Our 20-month son has started falling sick quite often every since he
started going to day care.  He was at home for the first year and he did
not fall sick even once.  Now it seems like he has some sort of cold or
flu pretty much once a month.  Most of the time the cold leads to an ear
infection as well, with the result that he ends up being on antibiotics
3 weeks out of 4.  I know kids in day care fall sick more often, but we
are beginning to wonder how often "more often" really is, whether our
son is more susceptible or has lower immunity than average, what the
longer-term effects of constantly being sick and taking antibiotics are,
and what we can do to build up his resistance.  He really enjoys his day
care and we think it's great too, but we are beginning to wonder whether
we should think about getting a nanny.

Are there any studies that can help answer some of these questions?

-- How often do kids in their first, second and third years fall sick?
How often do they get colds, flus, ear infections?  Is there any data on
home care vs. day care?

-- Does being sick "build immunity" (leading to less illness later),
does it make kids "weaker" (leading to more illness later), or does it
not have any long term effect?

-- Does taking antibiotics on a regular basis have any negative long
term effects?

-- How does one tell if a child is more susceptible to illness than
normal, and what does one do about it?

-- Is there any way to build immunity and resistance?

Any data, information or advice relating to this would be much
appreciated.  Thanks a lot.

Ashwin.

When kids stayed in the home until kindergarden or 1st grade, infection
incidence was much lower because exposure was lower.  Some studies suggest
that early exposure to various infectious diseases is probably beneficial
because exposure as an {*filter*} carries much more risk of morbitity and
mortality(mumps, measles. etc.).

Daycare will always carry a higher exposure risk than home care.

Exposure to infectious organisms does build immunity.  But many viruses
mutate and reexposure to the new strain requires another immune response(
new antibody production).  In addition, antibody levels tend to decline
with time and re-innoculation is needed to keep the antibody levels high.
Chronic overstimulation of the immune response can lead to immunosupression
but this is rare and very unlikely to occur in children.

Yes, chronic use of antibiotics can have an adverse effect on the good
bacteria that are supposed to be present in and on the body.  Health effects
of this depletion of the good bacteria is a very hotly debated topic in the
medical community with most physicians seeming to discount any health effects
of chronic antibiotic use( a view that I do not support).

Chronic infection in an {*filter*} or a child needs to be worked up( in my
opinion).  But most physicians feel that chronic infection in a child is
normal because of both exposure and lack of prior immunity to many
infectious diseases.  I do not share this view and there are some
physicians who also suspect that diet plays a big role in infection
frequency and severity.  Exposure to an infectious agent does not have to
result in a severe infection.  A strong immune response can minimize the
length of time needed to deal with the infection as well as the symptoms
associated with the infection.

There are five major nutrients that are responsible for a good strong
immune response to infectious agents.  They are: protein, vitamin C,
vitamin A, iron and zinc.  The American diet is not low in protein so this
is rarely a problem.  But vitamin A, vitamin C, iron and zinc are often low
and this lack of an adequate pool(nutrient reserve) can impair the immune
response.  Iron is know to be low in most kids(as is vitamin A).  There are
distinct biochemical tests that can be run to check the status of each of
these nutrients in a patient who is having a problem with chronic severe
infection.  Serum ferritin for iron status, dark adaptation for vitamin A
status, red {*filter*} cell zinc for zinc status and leckocyte ascorbate for
vitamin C status.  I have attempted to work up posts on these five
nutrients and their role in infection for this news group as well as the
others that I participate in.  I can e-mail you what I've worked up so far.
But my best advice to you is to try to find a physician who recognizes the
critical role that diet plays in the human immune response.  You may also
be able to get help from a nutritionist.  Anyone can call themselves a
nutritionist so you have to be very carefull.  You want to find someone(
like myself) who has had some formal training and education in nutrition.
Many Ph.D. programs in the U.S. now offer degrees in Nutrition and that's
what you need to look for.  Some dieticians will also call themselves
nutritionists but most dieticians have not had the biochemical training
needed to run specialized nutritional assessment tests.  They are very good
for getting general dietary advice from however.

Martin Banschbach, Ph.D.
Graduate degree in Biochemistry and Nutrition from VPI
and developer of a course on human nutrition for medical students

Sounds pretty familiar.  I posted similar cries about last September when
Caroline just entered daycare.  She was two, then, and have been with
continuous colds since until last March.  As spring approaches, her colds
slowed down.  Meanwhile we grew more and more relaxed about her colds.
Only once did the doctor diagnosed an ear infection and only twice she
had antibiotics.  (The other time was due to sinus infection, and I wished
that I did not give her that awful Septra.)

There are the 'net studies' -- that is, if you read this newsgroup often,
there will be a round of questions like this every month.  There might
be formal studies like that, but bear with my not so academic experience.
Okay?

Gee, I bet 50/50 you'll hear cases in all these catagories.

I am pretty sure, an insulated child at home sicks less.  But, that child
still will face the world one day.

That's what I believe and comfort myself with.  Caroline will get more
and more colds for sure before she learned not to stick her hand in other
kid's mouth nor let other kids do the same.  Cold virus mutate easily.
However, I hope that her immune system will be stronger to fight these
diseases, so she would be less severely affected.  Everytime she has a cold,
we make sure she blow her nose frequently and give her Dorcol or Dimetapp
at night so she can have good rest (thanks to some suggestions from the net).
That's about all the care she needs from us.  I try very hard to keep her
off antibiotics.  Twice her ped. gave me choice to decide whether she would
have antibiotics.  I waited just long enough (3-4 days) to see that she
fought the illness off.  I do understand that you don't have much choice if
the child is in pain and/or high fever.

If the child doesn't rely on antibiotics to fight off the sickness everytime,
then the child should be stronger.

I'll leave this to expert.

If your child just entered daycare, I'm pretty sure the first 6 months will be
the hardest.  (Then, you get more used to it.  Boy, do I hate to see me typing
this sentence.  I recall when I read something like this last September, I said
to myself, 'oh, sure.'  But, I do get used to it, now.)  However, I do hear
people say that it does get better after a year or two.  I am looking forward
to a healthier next winter.  As it gets warmer, I hope you do get some break
soon.

Eat well, sleep well.  Try not to use antibiotics if not absolutely necessary.

Good luck.

Wen-lin

--

Yes, isn't that the standard rule?

But look out for a possible explanation of at least parts of it: A lot of
allergic reactions look very much like cold/flu symptoms. The allergy won't
go away with antibiotics. Check out your day care center for which materials
are used in the carpets (and curtains and other places), whether the walls
are plywood or similar that may contain glues to which lots of people react,
if there are flowers or other green plants that may cause reactions etc.
It even could be as simple as your son finding a playmate that has a dog at
home and your son is allergic to dogs.

As a general rule, yes. But that is under the assumption that the body gets
a chance to recover and build this new immunity before the next attack!

For {*filter*}s, this is certainly true as a general rule: Your body will need
steadily increasing amounts to obtain the same effect, and after some time
you are "immune" to it. I see no reason why it would be different for kids.

It is possible to "recover", though. My brohter-in-law had a really bad flu
every winter for several years, and every year he took a stronger dose of
antibiotics. A few years ago, his doctor recommended that he prepared for
being *really* sick - taking no antibiotics at all that year, letting his
body do the fight alone. He did, and was really bad for several weeks, but
later he hasn't needed antibiotics at all (although he has had weak attacks
of the flu).

Definitely. And: Don't overprotect the kid! Don't put on more clothes until
the boy feels cold. Don't use a scarf and cap when the sun is shining and
the teperature is above freezing. Etc.etc. (But if you have had a tendency to
put on more clothes "just to be sure", don't make the change too fast!)

A college of mine had ear infections every winter, and in an attempt to fight it
he used warm caps from early fall. His doctor recommended the opposite strategy:
Don't wear a cap until it starts snowing. This did work for him.

I don't dress up very warm myself, and I've taken a single antibiotic treatment
in my life, and I am quite rarely sick. I certainly accept use of medical
treatment, but don't misuse it "just to be on the safe side". That is exactly
what moves the line between the safe side and the other.

For the first 9 months in daycare, Alex was constantly ill.  Plus he
has asthma, so that made every cold a major deal.  Now after 11 months
there, it's much better!  He doesn't catch as many colds, they're milder,
and we're much more relaxed about it.
Yes - if he gets it all now, supposedly he won't get it all in school.  Before
so many kids went to daycare/nursery, early school years were the time when
everyone got sick.
Alex IS more susceptible than most, related to the asthma,etc.  Unless the
child has a true immune disorder, you can do NOTHING.  BTW, you'd know if his
immune system wasn't functioning, so don't worry about that.

Yes, get sick alot! ;-)

  As a parent of two kids with suspected immune system problems, I don't
agree with this answer.  I'm no doctor, but there are two points I
disagree with -- first, even if there is a true immune disorder, there
often isn't anything that can be done about it.  Second, you won't
necessarily know if the immune system wasn't functioning unless it
is a total failure type of situation.  There are a number of components
to the immune system, and depending on which part isn't up to snuff,
you get different sorts of patterns.  Many of these are only caught
after any number of illnesses, by a doctor that is paying attention
and looking for patterns.  If you have switched doctors (not uncommon)
or working with a group that doesn't communicate well, the pattern may
be missed entirely.
  In our case, our son was pretty healthy his first year if you over look
a lot of ear infections, even though he started into full time day care
at 14 weeks.  His second and third years were terrible.  In one six month
period between 2 and 2.5 years, he had pneumonia twice, bronchitis twice,
strep twice, two ear infections, and something called hand-foot-and-mouth
disease (similar to chicken pox).  Note that this frequency of illness
was not considered cause for **any** concern, though the inclusion of
several bouts of serious chest infections was an issue.  So it isn't so
much a matter of how often they get sick, as what they get sick with.
  He never seemed to get plain old ordinary colds, and secondary infections
usually set in within 2-3 days of the original illness.  The latter was
considered somewhat significant; the former wasn't.  The main concern
came from his tendancy to get serious chest infections frequently, and
quickly.
  His younger sister followed much the same pattern, only earlier, and
worse.  She had pneumonia for the first time at 7 months, and has had
it 3-4 times a winter ever since (she is 3 now), along with regular
bouts of bronchitis, sinus infections, and bad cases of the flu.
  She was tested extensively last year for immune system and other problems,
both because of the repeated chest infections, and because she is small
for her age.  The tests turned up nothing, but the opinion of the various
experts is still that both kids have some type of immune system issue that
allows them to get sicker faster than normal.  Both improved in terms
of reducing the overall frequency of illness around the time they turned
3, but both continue to get pneumonia or bronchitis as a secondary
infection to almost everything except the stomach flu.
  My kids get more antibiotics, and get them sooner, than a kid without
these tendancies.  They get monitored a little more closely for growth,
and overall health.  Other than that, there simply isn't that much
difference.  They are probably going to be "prone" to chest infections
all their lives, and may yet prove to have asthma or some other issue
(tests so far haven't showed it, nor have they tested positive for
allergies).  Even if they'd been able to fully pin down the immune
system problem, they almost certainly wouldn't have been able to do
anything about it, beyond the preventative measures we already take
(they get flu shots, and the younger is on low dose antibiotics
during the winter months).

                                        Susanne Gilliam

[descriptions of son's apparently daycare-related illnesses deleted]

I don't have any great advice as I've never been in your situation.  I
can recommend a book that I really enjoyed, though: _How to raise a
healthy child in spite of your doctor_, by Robert Mendelsson (not sure
of the spelling on the name - that doesn't look quite right).  Dr.
Mendelsson is a pediatrician but pretty much of a heretic.  His views
are rather extreme, and sometimes he doesn't back up his claims with
data (not like most books do).  But there is also much excellent advice
about all sorts of childhood ailments, their frequency, causes, and
treatment.  I found his discussion of ear infections and antibiotics
very interesting.

Marilyn Walker