Scott Webb (Host): If it seems like your child is always sick in the fall and winter, and mine definitely are, you're not alone. And my guest today is here to help us to understand why our kiddos get sick, how viruses are spread, and what we can do to help. I'm joined today by Dr. Matthew Chamberlain. He's a Pediatrician with Acton Medical Associates. This is the HealthWorks Here podcast from Emerson Health. I'm Scott Webb. Doctor, thanks for joining me.

Matthew Chamberlain, MD: Nice to be here, Scott. Thanks for having me.

Host: We're going to talk today about why kids get sick and what we can do to help them and just want to get a sense, what we can expect as parents, especially with younger kids. What can we expect during the winter seasons?

Matthew Chamberlain, MD: So winter seasons are tough, especially. So, my practice is in New England. We're based out of Acton, so we're right in the middle of New England. So in the winter seasons and in the fall you can expect a lot of different viral illnesses, colds, but we have been seeing some pneumonia.

We'll talk about that. I would expect that kids can be sick, especially if they're in daycare. Kids in New England can get sick up to 10, 20 times a year. They can be sick pretty constantly especially if they're in daycare exposed to other kids. I always joke with my patients that I call it New Englanditis or Daycareitis because they're just constantly spreading viruses to each other.

Host: Has the pandemic changed the spread of viruses? Do they spread more easily? Maybe where does COVID fit in? You just mentioned pneumonia is making a comeback a little bit. Where does COVID fit in all of this? Maybe you could take us through that.

Matthew Chamberlain, MD: Yeah. So the last couple of years have been really interesting in the terms of infectious disease and healthcare in general, and especially pediatrics. So obviously 2020 was the COVID pandemic. Very interesting time, as people might know COVID didn't really affect kids as much as the older adults but it still had some fallout in kind of interesting ways.

First thing we saw in 2020 was something called MISC, which is multisystem inflammatory syndrome in children. Which was a kind of inflammatory reaction to COVID. And we would notice that in kids that had gotten COVID, had recovered, and then it's kind of like an immune reaction that occurred with COVID.

Weirdly enough, that kind of has been disappearing a bit. It still occurs. It's similar to another another type of disease that can happen called Kawasaki Disease. It's another type of inflammatory reaction that can happen to certain illnesses. That's a whole other topic though, but needless to say, very interesting things.

Then in 2021, we, you know, kids were still in school and masks and that played a big role. Kids would, we actually noticed kids in the hospital, because at that point I was a resident still and they would come in with COVID croup, so the kids were getting COVID, but they were getting croup, less of the MISC which was very interesting.

And then, of course, in 2022, kids kind of went back to school. Stopped wearing their masks and all of the viruses that were around started kind of coming back and coming back with a vengeance. Everybody was really sick and the biggest virus that came back was RSV which infected a lot of young children under two.

I'll talk a little bit about bronchiolitis in a second, I'm sure but it was basically the pediatric pandemic. Um, we had kids all over the country, hospital beds were full across the state and country. But things have gotten better. And this seems like the first season. Last year was not too bad in terms of viral spread because after that party that all the viruses and bacteria had, everybody's immunity seems to be building back up, and this year seems to be a little better as well, aside from the pneumonia going around.

Host: Yeah. You mentioned there bronchiolitis, and I want to know what that is. Like, I know what bronchitis is, but then I was putting my notes together. I was like, bronchiolitis, that's a word that I don't use very often. Maybe we don't want to, especially with our kids. What can we do to prevent it? And I know you want to get to pneumonia as well. Maybe we'll get to that soon.

Matthew Chamberlain, MD: Yeah, absolutely. They're both kind of important topics So, bronchiolitis is different than bronchitis. Bronchitis is more of a typical adult illness. It's more like a cold, a cough. Bronchiolitis is more of a pediatric illness, so it typically happens in kids under two.

Bronchiolitis physiologically happens when kids are, they get a cold, they get a virus, they're young again, that usually at under two and it occurs when the virus essentially will infect the little tiny tubes in their lungs. Those are called bronchioles. Those bronchioles are the little gateway to the alveoli, which is where our oxygenation happens in the lungs.

So when a virus infects those little tubes, kids are especially, under two, are especially small. And that means that their bronchioles are also really small. So those little tubes get inflamed. And then that makes it difficult to breathe. So what we were seeing in 2022, especially, was that RSV was the main virus causing this.

Of course there's many other viruses that cause this too, like, human metapneumovirus even the common cold. But RSV is main one that causes this. And what happens is these kids really can get pretty sick. They can get retractions, they can have nasal flaring, they have a lot of difficulty breathing.

 And what we had to do in 2022 is support these kids. Cause unfortunately the only real treatment for bronchiolitis is supportive care. You know, it's a virus so it can't be killed like a bacteria. The only way we could get rid of it was to allow the children to actually heal themselves to fight off the virus on their own.

And in order to do that, we just had to support them through it. And sometimes that support meant they had to go to the hospital to get oxygen support because they were having difficulty breathing. Sometimes they would need, pretty invasive, sometimes kids would need to end up intubated.

That's not to say all of them did. It was actually pretty rare for them to get intubated. But needless to say, it was a problem in 2022. To also say a lot of the kids that did get bronchiolitis, I would say 99.9 of them are doing perfectly fine. They all recovered because kids do recover from this illness.

And a lot, most kids, when they get it, they can have some trouble breathing, but they actually do pretty well and fight it off on their own.

Host: Yeah, it's one thing I miss about being a kid is that resiliency. Kids are just so resilient and they tend to bounce back maybe faster than someone my ripe old age. And we're using the word virus a lot here and I have to confess that when my kids would wake up with a sore throat, And I knew we had to go to the pediatrician's office to be tested for strep throat.

I would root for it because I knew strep was something that we could treat for versus these viruses where they just kind of had to run their course and hope that the kids could bounce back sooner than later. So maybe we should just as a baseline here make sure we all know what a virus is. Maybe you can talk about pneumonia here as well. Like how does this all tie together?

Matthew Chamberlain, MD: Yeah, so viruses, you'll hear your doctors, you know, I have a ton of patients that come to the doctor and say, I guess it's maybe viral. I'm not sure what a virus is, you know, what's a pneumonia. So bronchiolitis is not pneumonia. Pneumonia is you know, viruses infect our lungs and then fluid builds up.

And then what happens in pneumonia is that that fluid gets infected with bacteria and can, just kind of build up in the lungs. So the pneumonia is that fluid building up in the lungs and it causes a cough and causes you to feel sick. So just kind of talk about the difference between a virus and a bacteria. So a virus is a non, technically non living organism so it's a non living thing that infects us. It's essentially protein and either DNA or RNA, it's genetic material and nothing really else. And what it does is it uses our cellular components. So our, it uses our cells to actually replicate itself. You know, there's a lot of studies trying to figure out why viruses came to be, why they exist. There's a lot of evolutionary history there. It's very interesting. But for our point, they're not alive and they're not something that we can kill with antibiotics.

Whereas bacteria, those are alive. Those are cells. There's many different variants of bacteria that can happen. As there's lots of infections that kids get that we know are bacteria. There's skin infections, lung infections like pneumonia. So what often will happen is when kids get a virus, viruses cause some fluid to build up in the lungs, say when they get a respiratory upper airway infection.

They'll cough, the cells, and they're coughing because the virus is causing replication and irritation of the lungs, and the kids will cough. That's because fluid is starting to build up there. And a lot of times what will happen is bacteria will jump in on the party and hop in on that fluid and infect the fluid. And typically what happens with pneumonia is those kids, in a typical case of pneumonia, a bacteria most typically in younger children called strep pneumoniae, it's different than group A strep, like strep throat strep, and what that will do is it will infect the fluid that the virus has already caused.

So it's called a secondary bacterial infection. Sometimes kids can just get a straight up bacterial infection in the lungs right away, but most times it's from a concurrent virus. So they have a virus and a bacteria together. And then that just infects the lungs and we have to treat that with antibiotics.

Now, what we're seeing right now is something called walking pneumonia, which is a little bit different than a typical pneumonia. So similar, it's a bacteria, but it's a small bacteria called mycoplasma pneumoniae. They're very confusing names for bacteria. And what that does is it kind of acts like, almost like it's just a virus.

 It's somewhat milder form in some cases of pneumonia, most cases I've been seeing. But what it is, is it's tiny little bacteria that still infects the fluid in the lungs, but doesn't infect one pocket. Not always. It's a little bit of a funny bacteria. It does a lot of different things. It can cause rashes, it can cause you know, in rare cases, it can cause even behavior changes. I mean, kids can actually get encephalitis from mycoplasma or encephalopathy. So you can get some interesting brain changes from mycoplasma. Treatable, by the way.

Host: Right. That's music to a parent's ears. Is it treatable, Doc? Right?

Matthew Chamberlain, MD: Yeah, absolutely. So, that's the thing about viral infections, there isn't a whole lot of treatments available for viral infections but bacterial infections are, you know, we can always give antibiotics but it's important to talk to your doctor to kind of help discern what the best course of treatment is.

So what we've been doing for these cases of walking pneumonia where they're, most of what we've been seeing is kids in college, kids in schools, they're coughing, they have viruses, and then mycoplasma's kind of hopped in on the party and caused walking pneumonia.

These kids develop a cough that lasts two to three weeks and they just can't get rid of it. And it's, just getting deeper, they're not having super bad fever, so some kids do and they end up needing the antibiotic called azithromycin, or otherwise known as a Z Pak. And these kids do tend to get better but it's a very interesting time because as you know, the past few years have been interesting in terms of changes after the COVID pandemic.

 So for parents that have new infants, and want to protect against RSV; there are two ways to protect against RSV this fall and other respiratory illnesses. And so the two options are getting the RSV antibody.

So that's a passive immunity, kind of like what babies get through breast milk with the maternal antibodies. And that will help your young ones through RSV season which is basically now. So I, you know, if you haven't gone to your doctor yet and they haven't, you haven't talked about the RSV antibody. Then that's definitely something worth talking about.

And then for moms that are currently pregnant uh, you can also get the RSV vaccine yourself. So this, that's an actual vaccine that has the virus and your body will develop immunity to it. But then getting the RSV vaccine when you're pregnant will allow you to pass those antibodies along to your child and protect them as well.

So those are two really important ways to protect your child this coming respiratory season, along with your, all your regular vaccines as well.

Host: I wanted to ask you about fevers. In general, what do we need to know about fevers?

Matthew Chamberlain, MD: Fevers are our body's normal response to an infection. It's our body actually trying to help clear the infection. So evolutionarily, they're not dangerous. They're something that normally does occur, but in kids, fevers make kids look sick. They just don't look great.

So again, fevers can happen from either a virus or a bacteria and they just don't feel well. So the fever itself is not dangerous, but it can just make you feel like, not well. And the best treatment for that is ibuprofen or Tylenol to kind of help kids get through it. So ibuprofen is an NSAID and that helps kind of decrease the fever and inflammation.

The NSAIDs definitely do inflammation, which is fantastic, especially for like a bad cough, sore throat. So yeah, the best treatment for a fever is you know, you can definitely take Tylenol or Motrin or ibuprofen.

Motrin, ibuprofen, Advil, they're all the same thing. So Tylenol is great for fever and pain, so Tylenol will take down fever and pain. And ibuprofen will also add in an anti inflammatory effect because it is an NSAID. So ibuprofen is great for kids with a sore throat, ear infection, bad cough, and a little bit of chest pain from coughing.

Ibuprofen does a great job at kind of taking care of some of those symptoms along with the fever. So those are two good toolkits for fever. Now I typically don't say that, I did say that fevers aren't harmful, in themselves, but they can be associated with some scary things.

If you had fever for five days or more, we start to worry about something else going on. So a fever can be an indicator that something is brewing. So in a lot of kids that have had five days of fever we start to look for those pneumonias, those ear infections.

Because typically a few days of virus and a fever, we don't worry that it's something more. But if it's hitting four to five days of fever, we start to investigate a little further. We start to get x-rays, if we haven't checked your ears yet, we check them again to make sure there's no ear infection brewing, because that can certainly cause a lingering fever, pneumonia especially a bacteria called strep pneumoniae, that's a typical pneumonia, so that typical pneumonia where it infects the pocket of fluid in your lung. That can cause a really nasty high fever. And then there are some other things I look out for. I mentioned Kawasaki disease. That's one of the main reasons I have parents come back, because that's not a diagnosis we like to miss, and that usually warrants treatment, because that can cause inflammation of your heart, and it also causes inflammation of your skin, and, needs to be treated in the hospital.

 And one thing I did want to bring up with fevers as well is that sometimes parents are scared that their kid may have what's called a febrile seizure. So, sometimes in younger kids, we're not quite sure why, but physiologically when they have a fever and it gets really high, they can develop a seizure.

But the seizure is actually not harmful. It's maybe thought to be due to the immature brain. But what happens is this, if the seizure lasts less than 15 minutes and the kid is acting fine afterward, then we actually just let it be. It's certainly scary and, you know, it's something I do talk about with patients.

But it's not a reason for me to be scared of a fever to say. But certainly if you're ever worried, you know, we're here to talk about this stuff and we want to see your kid.

Host: I want to finish up and talk about why does it seem like our kids are more sick in the fall and winter? You mentioned uh, New Englanditis, I believe is what you called it, right? Because I remember being a kid and being told that if we didn't dress warm when we were outside in the cold, that we were going to get sick.

And I don't know if that's just something like my grandma said, because that's what she believed. Is that the case? Is it just because the weather changes and it's colder? Is that one of the reasons why we might or our kids might get more sick in the fall and winter? How does that work?

Matthew Chamberlain, MD: So that's actually a great question. You bring up a good point. That is lot of people think when they go out in the cold you'll get sick.

Host: Right. If you don't wear a hat in you're going to get sick.

Matthew Chamberlain, MD: Um, so, yeah, not always the case. What you'll notice every year is when kids go back to school, they start coughing. And, you know, in September in New England, this year, it was not cold. So what really is going on is that people are going back indoors. So people are going back inside, they're coughing on each other. They are breathing on each other and they're spreading these viruses. And I will say that you can spread these bacteria as well. They're also communicable.

So, if you cough, they can spread. So it's really hard to keep track of especially since we're not wearing masks all the time anymore which, you know, I think is a good thing. I mean, I think it's good that kids are now back in school and have some normalcy and they are building up their immunity again.

So, I mean, what happens in the fall is these kids just go back and the viruses again start having a party, not as much of a party as they were having in 2022. So what, kids need to do is just make sure that when they're sick, they're that they try to cover their mouth, wear a mask, I mean, that's a time where you could certainly wear a mask if you're sick in school, washing your hands all the time, not sharing drinks or food when you're sick.

Because that's one way to definitely spread around some strep, which that's another topic as well. So, I mean, it's not really the cold as much. It's more of the fact that there are people moving indoors more closer to each other and breathing on each other. Not, that's not to say if you go outside in the cold for a long time and are really shivering, that can actually, dull your immune response a little bit just because your body kind of is fighting off the cold. But that's separate from the fact that you probably have already been breathed on. And that, you know, this virus was going to happen anyway.

Host: Doctor, this has been great today. I loved having your time, picking your brain. I know we could talk about other things like kids that have pre-existing lung conditions. We could do an entirely separate podcast on asthma and how those kids are affected, this time of year. But for today, I really appreciate your time. Thank you so much.

Matthew Chamberlain, MD: All right. Thanks, Scott. Thanks for having me on the show.

Host: You bet. And to learn more or schedule an appointment with Dr. Chamberlain, go to actnmedical.com. And thanks for listening to Emerson's HealthWorks Here podcast. I'm Scott Webb, and make sure to catch the next episode by subscribing to the HealthWorks Here podcast on Apple, Google, Spotify, and wherever podcasts can be heard.