How Many Infections in a Child is "Normal" Per Year?

Kids get a lot of infections... but at what point should a parent be concerned on how often these infections occur, particularly upper respiratory infections?

A German study went about to determine the answer to just that question... They prospectively followed 760 children born in 1990 and followed them for 12 years. Parents recorded the child’s illnesses in a diary and answered structured questions yearly up to age 12.

This is what they found... The mean number of infections per year for each age group (standard deviation):

• 0-2 years: 3.4 episodes (3.7) per year
• 3-5 years: 2.3 episodes (2.6) per year
• 6-12 years: 1.1 episodes (1.2) per year

Two standard deviations above the mean can be still considered within normal limits, though on the high side of normal:

• 0-2 years: 11 episodes per year

• 3-5 years: 8 episodes per year

• 6-12 years: 4 episodes per year

If a child gets more than this number of infections per year, one may need to consider possible immunodeficiency.

Source:

History of respiratory infections in the first 12 yr among children from a birth cohort. Pediatric Allergy and Immunology. Volume 19, Issue 6, pages 505–512, September 2008.

How many respiratory infections in children are "normal" per year? Allergy Notes by Dr. Ves.

Natural Remedies for a Sore Throat, Cough, and Viral Infections

Homeopathy and alternative medicine often get a bum rap, but they have come up with some treatments for sore throats and upper respiratory viral illnesses that actually have been proven to work.

Here's a few...

1) Honey

Sore throats (and coughing) can be soothed by swallowing honey straight-up or slightly diluted with warm water with honey to make it easier to swallow. The best time to do this is at bedtime given it will stick around for awhile (eating/drinking will wash away the coating). The purpose of honey is to create a throat barrier to ease the discomfort.

Think of it like chapstick to coat irritated lips, but meant for the throat.

Use of honey is also recommended by the World Health Organization which has also published a monogram on viral colds and the various treatments explained. Pay particular close attention to Annex 3 (Page 11) which gives various recipes to treat pediatric cough including the use of honey.

Reference:
Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.

2) Humidification

Dry cool air increases risk of viral infections as well as giving it to others. As such, add room humidification to a bedroom and keep the door closed (small room humidifiers can't humidify an entire house... so keep door closed!).

Why does this help? Increased humidification inactivates viruses!

Humidification also helps minimize a persistent dry cough worse at night often due to reactive airway disease triggered by breathing in dry air.

However, keep in mind that if you actively have a viral illness, it is too late for humidity to help. It is best used as a preventative measure.

Reference:
Dynamics of airborne influenza A viruses indoors and dependence on humidity. PLoS One. 2011;6(6):e21481. Epub 2011 Jun 24. Influenza virus transmission is dependent on relative humidity and temperature. PLoS Pathog. 2007;3:e151.

Heated, humidified air for the common cold. Cochrane Database Syst Rev. 2011 May 11;(5):CD001728.

3) Gargling and Saline Flushes

Gargle with saline water... or even just tap-water on a daily basis. Why does this help prevent viral infections? It washes away the viral particles before it gets a chance to cause problems.

It's also probably why drinking lots of fluids also helps since the viruses get deactivated in the stomach from the acidic digestion.

Unfortunately, gargling only helps with the throat... saline flushes are required to help with sino-nasal problems.

Reference:
Can we prevent influenza-like illnesses by gargling? Intern Med. 2007;46(18):1623-4. Epub 2007 Sep 14.

4) Xylitol

This naturally-occurring sugar substitute apparently has all sorts of anti-bacterial as well as anti-fungal properties and has been known to doctors and scientists but hardly marketed or promoted in any fashion.

However, the importance of this compound is that it DOES appear to significantly decrease the incidence of ear infections and sinus infections when used regularly. It comes in nasal spray form as well as gum.

Reference:

Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.

A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996 Nov 9;313(7066):1180-4.

Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

Conclusion

Sometimes the BEST medicine are things you can do at home without need for a physician visit... and is based on fact rather than anecdotal evidence.

Cold Sores Due to a Single Gene

Specifically, individuals who suffer from cold sores triggered by Herpes Virus Simplex - 1 (HSV-1) several times a year may have a single nucleotide polymorphism in their gene C21orf91 – dubbed rs1062202. Researchers have suggested it be called by the more "easy-to-remember" name Cold Sore Susceptibility Gene 1 (CSSG1).

Having this genetic change of swapping a thymine to a cytosine nucleotide was significantly associated (p=0.0047) with more frequent cold sores. Analysis has also found collections of 5 variants that are transmitted together with the C21orf91 gene of which two seemed to be neutral in terms of cold sore frequency, one was protective, and two were associated with increased susceptibility.

What does this all mean for an individual? It means if your parents get them a lot, than you may too.

Such individuals may benefit from regular use of anti-viral antibiotics to prevent such frequent recurrences.

Reference:
C21orf91 genotypes correlate with herpes simplex labialis (cold sore) frequency: Description of a cold sore susceptibility gene. J Inf Dis 2011; DOI: 10.1093/infdis/jir633.