Before COVID-19 broke into the world and the pandemic dominated everyday life, it was common for a string of children with mucus, cough and other respiratory symptoms to appear after the start of school.
These days, after two years of pandemic and with the fear that arose around contracting the new coronavirus, the beginning of this school year, no longer so many protocols or bubbles in schools, fills many parents with unease.
As expected, respiratory viruses soon appeared on the scene, with the “aggravation” that SARS-CoV-2 is now circulating among them.
What to do, then, if a child presents a picture of those who did not take more than a few days of steam and rest at home before COVID? How to differentiate when it is of concern?
“Children have to be linked to the environment, it is normal and common for most of them to have respiratory secretions, and that is why they are called 'brats'. As they grow up and face different agents, they become immune to these airborne agents and children are expected to have fewer respiratory episodes.” Andrea Uboldi is a pediatric infectiologist (MP 10537) and, in front of Infobae's consultation, she began to explain: “The return of activities implies the reunion of children with their peers, and with it, more chances of being able to transmit agents that can be carried in the respiratory tract to each other. agents that are occasionally encountered such as an infection”.
“In general, when returning to school, and especially in the early stages of kindergarten and the first years of primary school, is when the highest number of infections occur in young children. The same happens in those who attend kindergartens or kindergartens whose respiratory system is even more immature,” he added.
In the same vein, pediatric infectiologist María Cecilia Torroija (MN 95152) noted that “when the youngest children enter kindergartens for the first time, their immune system is not yet fully developed because they have not yet been exposed to multiple microorganisms such as viruses, bacteria, fungi and parasites that usually cause infectious diseases. Activities such as play and eating facilitate close contact, plus the habit of the little ones to put toys in their mouths, allowing infections to spread quickly.”
“With regard to viruses, what mainly happened is that we had a very big impact of SARS-CoV-2, which displaced all the rest of the respiratory viruses, and on the other hand, the measures that were taken, such as closures, isolation, wearing a mask, ventilation and hand washing contributed to a decrease in all infections that are transmitted from person to person,” continued Uboldi, who stressed that “the viruses that children usually get are respiratory viruses such as rhinoviruses, parainfluenza and adenoviruses, and at this time there is a resurgence of the influenza virus, of the type A with the H3N classification 2, which is what is generally called “seasonal virus”.
Asked about the most common diseases that children can get in schools, the specialist, who is a member of the Infectology Committee of the Argentine Society of Pediatrics (SAP), specified that “in general, the cases of respiratory infections, that is, infections caused by agents viral or bacterial diseases that affect the respiratory tract usually occur with some seasonality and are well characteristic of autumn and winter due to cold and humid conditions”.
“The symptoms can be of upper airways, that is mucus, cold, congestion, pharyngitis or with airway involvement as occurs in cases of laryngitis, bronchiolitis, bronchitis, what is called influenza or influenza-like disease, cases of pneumonitis and pneumonia,” explained Uboldi, who added that other diseases that are common among the youngest “are otitis, conjunctivitis and gastroenteritis, some caused by respiratory viruses such as adenovirus”.
“Another disease that is occurring is the hand-mouth-foot syndrome, which is a contagious disease caused by a virus of the enterovirus family, which mainly causes blisters on the hand, feet and mouth, with fever and gastrointestinal symptoms,” added the expert.
Torroija, meanwhile, stressed that “respiratory and gastrointestinal infections are the most common diseases that occur throughout the preschool and school years”. “Respiratory infections often cause coughs and colds that usually last a few days, most resolve without specific treatment and without complications. It is estimated that, on average, a child under two years of age can have between six and eight banal respiratory infections a year, and as they grow, these symptoms tend to be less frequent,” said the specialist from the Foundation of the Center for Infectious Studies (Funcei).
At this point, Uboldi acknowledged that “it is difficult to make a differential diagnosis because the symptoms are extremely similar”. He added: “The common cold occurs with little fever and little muscle pain and a lot of congestion, while the flu is characteristic of fever of 38° or more, of sudden onset, muscle aches, headaches, usually dry cough and in general does not cause respiratory congestion. In the case of children, there may be gastrointestinal symptoms and this means that they may have diarrhea or vomiting.”
In the case of COVID-19, the specialist continued, “the characteristic symptoms at the beginning of the pandemic were very high fever, headache, muscle aches, cough and almost no respiratory symptoms, but from the Ómicron variant the picture looks more like a mixture between flu and cold and shares many of the symptoms”.
So, what to do in front of such similar paintings? First of all, common sense prevails and, as was the case before the pandemic, a child with respiratory symptoms should not go to school until evaluated by their pediatrician.
“It is always important to consult the family doctor, avoid self-medication, avoid going to school, not to associate with people with risk factors and ventilate environments at home,” recommended the SAP pediatrician, who stressed that “there are warning signs that determine the visit to a guard urgently, such as the feeling of shortness of breath or shortness of breath, the presence of deep sleep, in the case of babies if they have difficulty feeding, vomiting, or if they feel pale”.
And after highlighting that “these symptoms are generally viral and do not require the taking of antibiotics,” he pointed out that “with measures such as blowing the nose, using physiological solution to help them expel secretions, water vapor and in young children the aspiration of secretions reverses.”
“Of course, if the picture is sustained over time or fever or shortness of breath is added, a lot of drowsiness, it is an indication for urgent consultation,” he said.
How are infections spread? “In the school environment and in kindergartens, close contact, infrequent hand washing and inadequate cleaning and disinfection favor the transmission of microorganisms: viruses, bacteria, parasites and fungi,” Torroija explained.
There are four routes of infection or dissemination:
1- The airway: after coughing or sneezing, children and sick adults spread germs in the airways into the air.
2- The digestive tract or oral fecal route: Many germs that are eliminated in the stool are transmitted through ingestion of contaminated water or food, or through contact of contaminated hands or objects with fecal matter.
3- By direct contact with people and objects: requires close, prolonged and direct contact with the sick child, through contact with infected hands or any contaminated surface such as toys, school items, doorknobs, bathroom surfaces or other surfaces that are not properly sanitized.
4- Contact with saliva, urine and blood: most viruses that are present in blood, urine and saliva. In the rare cases where a child bites another — still causing skin disruption and minor bleeding — the application of standard precautionary measures with removal of blood and cleaning and disinfection of the wound is sufficient to prevent the transmission of diseases.
And on what are the main preventive measures to protect children and adolescents, the Funcei specialist stressed: “Encourage the correct and frequent washing of hands, especially after each visit to the toilet, before eating and when returning from recess; instill the practice of mouth protection with the forearm when coughing or sneezing; discouraging children from putting tools or their hands in their mouths, as well as sharing personal utensils, such as cutlery, straws, etc.; repeating hand washing and disinfecting objects, when returning home from school or work.”
Uboldi added that these are “all the measures that were incorporated since COVID and that should not be abandoned”. Among them, he highlighted: “covering with your elbow when coughing or sneezing, washing your hands frequently, cleaning surfaces such as countertops, desks and doorknobs, and ventilating rooms are all fundamental practices.”
He concluded: “Beyond these preventive strategies, I believe that the role of the influenza vaccine is key, which is a vaccine that is formulated 'tailor-made' from the strains that circulate each year and that must be applied by those who make up the risk groups in order to avoid complications, hospitalization and death caused by influenza infection ”.
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