Wednesday 24 January 2018

Peak season for wheezy babies... and spotty toddlers

Ask the GP

Wheezing and coughing can be quite pronounced
Wheezing and coughing can be quite pronounced

Nina Byrnes

Advice from our GP on how to prevent bronchiolitis and what to do when pink lesions appear on the skin.

Q. My niece has an infection called bronchiolitis. What is it, and how do I prevent my daughter from getting it this winter?

Dr Nina replies: Bronchiolitis is a ­respiratory condition that causes inflammation in the small airways of the lung. Mucus is also created, ­causing a cough and difficulty breathing in those affected.

It ­occurs most commonly in ­children aged three to six months. It is estimated that one in three children under the age of one in the UK develop the condition at some point.

Respiratory syncytial virus (RSV) is the cause in 50 to 90pc of cases. Other viruses may also be found. The majority of cases of bronchiolitis occur between November and March, the peak season for RSV virus.

Household smoke exposure is a well-known risk for bronchiolitis infections. Do not allow your baby to be exposed to smoke at all. Maternal smoking especially increases the risk.

Breastfeeding reduces the risk as the mother's immunity may pass across. Living in a crowded environment, having older siblings or attending childcare facilities also increases the risk.

Symptoms initially resemble the common cold. There may be a runny nose, cough and fever. Fever is usually below 39°C. Symptoms don't develop straight away on contact. Bronchiolitis may initially incubate for several days to a week. Symptoms peak on the second or third day and are gone in most after seven to 10 days.

In more severe cases, coughing may persist for weeks. For about 60pc of children, symptoms will remain mild but in 40pc of cases, increased coughing and difficulty breathing may occur. Vomiting, difficulty feeding, irritability and wheeze may also follow.

Wheezing and coughing can be quite pronounced, causing grave concern. Parents often arrive at the doctors very stressed and traumatised. Thankfully, reassurance is all that is required as most cases can be treated at home.

Only about 3pc of those infected will require hospital admission. Those who have underlying heart or lung problems, or reduced immunity, are particularly at risk of serious infection. Signs of severity include increasing sleepiness, a breathing rate above 70 breaths per minute, frequent vomiting or poor feeding.

Treatment is not usually required. It is important to reduce fever, and give plenty of fluids to avoid dehydration. Those admitted to hospital are sometimes given oxygen, IV fluids and nebulisers.

The majority of children with bronchiolitis recover fully but they may be more at risk of wheezing in the first few years of life. There is a vaccine available for RSV, but this is normally reserved for those considered at risk of serious infection. Another medication called immunoglobulin can pass on some immunity to RSV and may also be used in children at risk of severe infection.

The best way to help avoid bronchiolitis is to avoid cigarette smoke exposure.

Breastfeed your baby. Keep young babies away from sick children.

Finally, wash your hands regularly, especially after coughing or sneezing. This will reduce the spread of the virus, keeping you and your baby healthy and well throughout the peak winter season.

Q. My daughter has ­developed raised itchy spots over ­different parts of her body. They are smooth and a little shiny. She has them on her arms, legs and body. What are they? Do they need treatment?

Dr Nina replies: Molluscum ­Contagiosum are small raised pink pimple-like lesions that appear on the skin. They occur most commonly in those aged one to five years. 

They can vary in size from pinpoint to the size of a small pea. This infection is caused by a virus and is contagious.

Infection can occur from close skin-to-skin contact or by touching items infected with the virus such as towels, clothes and toys. The lesions may appear anywhere on the body, but in children they tend to concentrate on the limbs, chest and stomach. Lumps are normally painless but may be itchy. Scratching them may release the contagious centre fluid and spread infection elsewhere on the body.

Parents are concerned about the appearance of the spots, which can be quite dramatic, and so many present to their GP. It is possible to treat them but this is not normally advised. Treatment may be painful and lead to scarring. It is important to know that Molluscum don’t interfere with activities, are not dangerous and usually clear up not their own.

Most infections last between two and four months but some may last up to 18 months or longer.

Cryotherapy, which freezes the spots, may also work. Other options include laser treatment or scraping them off (curettage). All of these treatments may be uncomfortable and cause scarring. The best thing to do is to avoid further spread of the condition.

Covering spots with a waterproof plaster may limit transmission when swimming or in situations where skin-to-skin contact is likely. Avoid rubbing or scratching the bumps. There is no need to keep children out of activities, crèche or school.

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