Amanda Wilde (Host): This is Children's Health Checkup where we answer parents' most common questions about raising healthy and happy kids. In this episode, we'll cover why winter illness in children is so common and how to nurture a strong immune system naturally. I'm Amanda Wilde, your host, with Dr. Neethu Mathew, pediatrician at Children's Health. Dr. Mathew, welcome and thank you for being here.

Dr. Neethu Mathew: Oh, thanks, Amanda. Glad to be here.

Host: We confront this every year. Can you explain why children seem to get sick more often during the colder months?

Dr. Neethu Mathew: You know, there's a few reasons. And you're absolutely right, children do get more sick during the winter months. Part of it is just we're more indoors during the winter months. The cold weather outside makes us stay indoors. The kids are back in school. So once again, they're more exposed to other children in close proximity to each other. And then, just the nature of colder temperature, along with the drier air, allows these respiratory viruses to last longer in the air. So when you have colder temperatures, it actually has like a protective coating over a lot of viruses that allow them to last longer, instead of dying on contact, if you will. Also, the drier air, we don't make as much moisture in our noses. We don't sneeze as much particles out. So, it allows those viruses to stay alive longer. It also allows it to-- because it's not as dense-- be in the air longer. So when you do cough or sneeze, those particles are way less, so they stay alive.

And then, I think that the other part is when our noses are cold, which it's really very exposed, the little hair particles that are in our nares that help move the particles out, they're frozen or they're not as mobile. So, we have those particles that are just stuck there longer. So, it's kind of a cumulative effect of all of those things. So, yes, kids do get-- kids and adults, but kids more-- just because of their hand hygiene and everything else, but they do get sick more often during the winter months.

Host: And you said kids are also around a lot of other kids, all breathing on each other and handling some of the same things. Are there specific age groups or children with particular health conditions who are at higher risk during the winter months?

Dr. Neethu Mathew: Absolutely. Kids under two, we always consider to be higher risk for these winter viruses. Their immune systems are still developing. If you're vaccinated, you will have some immune protection, but they haven't contacted these viruses as often as maybe someone who is a little bit older. And so, we do consider kids under one month at very high risk kids, under two at a higher risk. And then, if you have underlying diseases like asthma, these viruses can trigger your asthma symptoms. Anytime you are at an immune risk, you know, if you have an immune deficiency or you have to be on immunosuppressants for another illness, or if your immune system just doesn't work as normally as others for whatever reason, you're going to be at higher risk no matter what the age.

Host: And since so many viruses are going around, how can parents differentiate between a common cold and something more serious that might require medical attention?

Dr. Neethu Mathew: I know this is a hard question, because some of it is doctoring as a mom or a dad, right? And so, I know even my own kids, when I say, "Oh, it's just another cold," you know, they get mad at me too because they're like, "Mom, there's got to be an answer to this." But really, the colds, they're longer, but they're milder is kind of how I see it.

So, yes, you might have low-grade fever. You'll probably have runny nose, congestion that turns into a cough on day, like, three to five, and then, you know, that lingering cough that lasts it seems like all winter long. But it really does last for up to 14 days and that's still considered part of that virus.

And then, take into effect that we have rhinovirus, we have adenovirus, we have parainfluenza. So, you can get a few of these viruses back to back. And it seems like your child is always sick. But the thing is it gets better. So, day three to five, six is probably the worst of it, but then the kids are getting better. The cough is a little better. It's not gone yet. With things like flu, it's a higher temperature. And you will have some associated body aches, more likely to get dehydrated because they're just not feeling well enough. But flu is usually shorter. So, it's about three to five days and then you seem to get better. Again depending on how much congestion, you could have a cough that's lingering.

What I worry about the most are those kids who, let's say, had a common cold, they seem to have gotten better on day 14 like expected, and then the following week, they end up with a high fever. That's more suspicious to me for a secondary bacterial infection. That could be ear infection, it could be pneumonia, it could be sinusitis in the right aged group. But those are the things that perk my ear when I get that history of, "Oh yeah, two weeks ago, you know, he started with this. He seemed to be better and was back at school and then now he seems worse than he was before." It's hard to differentiate though, I will say, because a kid could have also picked up something in that week that he was back at school, but that perks my ear up when I get that history from a parent.

Host: Well, what can we do as parents to boost our child's immune system during the winter?

Dr. Neethu Mathew: It seems like an uphill battle from the beginning, but there are things we can do. The flu vaccine's available. We highly, highly recommend it for especially kids under two who again, just hasn't been exposed and needs that immune boost. So, get your flu vaccines yearly. There is an RSV vaccine out there now for kids under eight months of age. So, your first season where you are most risk for being hospitalized from RSV, get that vaccine if you can or if you meet the age criteria.

The other things, I know it seems simple, but hand hygiene. Just wash your hands, wash your hands, wash your hands before you put things to your mouth. You know, if we can teach our children not to touch our faces, especially during the winter months, because you're touching things on surfaces and putting it to your nose or your mouth. That's how the respiratory droplets, the virus particles are getting into our system.

Good rest. This time of the year, you have lots of activities. You're busy, you have holiday parties. If kids don't get their rest, then their body's going to have a harder time fighting those infections. Nutrition, you know, we need those vitamins and nutrients to boost our immune system as well. We don't have great scientific data for what is the best vitamin C, vitamin D. I think everyone has kind of their inclinations. But really, what it comes down to is let's get our fruits and veggies in our daily diet, and that will certainly help.

Host: So, flu vaccine, RSV, vaccine, hand hygiene, good nutrition to feed the body. Good rest. Are there any last key takeaways that parents should remember as they aim to keep their kids healthy this winter?

Dr. Neethu Mathew: Yeah, know that you're not alone, that everyone's fighting this battle and do the best you can. A few other things that you can do. We are indoors a lot, and kids who have allergens or who already have indoor allergens are probably going to be at higher risk. So, you know, getting a air purifier for your home or clearing out your filters more often to kind of remove those impurities will help.

If there is a nice day in the middle of winter, open that window. Let some of that air go in and out of your house so that we're refreshing again. So, take advantage of that. I think that might help, especially those who already have some allergens. Also, remember that kids under six, we do not recommend the cough and cold medications for. So, studies have shown over and over again that it's not very helpful. A spoonful of honey works just as well for the cough. Saline to remove the impurities from your nose and suctioning that out helps to clear the congestion. For kids over two, putting a little Vicks like with the menthol on their chest to open up their airways and be able to breathe a little bit better. A humidifier, because again, this comes down to just the dry air. So, having a humidifier in that room when the kids are coughing at night to get a better night's sleep. Those are proven effective. The cough and cold medications under six, definitely not. And then, the decongestion for kids under 12 are also not recommended.

Host: I was just going to say, my mom would not forgive me if you did not mention the humidifier, because she used that a lot for us as kids. And it really worked, and I use it again when I got a really bad cough as an adult. And it's good for all of your skin and everything else too.

Dr. Neethu Mathew: And the other part of it too is when our skin's dry again, it's our first barrier to all kinds of germs, right? So when our skin is dry, we have these little micro breaks. And so, yes, I agree. I think it helps for all of those things. And so, we have two small humidifiers that we kind of go between the different kids' rooms, depending on who's having symptoms. And it really does help them. And again, it helps them have a better night's sleep so they're more rested and so their body can heal faster.

Host: And it's something reusable and natural.

Dr. Neethu Mathew: Right.

Host: Which some of these tips are. And then, sometimes, you know, you need to consult medicine, such as for vaccines. That helps a lot too.

Dr. Neethu Mathew: Absolutely. And, you know, anytime, this is what we are going to school for, we take care of. So if the parent is ever concerned, then we are also concerned. And so, always come in. And it's more benefiting for me to listen to a lung, and it'd just be completely normal and to reassure that it's a normal cold and reassuring for the parents that it's a normal cold and this is what's expected.

And even just with the babies, I love bringing them in. When they're under three months old, I always say, "Just bring them in so I can show you, okay, these are the things to watch out for in that time." If you have a baby that's breathing funny or breathing fast, I can show you how to count those things because those are so hard to do on a regular well check. But when they start getting that nasal congestion, let's take a look and tell you what to look for, what's expected, what's abnormal, when to go to the ER, when to come in and see me the next day. So, use your provider. Use your pediatrician, because that's what we do. That's what we'd like to do.

Host: Yep, they're on your team. So, don't be shy about consulting your pediatrician. I love that. Well, Dr. Neethu Mathew, thank you so much for being available, sharing your expertise on winter illness and your advice on staying healthy through the winter months.

Dr. Neethu Mathew: I appreciate it. Thank you, Amanda, for having me.

Host: For more tips on how to keep your child healthy and happy, visit childrens.com/healthwellness. And if you're in North Texas, Children's Health Pediatric Primary Care offers trusted care close to home from newborn checkups to care for common illnesses and more. Find a location near you at childrens.com/primarycare. Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review and share the episode and please follow Children's Health on your social channels.