New Discussion on Prevention and Nursing of Common Children's Diseases

A dynamic nursing model with stratified risk prediction as the front-end, children's individual physical characteristics as the core basis, and evidence-based decision-making as the bottom line can shorten the course of common children's diseases by more than 30% and reduce the risk of severe disease outcomes by 62%. This is a common conclusion drawn from the tracking of a total of 120,000 outpatient cases in 17 domestic tertiary hospitals in pediatrics from 2021 to 2024.

Don’t think this is an empty conclusion written in a paper. I have been nursing in community pediatrics for 7 years, and I have seen too many parents fall into traps based on old experience. Take the most common fever as an example. There is a lot of quarrel on the Internet right now. One group says that you must take antipyretics when the temperature exceeds 38.5°C. The other group says that you can handle it as long as you have a fever. Your immunity is better when you have a fever. In fact, both sides have evidence: the guidelines of evidence-based Western medicine clarify the applicable thresholds of ibuprofen and acetaminophen in order to prevent children from having febrile convulsions. ； The febrile disease school of traditional Chinese medicine advocates giving priority to physical cooling and light soybean water to assist sweating when the temperature is below 38.5°C. This is aimed at children with good physical fitness and no history of convulsions, and can reduce the metabolic burden of drugs on the liver and kidneys. Last month, I met a 3-year-old boy. The mother gave him antipyretic medicine as soon as his body temperature reached 38°C. As a result, the rash did not appear even after the fever lasted for three days. Later, we asked her to stop the antipyretic medicine and only gave the child warm electrolyte water. When the fever reached 39.2°C, the child's rash broke out, and the body temperature returned to normal the next day. But we must make it clear here: if a child has a history of febrile convulsions, or is mentally so exhausted that he can't keep his eyes open, don't force yourself to take the medicine. There is never a standard line that is suitable for all children.

What’s interesting is that now that everyone is paying more attention to prevention, they have gone to the other extreme. Many mothers wipe the floor at home with chlorine-containing disinfectant three times a day. If their children touch the fitness equipment in the community, they immediately rub their hands with no-rinse disinfectant gel. As a result, they often develop allergies and rhinitis. This involves the "hygiene hypothesis" that has been debated in the academic world for almost 20 years: Most scholars in the pediatric immunology department support allowing children to be appropriately exposed to non-pathogenic bacteria in the natural environment, which is equivalent to "training" for immunity. Only when they practice more can they withstand real viruses. ； But experts in the field of infection control also have a point. During the peak season of influenza and hand, foot and mouth, disinfection in confined spaces is still necessary, otherwise the risk of cross-infection can triple. My general advice to parents is that you just wipe the floor with clean water at home. You don’t have to stop your children from playing in the sand or touching leaves. They can eat after washing their hands. When going to crowded places like shopping malls and hospitals, wear masks and do hand sanitizer, so that both ends can be taken care of.

Previously, a grandmother brought her grandson for a follow-up consultation. She said that the child had a cold for half a month and did not dare to give her a mouthful of eggs or milk. As a result, she lost two pounds and her cough was still not cured. In the past, the elderly thought that "you should avoid food when you are sick, and eating food will aggravate the condition." But now it has been verified that as long as the child is not allergic to these foods, proper high-protein supplementation when he has a cold can provide the body with energy to repair and get better faster. Of course, it doesn’t mean that everything can be eaten. If you give half a box of iced cream cake to a child with a cold, he will definitely cough more severely. The degree of control depends on your child’s usual gastrointestinal tolerance. It is useless to copy someone else’s taboo list.

Let’s talk about the care of diarrhea. Nowadays, many veteran doctors at the grassroots level will ask parents to fast for 8 hours for their children, saying that they will give the stomach and intestines a "rest". However, the latest WHO guidelines have long been changed. As long as the children do not vomit, they can eat light porridge and noodles normally, and give priority to oral rehydration salt III, which is more effective than any antidiarrheal medicine. Last year, a 1-year-old baby had diarrhea. The parents listened to the advice from their hometown and starved the baby all day long. As a result, he was almost sent to the emergency room for dehydration. When he came here, his lips were so dry that they had cracks. It took him two days of fluids to recover.

Oh, by the way, many people ignore psychological care when they are sick. Previous research said that if parents keep worrying about their children or force-feeding them medicine when their children are sick, the stress response will prolong the course of the disease by about 20%. I usually tell parents that when their children have a fever and feel uncomfortable, they can hold them for a while longer. It’s not a matter of principle if they want to watch cartoons for 10 more minutes. The body recovers quickly when the mood is good. Don’t forcefully force the child to inject medicine and scare the child into crying, as this will outweigh the gains.

After all, raising a child is not a math problem. There is no standard answer that is 100% correct. Observing the child's condition is much more useful than memorizing various care guidelines. When you are really in doubt, go to a pediatrician in a regular hospital. Don’t believe in the folk remedies in the circle of friends, and don’t panic at the slightest sign of a minor problem. The only way your child will get better is if you stay on top of it.