WHY IN THE WORLD DO YOUNG CHILDREN GET SICK SO OFTEN?
Why in the world do young children get sick so often? This is such a frustrating problem for so many parents. Aside from the fact that parents have to miss a lot of work, there is a significant amount of misery for children when it happens again and again. Some kids are sick so frequently that it seems like their “normal” is to have a runny nose, and things are abnormal when they are well! We joke that some families should have a “frequent flier” plan, since I see them so often.
A child’s immune system is a blank slate at birth. From that point onward, the immune system has to learn from experience, and over time it will become stronger and more capable of fighting off infections. Fortunately, the mother’s immune system can offer a
lot of protection prior to birth as antibodies pass through the placenta and the umbilical cord from mother to baby. This protection lasts for a few months after birth. Antibodies in breast milk can continue to contribute to this “passive protection”, but this is not a
permanent defense against infections. After a few months, a baby needs to start making his or her own protection.
The only way to prevent every single infection is to isolate someone completely, and that is neither realistic nor practical. Children get sick most often by being around other children. The more children they are around, the more likely they are to get sick. Daycares, preschools, church nurseries, and childcare in the local gyms are the most common hot-spots for germs, but just having an older sibling that brings the germs home from school may be enough to increase a younger child’s likelihood of getting sick.
A young child’s world is full of germs, from the dirty floors they crawl on to the hands
that constantly go into their mouths. Just opening the front door lets germs in. Some germs float around in the air or stay put on surfaces for weeks at a time. There are some exceptions, but most of the germs in our environment help our immune systems grow, rather than make us sick.
We also hear about (and fear) the scary germs that come from animals – birds, mice, bats,
reptiles, mosquitoes, and ticks, as well as the outbreaks of infections from petting zoos that have been in the news over the past few years. Some of these germs are common enough that we have to constantly think about them when we evaluate sick children (such as the tick-borne illnesses), but most of these germs are uncommon or even considered exotic. Again, the vast majority of germs that make children sick are the ones that come from other children.
Part of the problem is that everyone’s definition of “sick” is different. One parent may
blow off a cold as just a natural part of childhood, while another may try to shield their baby from every single runny nose. Childcare centers are full of children who are contagious – happy, playful kids with clear runny noses – and they are there because they
are not considered sick enough to stay at home, by either the parent’s personal definition
or the center’s definition of “sick”. However, the same germs that cause simple colds in
some children can cause more significant infections in other children. I often laugh to
myself when parents tell me that nobody else at daycare is sick – they may not be
considered sick, but they’re all contagious! A child does not have to have a fever in order to be contagious.
There is no perfect solution. In order for an immune system to develop, it has to be challenged by germs. In order for some parents to keep their jobs, their kids have to go to daycare. Furthermore, we do not have a good test to determine when a child is truly no longer contagious, so we use imperfect rules, such as “twenty-four hours without a fever”
or “when they feel better”. It all comes down to using good judgment, but even the most
conscientious of parents cannot help but make the decision while looking at their own schedule!
In theory, a moderate number of minor childhood infections are a good thing. Not only do they help our immune systems develop, but studies have even pointed to the fact that as our world has become cleaner (as we have disinfected everything with hand sanitizer) and the frequency of childhood infections has been reduced, the risk of allergies has increased dramatically. The theory is that if our immune systems are not adequately challenged, then they will look for something else to challenge them, like pollen, dust mites, or food. However, it is fine to be able to intellectually understand the importance of germs, but that does not make anyone feel any better when your child is crying in the middle of the night.
So, what is considered to be normal? Respiratory infections are the most common infections, and children who are around a lot of other children may get two or three respiratory infections a month. This may range from minor colds to sore throats, or even ear infections. Colds last, on average, for one to two weeks. You do the math. If a child gets more than two bouts of pneumonia, if they get frequent sinus infections (requiring antibiotics), or if they get frequent ear infections (four in six months or six in a year), it is worth a conversation with your pediatrician to discuss other evaluations and treatments.
Even an isolated, breastfed baby with no siblings will still get sick from time to time. As a pediatrician, I want to do everything I can to prevent the truly scary infections (which is why we immunize children), to treat the infections that need to be treated (with antibiotics, if necessary), to watch for the infections that need closer observation or that might indicate a problem with the child’s immune system, and most often, to reassure
parents when their child’s immune system is likely to take care of the infection on its own.
Edward M. Pickens, MD
University Pediatrics at Highgate
5322 Highgate Dr., Suite 144
Durham, NC 27713