FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SCHOOL REALLY CAN MAKE KIDS SICK

Question: School has barely started and both of my kids already have colds. Winter is the time for colds and sore throats. Should I be worried because my children are sick even before the cold season starts?

Answer: While we do usually think of winter as cold season, I've often noticed in my practice that the cough and cold season starts a little earlier with the return to school. So when your daughter says school makes her sick, she might be partially right. In fact, sometimes her going to school can make you sick, too. It is common to see a mini-epidemic of coughs and colds two to three weeks after the start of school. The kids get the illness and then bring it home to the rest of the family.

The most common cause of these coughs and colds is a viral infection. However, the bacteria responsible for "strep throat" are also a common and more serious culprit. Both bacterial and viral infections are spread from person to person when we breathe, sneeze and cough on one another. In the winter we are in confined quarters without adequate ventilation, and we are, therefore, able to spread germs much more efficiently.

Question: What should I do for my children when they get a cough and sore throat?

Answer: Today's modern science hasn't discovered any medication that helps the body fight a viral infection the way antibiotics help fight bacterial infections. Since 90 percent of the respiratory infections in children are due to viral infection, the best treatment is directed at making the sufferer more comfortable as his or her own immune system fights off the illness. Chicken soup is always a good choice. Salt water gargle can help with a sore throat about as well as any of the more expensive products that are available.

A cough, particularly one that interrupts the child's sleep, has been traditionally treated with a cough medication. The most common ones contain the active ingredient dextromethorphan that is often indicated by the letters "DM" at the end of the brand name. The other common cough suppressant is codeine. Cough syrups frequently combine one of these medications with guaifenesin, food coloring and other "less active" ingredients.

Most moms, dads and doctors recommend one brand or another of these cough syrup products for children with a cough due to a cold. Recent research published in the Journal of Pediatrics, however, showed that none of these medications were more effective at controlling cough than simple cherry flavored syrup. Most of the participants in the study had marked improvement by the end of three days regardless of what they took. So much for traditional medical wisdom. It appears that common candy cough drops and time should really be the preferred treatment. The fancy cough syrups make mom, dad and doctor feel better without really helping the one with the cold.

Strep throat is definitely different than a cold. A sore throat caused by the germ with the lovely name of "group A beta hemolytic streptococcus bacteria" can and should be treated with an antibiotic. Penicillin is the medication of choice for this as long is the individual isn't allergic to it. The penicillin needs to be taken for 10 days to be sure the infection is cleared up. However, the child doesn't need to stay out of school the entire 10 days. Taking the antibiotic for 24 hours renders 83 percent of strep throat sufferers non-contagious. It is generally considered safe to send children back to class after the first 24 hours of medication.

The important question you didn't ask is, "How do I tell a strep sore throat from a viral one?" The only sure way is by having your doctor order a throat culture for the strep bacteria. However, there are a few physical signs that increase the likelihood of strep. A fever of 101 degrees, sore swollen lymph nodes in the neck, swollen tonsils, and a white, pus-laden "ooze" over the tonsils should make you suspect strep. If you or your child have some or all of these symptoms, I'd recommend that you see your family physician soon instead of waiting to see if the illness gets worse.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.