Winter Illnesses and Treating Children

Self care lecture 6

Asthma exacerbations

• Cold air is a major trigger of asthma symptoms such as wheezing and shortness of breath

• People with asthma should be advised to monitor their symptoms in winter

TIP for patients:

• stay indoors on very cold, windy days

• if patients go out, advise them to wear a scarf over their nose and mouth

• also advise patients to be extra vigilant about taking regular medications and to keep rescue inhalers close by

Arthritis flare-ups

• many people with arthritis report that their joints become more painful in winter — unclear why

• only joint symptoms such as pain and stiffness are affected by the weather (no evidence that changes in the weather cause joint damage)

TIP for patients:

• advise patients that many people get a little depressed during the winter months and this can make them perceive pain more acutely

• explain that for many patients, everything feels worse, including medical conditions

• advise daily exercise as it can boost both mental and physical states

• swimming is ideal as it is easy on the joints

• keeping warm is good — use hot water bottle, hot/warm patches

Heart attacks

• more common in winter

  • may be because cold weather increases blood pressure and puts more strain on the heart — heart also has to work harder to maintain body heat in cold temperatures

TIP for patients:

• advise patients to stay warm in their homes

• maintain room temperature at 18 degrees Celsius and to use a hot water bottle or electric blanket to keep warm in bed

• advise them to wrap up warm when outside and wear a hat, scarf and gloves

Cold hands

• Raynaud’s phenomenon is a common condition that makes fingers and toes change colour and become very painful in cold weather

  • Fingers can go white, then blue, then red, and throb and tingle. This signals poor circulation

  • The small blood vessels of the hands and feet go into spasm, temporarily reducing blood flow to these areas

  • in severe cases, medication can help but most people manage their symptoms without treatment

• Chilblains are small, itchy swellings on the skin that occur as a delayed reaction to cold temperatures

  • they often affect the body’s extremities and typically cause a burning/itching sensation, which can become more intense on entering a warm room

TIP for patients:

• don’t smoke or drink caffeine

• advise wearing warm gloves, socks and shoes when going out in cold weather

Dry skin

• often worse during the winter — environmental humidity is low

  • especially for those who have eczema (they might have flare up, which is hard to maintain)

TIP for patients:

• Moisturising is essential during winter — moisturising lotions and creams aren’t absorbed by the skin. Instead, they act as a sealant to stop the skin’s natural moisture from evaporating.

  • The best time to apply a moisturiser: after a bath or shower, while skin is still moist, and again at bedtime

• have warm, rather than hot, showers — too hot water can make skin feel more dry and itchy

Cold Sores

Stage 1:

• tingling, itching or burning beneath the skin (usually around the mouth or nose) may begin

• the first sensation is the ideal time to begin treatment

Stage 2:

• small red bumps begin to blister

Stage 3:

• the blisters fill with fluid forming a full-scale cold sore

Review cold sores

Norovirus

• contagious (easily spread) so advise patients to stay at home

• presents with symptoms of gastroenteritis which are vomiting and diarrhoea, which can occur at the same time

  • there can be nausea as well

• Recommended treatment for norovirus: plenty of fluid, paracetamol, and rehydration sachets

  • patient needs to stay at home to prevent the spread of disease

  • losing lots of fluids means losing lots of electrolytes — so they can feel tired, which is why it is important to drink lots of liquids

• personal hygiene is of paramount importance as it can prevent the spread of norovirus

• immediately after the symptoms have subsided, the advice is to stay at home a little longer past the symptoms being subsided

• there is no vaccine for norovirus

Cold

• a mild viral infection of the nose, throat, sinuses and upper airways

• can cause a blocked nose followed by a runny nose, sneezing, a sore throat and a cough

• in adults and older children, the cold will usually last for about a week

• cold in younger children = lasts up to 2 weeks

TIP for patients:

• no cure for a cold so need to wait it out

• BUT, symptoms of a cold can be relieve by taking over-the-counter medication (such as paracetamol) and drinking plenty of fluids

• may take 5-6 days to actually feel better

  • won’t feel immediately better so stay hydrated and well-rested

Flu

• major killer of vulnerable people

  • people aged 65 and older, pregnant women, children, and people with long-term health conditions (such as diabetes) are particularly at risk

TIP for patients:

• the flu jab (or flu nasal spray for children aged 2-18) is recommended to prevent catching the flu

  • vaccine lasts for one year

Coronaviruses (CoVs)

• a family of viruses that causes illness in human and animals

• of the 7 different types that have been found in people:

  • SARS (Severe Acute Respiratory Syndrome)

  • MERS (Middle East Respiratory Syndrome)

  • COVID-19

• Cause respiratory and intestinal illnesses

• usually present as mild colds but the above have caused severe disease — epidemics and pandemics

• made from RNA genomes — subject to constant change = mutations

• COVID-19 —> diverse effects that affect multiple organs of the body

How do coronaviruses differ from the flu?

• Current research: new coronavirus has a fatality rate among infected people that is 6-16 times higher than common flu (killing 0.6% - 1.6%)

• influenza viruses circulate in the population all the time and it is estimated that approximately one in a thousand (0.1%) of all people infected with common, seasonal flu die of the disease

• important difference: people have some level of immunity to common flue from previous infection or the flu vaccine

• COVID-19 — new coronavirus which our immune systems have not yet been exposed to

• there may be some cross-protective immunity from other coronaviruses that cause milder diseases that have been in circulation for a while — still unknown for sure

Cold and flu remedies for children

The Commission on Human Medicines (CHM) has advised that:

• cough and cold medicines containing the following ingredients should not be used in children under the age of 6:

  • nasal decongestants (pseudoephedrine, ephedrine, phenylephrine, oxymetazoline, and xylometazoline)

  • expectorants (guaifenesin and ipecacuanha)

  • antitussives (dextromethorphan and pholcodine)

    • Pholcodine can cause severe drowsiness so not recommended as 1st or 2nd line of treatment

  • antihistamines (diphenhydramine, chlorphenamine, brompheniramine, promethazine, triprolidine, and doxylamine)

• Cough and cold medicines for 6-12 year olds containing these ingredients will continue to be available in pharmacies, with clearer advice and strengthened warnings on the packaging/labelling and from the pharmacist

• for 6-12 year olds, these products should be indicated for “second line” use, and recommended for a max. of 5 days use

• all liquid cough and cold medicines (including those for adults) should be supplied in a child-resistant container

• certain combinations (such as cough suppressants and expectorants) should be phased out

Analgesics for children - Which analgesic should I prescribe for children under 16 years of age?

• prescribe either paracetamol or ibuprofen alone

  • both suitable first-line choices for treating mild-to-moderate pain in children

• if the child does not respond to the first analgesic:

  • check their compliance, and that an appropriate dose is being taken + time taken + interval between doses

  • if paracetamol has been used, switch to ibuprofen alone

  • if ibuprofen has been used, switch to paracetamol alone — dependent on condition, this may be given first

• if switching has been tried and the child has not responded sufficiently to appropriate doses of one drug alone, consider alternating paracetamol and ibuprofen

  • add a dose of the second drug (for example: after 2-3 hours), provided that the parents are confident to do this

  • paracetamol is usually given every 6 hours and ibuprofen every 8 hours

    • care needs to be taken not to exceed the maximum dose of each drug in a 24-hour period

  • a treatment diary may be useful if the parents or carers find it difficult to remember which was the last drug given and at what time

Analgesics for children - if child is still in pain

• if child is still in pain or more than short courses of analgesics are required, consider referral to a paediatrician for further assessment

• The following treatment options are not recommended for children in primary care:

  • combining paracetamol with ibuprofen (administering paracetamol and ibuprofen at the same time)

  • naproxen

  • diclofenac

  • aspirin

  • weak opioids

New guidance has been issued in the past on the recommended doses of paracetamol for children of different ages — be sure to familiarize yourself with this

• always check the PIL and manufacturers packaging

Additional good advice for all patients during the winter months

1. eliminate sleep debt

2. drink more milk

3. eat more fruits and vegetables

4. try new activities for the whole family

5. have a hearty breakfast

Scarlet fever

• contagious and mostly affects young children

• first signs include flu-like symptoms including sore throat and swollen neck glands

• appearance of a rash 12-48 hours later — red/sandpaper like — can cause cheeks to appear red

• white coating on the tongue — red, swollen and little bumps called “strawberry tongue”

• all cases should be referred to the GP

• complications can arise especially if patients suffering chickenpox at the same time

• treatments — after a swab of the throat and possibly a blood test, antibiotics reduce chances of serious illnesses such as pneumonia

• symptomatic relief of the symptoms

• transmission risks and how to avoid the spread