Problems of children who are often sick
According to various researchers, the number of children who are often sick varies between 30-70%, depending on the age of the children and the conditions of their upbringing. In early (up to 3 years) and preschool age, the number of such children is highest, and in the structure of diseases they are dominated by acute respiratory diseases. In children after 6-7 years, exacerbations of chronic tonsillitis, adenoiditis, sinusitis, as well as diseases of the digestive system, nervous system, etc. are more often observed.
Frequent diseases negatively affect the state of health: children are more often observed deviations from the norm of indicators of the functional state of the body (tendency to anemia, functional changes in the cardiovascular, nervous, immune, urinary systems). They often form chronic foci of infection at an early age, and a little later develop combined pathology of the respiratory, digestive and urinary systems.
Many years of research have shown that children who are often ill represent a heterogeneous group. The main “suppliers” of this group are children with lymphatic and allergic diathesis, born to mothers who had a pathological pregnancy (gestosis of pregnancy, viral-bacterial diseases during pregnancy, prolonged threat of abortion, etc.), born prematurely and immature, injured at birth. The poor health of parents, their bad habits, etc., also play a significant role in the formation of a group of children who are often ill.
Only in 3-5% of children, the cause of frequent diseases is primary immunodeficiency.
In the postnatal period, the most significant factors contributing to frequent diseases are early mixed or artificial feeding of children, irrational family lifestyle, lack of hardening of the child, insufficient exposure to the air, chronic diseases of the nasopharynx in family members who are constantly in contact with the child.
The prevalence of risk factors among children who are sick frequently or episodically is presented in the table. The data indicate that with increasing age of the child, the negative factors that acted on him during intrauterine development reduce their impact on morbidity. And the action of negative factors in the postnatal period contributes to frequent diseases in all the above age groups of children.
Prevention of frequent diseases in children
Prevention of diseases in children should begin with the improvement of the health of future parents and all family members who will often be in contact with the child. This especially applies to the mother - to prevent acute diseases and exacerbation of chronic ones during pregnancy. It is very important to foster a healthy family lifestyle, including physical activity, being outdoors, a balanced diet, a complete rest regimen depending on age, hygienic home maintenance, getting rid of bad habits, etc.
The health of the expectant mother during pregnancy requires special attention. Every pregnant woman should be systematically observed by an obstetrician-gynecologist, which will allow timely prevention or elimination of this or that pathology.
Every pregnant woman should be aware of and prepared for the need to breastfeed her child at least until 6 months of age, which in the vast majority of children will prevent the development of frequent diseases, will contribute to the formation of proper body resistance. This is especially true for children with diatheses, premature and immature.
Extremely important for the prevention of frequent diseases in children is the timely (in the first 3 months of life) diagnosis of a particular diathesis based on the study of heredity (presence of atopy), clinical data (periodic skin rashes, diaper rash, digestive disorders with a tendency to diarrhea, etc.) and systematic implementation of rehabilitation measures at the stage of diathesis, before it has been realized in a particular disease. For children with lymphatic and allergic diathesis, effective rehabilitation methods have been developed, which should be carried out especially carefully in the first 5 years during the period of the most intensive development and maturation of the body. In children with such diatheses, in premature and immature children, and in lymphatic diathesis, always, there is a lag in the formation of immune mechanisms compared to age norms, so they need to systematically carry out preventive measures.
Basic principles of restorative treatment of children
The selection of forms and methods of restorative treatment of children who are often sick should be carried out after determining the causes that contributed to the development of frequent diseases, and, if possible, with their elimination (hypoallergenic diet, hypoallergenic living conditions for children with allergic diathesis; maximum possible prevention of infectious contacts for immature, premature children with lymphatic diathesis).
Children's health improvement can be carried out both in home-outpatient conditions and in kindergartens. Currently, there are sanatorium-type kindergartens and health improvement groups for children who are often ill in preschool institutions.
Since in the structure of morbidity of such children, respiratory diseases are in the first place (82%), mainly acute respiratory viral infections, which due to their polyetiological nature do not have sufficiently effective specific means of prevention, the preventive measures included in the complex of children's health improvement should be aimed primarily at increasing the nonspecific protection of the child's body. Another important principle of prevention of frequent diseases in children should be its year-round implementation.
One of the main means of increasing the nonspecific protection of the child's body is hardening - air baths, local and general water procedures, contrast water procedures, etc.
When hardening, one should be guided by the principle of an individual approach to the choice of procedure, which will include taking into account the characteristics of the child's health and development, his reaction to cold, anamnestic data, living conditions.
Along with general air baths, washing the face with cool water, a gentle version of the contrast hardening method has proven itself well in sick children, in which the feet are first doused with warm water, then immediately with cool water, and then again with warm water. At the same time, for children over 3 years old, it is advisable to recommend rinsing the mouth and throat with room temperature water.
It is advisable to combine hardening procedures with gymnastics and massage.
Important conditions for hardening are gradualness, systematicity, and a positive reaction of the child to the procedure. The complex of year-round health improvement of sick children includes the use of physiotherapeutic means of prevention: general ultraviolet irradiation or irradiation of only the face and collar zone, inhalation with herbal infusions, tube quartzing of the nasopharynx, etc. Herbs that have antiseptic and anti-inflammatory effects are more often used: eucalyptus, chamomile, St. John's wort, plantain. Physiotherapy procedures should be carried out twice a year in 2-3-week courses in September-October and February-March. In addition, stimulating and tonic agents with a complex of vitamins and trace elements should be prescribed in parallel. The appointment of stimulating and tonic agents should also be individual, taking into account the state of the nervous system and possible allergic reactions (more often in children with allergic diathesis). For this purpose, tincture of Eleutherococcus, Echinacea, complex preparations of Svitanok, Dzherelo, diabazole, petoxyl, methyluracil, licorice root preparations are used.
The arsenal of non-specific drugs for the prevention of acute respiratory diseases is large, and their use in combination with other health measures can significantly reduce the incidence of children. Considering that the vast majority of children who are often ill, after 3-4 years of age, chronic foci of infection form in the nasopharynx and they are the main factors that cause frequent diseases, nasopharyngeal sanitation, prescribed by an ENT specialist, is one of the components of rehabilitation.
It is known that the most common pathogens of respiratory diseases, in addition to viruses, are pathogenic streptococci, staphylococci, Klebsiella, Escherichia coli, Proteus and others. Based on this, the use of such drugs that combine the properties of vaccine and immunomodulatory agents that affect both nonspecific defense systems and “selectively” contribute to the formation of specific immunity against specific infectious agents is promising in the complex of rehabilitation measures. Such drugs include Broncho-Munal, IRS-19, Ribomunil, which have been successfully used in pediatric practice in Ukraine in recent years. It is advisable to prescribe them according to the existing schemes for each of them in late summer - early autumn, as well as in spring. These drugs significantly reduce the incidence of children who are often sick and contribute to the rehabilitation of chronic foci of infection.
As for such immunotropic drugs as T-activin, thymalin, thymogen, thymostimulin, a-thymosin and other immunocorrectors, in our opinion, they can be used only in the presence of primary or secondary immunodeficiency, confirmed by a repeated immunological examination of the child. Such children among those who often get sick, no more than 10-15%.
Organizational principles of medical examination of children who often get sick
Conducting medical and preventive measures aimed at improving the health of such children is carried out by pediatricians. The effectiveness of their work with this contingent of children depends not only on these measures, but also to a large extent on the assessment of the child's heredity, the health status of parents and other family members who often contact the child, the family's lifestyle, nutritional characteristics, living conditions, etc. In addition to the pediatrician's observation, each child should consult an ENT doctor at least twice a year, and if there are indications - with other specialists. Children in this contingent should have blood tests (general analysis) and urine tests twice a year. Immunological examinations should be carried out only in cases where the carefully carried out above-mentioned measures have not had the desired effect or when changes inherent in an immunodeficiency state are detected in the child's blood test.