New Discussion on Prevention and Nursing of Common Children's Diseases

The current prevention and control of common childhood diseases has long since departed from the old logic of "unified template care." The optimal path is a combination of "stratified prevention + individualized care + evidence-based decision-making." There is no need to blindly copy the older generation's experience of "covering sweat, fasting, and indiscriminately feeding medicines", nor does it need to adhere to the "absolute standards" of foreign popular science. Flexible adjustment based on the child's immune characteristics and current symptom response is the most cost-effective way of care.

I have been working hard in pediatric clinical practice for almost 9 years, and I really don’t say this casually. Last week, I met a mother who came to the clinic in a hurry with her 3-year-old baby in her arms. She said that the baby had a fever for 3 days and she fed her with cephalosporin for 3 days. The fever did not go away and she had loose stools for two days. A blood test showed that it was an ordinary influenza A virus infection. There was no need for antibiotics at all, so she suffered in vain. I encounter this kind of scenario almost every week. To put it bluntly, people are confused by all kinds of conflicting information. They either believe in old experience or the "standard answers" on the Internet, forgetting that the core of nursing is "the living child in front of you."

Take the most controversial topic on the Internet right now, "Can you cover a fever?" Both schools actually have clinical basis, and no one is absolutely right: the view of the evidence-based medicine school is very clear, fever is the body's immune protective response. As long as the child is in good mental condition and the axillary temperature does not reach 38.5 degrees Celsius, there is no need to take antipyretics. The priority is to ensure comfort. When the hands and feet are warm, wear less heat dissipation. Absolutely no thick covering, otherwise it will easily induce heat stroke.； However, the school of traditional Chinese medicine in pediatrics also has its own practical support: if a child has cold hands and feet and is shivering all over when he or she first gets a fever, it means that the child is in a period of rising body temperature. At this time, it is appropriate to wrap the child in a thin blanket and feed him some warm water. Wait until the body temperature reaches the peak and the hands and feet turn warm before spreading the heat. This can reduce the child's discomfort and shorten the duration of the fever. Who do you think is right? In fact, they are all correct. The core thing is to look at the current state of the child, not to adhere to a certain theory.

Not only nursing care, but also the prevention concepts of common childhood diseases have also been updated a lot in recent years. In the past, everyone thought that prevention meant "going to less crowded places, disinfecting more, and wearing more clothes to avoid catching cold." Now, the latest research has long overturned this "over-protection" logic. A cohort study published last year in the "Chinese Journal of Pediatrics" tracked 1,200 children aged 0-6 and found that families whose homes were disinfected with chlorine-containing disinfectants every day and whose children were rarely allowed to touch the soil or pets were 2.7 times more likely to suffer from allergic rhinitis, asthma, and recurrent respiratory infections than those from families with normal cleanliness. To be honest, there are real-life examples around me. A few years ago, my colleague’s family was so nervous when they gave birth to their eldest child that they sterilized their toys three times a day and were not even allowed to touch the fitness equipment in the community when going out. As a result, the eldest child caught colds every three days and developed eczema when the seasons changed. This is the "micro-exposure immune training" currently mentioned in the industry. There is no need to pursue a sterile environment. Let the child's immune system properly "practice", but it can help build a more stable protective barrier. Of course, this does not mean that you should deliberately take your child to hang out with sick people. You must get all the vaccines that should be vaccinated. Non-immunization programs such as influenza, pneumonia, and hand, foot and mouth vaccines are recommended if conditions permit. This is the most reliable method of active prevention.

As for flexibility in care, it is even more obvious. For example, in the care of diarrhea, the old saying was to starve the stomach to "clear the stomach." Now the evidence-based view is that as long as the child does not vomit and is willing to eat, the child can be given light porridge, noodles, steamed apples, etc. without fasting, but can help repair the intestinal mucosa. There is also a point that has been controversial for a long time: should I drink oral rehydration salts or rice water? Many parents think that children who don’t like to drink rehydration salt will give them rice soup. In fact, oral rehydration salt III is the first recommended preparation by the WHO to prevent dehydration. The ratio is the most scientific. However, if the child is really resistant and is mildly dehydrated, add a little salt to the cooked millet soup (about half the amount of a beer bottle cap per 100ml). The effect is not much different. There is no need to force-feed the child, but it will make the child more troublesome. Last year, I met a 2-year-old child who suffered from rotavirus infection and diarrhea. The mother force-fed the child with rehydration salt until he saw the cup. Later, I asked her to switch to rice water with some salt. The child was willing to drink it. The dehydration was restored in 3 days, and the recovery was very fast.

In fact, what I want to remind parents most is "don't over-care." Many parents just follow the popular science and apply it mechanically. For example, if their child has allergic rhinitis, they wash their nose twice a day. As a result, washing the nasal mucosa too frequently breaks the nasal mucosa, causing nosebleeds and making it more susceptible to infection. ； Some parents are afraid that their children will lack nutrients, so they give them various vitamins and probiotics every day, which actually increases the burden on the kidneys. Is there any “universal nursing method”? Your baby's nasal mucosa is relatively thin, so the frequency of nose washing can be reduced to once a day or even once every two days. Your baby usually eats a balanced diet and digests well, and there is no need to take probiotics every day. These adjustments require you to observe your baby's condition. No matter how good other people's experience is, it may not be suitable for your baby.

To put it bluntly, the "new theory" we are talking about is not a subversive content that overturns all previous experience. In essence, it changes the previous logic of "nursing the patient" to "nursing the child." It is better to look at the child's mental state more, be less anxious, and adhere less to standards. Oh, by the way, if you are really unsure, don’t do it yourself at home. Go find a reliable pediatrician, which is much more useful than watching short videos all night.