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Wednesday, June 01, 2016

Building a strong immunity in children

A lot of people worry about this issue, so I thought I should tackle this here. The most important thing to know is that our body;s defensive abilities lie in the correct structure and function of our immune system. This system consists of several specialised organs including the bone marrow, lymph nodes, spleen, thymus and so on. These structures are all present even in a pre-term baby, but their functioning is not something that is optimal at that time. It is over a period of months inside the mother's uterus and then years in the world outside that the immune system develops into a mature system that can prevent and fight infections and other assaults on our bodies.

A strong immune system that can prevent the child from falling ill depends 
upon many things. One of these is the maturity of the system itself. As I have said, the more preterm a baby is, the less his/her immune system's development is, so that it makes sense to prevent premature births. The second most important thing is breastfeeding by the mother. This is so important that its significance cannot be underestimated. The milk of the mother is precious at all times, but even more so during the first few days after the baby has delivered. This milk is called COLOSTRUM. It looks yellowish, watery and not at all like the milk we see in bottles and in packs in the supermarket. It is very small in quantity, perhaps about 60-100 ml in all - but it is packed with antibodies and many important ingredients that help the baby to arm up against several kinds of infections right up to the end of the first year of life. We are still learning about the magic of mother's milk, and I won't be the least surprised if we discover that the benefit of mother's milk goes substantially beyond the baby's infancy.

The next most important factor that determines a child's immunity is their diet. A diet that is well-balanced and contains adequate amounts of all the essential food elements goes a long way in keeping the baby or the child fit and fine. Among the various factors in food that are important from the immune system's health point of view are the amounts of micro-nutrients and vitamins in the diet. Such adequacy can only come if the child is given substantial quantities of salad, fruit and dry fruit and protein-rich foods in the diet. 

Yet another potent immune-protector is proper hand washing by the child. While hand washing does not actually boost the child's immunity, it helps to prevent a lot of infections that can be spread through our inanimate environment.

And, to end this story, I am going to chip in a few lines on immunisation. This means vaccinating the child against a myriad range of infections. Most such activities take place during the first few years, but periodic immunisations continue throughout a child (and then, young person)'s life.These vaccines provide a mix of active as well as passive immunity against infections of all kinds. 

Acute Bronchiolitis in Infants and Young children

Most people have not heard of this exact word in developing countries. The word "bronchiolitis" means inflammation of the BRONCHIOLES. What are bronchioles? These are the smallest size airways in our lungs. They lead out from bigger airways known as bronchi and end into our air-sacs or what we call the ALVEOLI, where the crucial gas exchange of oxygen and carbon dioxide takes place thousands of times in a day, and throughout our life. 

Because infants have small bodies and small lungs, they also have very small bronchioles. These bronchioles catch infection with viruses very easily, and when they do, they get swollen, their internal diameter gets smaller, and their ability to allow effective gas exchange to take place gets reduced dramatically. 

When this happens, the baby becomes short of breath, as he/she can no longer breathe in and out without effort to push open the bronchioles with each breath. The breathing rate goes up, the baby works hard, and soon, he/she becomes tired. This chain of events is known as acute bronchiolitis. While usually a self-limiting condition, infants with this problem can sometimes become really sick and need hospitalisation. We will come to that a little later.

Acute bronchiolitis is an illness most commonly seen during the coldest months of the year. It begins with a simple cold - a runny nose, sniffles, a mild cough and perhaps a bit of a temperature. Over the next few days, the virus descends downwards from the upper airways into the lungs. When it reaches the smallest airways or the bronchioles, it produces inflammation - swelling and secretions in the tubes. This is when the child begins to be short of breath. He/she breathes more rapidly. At this stage, the illness can either remain static, and the child will have the breathing difficulty but not look very sick; or, it can become progressively more severe, and the child may become so breathless as to be unable to feed, sleep or look well. The severity may be such as to make the child's carers reach out to the doctors, with a visit to the hospital in the more serious ones. 

As this is a viral illness, and most of the times resolves by itself, doctors attending to infants and small children with acute bronchiolitis don't usually admit the child unless his/her blood oxygen levels are falling or the child is getting progressively more and more tired. Once admitted, such infants are treated with oxygen and nutritional support. Little else is helpful or needed/ Some infants may be given additional forms of treatment with medicines that open up their airways and make them breathe more easily. However, this is an exception and not the norm. 

Once the breathing difficulty is under control, infants and small children with acute bronchiolitis are ready to go home. Some of them will need medicinal support for slightly longer. A few of the infants who recover from their first attack might develop recurrences of a similar attack repeatedly. A very small percentage of such repeat-afflicted ones may develop an asthma-like chronic problem.

To summarise: Acute bronchiolitis is a frequent problem characterised by a breathing difficulty with a self-resolving natural course. Caused by viruses, it is not an illness that usually causes much distress or loss of productivity on the part of parents. Treatment is directed at maintaining the oxygenation and hydration of the affected child and allow him/her to recover on their own.

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Dr. Fuhrman

Dr. Fuhrman