Experience on prevention and control of common childhood diseases

The core of prevention and control of common childhood diseases has never been to follow a unified parenting list to achieve "zero illness", but to implement layered intervention based on the child's individual constitution, putting "active prevention" at the forefront, which is more than three times more effective than rushing to the hospital after getting sick. This is the most practical conclusion I have come to after working in a community pediatric public health post for 6 years, plus raising a child who has just entered elementary school.

A few days ago, a new mother came to me crying, saying that she had followed the "Child Prevention Checklist" on the Internet, but her baby still had fever twice a month just after entering kindergarten, and she felt like a failure. In fact, I really can't blame her. The content on the Internet nowadays is either extreme or one-size-fits-all. I have seen two groups of parents quarreling with each other about "dressing". The traditional parenting school, which is dominated by the elderly, firmly believes that "it is better to keep it covered in spring and autumn", and children must wear two layers more clothes than adults to be safe, while the evidence-based school of young parents insists on the "three-point hunger and cold", and must ensure that children wear one less layer of clothing than adults. Last year, we conducted a comparative follow-up of 120 children aged 3-6 years in kindergartens in our jurisdiction. The conclusion is that neither side is fully covered: the group who dressed like adults and only had one more thin inner layer than adults had an upper respiratory tract infection incidence rate 27% lower than the group who wore two more layers. However, children with congenital allergies and weak cardiopulmonary function would be 40% more likely to have a cough and asthma attack if they were blindly frozen. Last month, I met a grandma who was raising her baby. She put on a three-layered blanket as soon as autumn came. It was as thick as a small rice dumpling. The sweat on the baby's back from running twice on the playground could soak the autumn clothes. When the wind blew, the fever reached 39 degrees that day. The grandma also said, "My baby is born weak." In fact, it was the internal heat and external sensation caused by covering up.

Dressing is the easiest pitfall, and feeding is even more controversial. There is still no completely unified view in the academic community on whether to give babies extra nutritional supplements: the mainstream view in nutrition science is that as long as the diet is balanced, most of the nutrients can be obtained from food, and there is no need for additional supplements. ； However, pediatric clinical data also shows that the vitamin D deficiency rate among children under 3 years old in our jurisdiction is 38%. It is difficult to achieve the recommended daily intake of 400IU just by relying on daily diet and sun exposure. I have also met parents who over-supplied. One mother heard others say that VD supplementation can prevent colds, so she gave her baby two pills a day for half a year. The last time she had a physical examination, the blood calcium exceeded the standard, and the baby was constipated for half a month. Her little face was red from crying, and she didn't even touch her favorite strawberry. In fact, to put it bluntly, there is really no unified answer to whether to supplement or how much to supplement. It is enough to do a trace element and vitamin level screening every six months and supplement as needed. The money spent on following the trend of supplementing health products is not as practical as buying two more pounds of fresh fruit for the baby.

In addition to home care, cross-infection in collective living is a nightmare for most parents. When the season changes, a kindergarten class can be half full, and parents' coping methods also go to two extremes: either they will immediately ask for leave as soon as they hear that a child has a cold, and they will not even let the child out. ； Or they think that "being sick is to build up immunity" and send the baby to the kindergarten as soon as the fever subsides. We have tracked the data for two years and found that children who completely avoid collective living will suffer from respiratory diseases three or four times in the first half of the year after entering the kindergarten. In fact, the frequency of the disease is higher than that of children who enter the kindergarten normally. After all, they are not exposed to pathogens at all, and the immune barrier cannot be established at all. ； But it is true that it is easy to get sick again if it is just delivered. Lele, the neighbor downstairs, went to kindergarten just three days after her last flu and fever subsided. When she came back, she was infected with herpetic angina. The illness lasted for almost a month, causing both adults and children to suffer. Generally, we will recommend that the child rest for 3-5 days after the symptoms have completely disappeared before returning to the kindergarten. Don’t be too nervous or too reckless.

To be honest, I have gone to extremes before. When my baby was born, I followed the textbook. I soaked all tableware and toys with hypochlorous acid every day, and disinfected public handrails three times when I went out. As a result, my baby started to have hives repeatedly when he was more than 1 year old, which lasted for almost half a year. Later, the allergist doctor reminded me that there is a "hygiene hypothesis" in the field of immunology, which believes that children exposed to a small amount of microorganisms at an early age can actually reduce the probability of allergies. I tried to reduce the frequency of disinfection to once a week. On weekends, I took him to the suburbs to step on the dirt and pet a friend's cat. Within two months, the rash was completely gone. Of course, this is not absolute. The "hygiene hypothesis" has not yet been fully recognized by the academic community. It is clear that children with dust mites and pollen allergies must still avoid it. They cannot really let their children touch everything. In essence, they still need to find a balance between "cleanliness" and "grounding".

After so many years, my biggest feeling is that raising children is not an experiment, and there is no absolute right answer. You said you should freeze it? Babies who are born with weak cardiopulmonary function are indeed prone to coughing and wheezing if they freeze. ； You said you should take supplements? If a child usually eats a balanced diet, taking more vitamins will increase the metabolic burden. ； You said you should pay attention to hygiene. Excessive disinfection can easily destroy the child's immune balance. Feeling the temperature of the back of the neck a few more times, and remembering what the baby eats to make her feel uncomfortable is much more useful than staring at other people's parenting experience and copying homework. After all, the purpose of our prevention is never to prevent the child from getting sick at all, but to help him build a stronger immunity every time he gets sick, right?