Chapter 10: Cold Remedies

COLDS AND NASAL CONGESTION

Cold RemediesMore money is spent on non-prescription cough and cold drugs than the defense budgets of most countries. Worse, many colds, also known as URI’s (upper respiratory infections) are treated with antibiotics. Yet there is hardly a valid study which has found these treatments to be anything but worthless in children. Like so many pediatric ailments, much of the treatment is based upon folklore and medical myths, very few remedies based upon sound scientific information.

Where in the world did you hear?

Better take something for that cold. You don’t want it to become bronchitis or pneumonia.

Sound Advice

All colds are caused by viruses: rhinovirus, coronavirus, adenovirus, respiratory syncytial virus, influenza virus and others. Viruses, we know, are unaffected by antibiotics. Therefore, treating a cold with an antibiotic is not only useless, it can result in the emergence of resistant bacteria, a harmful side effect. Not to mention other problems: diarrhea, allergic reactions and yeast infections. Why would anyone want to subject his or her child to this kind of misery?

What if the cold becomes something worse: bronchitis, pneumonia or an ear infection?

Although more than 95% of common colds come and go without the development of a secondary infection, parents know that children with a history of wheezing or ear infections need special watching. But treating with antibiotics in anticipation of such complications is not a good idea. Infections that develop after antibiotics have been taken are often more severe, the germs resistant to many antibiotics. These risks are too great. The best defense is to keep mucus secretions as liquid as possible by using saline nasal spray or drops and by quickly initiating treatment for wheezing if the child develops a persistent cough.

The Conclusion

The common cold is an infection caused by a virus and never requires treatment with antibiotics. Since some children develop secondary illnesses such as wheezing or ear infections, it’s a good idea to check with the doctor if the child’s symptoms seem to change or worsen.

Where in the world did you hear?

You should get one of those over-the-counter cold remedies to relieve your child’s symptoms.

Sound Advice

Save your money. Most cold “remedies” are worthless in children. Virtually every cold medicine contains the same two ingredients: an antihistamine and a decongestant, neither of which addresses the basic causes of cold symptoms. Mucus, congestion, fever and cough are caused, in large part, by cytokines and leukotrienes, inflammatory proteins produced by the body in response to infection, not histamine. And yet, almost every popular over-the-counter medicine contains antihistamines, drugs appropriate for treatment of allergies, not colds. Most studies in children show these medications are useless and, worse, they often produce side effects of irritability and whining. Parents can be misled into thinking the child’s illness is getting worse, not realizing that the treatment itself is responsible for the misery.  They can only hope that their fussy children will, at least, become sleepy from the antihistamine. But often, just the opposite occurs:  the kids become “wired” and won’t sleep at all. And decongestants, the other ingredient in cold medicines, whether combined with antihistamines or packaged separately are troubling as well, capable of causing sweating, restlessness, elevated blood pressure and cardiac excitation with minimal or no relief of cold symptoms, another poor choice.

You might then ask if over the counter cough medicines have a better track record. Sony you asked, because the answer is no. Most cough medicines that advertise relief from day coughs, night coughs, mucusy coughs, fever, headache and achy muscles are equally ineffective.  Studies in children fail to show any significant shortening of cough symptoms compared with cough drops and increased fluid consumption. The reason is that the main ingredients in most over-the-counter cough medicines are the same as in the cold remedies except for the addition of “expectorants,” compounds to help thin the mucus. They don’t.

And why combine these ineffective cold or cough medicines with acetaminophen or ibuprofen? It doesn’t make therapeutic sense but lots of manufacturers do just that. In the absence of fever or pain, those drugs are inappropriate and, in some cases, can interfere with the body’s production of antibodies, thereby prolonging the illness. Not to mention that by combining medications, it is difficult if not impossible to administer the correct dose of each individual medicine.  So, are we left with nothing? Isn’t any treatment available to relieve the symptoms of the common cold? The answer is yes, it’s simple and inexpensive: nasal saline, a solution of salt and water. This remedy is remarkably effective in liquefying nasal mucus and helping to alleviate the post- nasal drip cough that accompanies most colds. Spraying or dropping saline into the nose several times a day and, especially, before going to sleep helps to move mucus out of the nose without side effects. It works and it can be made at home. How? Add 1/4 teaspoon to 8 ounces of tap water, boil and cool. That’s it.

Children should be encouraged to drink plenty of fluids to keep mucus as thin as possible. It used to be thought that milk and dairy products should be avoided during respiratory illnesses, believing that the mucus would become thicker. Not true. Milk is a good fluid source and can be used at will. Running a humidifier or a vaporizer with plain water, hot or cold, will add moisture to the inhaled air and lubricate the linings of the respiratory tree, soothing and effective. Adding menthol or any other “medication” to the evaporating water is not a great idea. Studies have failed to show that additives are helpful and some may even irritate the tender linings of the nose and respiratory tree resulting in a greater production of mucus. Fever, headaches and muscle pains usually respond nicely to the correct dose of either acetaminophen or ibuprofen. The good news is that all colds have a relatively short existence, disappearing within one to two weeks no matter what treatment is used

Newer medications are becoming available and may soon be used in the treatment of the common cold. One of the most promising is a medication called montelukast, an oral medication that blocks leukotriene, an inflammatory protein which increases congestion. More specific anti-inflammatory medications are surely on the way as are vaccines to immunize against many of the viruses which cause the common cold.

Have any questions? Please contact Dr. Mesibov

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Chapter 11: Behavior / Social Skills

BEHAVIOR, REWARDS AND FEAR OF DISCIPLINE

Child Behavior Rewards Discipline Social SkillsPediatricians are in an ideal position to see how parents interact with their kids. Visits to the doctor, sometimes stressful for both parent and child, can reveal a lot about family dynamics. The doctor witnesses how parents respond to the anxieties and demands of their children, getting a good look at parenting strengths and shortcomings

Being an effective parent means providing structure. When mom fails to be consistent or confident, behavior suffers. Children feel insecure when rules are unclear, threatened if parents seem nervous, angry or unsure of themselves. Boundaries mean security. But some parents are terrified of disciplining their kids, worried that they’re inflicting psychological trauma by imposing their will. What a mistake. Children need to know that a calm adult is in control. Kids become confused and distressed when they sense ambivalence or anxiety in their parent. Even infants may respond negatively to parents who lack firmness in purpose and fail to show composure and consistency. Rules are very important to small children, giving them structure that they can rely upon. Parents who become upset when their children cry or have a tantrum are failing to help their kids cope with frustration or to learn social behavior.

Where in the world did you hear?

Children should be praised for everything they do.

Sound Advice

We want to instill a sense of confidence in our children, not delusions of grandeur. Having only the best intentions, some parents feel obligated to applaud and cheer for every act of obedience or performance they witness. While this can certainly bring a smile to the child, it often backfires by unrealistically raising the child’s expectations, resulting in frustration and fits of temper when applause by others is not forthcoming. Children who expect praise and celebration for the most mundane acts will fail to learn the nuances of special achievements and may, in fact, fail to make special efforts for special goals. If they are rewarded for virtually every act of living, they may become immune to praise and lose their motivation to increase their efforts or strive for improvement. Additionally, children who are continuously the objects of their parents’ adulation may develop a false sense of importance, failing to develop good interpersonal skills and resulting in demanding and bossy behavior. Simple acts of spontaneous caring and loving are more important than applause.

The Conclusion

Parents can serve their children best by responding in a realistic manner to their daily achievements. Recognizing children’s performance with a quiet smile or a hug is more effective than a theatrical cheer.

Where in the world did you hear?

Kids don’t need social skills when they’re little, they’ll develop them as they grow.

Sound Advice

This sad omission will only come back to haunt both parent and child later in life. Those children, no matter how smart, will find the road to adult life quite bumpy if they are poorly prepared to deal with the world outside the family. There is no instinct for the development of social skills. The ability to establish effective interpersonal relationships must be taught as early as possible. Yet, many parents fail to prepare their children for such a critical part of their lives. Lessons of social skills are in competition with time allowed for TV’s, DVD’s, IPOD’s, Gameboys, Walkmen, and cellular phones. How can a child learn to make eye contact, shake hands, say “thank you” or “hello” when his eyes are glued to the screen, fingers on the keyboard, thumbs dialing a number, or ears blocked by the loud music in earphones? Why would a child leave his room to greet visitors when he is busily engaged with “Invaders from Space?” How does a child learn to answer the phone politely (without grunting in monosyllables) if he is not taught such a skill? How does he learn to refrain from loud, self-indulgent behavior in public if he is not reminded to show respect for others’ space? Moms and dads may incorrectly assume that their frantic acts of shuttling the kids back and forth from soccer, tennis, dance, karate, religious lessons and other extracurricular activities are the key to raising well rounded citizens. It’s not enough. Too many of these busy children fail to develop interpersonal skills, unable to carry on social conversations or to show basic etiquette or courtesy. Lacking in these qualities, they may find life frustrating and hostile after they leave the protection of their home, wondering why they have difficulty navigating the world of commerce and genteel society.

The Conclusion

Social skills are critical tools for all children to have. Parents must start these lessons as soon as they can carry on conversations. The ability to be perceived as socially sensitive by others is your child’s gateway to successful integration into society.

Where in the world did you hear?

Temper tantrums are impossible to control.

Sound Advice

Not so. Temper tantrums, screaming, laying on the floor, kicking and flinging objects are powerful theatrical performances. No matter how young, children intuitively understand that a tantrum is a big-time power play, an attempt at coercion, a bullying tactic, a ploy. Tantrums are “successful” when they elicit any response from mom or dad: pleading, yelling, cajoling, coercing, or even attempts at “reasoning.” Stopping a tantrum by responding in this way has only one result: more tantrums. Yet, since tantrums are a performance, they are made totally ineffective when deprived of an audience. What show would continue to run if it failed to attract spectators? Therefore, the technique to stop all tantrums is simple, just walk away.  Make it known to your child that you don ‘t like tantrums by declaring, when the action takes place, “I don’t like tantrums (or temper or  naughtiness.) I’m leaving.” And with those words, you must immediately turn on your heels and exit the room. Obviously, you would feel more secure if you could defuse such tantrums when they occurred in the safety of your home. It’s better than walking away in the middle of a busy intersection but, even in public places, you must be prepared to leave the child to have his tantrum without you. You might end up hiding behind a shelf or the side of a building but, for the eyes of the child, you must appear to have vanished. Invariably, the child will learn that tantrums produce an unwanted result: no parent present. You must, however, be consistent in your behavior, otherwise this ploy will fail since the child will guess that you are still an easy “mark.” This technique works. Try it.

The Conclusion

A tantrum is an unacceptable performance. Leave the theater and the show will stop.

Where in the world did you hear?

Time outs just don’t seem to work. Kids ignore them.

Sound Advice

Time outs are effective. But merely threatening time out is not. If your toddler is doing something that you can’t permit to continue, perhaps throwing clothes from the drawers, there is an effective method to control such behavior. Dr. Stella Chess, a child psychiatrist, described this technique more than thirty years ago. She pointed out that when a child is threatened with a punishment for continuing misbehavior (if you don’t stop, I will give you a time out) the behavior would probably continue because, in that threat, you are implying that he might not stop. In fact, you have told the child that you are preparing punishment in anticipation of his not stopping. Whoops! She’s right, most of the time the child will continue to misbehave, giving you sneaky looks while the misdeed continues. The solution is in the message: “you will stop that immediately!” No threats. No ifs. Of course, initially nothing will happen; the child will continue to throw the clothes on the floor. But you aren’t finished. Your next move is to calmly and quietly repeat your command “you will stop that” while you gently, but firmly lift the child away from the guilty action and carry or lead him to a time-out place, some location where toys or distractions are not available. Ideally, stay near him while he is having his time out, preventing him from leaving, and explain that as soon as he is ready to behave, he can leave. This may take a while, but he will eventually say ‘ok’ and leave. The next time or two that he misbehaves, use the same technique: “you will stop that” followed, if he continues, by using the same phrase with an immediate time out. After you have done this a few times, he will heed your first command (or at least think about it very carefully) and you will have a little better grip on your household. It works.

The Conclusion

Time outs work when Mom is in control.

Have any questions? Please contact Dr. Mesibov

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Table of Contents

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