PedSPAM December 1997

Here is some "spam for the holidays." I've added a page to the Tips section on the practice website (below).

As always, comments and suggestions to me at or post them on the comment board through the websites.

Frequent Infections

(Also found here.)

"My child is sick all the time!"

What can parents can do short term and long run to prevent the infections that drive us crazy every winter?

Well, first, know what the normal number of infections is. There may be a perception problem. I have read that the average child might get 20 infections in the first two years or so of life - counting all colds, viral diarrhea attacks, earaches - everything. That seems pretty close to my experience for the "average" child. (Of course, as we say, "your mileage may vary." There can be wide variation in "average.") So what to the parent is "too many" might be a fairly normal number of illnesses. Of course, from the parental perspective, one infection is probably one to many.

But let's assume that you are right. Your child does indeed have more infections, more doctor visits, more antibiotics than other kids. What can you do in the real and practical world?

Avoid mass daycare if at all possible. The medical literature is replete with data confirming what everybody knows: group daycare means more illness. The smaller the exposure group, the better. One grandmother per baby is ideal.

If your child truly seems to have more infections than are "normal," it would be perhaps wise to check her iron status with a simple fingerstick blood count. Iron deficiency, with or without anemia, can cause increased susceptibility to infections. It is the number one (and two, three and four!) mineral deficiency of children. And by the way, Mom, iron deficiency in women of childbearing age is also a problem. You probably should take a good supplement with iron as long as you are having menstrual periods and folate as long as you might possibly become pregnant.

If ear infections are the problem, be sure you get your child off the bottle and off the pacifier as soon as possible. These are both known to increase the risk for recurrent ear disease. Remember especially, no bottles in bed! Always hold your child upright to feed the bottle, and never ever prop it.

Do vitamins prevent infections? There is no good evidence that they do, with the exception of iron. But then again, there is no evidence that a good multivitamin, especially one with iron, is a bad idea - so if your child seems sick a lot - give him a good childrens multivitamin with iron and be done with it.

Stop smoking! For goodness sake, why are you still doing this? Again, the evidence is clear, parental smoking increases childhood infections by 30% even if the parents don't smoke at home!

Flu shots for children are coming into vogue now and I think they are a great idea. We have been giving influenza shots for years to children who have medical conditions such as asthma, cystic fibrosis, or heart malformations which would put them at risk for complications of influenza: pneumonia, sinusitis, ear infections and so forth. There is now good evidence in the adult medical literature that adults who receive a yearly flu shot have a 30% reduction in respiratory infections of all types that winter. This is significant, especially in light of how cheap and safe the flu shot is. I get one yearly for this reason. Now many pediatric infectious disease specialists are recommending the flu shot for all children over 6 months, period. I think this is a great idea and plan to actively promote it next fall.

The "health food" industry has a number of products to sell you which supposedly ward off infections. I am highly skeptical about these. I am even more concerned about possible toxic stuff that might be found in some "natural" products, which are often not inspected for quality or safety. (The worst thing is when some health food true believer starts spouting off about how the medical profession doesn't want you to know about some wonder herb because it would kill profits.) But in the end, the refutation is simple: I notice that these wonder products just don't work; the people who take them still get just as sick, even if they don't want to believe it.

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