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儿童感冒必看的秘籍

askdrzhai PEDI 2023-10-13


1.儿童感冒几天能好?


俗话说:感冒吃药一周治愈,不吃药七天自愈。很多人就以为,儿童感冒了一周就应该好,是这样吗?


CDC认为:感冒的嗓子痛大约8天能好,头痛9到10天,而鼻塞流涕和咳嗽,都可能需要两周多才能好。



Uptodate认为:六岁以下宝宝感冒拖的时间长些,大约两周左右;大孩子及成人感冒一周多,吸烟人群感冒拖得比较久。


Children younger than six years have an average of six to eight colds per year (up to one per month, September through April), with a typical symptom duration of 14 days...Older children and adults have an average of two to four colds per year, with a typical symptom duration of five to seven days. The duration of symptoms is increased among cigarette smokers.   


2.感冒必须洗鼻吗?


洗鼻越来越热门了,以至于很多循证宝妈误以为感冒了必须洗鼻,不给宝宝洗鼻似乎有一种犯罪感。下面这段话说得很好:


用生理盐水滴鼻、吸鼻可能会有效地暂时缓解婴儿的鼻塞。然而,现有的数据不足以证明生理盐水洗鼻对感冒的疗效。另外有40%的婴儿不能接受盐水洗鼻/滴鼻。


The use of isotonic saline drops and gentle aspiration may be effective in the temporary relief of nasal obstruction in an infant. However, a Cochrane Collaboration review noted that available data was not sufficient to demonstrate efficacy of saline nasal irrigation.119 It alsonoted that 40% of babies did not tolerate nasal saline drops. The general humidification of room air may be useful because this moisture tends to dilute tenacious nasal mucus and facilitate its elimination. Textbook of Pediatric Infectious Disease 7th ed. 


总之,如果孩子感冒后鼻塞严重,孩子也还能配合,能用盐水洗鼻/滴鼻就尽量吧。不能洗,可以喷;不能喷,可以滴。但孩子实在不配合的话,就像宝妈们说的那样:只要一洗鼻就像杀猪样地哭,就别勉强了。


3.感冒后鼻子下面的护理


感冒初期孩子们不停地流鼻涕,鼻子下面很快就红起来,很难受,河南这边的土语叫:给qu的了。分享我的一个小经验:鼻子下面抹氧化锌软膏(屁屁霜),能缓解鼻子下面的不适,保护皮肤,比抹凡士林要好,很有效。


4.咳嗽喝蜂蜜


前不久英国医学杂志/循证医学上的一篇新文章:分析蜂蜜对上呼吸道感染咳嗽症状的疗效,结论是:


蜂蜜对上呼吸道感染咳嗽症状的改善优于一般护理。它为抗生素提供了一种广泛可得且廉价的替代品。蜂蜜可以帮助减缓抗菌素耐药性的传播,但还需要进一步的高质量、安慰剂对照试验。


上面这段换成翟医师的大白话就是:感冒咳嗽,孩子和家长(特别是家长)都需要一些安慰,用无害的、甜甜的蜂蜜,总比用阿奇霉素、头孢克洛等本不该用的抗生素要好,也比喝那些难喝又没效的中成药强。(注:一岁以下别喝!)


5.咳一个月了,是慢性咳嗽吗?


慢性咳嗽的定义是连续咳嗽一个月。不但中间不好,还逐渐加重。很多孩子好像确实连续咳嗽了一个月,例如类似下面的问题:


医生,我孩子11.2号刚感冒过,咳嗽今天又严重了,今天也打了好几个喷嚏,还流鼻涕了。


下午流清鼻涕,咳嗽也不再是早上起床咳一阵了,昨晚半夜也咳嗽一阵子,白天也咳嗽,有痰声。


烧起来了,38.5....


我把上面孩子咳嗽的病程画了个图,你说这是“慢性咳嗽”吗?



翟医师语录:小宝宝们,特别是那些刚上幼儿园的,在秋冬季,经常是一波感冒还没有完全好,新的一波感冒又来了,孩子咳嗽了似乎很久,但这还不是慢性咳嗽。


When a child who has not fully recovered from a URTI-related

cough acquires a subsequent URTI, the coughing illness

may seem prolonged.

Managing Chronic Cough as a Symptom in Children and Management Algorithms CHEST Guideline and Expert Panel Report


6.儿童慢性咳嗽的最常见原因是?


很多家长已经变成了呼吸科专家:咳嗽变异性哮喘,胃食道反流......感冒咳嗽也说成是鼻后滴流。


社区范围内,儿童慢性咳嗽最多见的原因是:上呼吸道感染/病毒感染后的咳嗽(post-viral cough)。


Post-viral cough is a term that refers to cough after the acute upper respiratory tract infections (URTIs). In contrast to the hospital settings,

cough post viral URTIs is likely the most common cause of chronic cough in children in the community. 

Managing Chronic Cough as a Symptom in Children and Management Algorithms CHEST Guideline and Expert Panel Report


7.感冒能自愈吗?


这是不争的事实,多年来给福利院的重症孩子看病,肝移植术后长期吃免疫抑制剂,唐氏综合征,还有重度脑瘫的孩子,这些被遗弃的孩子几乎都还没有吃过母乳。即使这样,大部分情况下他们的感冒也都能自愈。何况你家吃了母乳,而且还健康的宝宝?




参考文献:


1.Common Cold 

https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/colds.html


2.The common cold in children: Clinical features and diagnosis Via Uptodate


3.Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis 

https://ebm.bmj.com/content/early/2020/07/28/bmjebm-2020-111336


4.Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report https://www.sciencedirect.com/science/article/pii/S0012369220303251



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