Winter Icks and Tricks: An Integrative Approach
Updated: Jan 6, 2020
Influenza, strep, coronavirus, respiratory syncytial virus, influenza, parainfluenza, norovirus, pertussis, pneumonia, rhinovirus, parovirus….winter is coming!
The “common cold” has a fancy name in medicine: URI, which stands for Upper Respiratory Infection.—A URI is an acute, self-limiting viral infection of the upper respiratory tract characterized by variable degrees of sneezing, nasal congestion and discharge (rhinorrhea), sore throat, cough, low grade fever, headache, and malaise.
A URI is usually a mild and self-limiting viral illness, usually caused by rhinoviruses. Antiviral therapy is not available for the viruses that cause the common cold with the exception of influenza virus.
In infants and young children, the symptoms of the common cold usually peak on day 2 to 3 of illness and then gradually improve over 10 to 14 days. The cough may linger in a minority of children but should steadily resolve over three to four weeks. In older children and adolescents, symptoms usually resolve in five to seven days (longer in those with underlying lung disease or who smoke cigarettes).
While most clinic, urgent care, and ER visits are for the common cold, many other more serious illnesses have similar symptoms. It is never a bad idea to see a medical provider if you aren’t sure.
Why does it seem there is more illness in colder months? Simple answer: we are inside more, where microscopic droplets from that cough or sneeze are invisibly suspended mid-air, just waiting for you to walk through the nebulous of contagion as you practice your deep-breathing. It is a good thing our immune systems are primed for systemic, underground warfare, ready to protect us with layers of defense. One our most under-appreciated defense systems works as a physical barrier: our skin.
Beneath our skin circulates our under-armor powerhouse: antibodies. Our intelligent body provides us antibodies in various methods, via natural exposure to a pathogen (virus or bacteria), via maternal antibodies, and via immunization.
Our immune system is incredible, but there are certainly ways in which we can either help or hinder our body’s ability to fight the Yuck. Here are some suggestions (not in any particular order of importance) for the general population.
1. Encourage sleep! Without sufficient sleep, our body goes into a stress response, which lowers immunity. This is true for all ages. As a general rule, preschoolers (ages 3-5), should get between 10 -13 hours, ages 6 to 13 should get 9- 11 hours, and adolescents ages 14-17 need between 8- 10 hours. Insufficient sleep reduces the body’s ability to produce proteins called cytokines that help fight infection and reduce inflammation.
2. Decrease the pressure—take the pressure of your child to go-go-go or perform, perform, perform. Teach your child healthy coping mechanisms and mindfulness. Anxiety, stress and depression often result in higher levels of the stress hormone cortisol, which lowers the immune system.
3. Increase the joy and cuddles: the mind-body connection is powerful! Multiple studies show that those who are joyful and positive tend to have more robust immune systems. Even laughter has been documented to increase immunity! Hugging your child, cuddling up for story-time, and doing skin-to-skin with your newborn does wonders for both mental and physical health.
4. Choose warm water and soap over hand sanitizers whenever possible. Wash those hands! Recent research has found that preventing flu is more successful with even just rinsing our hands in water versus using a hand sanitizer. Also, most hand-sanitizers contain some ingredients that may be more harmful than good, as do many anti-bacterial soaps. Opt for the simple, most natural soap.
5. Protect your barrier defense mechanism: the skin. Keep it free from cracks by using a thick moisturizer, staying hydrated, and being mindful of what products you do use on your largest organ. I like to verify ingredient safety on the Enviromental Working Group website.
6. Food as medicine: whenever ever able, choose organic, colorful fruits and vegetables and add them to every meal. Choose organic whole grains for carbohydrates—instead of white rice, choose brown. Instead of “wheat bread” which is most white flour, choose “whole wheat bread” or sprouted grain bread (I love Ezekiel bread). Non-organic costs less, it is true, but often has pesticide contamination and is grown in nutrient-depleted soils. I also opt for non-GMO whenever possible. If you drink milk, choose milk from cows that are pasture-raised and not given growth hormones nor antibiotics. Limit your child’s consumption of meat in favor of a plant-based diet to increase nutrient-dense calories. There are many other ways to get complete proteins and iron.
7. Teach your children to cough and sneeze (into their elbows) rather than into the air.
8. Surround yourself as able with healthy people and caregivers
9. Choose your supplements wisely and be conservative. I appreciate many non-prescription options for health and often integrate herbs and supplements into my medical practice. However, I urge all my parents to exercise caution with supplements, especially pregnant or breastfeeding mothers, infants and young children. Some are safe while some are not so safe. Some can interact seriously with prescription medications or exacerbate health conditions. Supplements are not regulated by the FDA, so what is in the actual product may not be what is on the label, or may be contaminated.
Comprehensive reviews on multiple studies provide conflicting data, making it hard to know if there is much benefit of taking supplements compared to a placebo pill. A systematic review of two randomized trials in children found that zinc sulfate, taken for a minimum of five months, decreased the rate of development of colds and school absence. However, most children poorly tolerate zinc due to nausea and “taste.” The US Food and Drug Administration (FDA) issued a public health advisory advising that over-the-counter zinc-containing intranasal products (Zicam) should not be used because of multiple reports of permanent loss of smell.
A 2013 meta-analysis of 29 trials showed that regular supplementation with vitamin C did not significantly reduce the incidence of colds but often caused diarrhea if taken in high amounts in children. However, small amounts are generally regarded as safe and may be helpful. Be careful not to "mega-dose" your child — kids should have no more than 500 milligrams (mg) of vitamin C a day. (A cup of orange juice has about 120 mg, while many chewable vitamin C tablets have 500 mg.)
That said, I do believe that nature gives us a magnificent medicinal cabinet, and when my littles are sick, I make soups, smoothies and popsicles packed with nutrition. I am a believer in putting my money into high quality, nutrient-dense organic foods for prevention and well-studied immunizations rather costly remedies that have not been rigorously studied for safety in young children. There are many wonderful herbs that can help the body be more resilient if taken in safe forms and dosages, but sadly research is often lacking on safety and dosing for tiny bodies, and there is lack of regulation.
10. Breastfeed if able. I was one of those who really struggled to breastfeed, for many reasons outside of my control, so I’m not standing here shouting from a podium of success. However, if you are able to breastfeed, you will be able to provide your baby your own antibodies, which can really benefit your child’s health on many levels. If you can’t breastfeed, don’t lose heart! There are many other ways (some listed here) that can keep your baby healthy.
11. Hydrate! Our body is mostly water, so it seems to reason that it works better when watered. Maintaining adequate hydration may help to thin secretions and soothe the respiratory mucosa. Warm liquids (eg, tea, chicken soup) may have a soothing effect on the respiratory mucosa, increase the flow of nasal mucus (possibly also mediated by the inhalation of steam), and loosen respiratory secretions, making them easier to remove. If you have infants or very young children, invest in a “Snot Sucker” such as the NoseFrida or NeliMed Naspira.
12. Avoid foods that hinder the immune system, such as processed foods (foods far from their original form and most foods with a long shelf life), certain preservatives, white breads, most breakfast cereals, anything high in sugars.
13. Get OUTside. There is a reason our clinics and ERs are busier in the winter: all those pathogens having a party in one tiny room.
14. Get sunshine and vitamin D. There is no clear nor conclusive evidence that taking a Vitamin D supplement results in lower incidence of winter illness, but many providers agree that getting enough Vitamin D3 in one’s diet, especially in the darker winter months can be beneficial. Breastfed infants are encouraged to be receive 400 IU daily of Vitamin D drops. Wild salmon is a natural source of vitamin D3. On average, wild-caught salmon packs 988 IU of vitamin D per 3.5-ounce (100-gram) serving. If you aren’t into fish, one typical egg yolk from chickens raised indoors contains 18–39 IU of vitamin D, which isn't very high--However, pasture-raised chickens that roam outside in the sunlight produce eggs with levels 3–4 times higher. We get our eggs from a local free-range farm (Hope Springs Dairy). If you are considering giving your child a vitamin D supplement, discuss safe dosages first. Vitamin D is a fat-soluble vitamin, meaning it can build up to toxic levels if too much is given. Additionally, eggs from chickens given vitamin D-enriched feed have up to 6,000 IU of vitamin D per yolk. That’s a whopping 10 times the RDI
15. Use a humidifier (but be sure to clean it regularly so you aren’t spewing mold particles in your home)
16. Cut back on the energy drinks (even better, just don’t)—caffeine in children hinders overall health and immunity.
17. Be active-sedentary humans are more likely to get ill. They just are. The body is healthiest when it moves, and that includes the immune system.
18. Be careful what you touch: teach your child to avoid touching their eyes and nose, especially at first signs of illness. Feeling OCD about germs and surfaces? Ditch the toxic household chemical cleaners which can actually worsen your child’s immunity (along with our environment) and opt for something safer and more natural, like a vinegar or light bleach spray.
19. Avoid polluted air, including second-hand smoke, especially in children with asthma or prone to pneumonia.
20. Mind your biome. As science evolves, we can appreciate the role that our microbiome (gut bacteria) plays in our immune system. While giving probiotic supplements is still somewhat controversial and more research is needed, most providers do agree that a small amount of good bacteria from a trusted source may be beneficial. I encourage foods that are naturally occurring in good bacteria, such as plain Greek yogurt, which is low in sugars, moderate in protein, and full of good bugs. Miso and kefir (similar to a drinkable yogurt) are other nutrient-packed foods with probiotics. Whenver possible, obtain your probiotics from food sources. If you do supplement, consider paying more for a refrigerated variety. A 2015 meta-analysis of 12 randomized trials including both children and adults comparing placebo with probiotics (various strains of lactobacilli and Bifidobacterium) found that probiotics decreased the number of individuals experiencing at least one episode of acute respiratory infection. However, many other studies confirm that the actual amount of “living” probiotic varied greatly from product to product despite label claims.
21. Don’t be afraid of the mask: hanging out at a clinic or small room full of coughing kids? If they aren’t wearing a mask, you and your little should. If your provider offers the option of house calls, having your provider come to you is another way to decrease exposure. I've had the honor of making several house calls over the past two winters to those who couldn't get out due to snow, and to those who had infants/young children they did not want to bring into the clinic. However, if you do need to come to the clinic, we are often able to see more than one family member at the same visit.
22. Allow time for recovery, for your child and for their sick friends—it is easy to forget that though someone is no longer showing symptoms, they may be actively shedding the virus and still contagious. Though as an NP I’m very aware of this, I had to opportunity to take the lesson to heart personally when my beloved family from the East Coast flew to see us while I was 8 months pregnant. “We all just got over the norovirus,” they explained on the phone. “But we haven’t had any vomiting or diarrhea for at least a couple days.” I knew the math. I knew they were still contagious, but I didn’t have the heart to ask them to get a hotel. Literally within 24 hours of their arrival I was curled up in a pool of my own vomit on our kitchen floor, very pregnant, and trying to keep my then toddler from walking through the puddle. Within hours, my toddler was lying beside me, also vomiting. If you aren’t sure if someone could still be contagious, call your medical provider or a triage nurse line and ask, or at the very least, provide your family a health cushion of time before you possibly expose anyone.
23. Cocoon! Parents of newborns often ask me, “But how can I keep my newborn safe, especially before she has gotten all her immunizations?” One of the best ways to advocate for your infant’s health is to ask all your close family and caregivers who will be in close contact with her to also be up-to-date on their immunizations. This is called “cocooning.” I recently learned of a five week old baby who passed away from pertussis. She was exposed to pertussis from her grandfather, who unknowingly was infected and contagious likely while caring for his new granddaughter. These stories are not meant to motivate us to immunize due to fear, but rather to understand the rational behind cocooning.
24. Prime your child’s body with antibodies before he is exposed to the virus. Every fall and winter, our clinic is hammered with requests for same-day appointments for fevers, coughs, sore throats, sore ears, sore tummies. While there are thousands of viruses and bacteria to be blamed, there are thankfully some that can be prevented (or at least symptoms and potential complications can be greatly reduced if exposed). Routine childhood immunizations starting at age 2 months protect our children from some of the winter villains, such as the bordetella pertussis bacteria (whopping cough), rotatvirus (severe diarrhea and dehydration), pneumococcal bacteria ( pneumonia, ear and sinus infections, meningitis), haemophilus influenzae type b bacteria (ear infections, pneumonia, blood infections, cellulitis, arthritis, epiglottitis-a severe infection of the throat that can close off the airway--, and meningitis.) and the common influenza virus (responsible for ear, sinus, lung infections).
An immunization works by presenting your child’s body with a minuscule amount of dead or highly weakened virus or bacteria, which then activates their body to make antibodies to that virus or bacteria. A child who has been immunized has a far greater likelihood to not get infected when their body comes in contact with that virus or bacteria, since the body has been primed with antibodies and “recognizes the intruder.” However, in some cases, a child who has been immunized with still get infected, but almost always will have significantly less severe symptoms and complications from the infection than if they had not been immunized at all. Infants and young children are at high-risk for getting an illness if exposed, which is why we want to start protecting them very soon after they are born.
The flu can be very serious, and much more serious than the common cold. Last year during the 2018-19 season almost 200 U.S. children died of confirmed flu, some of them otherwise healthy. Many hundreds more were hospitalized. Children with high-risk medical conditions such as asthma, diabetes, and certain types of cancers are at a greater risk of dying from flu complications. “On average, the vaccine is anywhere from about 50-60% effective. That means if 100 people got the shot about 50-60 people would be protected from getting the infection when exposed to influenza. If you don’t get the flu vaccine, you have absolutely zero additional added protection when exposed. Anywhere between 10-40% of children are exposed to influenza every year so every layer of protection helps.
When we immunize our families, we not only protect them, but we help create community immunity and support those who may not be able to get the vaccine. Flu can be a major killer of vulnerable people. Infants younger than 6 months cannot get the flu vaccine, but their family members can to give them an extra layer of protection.
People aged 65 and over, pregnant women and people with long-term health conditions, including diabetes, kidney disease and chronic obstructive pulmonary disease (COPD), are particularly at risk. If you have a family member over 65 or have a long term health condition, they are also eligible for the pneumococcal vaccine, which provides protection against pneumonia.”
Questions, concerns, fears or confusion about immunizations? I love meeting with parents for “vaccine consults”—this is about an hour long visit where I listen to your concerns and questions, then provide feedback and clarity where I can on ingredients, side effects, risks for getting and not getting the vaccine, schedule, family history, etc. You are always invited to schedule a vaccine consult. I never turn away nor shame patients for choosing to not immunize. It is my role as provider to provide the information, but ultimately, you are the parent and make the decision.
A Few Last Pearls...
That Cough! To treat or not to treat? Although caregivers frequently seek interventions to suppress cough, they should understand that cough clears secretions from the respiratory tract and suppression of cough may result in retention of secretions and potentially harmful airway obstruction. Following guideline American Academy of Pediatric (AAP) guidelines, I suggest that airway irritation contributing to cough be relieved with oral hydration, warm fluids (eg, tea, chicken soup), honey (in children older than one year), or cough lozenges or hard candy (in children in whom they are not an aspiration risk) rather than over the counter or prescription cold medications.
Honey has a modest beneficial effect on nocturnal cough and is unlikely to be harmful in children older than one year of age. Honey should be avoided in children younger than one year because of the risk of botulism. The AAP suggests that cough lozenges or hard candy may be used to coat the irritated throat for children older than six years.
The AAP advises that OTC (over-the-counter) cough and cold medications should be avoided in children <6 years and suggests not using OTC cough and cold medications in children between 6 and 12 years of age. These medications have no proven benefit for children and may have serious adverse effects. For children ≥12 years, medical resources such as UptoDate suggest either ipratropium nasal spray or OTC decongestants (oral or topical).
Irrigate! Topical saline may be beneficial, is inexpensive, and is unlikely to be harmful or impede recovery. The application of saline to the nasal cavity may temporarily remove bothersome nasal secretions, improve mucous clearance, and lead to vasoconstriction (decongestion) Side effects may include mucosal irritation or nosebleed. In infants, topical saline is applied with saline nose drops and a bulb syringe. In older children, a saline nasal spray or saline nasal irrigation (eg, squeeze bottle) may be used. It is important that saline irrigants be prepared from sterile or bottled water; cases of amebic encephalitis associated with nasal irrigation prepared from tap water have been reported but are extremely rare.
Black Elderberry extract was found to be "significantly effective at reducing the total duration and severity of upper respiratory symptoms, as compared to a placebo group. The effect of elderberry supplementation is larger among cases of the flu than the common cold, but supplementation successfully reduces the symptoms regardless of underlying cause" reports a meta-analysis paper published in the journal of Complimentary Therapies in Medicine, February 2019. It is important to note that the research did not demonstrate that elderberry supplementation prevented illness, but rather reduced symptoms and duration.
*****Any infant with a rectal temp of 100.4 or greater should always be seen by a licensed medical provider. ******
About the Author:
Havilah Brodhead is a family nurse practitioner and owner of Hearthside Medicine Family Care in NE Bend. Her practice is located inside the Pilot Butte Medical Center near the hospital. Hearthside Medicine offers full primary care with an emphasis on integrative medicine. Hearthside also offers house calls!
Havilah is a mother of two young children, lover of mountain biking, and values connecting with her patients in a real and un-rushed way. She appreciates “nature’s medicinal cabinet” and often incorporates natural remedies into her medical practice to give patients options beyond or instead of prescriptions. She sees pediatrics and adults and accepts most insurances. She is accepting new patients. Learn more at www.hearthsidemedicine.com