Toddler illness in the post-COVID world

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Transcript:

These days, I hear the word, the post-Covid world being used. 

To me, it doesn't really mean that we're all done with that. Who knows what's going to happen in the future? My fingers are crossed that we won't have many more bad strains, but we've learned if nothing else that we can't predict the future there. We're definitely in the post-Covid world in the sense that it has changed our world. We're living in an era now where those changes are affecting us.

In this context, I have been getting a lot of questions from parents about toddlers and their illnesses. There's a lot to unpack in this area or going to talk all about it in the episode. Two main things are coming up, one is the constant illness. It just seems like they're sick all the time. Is that allergies are a sinus infection? Why do they have runny noses 24/7?

In this area, there's a lot of fear of kids getting sick, high fevers, and the nonstop viruses plaguing the household that kind of thing. Then the second area that's related is the overwhelm of dealing with sick kids as working parents. What happens to your child care? You can't go to daycare.

You know, parents especially mothers have had their work-life, squeezed so much during the pandemic. Now, maybe you working from home, and if the kids have no childcare, there goes your day.

In this episode, I want to talk about all these issues, let's start with the illness itself. I think on a collective level, we've all gained a level of hypochondria and it's not even hypochondria, it's a real fear that we've been dealing with Covid. What it could do to our loved ones for so long now?

Number one, there's the fear of kids getting Covid, especially these days because the latest strains are much more transmissible. They are overall causing less serious illness also because many adults are vaccinated. That fear never goes away, you know, Covid has made a cultural impression on us, and even though most kids continue to do fine with Covid.

In fact, I have maybe three to five patients in my own cohort right now with Covid. I'm seeing about 2-3 days of fever, and they really actually recover much faster and nobody's ending up in the hospitals. Of course, there are kids who are having a more complicated course, but that's exceedingly rare and we're very grateful for that.

Any case we have to put this out there, the fear of kids getting Covid, that's one. Number two, because we've dealt with this for so long on a collective level. I feel like Covid has given us the feeling that viruses are very scary.

Indeed, Covid was a very scary virus, especially for the elderly and the vulnerable, because we've focused on it for so long and for so much, I think that the overall anxiety about getting any kind of virus has gone up. Even though we always lived with the seasonal flu and all the viruses that are causing colds in people. I think the gut-level reaction to it is a little bit scarier now.

Thankfully for most kids because there was so much quarantine and also mask-wearing. In the last two years, kids have not been ill as much or as frequently as they previously were, and I and other pediatricians know this very intimately. Pediatrics is kind of seasonal once you get into the fall and winter. We're used to the onslaught of runny noses, viruses, the fevers.

For the last two years, that just didn't happen and we know that kids mostly get these from each other, daycare, and schools. When those things closed, the illnesses also had a dramatic drop. In fact, I didn't even see really any flu the last season. There's more flu now, as kids are going back to school. In the winter, when we usually have them, there was this eerie quiet where we usually have seen a lot of flu.

I think, especially for new parents, especially those who became parents during the pandemic or whose kids became toddlers for the first time during the pandemic, it's been a really unusual time. First, you have this prolonged period without illness, and now, there is an increase of intense and frequent viral infections among kids.

The immune system is like it's almost like a living organism that's constantly being modified by the environment, it's a constant dance. Each time we get sick, the body learns about that virus and prepares for it. Kids have a very active immune system in terms of learning because they're new to the environment, every virus that comes in contact with that interplay is just developing.

It's not your imagination, it's actually true that kids are getting more sick right now and sick more frequently because after a prolonged period without seeing many viruses, suddenly they go back to school, they go back to daycare, and bam! The normal load of viruses is there again.

I totally understand. I hear you, when you say seems like my kids are sick all the time and more sick than I would expect them to be. You're right, we're seeing that across the board. The good news is that shouldn't last forever. This is kind of a reintroduction of the toddlers into this world of viruses.

Once that equilibrates, it should more or less go back to normal. Normal for toddlers is also constant illness, where at least constant symptoms lingering things like a cough that won't go away, and a runny nose that's always there. It might seem like you never go back to normal before the next virus hits.

The good news is mostly, they are mild, their short-lived and they are usually seasonal being worse in the winters and falls. I know it's been a lot to deal with, especially if you have multiple kids giving it back and forth to each other. I just want to validate you and I am seeing what you're seeing.

I'm not worried in the grand scheme because I know that these little immune systems and bodies will do their thing and we'll get through this. I know that doesn't necessarily make the experience any easier for you, living through right now. With that, a question that comes up often is, is it allergies, or is it viruses? Is there something wrong with my kid's sinuses? That's another question I got seems to be a runny nose every day, all day.

That's a really good question because again, those things are similar, they can look very similar in terms of symptoms. The runny nose, the cough, the puffy eyes. What's more, it's not always black and white, you can have a component of allergies that produce a lot of mucus that makes it more likely to catch a virus so on and so forth. I think it's also worth talking about some of the differences between these.

For allergies, if you have environmental allergies, one key thing that often happens which does not exist in viral infections would be itchy watery eyes. If the kids are, you know, their eyes just look red and watery or they're always rubbing their eyes and that might at least have an allergic component.

The other thing is runny nose can definitely linger after getting a cold but it shouldn't be there always. If it's been weeks and months and it just never goes away, then yeah, more than likely there is an allergic or what we call atopic component, where they're reacting to something.

Environmental allergies, often watery eyes, constant runny nose, and then there's the other component which is diet. Here is again where it gets a little bit nuanced, there are the straight allergies, where they eat something that gets the rash, they even anaphylaxis is really scary. Those are, you know, acute allergies that are easy to tell.

They're actually a lot of chronic subtle allergies or at least intolerances that we might not identify as allergies that can contribute to this whole thing as well. If your kid has asthma or eczema, the diet can definitely play into them and cause more reactions if they eat things that they're not tolerating.

There are also other subtle signs like constipation or appetite changes that can point to some things not quite sitting with them in the diet. Again, we might have thought of those as normal, that toddlers are constipated. That's why I think it's quite underdiagnosed.

One frequent culprit in all of this is the consumption of dairy. I've met a lot of content on especially YouTube about why a lot of kids actually have a subtle dairy intolerance, that's not picked up. Again, we've normalized some of the symptoms, like, constipation. I don't think every kid needs to be dairy-free, I think more than we know of are reacting in subtle ways.

One thing you can see with that is more mucus production is runny noses and symptoms that are always in the toddlers. I'm not an allergist, I really don't pretend to have special expertise with allergies. One thing, I actually don't like personally are those large panel allergy tests, where they scratch the skin or they do some controlled exposure. Then they tell you, you're allergic to, I don't know, grass, or gluten or dairy.

The reason I don't like them is that they are theoretical tests that don't always translate into real life. In fact, more than often they don't translate meaning that you can be found to be allergic to something on that test, and not react to it in real life and vice versa. In my mind is just not so helpful because I don't recommend changing your lifestyle based on those panel tests.

I do recommend for us to be mindful and observational in our normal lives to see if something is triggering and reaction. For parents, especially, you know, you're with your kids all day, you know them better than anybody. I would encourage you to have a scientific experimental kind of approach.

If you think they might be reacting to something, take it away for a few weeks, and see if things get better. If they do, you can actually reintroduce it at one point and see if that symptom comes back. That's how you know, for sure. I think there's no better system than real-life experimenting to find what's best for you and your kid because we're all so different.

Unfortunately, the lab tests that we have these days are just not accurate enough to really improve these real-life experiences. For my own patients. I'd always do a diet history as part of the intake, I think it's an overlooked and very powerful impact on our day-to-day health and these symptoms.

For toddlers, I really encourage you to talk to your pediatrician about the diet. Toddlers should have a different diet than adults and babies. What's their specific nutritional need? I think we should do an episode just on that. Also, what are the things that are frequently in an American toddler's diet, that might be causing these symptoms?

In a nutshell, yes, we've been afraid of a very long of viruses. Kids are having this window of a lot of infections and high fevers and getting more sick for example from adenovirus. I want to reassure you that for kids with normal immune systems this should be short-lived, they will be okay as scary as it is to have a kid with a fever.

I want you to try to reframe the thinking towards these viral illnesses. Like we said before, it's actually a prime training opportunity for the immune system. We're seeing now what happens if the immune system does not get the challenge that it needs to keep growing and adapting to the environment that you end up with more intense illnesses.

When they are seeing these viruses and getting sick, their body is learning, they're producing antibodies that will serve them for the rest of their life. If your kid has a fever, that means the immune system is working. I mean, we have somebody without a normal immune system, you actually don't see that fever. It's unfortunate because it's part of our body fighting off, something it recognizes as not good for us.

Fever can make kids feel crummy and they need some support and help to keep them hydrated and get through it, but fever itself is not a bad thing. You, as parents, I think your job is like getting your kid through an obstacle course, that's how I think of viral infections, when they get sick, they need your support but they need to go through this, obstacle course, to grow and for the immune system to be benefited from it.

I encourage you to think about the diet and try to optimize it to kind of distinguish things from exposures versus a true Illness. If it is a true illness often marked by a real high fever, you know above 100.4, I hope you can think of it as something that is not fun to go through. That has a silver lining in that, it is protecting your child in the long run and trains their immune system for the future.

The second part is the life complications of having a toddler who's always sick. This was also affected by Covid. Daycares are one of the hardest-hit industries. They are still being hard hit by a labor shortage and all the pressure that they're under to both provide consistent childcare and also to prevent illnesses.

With that being said, I think the PTSD and the fear of the Covid era have led to some policies in many daycares that are, I don't want to say they're wrong, but maybe they're not keeping up with evidence of the day. Means some of the criteria for exclusion, I think might be becoming too unrealistic.

I know a daycare that sends the child home with any runny nose, which disqualifies most toddlers. Understand the last two years, every facility had to draw a line to being responsible for the kids who are there to send someone home at the earliest possible sign of illness.

You and I know that kids have these on and off symptoms, they can have a runny nose for months and months, and they can have randomly one loose stool. It's not necessarily diarrhea if it doesn't continue. I know that's a criterion for many daycares, they have all sorts of rashes. That again, might not be an allergic thing. I understand why they had to do this, but I do think maybe it's time for a re-evaluation because providing childcare is incredibly important for the parents and the world to continue.

There's not a very clean solution here, but I encourage you to start the conversation with your daycare. Should we re-evaluate our sickness and inclusion symptoms, and policies, and ask, who's making these policies? Who are the pediatricians they're consulting? Can we actually make more realistic guidelines while still keeping people safe?

I think it is possible in this country would pay so much for daycares. You're a client. I know that you cannot walk in there and change their policy, but I just want you to start the conversation so that they are also thinking. Is it time to re-evaluate something? Are we keeping up with the newer recommendations? Is it actually safe to keep a kid with just a runny nose and nothing else? Which pre-pandemic was the case for many daycares?

When the daycare sends your kid home or if your nanny calls out that's it for work for most parents, maybe you're spending the day at the doctor's appointment. You might not necessarily be needed to be there in person which is a huge reason I found it, Kinder so that parents can send me a text or send me a video and we can troubleshoot it and do a much more efficient diagnosis.

I would also encourage you to find a pediatric practice that has some of this flexibility and of a pediatrician who's willing to work with you to make the healthcare that fits into your life. Oftentimes I find a quick phone call, a text, or video conference is enough, and the pediatrician should know when clinically you need to be seen.

In these kinds of evolving subtle symptoms, it really helps to have someone who's willing to have the conversation without always making you wait. If you find that your daycare is not open to these conversations, I know this might not be a very easy solution, but I do think that if the policies of a place are not working for your family, there are other options.

One thing that I think is on the rise is nanny shares. Of course, with a private nanny, you have more options to work out something that works for everybody. Nanny shares actually offer a great combination where you get to control the rules and policies and come up with something that works for the other families and for the nanny.

Also, you get the socialization of having other kids spend the day together. Economically, it might actually be a lot cheaper to go for a nanny share than to pay for daycare. This one takes some more work.

There's some luck involved, you have to find the right nanny and then the right family or families to share his or her time, but it is possible and I see it more and more every day. If your situation is not working out for you, I encourage you to look for other options which will take more time and effort up front to set up.

Once you find the cohort that works for you, the peace of mind that comes with knowing you have a say and you know what's going to happen with your child care is invaluable. Frequent viral illnesses, even though they're technically mild are one of the biggest challenges of the toddler period.

This year, we're having it harder than most given the backdrop of Covid and also the lack of the normal illnesses in the last two years. Just know. I'm here for you. I'm cheering you on as you're getting through this. In a similar way, be proud of your kid training his or her immune system to thrive in the world.

I would Empower you to reach out to the pediatrician and the daycare, the Nanny, and the situation that works for you. Don't forget, I encourage you to look over the diet and the environment, and think about how to maybe reduce some of those possible risk factors and day-to-day mild symptoms.

I hope you found this episode helpful. If you're interested in a one-on-one consultation with your own on-demand Kinder pediatrician, like me, you can find us at gokinderkid.com. You can find the show notes for this episode at askdoctoramy.com, and you can find me on Instagram also askdoctoramy.