cough during acute respiratory infections in infants can be caused by several reasons:

• damage to the lower respiratory tract;
• flow of mucus from the nasal passages into the throat;
• throat irritation.

In case of damage to the lower respiratory tract (for example, bronchi), it is necessary to ensure the fastest possible removal of sputum. For this purpose, thinning and expectorant drugs, as well as anti-inflammatory drugs, are prescribed. If stagnation of sputum leads to inflammation, antibiotics will be required.

You can alleviate the baby's condition with massage. As a rule, stroking and light tapping on the back are used.

In the case of a dry cough caused by throat irritation, medications are not prescribed to infants. Plenty of warm drinks and moist air are recommended.

Cough treatment is carried out only with drugs and massage. Procedures such as mustard plasters, baths and rubbing are not used, since heating increases blood flow, which causes even greater swelling.

In addition, menthol and essential oils are added to many balms and ointments. These drugs can cause not only an allergic reaction, but also bronchospasm.

Of course, there are balms for children under one year old, but they can only be used as prescribed by a doctor and only at normal body temperature.

Treatment of cough in infants with folk remedies is unacceptable.

Only a doctor knows how and how to treat a baby so as not to harm his health.

How to reduce the temperature?

Acute respiratory disease is usually accompanied by an increase in body temperature. It is not always a fever that requires medication. In some cases, the temperature barely breaks 37 ºС. Then the only thing that is required from parents is to give the baby as much water as possible. Solutions with glucose are highly effective.

If the child is red, restless and hot, the treatment is supplemented by wiping. Particular attention should be paid to areas with folds to prevent irritation (heat rash).

But you need to remember that only water at room temperature is used for rubbing. Under no circumstances should you add alcohol, vinegar or other substances to it. This will speed up the evaporation of moisture from the baby’s skin, and the temperature will drop faster, but there is also a high probability of intoxication of the body. The skin of children absorbs everything that comes in contact with them; such treatment will do much more harm than good.

At high temperatures, you need to change the child into light, loose clothing. But not in the case of pale fever. Its symptoms:

• chills (baby is shaking);
• pale skin;
• cold extremities (the temperature can be very high).

Treatment of pale fever is aimed at warming the baby. Hands and feet become cold due to vasoconstriction. To restore blood circulation, you should rub them with a towel or with your own hands, then put on warm socks, mittens and give an antipyretic. Symptoms should disappear after 30-60 minutes; if this does not happen, you must call an ambulance.

For children, antipyretic drugs based on ibuprofen or paracetamol in the form of syrup and suppositories are used. If the temperature is accompanied by vomiting, suppositories will be more effective.

It is recommended not to lower the temperature to 38 degrees if the child is not prone to the following complications:

• convulsions;
• vomit;
• loss of consciousness;
• pale fever.

These children even have their minimum temperature reduced.

It is important to maintain a comfortable temperature (20-23 ºС) and high air humidity (70%) in the room. It is worth giving up walking and swimming for 2-3 days. It is necessary to ventilate the room as often as possible. If your baby's appetite is reduced, there is no need to insist; it is better to drink more water.

Source: https://elaxsir.ru/zabolevaniya/gripp-i-prostuda/bezopasnoe-lechenie-orz-u-grudnichka.html

Preventive measures

To prevent acute respiratory infections and acute respiratory viral infections in children, it is necessary:

• accustom the child to hygiene, especially to washing hands after going outside;
• ventilate the nursery and regularly do wet cleaning;
• feed the baby a variety of fortified foods;
• strengthen the child’s body with daily physical education;
• dress the baby according to the weather, do not bundle it up unnecessarily;
• during mass flu illnesses, avoid visiting crowded places, and especially contacts with sick people;
• in the summer - do not allow your child to stay near a fan or air conditioner for a long time, since you can catch a cold even at home.