Dr. Marc A. Tanenbaum, MD

Hello,

I am happy to share with you that a newborn's immune system is fully developed at birth, although it is inefficient or immature. Without a fully developed immune system at birth, a baby would be quickly overwhelmed by bacteria and viruses and life would be impossible. In addition to the newborn's own immune system for survival, other factors are active to protect the newborn. The mother's immune system allows for the passage of her own antibodies to the fetus during her last trimester through the umbilical cord to her baby. These antibodies once in her baby allow for some protection from bacterial and viral infections for the first few months of the baby's life. That's why women in their last trimester are encouraged to get an influenza vaccine and a Tdap vaccine to protect both themselves and their newborns against the flu and pertussis (whooping cough). In addition, a breastfeeding mother gives her baby in her breast milk living white blood cells and antibodies that protect her baby from many intestinal infections.

A baby's first childhood immunizations can be given as early as 6 weeks of age to develop antibodies to selected germs before the baby actually encounters these germs in real life. Because a newborn's immune system is inefficient/immature at birth, care should be taken not to expose the newborn to unnecessary risks of germs in large crowds or social gatherings, e.g., restaurants, airports, movie theaters, parties, etc.
I hope this information is helpful.

Best regards,

Dr. T

Paracetamol is dosed for a child by his or her weight. An optimum dose is 15 mg/kg by mouth every 4 hours up to a maximum of 5 doses in 24 hours. That's how it is dosed. However, a more important issue is what is paracetamol for? It is not for a child who feels "sick." Paracetamol is for fever that makes a child feel bad. And it is for pain or aches. It is not for vomiting, nausea, diarrhea, cough, congestion, runny nose, or mild pains that can be easily relieved by other means including distraction, warm packs, or cold packs. Your doctor would want to know more about what your child means by "feeling sick" to give medical advice. I suggest that communication with your child's doctor is best practice and not posting a vague query to the internet.
I hope your child feels better soon.

Marc Tanenbaum, MD

Why not use an aspirator to clear nasal mucus? It can be done gently, with love and can be very effective. You can wipe a child's nose with a kleenex to remove visible mucus, but it will not "clear" mucus upstream. If your child is old enough, you can encourage your child to blow his/her nose into a tissue, but until a child masters this technique, it usually is only partially effective and there is no way an infant can do this. There is no medication that will "clear up" nasal congestion despite what pharmaceutical advertising claims. Instilling nasal saline drops can loosen nasal mucus so it flows more easily, but that does not "clear up" nasal mucus by itself. Humidifying the air around an infant also improves the flow of nasal mucus. Most parents will find that a nasal aspirator can be their best friend for "clearing up" nasal mucus, but that's only temporary as mucus production is ongoing until its cause winds down. So, my suggestion to you is not to give up on a nasal aspirator. You may need to try a variety of aspirators until you find one that is comfortable to use for both you and your baby.

Marc Tanenbaum, MD

This is a common question and guidelines have changed over the decades. In general, most pediatricians suggest that 6 Strep throats in a year or 3 Strep throats per year for 2 or 3 years in a row are reasonable criteria. There are also additional criteria. If terribly enlarged tonsils alter the voice, removal can be helpful. Also, apnea (pauses in breathing longer than 10-15 seconds) while asleep overnight can benefit from tonsillectomy. Enlarged tonsils that require constant open mouth breathing instead of normal nasal breathing can justify tonsil removal as an option. The best way to know if your child needs his/her tonsils out is a good discussion with your child's doctor. Tonsillectomy is much less common today than a few decades ago.
Good luck in your search to have this question answered.

Marc

You are supposed to have a cough when you have bronchitis. A cough keeps you from drowning in your own airway mucus resulting from bronchitis. One goal is to have mucus flow efficiently so that one's cough can clear it effectively. A second goal is to be comfortable when you cough. Having adequate saliva in one's mouth can ease somewhat the "tickle" that makes you cough. That's why sucking on a lozenge safely can soothe a cough. It's not a medication effect; it is a liquid soothing of the cough-requiring throat tickle. A third goal is being able to sleep adequately so a cough at night won't wake you. Narcotics can calm a cough so you can sleep, but they have their own problems. Seriously narcotics should not be prescribed for cough control. There is a cornucopia of cough medicines available over-the-counter for cough. If you read their labels, they all share similar contents. Usually, there is DM (dextromethorphan). There can be an antihistamine, e.g., Benadryl (diphenhydramine). Often a decongestant is included which does nothing to suppress a cough but is intended to
decongest the nose. There is often Guaifenesin, which is supposed to liquefy mucus and assist expectoration, but actually has minimal benefit in humans_only in lab rats in large dose. Guaifenesin has been grandfathered by the FDA for OTC meds. There is some research to show that organic honey (dark honey, Buckwheat honey) can soothe a cough. Adults can take 10 mL of dark honey for that purpose especially at bedtime. Children over 2 years old, usually 2.5 mL; older children, 5 mL. Asking your pediatrician is a good idea.

Most bronchitis in children and adolescents (even adults) are viral in origin. Antibiotics are not indicated for treatment. Cough from bronchitis should not last more than 2-3 weeks. All coughs are not bronchitis, so a correct diagnosis is important. Don't see your doctor more mild cough that doesn't intrude in your life. But if you can sleep due to cough, or your chest hurts with cough, or one is short of breath and winded with cough and between coughs, communicating with your doctor would be wise.

I hope it's obvious to readers that "bronchitis" today during the pandemic might be a manifestation of COVID-19; it can also be any number of other viruses. If you are well with a cough, in my opinion, you don't need a COVID test as long as you are willing to self-isolate for 10 days so you are not a risk to your community. If you can't self-isolate, you should get advice from your doctor and not self-treat. If you are "well" with a cough, bronchitis or not, you might have a COVID illness and should communicate with your doctor. This can be a virtual telemedicine visit if you are well. But if you are not well with a cough, your doctor or another health professional will need to listen to your chest as part of an appropriate physical examination. I recommend you start with a phone call to your health professional for advice and a plan to monitor your progress and recovery.
So, my bottom line answer to your question of what is the best cough medicine for bronchitis is the one that works for you.

Marc Tanenbaum, MD

The short answer is yes, but mono in a baby appears quite different than mono in a teenager or a parent. Usually, mono in a baby looks like a cold. Sometimes there is a rash, but usually not. Like other causes of a cold in a baby, a mono cold eventually goes away with only a small chance of a complication from the cold, e.g., ear infection, sinus infection, or sore throat. You may remember that mono in an adolescent or adult is often called a kissing disease. The best way to protect a baby from a parent's mono is to not share saliva with the baby in all the obvious graphic ways you can imagine. Additionally, covering one's mouth when coughing using a tissue or the elbow-cough-covering technique is highly effective. And let's not forget frequent hand washing.
I hope that that this information helps.

Marc Tanenbaum, MD

Hello,

Chest pain in an 8-year-old can have many causes. More info about the character and timing of the pain can allow the doctor to categorize the possibilities. Most are minor causes, but some can be serious. As you might imagine, chest pain of a few days in an active happy playful 8-years-old who is sleeping well is likely to be of no medical consequence and should be expected to go away within a few days. Chest pain, even mild pain, that has been around for weeks or interferes with normal activity and play, or wakes a child up at night needs a doctor's evaluation. A common cause for lingering or recurrent pain is some form of asthma even without wheezing, especially if it is connected to physical exertion. Often, chest pain is actually upper abdominal pain such as heartburn or acid indigestion. Again the pattern and timing of the pain is a big clue. If associated with "wet burps" (stomach acid entering the throat, then being swallowed) can be associated with breast bone pain. Another factor is the family history of chest pain, intestinal ailments, and early unexpected death. Chest pain from a heart origin is very uncommon, but must be considered, especially if the family history of early or sudden death is discovered. A swallowed foreign body even if at age 8 years can lodge in the esophagus (swallowing tube) and lead to chest pain. Chronic chest pain associated with meals might also be eosinophilic esophagitis/gastritis from allergies to certain foods. Again, the family history can be helpful in recognizing these issues. I recommend this weblink from the Academy of Pediatrics for a nice review of chest pain:
https://www.healthychildren.org/English/tips-tools/symptom-checker/Pages/symptomviewer.aspx?symptom=Chest%20Pain

Dr. T/Marc Tanenbaum, MD

Hello,

If your baby is under 3months of age, I would recommend you discuss your baby's fever with your baby's doctor since sometimes fever is a warning sign of serious illness from birth to 2-3 months. Over 3 months of age in babies who are immunized and have had no serious past illnesses, hospitalizations, or ER or Urgent Care visits, Tylenol or ibuprofen is not needed for fever unless the infant feels badly with fever. Babies are allowed to be a little tired when they have fever, but they should always be consolable, be aware and able to engage with care takers and not appear to be uncomfortable or in pain. Babies over 6 months of age who feel badly with fever can benefit from Tylenol or ibuprofen in the appropriate dose. In babies under
6 months of age, ibuprofen is preferred. In an unimmunized baby of any age, fever can indicated an early bacterial infection and your doctor should be consulted as to what to do. There are circumstances surrounding fever in a baby who looks well that in today's world if present should be brought to your doctor's attention: recent travel in the past 2-3 weeks preceding the fever, pets in the home (turtles, guinea pigs, snakes), COVID-19 exposures, exposure to others recently significantly ill, etc. Asking if Tylenol should be given to your baby with no other contextual information is like asking if salt or hot peppers should be added to your meal with no other information about the meal or the salt preferences of those who are expected to dine on whatever the meal might be. In general, healthy babies over 6 months old with no unusual circumstances or past significant health problems can use Tylenol if they feel badly with fever. If they do not feel better regardless of the subsequent temperature after dosing, the babies doctor should be called and involved in the decision.

Regards,

Dr. Marc Tanenbaum, MD

Hello,

The only recommended "medicine" for a child's runny nose is nasal saline spray or saline gel. You may have noticed that runny nose, cough medications have been removed from pharmacy shelves by the FDA as there is no evidence of benefit and because occasional serious side effects have resulted from accidental overdose. We've known for decades that such medications have been generally placebo, but they were "grandfathered" by the FDA originally and permitted on the market. It is very unlikely that pharma will undertake the necessary research to prove these medicines are safe and effective for children's runny noses and cough control. Azelastine (Astelin) nasal spray is sometimes used for control of runny nose from a cold, but this medication is prescription and you must seek advice from your child's doctor for this use. The runny nose from an uncomplicated cold should not last longer that 3 weeks, 4
weeks maximum. Should it last this long, other causes should be suspected, e.g., sinus infection, allergy, foreign body in the nose, physical airborne irritants, exposure to passive cigarette smoke, swimming pool chronic nasal irritation, etc.

Best regards,

Marc Tanenbaum, MD

Hello,

With respect to helping a 9-year-old sleep through the night, an appropriate conversation to explore daytime activities, screen time, school, friendships, academics and family relationships would be necessary to understand better antecedents to this behavior to offer proper advice. While obtaining this information, I would provide basic information from
the Parent Web Site of the American Academy of Pediatrics, e.g.:

https://www.healthychildren.org/English/ages-stages/preschool/Pages/Nightmares-and-Night-Terrors.aspx
https://www.healthychildren.org/English/healthy-living/sleep/Pages/Sleep-and-Mental-Health.aspx,
and
https://www.healthychildren.org/English/healthy-living/sleep/Pages/default.aspx

This would not be a 10 minute office visit, but more a 30-60 minute visit.

Dr. Marc Tanenbaum, MD

The only sure way to protect your son is to see an allergist and once your son’s bee sting allergy is confirmed by history and perhaps supportive lab test, or skin testing, the only certain intervention is desensitization with allergy shots to bee sting. I don’t think you can count on insect repellents to protect your child. Antihistamines by mouth after a sting are not certain to prevent shock. Desensitization is the only way that I am aware of to protect against shock and fatalities from bee sting. The other protective measure even with desensitization is to have ready access to epinephrine (Adrenalin) for administration after a bee sting at the earliest suggestion of a reaction. The EpiPen is available for under and over 30 lbs children. There is a portable form of Adrenalin again available called the Audi-Q auto injector which is about the size of a cigarette lighter and can be easily carried in a pant pocket or purse. Good luck with your search to protect your son.

Dr. T