Keep Clear and Carry On
|Jason L. Kastner, MD
Board Certified Pediatrician
About the author: Jason L. Kastner, MD is a Board Certified Pediatrician in his 14th year of private practice in Middle Tennessee. He is in a well-established General Pediatric practice with multiple clinic sites. He manages a variety of pediatric and adolescent conditions seeing patients of all ages from birth through adolescence. He works for VIP Mid South and is affiliated as clinical faculty with The Monroe Carell Jr Children’s Hospital at Vanderbilt. He is a Fellow of the American Academy of Pediatrics
As a general pediatrician in my 14th year of private practice, I have a confession to make. Winter is not my favorite time of the year. I once heard it said about Pediatrics: “if it weren’t for the winters you couldn’t afford to be a pediatrician; if it weren’t for the summers, you couldn’t stand to be one.” While that might be a little over-the-top extreme, it is this time of year that I feel the fatigue and bombardment of “cold and flu” season and the lack of sunlight does make me wonder if I do have a touch of Seasonal Affective Disorder. This season is also tiring for parents who have to battle more frequent upper respiratory infections that spread through all family members, influenza, the refractory ear infections that require multiple doctor visits and rounds of antibiotics and of course the “never ending” course of bronchiolitis. Time missed from school, daycare and work cannot be minimized. The increase in volume of these illnesses makes it important that we give sound advice about treatment that will offer the most relief for our patients (and their parents). The complicating factor in treating these types of patients is that by in large, there is little that we can offer other than supportive care.
Antipyretics and analgesics provide some relief. Antibiotics, of course are helpful and sometimes necessary for bacterial infections. For the children with asthma triggered by respiratory illness, we can use inhaled bronchodilators. For influenza, we know we can possibly blunt the course and severity of that illness with antivirals. That said most of the symptoms these patients suffer from (cough, congestion, drainage, breathing difficulty due to mucous plugging, etc.) do not have great treatment options. As physicians, we are all aware of the studies that show cough and cold remedies to not be more effective when compared to placebo and we also know the age limits that the FDA has placed on these products in the interest of safety. It is the younger and smaller patients that, due to size of their airways, suffer more. It is also in this age group that we have fewer options for symptom relief.
The other day I had in front of me a young first-time mother with a 4 month old infant that had RSV bronchiolitis. This very reliable young mom knew enough from the internet and social media to be scared to death. The infant was well hydrated but wasn’t able to breast feed as well due to copious nasal secretions. She had helped her baby feel a little better using acetaminophen for fever but the coughing from all the mucous continued to cause sleep disruption. She pulled out her bulb syringe the hospital had given to her after the baby was born and told me essentially how worthless it was. We tried a dose of nebulized albuterol in the office; to no surprise, it didn’t help. The oxygen saturations were lower than normal but not significantly low. Her baby didn’t meet criteria for hospitalization but we made plans for close follow up the rest of the week. After a lengthy discussion, she came to the conclusion: “so there really isn’t anything we can do?” She had come to realize what I have come to realize after all these winters as a pediatrician: most things just have to get better on their own and supportive care is about all we can offer. Frustrated would have been an understatement.
I gave her a sample of the Naspira Oral-Nasal Aspirator by NeilMed and some samples of saline drops and instructed her on how to use it. After she gave me a look as if to say: “you want me to do WHAT with this?”, I sent them on their way with plans for follow up in 2 days.
Upon her return, the baby was doing better but clearly still very much symptomatic in the ramp-up phase of the illness. Her fever was controlled, she was nursing better and her wheezing wasn’t any worse. I asked the mother how she was making it and she promptly told me that the Naspira was the best thing she had ever tried. She was so convinced she told her friends who also had young children and even bought a “back up”. After being introduced to the products, I have suggested the Naspira Oral- Nasal Aspirator and other nasal rinse products from NeilMed for some time now. This particular example the other day however, reminded me that parents just want to do whatever they can (with the advice of their pediatrician) to help their baby during an illness. This is a safe, non-toxic, easy to use and very effective remedy to arm our parents with during this time of year. Maybe winter won’t be so bad after all…