Maggie McKay (Host): Welcome to The Peds Pod by Le Bonheur Children's Hospital. I'm your host, Maggie McKay. Joining us today is Dr. Stephen Bauch, general pediatrician, to give some tips for preventing fall and winter sickness and managing parental anxiety. Thank you so much for being here today.

Dr. Stephen Bauch: My pleasure. Thank you for having me.

Host: Absolutely. So, what are the most important day-to-day hygiene practices for families with young children, and which ones actually make the biggest difference in preventing common infections?

Dr. Stephen Bauch: Well, in terms of hygiene, that is one of the core things for preventing illness. And usually, we talk about hand hygiene for kids, and that involves using soap and water's the simplest method and still probably the best method. If you don't have it available, hand sanitizer is fine and works as well. But soap and water typically for 20 seconds. So for smaller kids, some parents will, like for instance, sing the "Happy Birthday" song twice while they wash their hands or just giving it adequate time to get the soap on and then wash the hands off. Typically, the best times to do it are after school or after daycare, after they've been outside, so when they come back through the door. And then, before eating tends to be an important time too. Of course, if they cough on their hands or get their hands dirty, that's good as well.

The other things that we think about, in terms of hygiene is also counter surfaces that are frequently used for food or preparing food that they use for other reasons. And you don't have to go totally berserk with cleaning surfaces, but it's a good idea for the often used surfaces to be cleaned every so often.

Host: How do you feel about wipes versus hand sanitizer? Are they equally effective or is one better than the other?

Dr. Stephen Bauch: Well, the main thing with hand sanitizer helps with sterilization is the isopropyl alcohol. About 70% is usually what we were recommending when COVID was around. Hand wipes typically don't have that. So, it's more for just cleaning up messes on the hands or where you can see visible dirt. So, sanitizers tend to trump hand wipes in that regard. Now, there are hospital wipes that are used, but that's not readily available to the public usually.

Host: Right. How can parents recognize when their anxiety about their child's health is becoming excessive or affecting family life? And what's recommended to manage this anxiety? I understand it, especially when you're a first-time parent.

Dr. Stephen Bauch: So, I think anxiety is becoming too much when it's intrusive and starting to interfere with your daily living. I think things we talk about in terms of parental anxiety is first we of course tell them that it's normal to feel anxiety, that it's quite appropriate you wouldn't be a mom or dad, a parent, if you didn't have anxiety about things. But also, to realize that illness is common in kids.

The most common illness in kids we see is viral upper respiratory infections, and it's common to get those up to eight times, 10 times a year. So, it does not mean the immune system is not working. It means that that's the expected number of colds they're going to get. And it's a sign their immune system's being tested. So first of all, normalizing frequent, simple illnesses, and then talking to them about how to manage them at home.

For instance, there's a lot of anxiety about fever. Fever is actually something that can be very helpful for your body to fight infection, and it helps with dealing with infection. So, fever in itself is not bad. And you want to treat the child, not the temperature reading. For instance, a child that has a fever of 103, but is drinking and eating, is active, playful, moving around, that worries me less than a fever of 100.5 where the child is lethargic or is not wetting diapers and is breathing bad.

So, I think we also tell them to focus not on the fever as much as the child. And that's what we say for home, they say, "If your child is sick, look at them. If they're active, hydrated, playing, then don't worry. Continue to monitor for any changes. But if they have breathing issues, they're dehydrated and lethargic, or they're not responding to you appropriately, or they're not wetting diapers, if they're persistently vomiting, persistently fussy, then it doesn't matter what the fever is. That's when you act and bring it to the attention of the doctor."

Host: Well, I already just learned two things in that one answer, Doctor. I didn't know that kids get colds that often, like once a month, like you said, right?

Dr. Stephen Bauch: It can seem continuous. It can seem continuous, especially after they first start going to either daycare or school. Typically, in pediatric practice, summertime, we're doing lots of checkups, and then there's a little lull and about a week or two later after school starts, in comes all the illnesses, because they have this high exposure.

Host: How can parents tell the difference between a minor viral illness that can be safely managed at home and a situation that requires urgent medical attention? Because we're not doctors, we don't know.

Dr. Stephen Bauch: You know, again, you're not treating fever. You're a good triage checklist would be, number one, how do they look? Are they active? Are they playing, sitting at the table coloring, doing some activities? That's good. If they're lethargic not responding to you appropriately, look dramatically ill, then that's something you would trigger a phone call to the office or ER.

Second would be breathing. If they have a snotty nose, that's one thing, but if they're having blue lips, they're breathing fast, can't talk completely in sentences or are pulling what we call retraction, meaning that their chest is moving in and out and you can see the rib cage moving, that would be another red flag to get medical assistance.

Dehydration would be another thing. So For babies, we say if they haven't peed in eight hours. For older kids, if they, you know, haven't urinated for over 24 hours or they appear very dry with lips dry, their skin feels different, and again, lethargic when you're dehydrated, then that would be a red flag to seek medical care as well. So, treating those triage lists there can help them determine. But a happy child with a cold and a fever, that's okay to monitor.

Host: What evidence-based strategies can parents use to reduce the spread of infections in schools and daycare settings without causing children to feel fearful or stigmatized? '

Dr. Stephen Bauch: Well, yeah. But we have evidence in four things I think about. Number one is vaccinate. So, there are very common respiratory viruses that we have vaccines for flu, RSV, although it's not a vaccine, it's actually different than that. COVID, a vaccine for COVID.

And just for instance those three we can vaccinate a child and prevent or mitigate the illness they get, especially RSV, which is probably the number one hospitalizable cause in infancy. We now have and have had these antibody shots that can help reduce the seriousness of RSV, which is an important one.

So if your child is less than a year old, it depends on which formulation you're using, but you might ask your doctor about that. Flu shot is well-known to help prevent or decrease the symptoms of flu, which is very important. It's changed every year, so you have to get it every year because the virus has changed. And little known fact, it's no longer contraindicated to get the flu vaccine if you have an egg allergy. You can still get the flu vaccine, so don't let that dissuade you from getting it. COVID vaccine is also out there to prevent the COVID illness.

Second thing would be hand hygiene, which we already went over one of your earlier questions. Third would be keeping the home, or the school for that matter, smoke-free. Tobacco tends to paralyze the cilia that can get the mucus moving and get the organisms out in those, and also avoiding a dry environment. That's why wintertime, it seems like there's so many colds, because it's dry cold outside, and it's warm dry heater air inside, and that dries out the nasal passages and causes illness to come in.

And the fourth thing would be general good old-fashioned health. Sleep well, eat well. Make sure you get adequate sleep at night. The cytokines that help fight infection are generated while you're sleeping. And then, eating healthy can also, of course, keep your body healthy and prepared to fight infection.

Host: Dr. Bauch, a lot of parents worry about germs everywhere. Understandably, I have to admit I was like that when my son was a baby. So, how can clinicians explain the difference between a virus and bacteria in a way that reassures families?

Dr. Stephen Bauch: In terms of exposure, we see a lot more of common viruses like the cold virus, rhinovirus, you heard of flu and RSV, and there's also, like, the cold virus. There's also viruses that cause diarrhea a lot of times. There's viruses that can cause a lot of different types of infections.

Bacterium tend to cause more severe infections in general, and those are the ones that we can treat with antibiotics. Although you have to understand that a lot of us are colonized with bacteria that are there all the time. So, I would say, for instance a couple of myth busters. Again, fever doesn't mean it's more bacteria than virus. The height of the fever doesn't mean that. If snot is green, that does not mean it's bacterial as opposed to viral. The main reason we kind of press on these differences is because we don't want to overuse antibiotics when it's not needed. So, most colds, in fact, don't need antibiotics.

Host: And why is that? So you don't become immune to them?

Dr. Stephen Bauch: It's more that you don't develop resistance patterns that would make it in the future hard for you to use an antibiotic that's effective. For instance, we have evidence of this already with adults that are resistant to certain common antibiotics. Because when they used it a lot before, they developed resistance to it.

So, that's the danger. When a pediatrician is sitting down with an anxious parent and they're worried about a cold that's been going on for a week, the reason we're not giving antibiotics is not because we're cruel or anything. It's just because we realize antibiotic is not the right tool for that job. And also, we're thinking of little Johnny 25 years in the future in the hospital and the antibiotics available that we have won't treat the infection because he's been exposed to it so many times they develop resistance.

Host: You mentioned nutrition playing a part. What role does that and sleep and physical activity play in strengthening a child's immune system? And what realistic lifestyle changes can a family make to reduce illness frequency?

Dr. Stephen Bauch: Sleep sets the stage for the following day. And there's a lot of hormone and also activities that occur with your sleep cycles. And we mentioned the cytokines, for instance, that are used to fight infections are something that can be generated with sleep. And then, you've got early morning cortisol surges. But it does biochemically help with a lot of the things that help with your immune system.

And then, also, the physical activity, it allows you to basically tolerate more extremes. It conditions your body to fight infection and also reduces to a degree fatty tissue that can lead to complications like diabetes, which can affect your immune system.

Same thing with nutrition. For instance, there are a lot of vitamins and minerals that play crucial roles in fighting infection that are available in fruits and vegetables. And there are bad things in diet like fructose or sugar that can lead to conditions later on, like diabetes, that could affect your fighting the infection.

Host: Well, this has been so educational and helpful. I'm telling you what, I've learned at least four new things that I probably should have known at my age, but thank you for sharing your expertise. Is there anything else you'd like to add in closing?

Dr. Stephen Bauch: I think the basic things are get your flu shot and wash your hands. That's probably the two most impactful things that we can tell you. And also, to realize that, you know, treat the child, not the fever. And I think that's an important one too.

Host: That is. Well, thank you again so much for your time.

Dr. Stephen Bauch: Thank you very much for having me

Host: Of course. Again, that's Dr. Stephen Bauch. To find out more, please visit lebonheur.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to The Peds Pod from Le Bonheur Children's Hospital.