Introduction

From the time they are born, children are exposed to the same infectious pathogens as we are. The main difference between a newborn and an adult is the baby’s underdeveloped immune system, which does not fully develop until the baby is approximately six months of age. Prior to birth, the mother passes antibodies to the fetus via the placenta. After birth, the child continues to receive antibodies from the nursing mother. By the age of two to three months old, a healthy baby will begin to produce its own antibodies but at a much slower rate than an older child. By the time the child is six months old, they are producing antibodies at a normal rate.

During the more vulnerable period between birth and six months, a parent can strictly control a baby’s environment to limit exposure. However, once a child begins experiencing the world, they become susceptible to bacteria and viruses in their new surroundings and a parent needs to make an important decision about vaccinations. Always consult with your pediatrician about when and where to receive the age-appropriate vaccinations. If you’re not sure about vaccinations, you can access more information HERE. Here’s what the Western Journal of Medicine has to say about the 1998 report in the Lancet that began the controversy about the link between the MMR (measles, mumps, rubella) vaccine and autism. Whatever your decision, make sure you’ve accessed all the facts about immunization from a reputable source first.

Your best source of information and advice will always be your pediatrician or primary health care provider. If you’re not sure what to do about common conditions such as diarrhea, teething problems, sleeplessness, breast-feeding issues, or any other situation that might arise with your children, call your medical professional first. He/she knows you, your circumstances, and your child’s medical needs best and will tailor his/her advice on how to handle the situation based on your personal requirements.

In Canada, mothers have the opportunity to spend the first twelve months at home with their baby before returning to work. If you do return to work when your child turns one, you’ll want to ensure you have top-notch child care, whether that be outside the home or with an in-home caregiver. The next stage for a child is generally playschool, as early as age three, then kindergarten, and then grade one. At each stage, proof of immunization may be required before your child is accepted. And, at each stage, infections can make your child sick. Let’s take a look at some of the more common illnesses your child might experience before the age of five.

Croup

More common in Winter and early Spring, croup is an infection of the throat and vocal cords that is caused by a virus. The most common viruses are parainfluenza, influenza, adenovirus, respiratory syncytial virus (RSV), and measles. When children older than five years of age contract this virus, it is referred to as laryngitis.

Croup begins much the same as a cold or the flu and develops into a fever with a cough. The lining of the throat will become red and swollen, causing a child’s breathing to become faster than normal, difficult and noisy. Due to the difficulty in breathing, your child may be less likely to want to exert themselves, as well they shouldn’t. The most tell-tale sign of croup is the cough which sounds more like a “bark”. Try not to be alarmed by the sound of this bark; in most cases, it sounds worse than it actually is. The calmer you appear, the calmer your child will stay.

As you might have guessed, croup can be spread by coming into contact with the virus in the air (via coughing and sneezing). It can also be spread via hand contact with someone who has the virus and hasn’t washed their hands, or by touching something that an infected person has touched or sneezed/coughed on (such as toys, the handle of a shopping cart, or a school desk).

Because it is so easily passed from one person to another, it is best to keep your child home from their activities if you suspect they have croup. Rest, quiet, fluids, and medication for fever (only on your doctor’s advice for a child under six) are the best support mechanisms for your child. Keep their room cool and keep extra blankets handy, but don’t keep your child too hot. Sit your child as upright as you can to help keep them comfortable. A cool mist humidifier helps to ease the symptoms of croup. You may wish to sleep in the same room as your child so that you can monitor his/her breathing. Visit your pediatrician if these support mechanisms don’t seem to be helping. Antibiotics are not used to treat croup as it is a viral infection.

Pertussis (Whooping Cough)

Believe it or not, according to the Canadian Lung Association, one of the best things you can do for a child with croup is to bundle them up warmly and take them out into the cold air, day or night. On the flipside, you can also fill your bathroom with steam, close the door, and sit with your child in this steamy air for 10-15 minutes.

Another highly contagious infection of the respiratory system, pertussis or “whooping cough”, is not unique to infants but does cause them to become more ill than adults and older children who contract it. The name “whooping cough” comes from the sound made by a child with the infection. It causes the patient to cough so hard and so rapidly that they begin to run out of breath and have to take in very deep breaths, making a “whooping” sound when they do.

Whooping cough begins with a runny nose, sneezing, low-grade fever and a mild cough and progresses, over one to two weeks, into severe coughing spells, often causing the patient to turn red/purple. Pertussis is most contagious during the first two weeks after the cough begins. Duration includes the first one to two weeks of cold and flu-like symptoms followed by two to four weeks of coughing. The recovery period lasts anywhere from one to four weeks after the coughing has subsided. Not everyone who contracts pertussis will end up with such violent coughing spells. Infants with milder infections may look as if they’re gasping for breath and could experience momentary periods of apnea (not breathing at all). If you suspect your child has pertussis, contact your primary health care provider right away. It can usually be treated with a course of antibiotics.

Oral Thrush

According to the CDC, more than half of babies under 12 months old who get pertussis have to be treated in the hospital. It generally afflicts infants under six months old as infants are not vaccinated for pertussis until the age of six months. This is why it is so important to have your child vaccinated against this bacterial infection. Immunity to pertussis dwindles after five to ten years, making it necessary to administer booster shots in later teens and adulthood.

If you begin to notice thick white or cream-colored cottage cheese-like deposits on the insides of your child’s mouth or on his/her tongue, you’re most probably dealing with oral thrush, which can also spread to the roof of the mouth, tonsils, and the back of the throat. On occasion, the infection can spread even further to the esophagus.

Lesions on the inside of the mouth can be painful and bleed slightly if scraped. The insides of the mouth can also appear slightly red and swollen. This infection can be passed to the mother when breastfeeding, and if not cleared up, can be passed back and forth between baby and mother until it is.

This condition is most commonly caused by an opportunistic yeast fungi called Candida albicans which takes advantage of weaker immune systems and beneficial bacterial flora which are out of balance. Your primary health care provider will treat this condition with a course of antifungal medication. In the meantime, unless other allergies prevent it, you can try giving your child unsweetened yogurt to reintroduce beneficial bacteria to the mouth and throat.

Moving back into the realm of the virus, measles is a contagious respiratory infection which is spread via droplet transmission from the nose, throat, and mouth of an infected person. The virus can actually remain airborne for up to two hours after the infected person has left the room. Measles eventually causes an all-over rash of slightly raised red spots/bumps but usually starts by presenting itself as a cold or flu with symptoms such as a cough, red eyes, runny nose and a fever. The fever will start off mild and continue to get progressively higher (up to 103F, 39.4C). Koplik’s spots (small red dots with blue/white centers) appear first inside of the mouth and across the forehead. They will continue spreading downwards to the face, neck, chest, arms and finally the feet. Supportive therapies such as pain management with acetaminophen, fluids, topical antihistamines for itching, and bed rest are all you can do for your child. The virus simply has to run its course before recovery can begin.

Because measles are so contagious, you should prevent your child from partaking in any regular social activities such as play groups, day care, swimming lessons, etc. It is especially important for pregnant women to avoid contact with someone who has the measles. A child can be contagious anywhere from a day or two before symptoms actually appear until four to five days after the rash shows up. Infants up to the age of six months will be protected from measles thanks to the immunity received from their mothers. Vaccinations begin for measles at twelve months and are given again at age four to six. It is generally accepted that once you’ve had the measles, you cannot get them again but exceptions can, and do, happen.

Some children will break out in a rash yet still be their lively self, feeling mostly unaffected by the infection. In other cases, measles may lead to other complications such as croup, pneumonia, and serious ear infections. For this reason, children with measles should be closely monitored and taken to their pediatrician if other symptoms begin to arise.

Mumps

Yet another contagious illness caused by a virus, mumps affects the parotid salivary glands located between the bottom of the ear and the jaw. Via simple palpation (feeling with the fingers) you can usually tell if your child is suffering with mumps as these glands become swollen and pretty sore, making the patient look like a little chipmunk and making it difficult to swallow or talk. In typical cases, swelling can happen on both sides at the same time, on one side only, or one side will swell before the other. In rare cases, the infection might travel to other salivary glands under the tongue or the front of the chest. Mumps are transmitted via saliva so a child may contract it after sipping from an infected child’s glass or being too close to a cough or sneeze. It can also be transmitted through direct contact with either a soiled Kleenex or a drinking glass. The contagious periods lasts from two days before symptoms begin up to six days after symptoms disappear altogether. A typical incubation period for mumps is anywhere from twelve to twenty five days. The recovery period is anywhere from ten to twelve days with the reduction of swelling after approximately seven days.

Mumps begins with a high fever (103F, 39.4C), headaches, general malaise, and a loss of appetite. Your child will not want to drink juices such as orange juice as the glands become very sensitive to the acid in this type of juice. Glands begin, and continue, to swell over a period of three days. If the high fever persists or increases and is accompanied by a stiff neck, nausea, drowsiness, vomiting, and/or convulsions, it’s time to call the pediatrician as this could indicate inflammation or swelling of the brain. However, it is rare for mumps to progress to this level.

Rubella

Again, supportive therapies are all you can do for your child. Keep them quiet, comfortable, and monitor their fever. If necessary, acetaminophen or ibuprofen, but never aspirin, can be used to bring down their fever and make them more comfortable. Warm or cool packs, depending on what your child will tolerate, can be applied to help provide relief and bring down the swelling. Provide liquids with no acidic content such as water, luke-warm tea, and clear broth. Foods should be soft and easily swallowed and offered in very small bites such as small pieces of bread soaked in milk or chicken noodle soup.

Cases of mumps have drastically declined since the introduction of the vaccine MMR (measles, mumps, rubella) in 1967. However, since it is highly contagious, all members living in the same household as the infected patient should be monitored for signs of infection once a diagnosis of mumps has been made. If you suspect your child has mumps, it’s wise to contact your primary health care provider or child’s pediatrician as cases of mumps are recorded, reported and tracked via public health organizations.

Caused by the Rubella virus, rubella, or German measles, or three-day measles, involves the skin (in the form of a rash) and lymph nodes at the back of the neck and behind the ears. It is contagious from one week before to one week after the rash appears and is passed through fluid droplets from the nose and throat. The incubation period is two to three weeks.

It begins with a mild fever (99F, 37.2C) and tender/swollen lymph nodes, culminating in a rash of itchy pinkish spots that begin on the face and move downward on the body. The lower the rash gets, the clearer the face becomes. Other symptoms can include headache, lack of appetite, stuffy nose, or there can be no other symptoms at all. Supportive therapies are really the only way to address this viral infection.

Chickenpox

The real danger of rubella is to pregnant women. Contracting rubella can cause serious damage, retardation, and birth defects to the developing fetus. Immunization against rubella is critical to controlling the spread of the disease and is given to children between the ages of twelve to fifteen months of age as part of the MMR vaccination.

Chickenpox is another viral infection noted for the spots it causes and is attributed to the varicella-zoster virus. Beginning with a fever, the patient breaks out in a rash of red spots within forty-eight hours that eventually turn into fluid-filled blisters that will either cover part or all of the body. The blisters will dry up and scab over within four to five days but the itching is intense. As much as possible, try to discourage scratching which can lead to infection and scarring. To prevent babies and smaller children from scratching, you can:

• Apply calamine lotion to the spots.
• Keep fingernails on the shorter side.
• Soak your child in a tub of baking soda and warm water.
• Cover their hands with loose, clean cotton socks stitched on to the wrists of their pyjamas.

Chickenpox is highly contagious, enters the body through the nose or mouth, and can spread two ways: 1. Either through direct contact with the fluid in the blisters or the saliva from an infected person, or 2. Through droplets in the air.

While taking care of an ill child, you must wash your hands as often as possible so as not to transmit the virus to others you might touch. The good news is the virus can’t live on surfaces like toys or countertops; it has to be spread from person to person. The bad news is chickenpox is contagious up to forty-eight hours before the rash appears. You can also catch chickenpox from an individual suffering with shingles via their saliva or blisters. The reverse is not true; you cannot catch shingles from someone with chickenpox. The only viable way to completely prevent chickenpox is through vaccination.

Impetigo

Supportive therapies include the usual list; acetaminophen or ibuprofen, quiet, rest, warm baths with baking soda, calamine lotion for the itching, and keeping your child home from regular social/academic activities. However, since chickenpox is contagious before the rash appears, the damage (as far as spreading it) has probably already been done.

You should also monitor your child for the following developments and call your pediatrician immediately if:

• Your child’s fever is high (over 102F or 38.5C).
• The fever goes away and then comes back again after twenty-four hours.
• Your child develops a skin infection other than the blisters.
• If a spot or blister becomes enlarged, red or very sore.
• Your child seems very ill, over and above the chickenpox.

Caused by the ever-present, common bacteria Staphylococcus aureus or Streptococcus pyogenes(aka Group A streptococcus which causes strep throat) this infection is widespread in children between the ages of two and six. A child with an existing skin problem such as eczema, or a child with broken skin from cuts/scrapes is more likely to contract this infection. Why? Because overly aggravated skin that has been scratched and scratched and finally broken is less able to fight off an invading bacteria as the skin barrier has now been breached and is open to outside pathogens.

The two types of impetigo are bullous impetigo (large blisters) and non-bullous impetigo (crusted) impetigo. The non-bullous or crusted form is most common. It’s usually caused by S. aureus but can also be caused by infection with group A streptococcus. Non-bullous begins as tiny blisters, which eventually burst and leave small wet patches of red skin that may weep fluid. Gradually, a tan or yellowish-brown crust covers the affected area, making it look like it has been coated with honey or brown sugar.

Bullous impetigo is nearly always caused by S. aureus, which releases toxins that trigger the formation of larger fluid-containing blisters that appear clear, then cloudy. These blisters are more likely to stay longer on the skin without bursting.1

If your child is diagnosed with impetigo (pronounced im-pah-tay-go) be sure to keep everyone in your household from interacting too closely with the patient as it is very contagious. Here’s how that works…

The rash first appears on the face, neck, hands, and/or diaper area as clusters of itchy little bumps which quickly develop into sores. The fluid in these sores seeps out forming a crust over the sore. It’s this fluid that, if touched and transferred, spreads the infection further afield on your child’s body and to others who have come in to contact with the fluid or anything that may have the fluid on it (bed linens, towels, facecloths, serviettes, tissues, etc). Luckily, the sores heal without causing scars. Your challenge will be to prevent your child from scratching the sores and spreading the infection, creating a secondary infection, or leaving lasting scars from an overly aggravated patch of skin. Cover the infected patches of skin with clean gauze and first aid tape or a Band-Aid and keep your child’s fingernails short and very clean.

Because this is a bacterial infection, it can be handled with antibiotics. If the infection is small, your pediatrician is likely to start off with prescribing antibiotic ointment. If this doesn’t work, he/she will switch to a pill/liquid for seven to ten days. Apply the ointment with a cotton swab or piece of gauze. Avoid baths and showers that may spread the infection. Instead, opt for sponge baths, and gently clean the infected areas separately with antiseptic soap on a clean gauze every day. Never scrub at the crust of a sore; dab at it gently to remove the outer crust, leaving the rest of the sore to heal on its own.

The best way to prevent an impetigo infection is by frequent handwashing and thorough showers/baths. Any areas of broken skin from cuts, poison ivy, or bug bites, etc., should be kept clean and covered. Call your primary health care provider if you notice signs of impetigo. The faster you can get antibiotics onto the rash or into the patient, the quicker the infection will heal. If you’re already on a course of antibiotics and no significant signs of healing occur after three days, call your health care provider again…especially if you see signs that might indicate a secondary infection has set in such as redness, warmth or tender-to-the-touch in the area of the infection, or fever.

Reye’s Syndrome

Reye’s Syndrome is a condition which affects the brain and liver in children (up to the age of 19) dealing with a viral infection. It should be noted that while Reye’s is still not well-understood, credible studies have shown an association between the use of aspirin (acetylsalicylate, acetylsalicylic acid, salicylic acid, or salicylate) and the development of Reye’s. Since this discovery, and the subsequent advisory against giving children with viral infections aspirin to relieve their symptoms, cases of Reye’s have significantly declined.

The U.S. Surgeon General, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics the National Reye’s Syndrome Foundation, and WHO recommend that aspirin and combination products containing aspirin not be given to children under 19 years of age during episodes of fever-causing or viral illnesses.2

The duration and severity of the illness can vary greatly from insignificant to serious and is almost always preceded by a viral illness. Because Reye’s can also develop in a child recovering from a viral illness who has not been given aspirin, it is important to know and recognize the symptoms:

• Frequent vomiting
• Lethargy or sleepiness
• Diarrhea and rapid breathing in infants
• Irritability or aggressive behaviour

Speak with your pediatrician about alternatives to medications containing aspirin or aspirin-type substances. The National Reye’s Syndrome Foundation, U.S. Surgeon General, the Food and Drug Administration and Centers for Disease Control and Prevention recommend that aspirin and combination products containing aspirin not be given to children or teenagers who are suffering from one of these illnesses. This LIST shows products containing aspirin or salicylate compounds. Scroll down the page to see the lists. NOTE: This list is not complete and manufacturers may change ingredients in their products. To ensure you’re not using a product containing salicylates, always read the label.

 Centers for Disease Control & Prevention, Diseases & Conditions, Ages 0-3

 Centers for Disease Control & Prevention, Raising Healthy Children, Ages 0-3

 Caring For Kids, Info from Canadian Pediatricians

REFERENCES:

1. Kids Health, Impetigo

2. National Reye’s Syndrome Foundation