Wet cough in a child: methods of treating cough with sputum

Why does a child cough?

During inflammatory processes, an increased amount of mucus appears in the bronchi and lungs. The accumulation of mucus and inflammation causes irritation of sensitive receptors in the respiratory tract (pharynx, trachea, larynx, bronchi) and pleura. And then the body tries to get rid of the irritation through coughing exhalation.

Excessive mucus production can be caused by viruses, bacteria or allergens. That is, the two most common causes are an infection or an allergic reaction.

With the infectious nature of the disease, in addition to a wet cough, other symptoms are present: acute onset of the disease, runny nose, fever. If the general condition is slightly disturbed, and the main problem is a prolonged wet cough in a child without fever, then there is a high probability that the disease is of allergic origin.

Symptoms may also have a reflex origin, when the source of irritation is outside the respiratory tract, for example, polluted air. A rare but possible cause is emotional stress or anxiety.

The process itself goes like this:

first the person takes a deep breath;
the respiratory muscles then tense, creating high pressure in the chest cavity;
a jerky strong exhalation occurs with a characteristic sound through a narrowed glottis;
as a result, a stream of air removes mucus or a foreign body from the respiratory tract.

There are the following types of cough:

depending on the presence of sputum, it can be wet or dry;
in duration it can be paroxysmal, as with whooping cough), short and continuous with pleurisy; periodic (with bronchitis).

Reasons why wet cough occurs in children

There are two types of cough: dry and wet, with the second one producing sputum. In some cases it gives the child relief, in others - suffering. According to the degree of development, it is divided into acute, protracted and chronic forms. In the acute form, the cough goes away within three weeks. If it lasts up to three months, this is the second form of the disease. After this, the third stage of the disease begins.

If your child coughs constantly, including at night, you should immediately consult a doctor. He will determine the cause of its occurrence and prescribe treatment. The reasons may be:

Cold or acute respiratory infection. A wet cough in a child without fever is the first sign that the baby has a cold. With acute respiratory infections, symptoms such as a sore throat or runny nose disappear within a few days. The cough remains for a long time. In this case, there will be no temperature.
Development of ENT infections. In this case, discharge from sinusitis or rhinitis can enter the respiratory tract and provoke a cough. In this case, there will be no temperature either.
With tuberculosis, the first symptom will be a wet cough in a child without fever.
Bronchitis, pneumonia, and lung abscess are accompanied by a wet cough during the recovery process.
Allergy. During any illness, an allergic reaction may occur to medications. It can be accompanied by both dry and wet coughs. At this time, other symptoms also appear, such as wheezing and difficulty breathing.
With whooping cough, children may continue to cough without fever. He is most annoying at night. Doctors explain this phenomenon as psychological. Since the illness has already passed, and the child subconsciously continues to cough.
When a child has worms, they move throughout all internal organs and the respiratory tract is no exception. At the same time, the lungs and bronchi are teased and secrete mucus. In this case, a cough with sputum without fever appears. This illness is often mistaken for a cold. But at the same time, the symptom can appear suddenly or disappear suddenly. It depends on the activity of the worm.
Due to nervous tension, a cough without fever often occurs. In this case, it torments throughout the entire time during active games. During rest, he retreats.
The air in the room is very dry. This is also the cause of cough.
Allergic reaction to household chemicals. Often children are allergic to various types of powders and detergents.
Foreign body in the bronchi. If a child swallows a foreign object and it enters the respiratory tract. In this case, a cough also occurs, with the help of which the body tries to push this body out of the passages.

Physiological reasons

Children cough for various reasons, which can be grouped into two large groups: physiological and pathological.

A physiological cough is a completely normal and correct phenomenon. Thanks to it, the airways are cleared of foreign bodies or sputum. As a rule, coughing is short-term, periodically repeated; There are no other symptoms of illness. The physiological cause of breathing problems is the properties of the surrounding air. Too much dust, dryness, pollution provoke a constant need to cough.

You can also cough when you have a runny nose, when some of the nasal discharge gets into the throat. Subsequently, mucus accumulates in the respiratory tract, and the body gets rid of it by “coughing up.”

Causes

A productive (wet) cough along with a runny nose without fever can appear for several reasons. Very often, it is caused by a runny nose, or rather mucus that flows down the back wall of the nasopharynx, irritates the nasopharynx and respiratory tract, thereby causing a wet cough. In such situations, primary treatment should be aimed at treating rhinitis, which can also be caused by a viral, bacterial infection or an allergic reaction.

A cough with phlegm, runny nose, but without fever, may indicate the presence of a cold. In addition, such symptoms are often present with bronchitis, bronchial asthma and other diseases of the nasopharynx or respiratory system.

If there is no runny nose or fever, but a wet cough is present, perhaps the cause is the child being kept in a dry or dusty room, where dry air irritates the mucous membrane of the throat, causing soreness and other symptoms.

Pathological causes that cause such symptoms include gastroesophageal reflux, when gastric juice is released into the esophagus, which irritates the mucous membranes, thereby causing a cough.

Another cause of wet cough and runny nose in children can be the period of teething, when excessive production of saliva occurs and it enters the respiratory system.

Based on the reasons considered, we can conclude that a runny nose and wet cough without fever can appear for several reasons, and treatment is not always required. A doctor will be able to identify the factor that provoked these symptoms, while parents should monitor the child’s condition and see if there are other symptoms indicating a particular disease.

Pathology – when to sound the alarm

A strong wet cough in a child is always a sign of acute inflammation, a signal that the inflammatory process is developing in the bronchi, and possibly even lower - in the bronchioles, alveoli and lungs. Coughing sounds may appear as a symptom of the following diseases:

childhood bronchitis;
pneumonia;
tuberculosis;
bronchospasm (narrowing of the bronchi), for example, with asthma;
diseases of the upper respiratory tract, such as laryngitis in children;
inflammatory processes in the lungs and bronchi;
allergies;
a prolonged paroxysmal cough ending in vomiting and redness of the face is often a sign of childhood whooping cough.

One of the most common causes is bronchitis: inflammation of the lower respiratory tract, accompanied by damage to the bronchi. Children's bronchitis is divided into several types, and each has different symptoms:

Acute bronchitis begins with signs of a viral infection: discomfort in the throat, coughing, runny nose. Then the cough becomes dry and obsessive, and by the 7th day of the disease it becomes soft, with the separation of mucous sputum. During an attack, pain occurs in the chest, and shortness of breath is typical for children. With proper treatment, recovery occurs within 10-14 days.
From 2-3 years of age, obstructive bronchitis may occur, and the child develops a paroxysmal wet cough without fever. Breathing is noisy and whistling, exhalation is prolonged, wheezing is heard. As a complication, respiratory failure may occur.

Allergic bronchitis is characterized by relapses and is often combined with conjunctivitis, skin rashes and asthma. During an exacerbation, weakness, sweating, and an allergic cough with mucous sputum occur. The temperature does not rise.
Chronic bronchitis worsens 2-3 times a year, the baby practically coughs constantly; only during remission it is a dry cough, and during an exacerbation it is a wet cough. During an exacerbation, mucus is coughed up with difficulty, has a purulent or mucopurulent character, and the temperature is constantly slightly elevated.

Symptoms of a wet cough in a child

The fact that a child has a wet cough is indicated by the sputum produced, the suddenness and duration of attacks, wheezing, chest pain, general malaise, and often an increase in temperature. Sputum may be difficult or easy to separate. The more difficult it is to separate the sputum, the more severe the child’s general condition. The sooner sputum discharge is achieved, the faster recovery will occur.

The volume of mucus discharge, its consistency and color indicate the degree of the inflammatory process. It can be light at the beginning of the disease or in mild conditions, serous, purulent or bloody when the process worsens.

The presence of pus indicates the active functioning of the immune system, when lymphocytes absorb pathogenic microbes, forming colonies of macrophages, that is, pus.

By the nature of the moisture released when coughing, you can determine the causes of cough:

thin, watery discharge in moderate quantities: inflammation of the upper respiratory tract (with acute respiratory infections, acute respiratory viral infections);
copious sputum: bronchitis, tracheitis;
viscous glassy consistency: bronchial asthma;
rust-colored mucus: pneumonia;
sputum with blood; tuberculosis, heart failure. You should not be afraid of occasional streaks of blood in the sputum - this often happens with a strong cough, when small vessels are torn;
sputum with pus, with a fetid odor: lung abscess.

How does a wet cough manifest?

When coughing wetly, wheezing, bubbling, and gurgling are heard in the chest. Periodically, during attacks, clots of mucous sputum are released.

The sound of coughing itself comes from inside the chest and is localized in the area of the bronchi or lungs. A wet cough can also be unproductive, just like a dry cough. This happens if the mucus in the respiratory tract is too viscous. In this case, the amount of mucous discharge is insignificant. However, usually more mucus is coughed up as the disease progresses. The attacks are not debilitating; after the sputum is discharged, temporary relief occurs.

Causes

Pathological causes that cause such symptoms include gastroesophageal reflux, when gastric juice is released into the esophagus, which irritates the mucous membranes, thereby causing a cough.

Another cause of wet cough and runny nose in children can be the period of teething, when excessive production of saliva occurs and it enters the respiratory system.

Diagnosis and treatment

First of all, if parents have any signs of concern, they should contact their pediatrician. To clarify treatment, an examination by a pulmonologist and phthisiatrician may be prescribed. The task of parents during a visit to the doctor is to talk about all previous circumstances and features. When a child develops a wet cough, the doctor must decide how to treat it. And independent use of drugs is fraught with complications.

If a child has a strong wet cough due to the accumulation of mucus in the respiratory organs, then it is necessary to treat the root cause, and not the consequence. After all, constant coughing actually helps get rid of excess phlegm. If it is muffled by some means, then, accumulating in the lungs, mucus will create a beneficial environment for bacteria and the development of inflammation. Namely, this is what will happen if, without understanding the reasons, parents begin to treat with antitussives.

The same applies to expectorants. Necessary for dry forms, with a wet cough, on the contrary, they increase the amount of mucus, provoking even greater irritation.

Important! The main goal of therapy is not so much to treat as to relieve cough, to make sputum liquid so that the child can easily get rid of it.

If the sputum is liquid, then it is coughed up virtually in one go. But the thickened one coughs out for a long time and painfully.

There are three main groups of drugs:

Antitussives that relieve attacks.
Expectorants, which, on the contrary, help cough.
Mucolytics to thin and remove mucus.

The first group of drugs is used for “dry cough in a child,” when the attack is not productive in nature, but only irritates the receptors and the cough center. This happens with polluted dry air, allergies, whooping cough. The need to treat children with antitussives is very rare, and their independent use is extremely dangerous. Due to suppression of the cough reflex, bronchial drainage may worsen and respiratory failure may worsen.

The mechanism of action of the means of the second group is the dilution of sputum, transforming the process from unproductive to productive. Safe expectorants include:

herbal preparations;
tinctures;
herbal syrups.

For the expectorant effect, marshmallow root, licorice, plantain leaves, pertussin, broncholithin, and thyme are most often used. They treat symptoms of colds, bronchitis, and pneumonia.

Important! Antitussives and expectorants should not be used at the same time. This leads to blockage of the bronchi with mucus, breathing problems and secondary infection.

Mucolytics - drugs from the third group, thin sputum without blocking the cough reflex. This group includes: ambroxol, bromhexine, gedelix, broncholithin, acetylcysteine.

Course of the disease

A cough with sputum in a child with acute inflammation indicates resolution of the pathological process. In the chronic course of the disease, the appearance of a wet cough indicates an exacerbation of the process.

Depending on the course of the disease:

acute (up to 3 weeks);
subacute (3-8 weeks);
chronic (3-8 weeks or more).

Cough in children often occurs hidden due to the physiological age-related inability to cough up sputum. Young children (2 years or less) cannot cough. Cough discharge in a child aged 1-5 years is more difficult to separate than in older children. Sputum is characterized by increased viscosity and weak adhesive ability.

If bronchospasm is caused by hypothermia, the disease, as a rule, has an acute course and can resolve without specific treatment. A complicated process provoked by pathogenic microflora lasts about a month, proceeds subacutely or becomes chronic.

Synthetic medicines for wet coughs for children

A doctor should prescribe antitussive drugs after the cause of the disease has been determined. When choosing, the doctor takes into account the effect of cough on the baby’s general condition, its intensity, productivity, duration, and the presence or absence of bronchospasm. After all, if treated incorrectly, then instead of recovery, you can cause more harm to your health.

The drug selection algorithm is as follows:

Synthetic expectorants are based on sodium bicarbonate or semi-synthetic extracts (for example, guaiac tree resin). Mucolytic drugs are taken to cleanse the lumen of the bronchi, liquefy and better cough up mucus. These include bromhexine, acetylcysteine, trypsin, ambroxol.

When treating ARVI, combined antitussive drugs are indicated: Dr. Mom, Travisil. They simultaneously liquefy the mucous contents, relieve inflammation, and have an antimicrobial effect.

Combination drugs with ephedrine, such as broncholitin and solutan, are “drying” medicines for wet coughs for children.

"Stomach cough"

If a child has a strong productive cough mainly in the morning, and his nasopharynx is clear, a consultation with a gastroenterologist may be required. This symptom, combined with belching, can warn of problems with the digestive tract, scientifically called reflux esophagitis. If the muscle that separates the esophagus from the stomach does not work properly, then when the child lies down, the contents of the stomach return down the esophagus into the pharynx and cause involuntary expectoration.

Up to contents

Traditional methods of treatment

Probably the most famous folk treatment method is steam inhalation. When inhaling medicinal vapors, there is a direct effect on the mucous membrane of the respiratory tract and nerve endings. Inhalation reduces bronchospasm, thins mucus and eases coughing attacks.

The inhalation method is effective for diseases of the upper respiratory tract: rhinitis, laryngitis, tonsillitis. At the same time, it is absolutely not necessary to add any active substance to the hot steam, for example, essential oil or soda. To intensively moisturize the respiratory tract, just warm steam is quite enough.

During the procedure, observe the following measures:

This method can be treated no earlier than the age of five;
inhalations are carried out with warm, not hot steam, with a water temperature of 40-50 degrees;
duration of inhalation – up to 5 minutes, 1-2 times a day.

You can treat babies using a compression inhaler - nebulizer. This is a special device with a mask that produces an aerosol cloud of small particles of a medicinal substance. The inhalation time is 5-7 minutes; you can pour medicines directly into the inhaler, for example, Prospan syrup. The nebulizer has proven itself well for bronchial asthma, pneumonia and bronchitis.

How to treat a wet cough in a child? Causes and treatment of wet cough

A cough is not always a symptom of any disease. This may be a simple defensive reaction to a foreign body or dust entering the respiratory tract. But if a child suffers from a debilitating cough for several days, parents should sound the alarm. A symptom of a viral disease can be a wet cough, which is characterized by the release of special mucus from the respiratory tract - sputum.

When is a cough considered normal?

During the life of a healthy person, including a child, mucus accumulates in the larynx. It is through coughing that the body removes it. An absolutely healthy baby can cough up to 10 times a day. This is especially true for infants who may choke on milk. A cough may also accompany teething. At this time, the baby produces a large amount of saliva.

If a completely healthy child begins to cough sharply and cannot stop, this may indicate that a foreign object has entered the respiratory tract. This situation is quite dangerous for the baby’s life and requires immediate intervention from a specialist. If a child develops a strong wet cough, it can be treated at home, following all the pediatrician’s recommendations.

Alarm bells

A cough caused by a viral infection should under no circumstances be neglected. Complications may arise that will require longer and more expensive treatment. Parents are advised to immediately go to the doctor if the baby has a fever and refuses to eat. Most viral infections are accompanied by an increase in body temperature. If it lasts more than a day and does not go astray, the doctor will suggest going to the hospital. Under round-the-clock supervision, the child will be able to recover much faster.

Wheezing during coughing attacks is also considered a bad sign. It is no coincidence that the pediatrician listens to the child first at the appointment. If inflammation is suspected, the pediatrician will prescribe an additional examination. An x-ray will help determine the presence of an inflammatory process.

You should consult a therapist as soon as possible if your child has a long, wet cough that prevents him from falling asleep or if there is blood in the sputum. Chest pain can also be a symptom of incipient inflammation.

Why does a wet cough start?

Before you understand how to cure a child’s wet cough, it is worth understanding its nature. In most cases, such a cough is a consequence of an infectious disease of the respiratory system. The production of bronchial secretions, which irritates the mucous membrane, increases significantly.

Diseases such as tuberculosis, lung abscess, and pneumonia in remission are considered serious causes of wet cough. Therefore, it is impossible to leave a child’s cough unattended. Especially if it continues for a long time and no positive dynamics are observed.

The causes of a wet cough in an infant may also be associated with a runny nose. When lying down, mucus from the nose can enter the larynx, causing a cough. In this case, treatment will be aimed at removing mucus and using vasoconstrictor drugs.

Sputum examination

The nature and nature of the disease can be determined by sputum tests. Thus, abundant sputum indicates the presence of tracheitis or bronchitis in the child. Pneumonia is accompanied by rust-colored sputum. In bronchial asthma, viscous translucent sputum is observed. The most dangerous symptom is sputum mixed with blood and pus. This situation can occur with advanced tuberculosis or lung abscess.

The doctor can conduct a mucus examination if the diagnosis of the disease becomes more complicated. Laboratory analysis helps to quickly identify the cause of cough and prescribe the correct treatment.

Treatment of wet cough in children

A wet cough in a child requires a special approach. The fact is that sputum in children is much more difficult to clear than in adults. This is due to the fact that the muscles that should push out mucus are not yet fully developed. Under no circumstances should mucus be allowed to remain in the respiratory tract for a long time. A wet cough or fever in a child may indicate the development of an infectious disease. Sputum is an ideal environment for the rapid proliferation of bacteria.

The doctor will first of all suggest to ease the discharge of sputum with the help of medication. Mucolytic agents are used that promote mucus formation. The sputum becomes less viscous and leaves the child’s respiratory tract faster. All expectorants for children are divided into herbal and synthetic preparations. They are practically the same in terms of efficiency. But medicines of natural origin are less harmful to children's health.

Parents should never treat their child themselves. A huge mistake would be the use of antitussive drugs. A pediatrician should prescribe syrup for children with a wet cough. Incorrect drug treatment will contribute to the deposition of mucus on the walls of the respiratory tract and the occurrence of complications.

Cough in a baby

Most drugs that promote sputum removal are intended for children older than one year. The question arises: “How to treat a wet cough in a child if the baby is still so small?” Breast milk is an excellent assistant in this matter. It not only helps thin mucus, but also strengthens the baby's immune system.

A light massage using warming balms has a positive effect. Ointments such as “Doctor Mom”, “Lazolvan” and “Evkabal” are popular. But they should be used strictly as prescribed by the pediatrician. The specialist will show you how to properly rub your back and chest to quickly overcome a wet cough. A child's temperature is a contraindication for the use of warming balms. You must definitely remember this.

Inhalation

Treatment of wet cough in children is not limited to the use of medications alone. Inhalations using saline and medicinal herbs help to overcome the disease perfectly. This method is the most gentle and safe for children's health. The only problem is that only a child over five years old can do inhalation correctly.

Inhalations for a child with a wet cough can be done at home. An ordinary saucepan is suitable for this procedure. Water is boiled in it with the addition of medicinal herbs. You need to breathe hot steam for at least ten minutes.

It is safer and easier to carry out inhalations using a nebulizer. Domestic pharmacies offer two types of devices – ultrasonic and compression. The former are much more popular. They operate almost silently and are small in size.

Folk remedies

At the beginning of the last century, only a few could afford drug treatment. At the same time, a wet cough in a child was considered quite common. Our grandmothers knew how to treat it. Folk remedies today cannot replace medicines from the pharmacy, but they will contribute to a speedy recovery.

Drinking plenty of warm water improves the effect of expectorants. It’s good if it’s not just tea or cocoa, but a drink made from medicinal herbs. Chamomile tea or a hot blackcurrant drink has a healing effect. If a child has a wet cough, every mother should know how to treat it. Warm milk with honey is considered an irreplaceable remedy. The vitamins and microelements contained in honey strengthen the immune system and contribute to the baby’s rapid recovery.

Let's go outside

The key to successful recovery is not only the correct use of medications, but also adherence to a daily routine. Walking in the fresh air will help you overcome your cough faster. An illness is not a reason to stay indoors. The only contraindication is elevated body temperature.

“How to treat a wet cough in a child?” - It’s better to ask your pediatrician this question. If the baby feels well, you should go to the children's clinic on foot.

During illness, it is worth protecting the baby from communicating with peers. A walk should be beneficial for both the child and those around him. It is worth remembering that coughing contributes to the spread of infection.

fb.ru⁪>

Adviсe

There are several tips that will help in treating wet cough in children:

Clean, cool and moist air in the room facilitates the breathing process, thins mucus and helps in treatment. The optimal temperature is from 20 to 26 degrees, and humidity is in the range of 50-65%. In this case, the child must be sufficiently dressed so as not to freeze.
The thickness of mucous secretions directly depends on the thickness of the blood. To keep the blood liquid, make sure you drink plenty of liquid (compote, warm tea, water). The total daily volume, depending on age, should be 1.5-2.5 liters.

Quiet walks in the fresh air are great for clearing your lungs and bronchi.
To prevent mucous secretions from flowing into the nasopharynx during a runny nose and irritating the receptors, it is recommended to rinse the nose with saline solution or use children's nasal sprays.
If a child has a cough with sputum without fever, then the basic treatment will be to create the right conditions for recovery. Humidifying the air, ventilating the room and drinking frequently are the main therapeutic measures to prevent excess mucus accumulation.

At normal temperatures, to facilitate expectoration, you can give a special percussion massage to the child when coughing to expel sputum. The massage consists of tapping, patting and rubbing movements in the chest area. Additional rubbing with herbal balms, such as Doctor Mom and others, increases the effectiveness of the massage.

Etiology and pathogenesis

Cough is one of the most common symptoms observed in children. This is a complex protective reaction of the body aimed at removing bronchial secretions, foreign particles, microorganisms from the lungs and bronchi. Thanks to coughing, the patency of the respiratory system is restored.

A wet cough is called productive. Such bronchospasm is accompanied by the formation of bronchial secretions and its subsequent removal.

More often, an unpleasant symptom occurs in the cold season; summer and spring are quite favorable periods. The occurrence of a wet cough (without symptoms of flu or ARVI) in the summer is associated with the effect of an allergen on the body during the flowering of certain plants. Hereditary predisposition plays an important role in this.

Exposure to an allergen causes swelling of the mucous membrane of the respiratory tract, which makes it difficult to secrete secretions. A lot of mucus accumulates in the bronchi and a cough occurs. Eliminating the allergen allows you to get rid of cough without the use of mucolytics and antibacterial agents.

Important! Cough is a protective reaction of the body. Its appearance is the first signal for parents about the presence of a pathological process in the child’s body.

Frequent causes of wet cough are acute respiratory infections with localization of the inflammatory process in the lower (larynx, trachea, bronchi and lungs) and upper (nasopharynx, oropharynx) parts.

Causes of wet cough:

acute and chronic bronchitis;
pneumonia;
bronchial asthma;
foreign body in the respiratory tract;
bronchiectasis;
lung abscess;
tuberculosis;
allergy.

A wet cough is the first sign of respiratory system diseases caused by pathogenic microflora. Accompanied by an increase in the formation of bronchial mucus. The accumulation of viscous secretion in the lumen of the bronchi provokes the addition of bacterial microflora and complication of the inflammatory process. The mucous membrane swells and the motor activity of the ciliated epithelium decreases, which complicates the removal of secretions from the bronchial lumen. When sputum accumulates, a favorable environment is created for the reproduction and development of pathogenic microflora, which is impossible with productive coughing.

In children aged 2-4 months, the cough reflex is very weak, which aggravates the course of the disease, accompanied by the formation of sputum. The situation has been improving since six months.

The occurrence of bronchospasms is often preceded by rhinitis and tonsillitis. The secreted mucus irritates the mucous membrane of the upper respiratory tract when it flows into the throat, which provokes a cough reflex. A severe attack occurs in the morning and evening, especially when changing body position.

Cough is caused by:

hypothermia;
decreased immune status;
stress factors (attending preschool and school educational institutions);
contact with sick children in a children's group;
communication with sick family members;
malnutrition;
violation of the indoor microclimate;
lack of walks in the fresh air.

The course and resolution of the inflammatory process depends on the characteristics of the bronchial secretion: viscosity, elasticity and fluidity or adhesiveness (the ability of mucus to separate during a cough impulse).

Prevention Tips

A good preventative measure would be hardening procedures: water and air. Make sure your baby doesn't overheat. Walking barefoot also has a hardening effect. In the summer, allow them to run on the grass and sand, and in the cold season, you can moisten a towel with a solution of water and salt (1 tablespoon per 1 liter) and let them walk on the damp towel. Then you need to rub your feet. Impact on the areas of the feet activates the immune system.

Good health requires proper nutrition, and in late winter - early spring you may need to take multivitamins.