Bouts of viral fever repeatedly occurring in a short span of time, within a fortnight or a month, among children has been a concern for many parents. While the typical symptoms (fever, cough, cold) mimic the Covid-19 infection, adding to concerns amidst the pandemic, doctors say viral infections are common and a way to gain immunity.
“My 10-year-old was very excited to join his friends in school after attending virtual classes for so long. Just a few days after school reopened, he was down with fever and a bad cold. Upon enquiring, I found that several of his friends were down with fever as well. Just a month later, he is again showing signs of a mild fever,” says Janaki Parameshwaran, a resident of Harlur, Bengaluru.
Pediatric units in hospitals and clinics across India are currently seeing a spike in the number of patients and parents lining up for a doctor consultation.
“So many children show up with recurring episodes of fever, cold and other respiratory symptoms,” says Dr Harish Kumar, consultant, pediatrics and pediatric intensive care at Aster CMI Hospital, Bengaluru. “We see large groups of children from the same school coming in with the same symptoms, which shows that these recurrent infections in kids are contagious. The symptoms in these cases are usually very mild.”
What’s normal, what’s not
According to authors of the paper ‘Clinical Immunology Review Series: An approach to the patient with recurrent infections in childhood’, it is during infancy and early childhood that the immune system is exposed to antigens for the first time, which helps children build immunity. Children tend to interact with others in schools and playgrounds, making recurrent infections in children common.
“In the first six to seven years of their life, children are very likely to fall sick with viral infections. With schools starting, we are seeing an overload of children showing up with symptoms of fever, cough and cold in the outpatient department,” says Dr Faisal B Nahdi, senior pediatrician, Rainbow Children’s Hospitals, Hyderabad. “In most cases, parents do not have any need to panic and the symptoms are easily manageable at home.”
According to a paper published in the journal Pediatric Allergy & Immunology, normally, the average infant (0-2 years) has 11 respiratory infection episodes per year while the average preschooler (3-5 years) has eight episodes, and the average school-going child (6-12 years) has four episodes.
“The basic reason would be that they are exposed to a very allergic, crowded environment. Crowding spreads viral infections more rapidly than anything else. Schools are crowded, and even when they travel to school, they are travelling in crowded buses or vans, so they easily spread the viral infection. The causes of recurrent infections are influenza A or B, or adenovirus or in some rare cases, even norovirus, which causes gastroenteritis. These are the viruses spreading upper respiratory tract infections at this point of time,” says Dr Radha Balaji, pediatrician, Rajawadi Hospital, Mumbai.
According to Dr Balaji, out of the total number of children showing up with symptoms of recurrent infections, 90 per cent show symptoms of respiratory infections.
“The past few weeks, we are also coming across hand, foot and mouth disease, which is extremely rampant. This disease is caused by the coxsackie virus. This simple viral infection stays for five to seven days and then recedes on its own. It is not a life-threatening disease. The child will suffer from high-grade fever for the first 48 hours, during which time, it is very difficult for even the parents to make out if it is a viral infection or dengue or a simple viral fever. The moment rashes show up on the child’s body, we know it is hand, foot and mouth disease. The child is also unable to eat during this time because of ulcers in the oral cavity. We must treat it only symptomatically,” she says.
In case of infection by the coxsackie virus, post treatment, the child takes around five to seven days to fully recover, say doctors. During this time, parents must ensure that the child is confined at home and gets plenty of rest. Only when the skin lesions dry up should the parents consider sending the child back to school.
Symptoms of recurrent infections
Authors of the article ‘Approach to the child with recurrent infections’ point out that children affected by recurrent episodes of respiratory infections fall into two categories: those with an underlying immunodeficiency and those with a normal immune system. While children in the former category need timely diagnosis and treatment in order to live a healthy life, those that fall in the latter category usually respond well to treatment and recover completely in a few days without their overall growth and development being affected.
As per the paper, some common signs of an underlying primary immunodeficiency include:
- Recurring episodes of sinus infections, pneumonias, sepsis or meningitis in a year
- Family history of immunodeficiency
- Two or more months of antibiotics intake with no recovery
- Slow growth and development
- Swelling in tissue and organs of the body
According to doctors, common symptoms of a viral infection in a child with a normal immune system include
When to consult a doctor
Dr Balaji says parents should enforce a three-day protocol as soon as the child starts showing symptoms of an infection.
“The moment the child gets high fever, parents must record the temperature. We tell them to always keep a dose of paracetamol handy as well. We tell them to administer the medication and start sponging the child because children have a high propensity towards developing convulsion — a condition where the temperature can suddenly shoot up to a very high level within minutes. The child becomes completely unconscious, and parents are completely in a state of shock. We must reassure the parents at that point of time that this is happening because of the high temperature. During the first 48 hours, parents must keep making a note of the temperature. It is recommended that they consult a doctor if the fever doesn’t subside in the first 24 hours. In case the child is developing any other associated conditions such as diarrhoea, vomiting or convulsions within four to six hours after developing a fever, it is recommended that a doctor be consulted immediately,” says Dr Balaji.
Treatment for recurrent infections
What is unusual, says Dr Kumar, is that while earlier, a mild viral infection would last three to four days, now it lasts for prolonged periods — from one to two weeks — which he says could be attributed to altered immunity post the spread of Covid.
“The first step is to get children the treatment they need. The next is to improve their immunity over time, by giving nutritious, home-made food and avoiding intake of junk food. Going out in the sunlight to play improves the immunity of children. During Covid, most children were confined to their homes and had very little exposure to sunlight,” he says, adding that infected children should avoid going out until they are fully recovered.
“In this season, we ask parents to follow up almost for the first five days. If the child is unable to take oral antipyretics, we ask them to insert a suppository from the anal area and try to bring down the temperature as soon as possible. By the third day, the child’s health [usually] starts improving,” says Dr Balaji.
The entire pandemic period has made kids so low on immunity staying indoors all the time. It’s getting almost unmanageable with the frequent episodes of illness now.
Ever since the schools have reopened it’s always a worry sending kids to school. The entire pandemic has made them so weak on immunity by being not exposed to anything.