Antibiotics Should Not Be Used for Every Infection in Children

With the arrival of winter, it is possible to reduce infectious diseases that increase and spread among children, especially in schools, through protective measures taken by both schools and parents. Among these, rhinovirus, parainfluenza, and especially the RSV virus seen in children attending daycare are at the forefront. Anadolu Medical Center Pediatric Health and Diseases Specialist Dr. Ayşe Sokullu stated, “The ideal precaution for children who have contracted any infectious disease is to rest at home and not attend school, to prevent the infection from spreading to other children.” Anadolu Medical Center Pediatric Health and Diseases Specialist Dr. N. Kemal Akpınar added, “Parents' overly protective attitudes prevent the child from encountering natural microorganisms. This can lead to a lower response to those microorganisms and may cause the child to experience more severe infections.”

Dr. Ayşe Sokullu and Dr. N. Kemal Akpınar from Anadolu Medical Center emphasized that it is much easier to take precautions against infections while our children are with us, but the situation becomes more challenging for parents when it comes to schools where intervention is not possible. They said, “Parainfluenza virus affects the areas near the vocal cords and can cause a cough resembling a dog’s bark. Rhinovirus primarily affects the nasal area and is especially characterized by headaches. Measles, rubella, infectious mononucleosis (commonly referred to as ‘kissing disease’), parvovirus, and chickenpox can cause rashes in various parts of the body, and certain illnesses related to chickenpox, such as pneumonia associated with measles, can also occur. In viral infections affecting the gastrointestinal system, watery stools are observed. This manifests as fever and vomiting, whereas if a bacterial infection is present, it is accompanied by high fever, blood, and a mucoid appearance in the stools.”

It is Possible to Monitor Children by Asking Questions About Hygiene

Emphasizing that children's eating habits, behaviors and attitudes that should be taken when they are ill, and precautions to be taken before getting sick are easier to manage at home than at school, Pediatric Health and Diseases Specialists Dr. Ayşe Sokullu and Dr. N. Kemal Akpınar stated, “However, parents should not lose control even if they cannot see their children at school. It is almost impossible to get children to talk about what they experienced at school when asked. Therefore, indirect questions can be asked to children coming home from school. For example, instead of asking, ‘Do you wash your hands?’ you might ask, ‘Does your soap at school smell nice?’ or instead of ‘Do they clean your classroom?’ you could ask, ‘What is the name of the aunt or uncle who cleans your classroom?’ Such questions will test both the child and the school regarding hygiene and allow for intervention against possible misconceptions.”

Children with Infectious Illnesses Should Rest at Home

Dr. Ayşe Sokullu and Dr. N. Kemal Akpınar emphasized that the risk of infection is higher in crowded schools where children's access to toilets and water is difficult, stating, “Because infections are most often spread by hand. Particularly, influenza viruses can survive on certain objects that children touch at school, such as plastic or wood, for nearly 24 hours. The viruses that spread most via droplet infections live in the saliva particles suspended in the air due to coughing and sneezing. Therefore, when in crowded places, it is also easier for children to breathe in this air. The ideal precaution for children who contract any infectious disease is to rest at home and not attend school to prevent spreading the infection to other children. Additionally, during the winter months when illnesses are on the rise, it is also crucial for children not to kiss or hug sick friends at school or use the materials used by sick friends. Generally, upper respiratory infections can be overcome without medication within a week with rest, hydration, and nutritional support. However, if the child has difficulty reducing fever and providing nutritional support, is experiencing vomiting, or has a family history of seizures, managing treatment at home may become challenging. In such cases, it is more appropriate for treatment to be carried out at a well-equipped health center. Since it is difficult to administer oral medication for treatment, fever reducers can be given intravenously to help the child recover more quickly.”

First Children Get Sick More Often

Noting that the susceptibility of school-age children to microorganisms causing infections can vary based on certain parental attitudes, Dr. Ayşe Sokullu and Dr. N. Kemal Akpınar stated, “Overly protective attitudes, such as preventing children from playing in the park, on the street, or in the garden, also prevent them from encountering nature’s microorganisms. This can result in the child having a lower response to those microorganisms and experiencing more severe infections. The earlier children encounter microorganisms, the more easily they can overcome the infections they will encounter in school. Second children typically do not get sick much when they start school after being ill as infants. This is actually because their older sibling brings home illnesses from school, providing immunity against the diseases they will face in school age. However, first children often experience infections more frequently in school because they are entering a crowded environment for the first time.”

Not Every Infection Should Be Treated with Antibiotics

Explaining that exercise is extremely beneficial for strengthening the immune system against infections, Anadolu Medical Center Pediatric Health and Diseases Specialists Dr. Ayşe Sokullu and Dr. N. Kemal Akpınar continued, “However, because children are very active, they are already getting exercise. Additionally, sending a child for 1-2 hours of an activity such as basketball, swimming, or soccer once a week should be considered a hobby rather than a sport. This is because exercise is an activity that should be done regularly throughout the day. Regular exercise is very beneficial for children's development and for strengthening the immune system. In upper respiratory infections, for example, if a child has a high fever, feels weak and lacks appetite but has no nasal discharge or cough, antibiotics may sometimes be given early if a bacterial infection is found upon examination. However, if the child has a fever of 40 degrees, nasal discharge, cough, lack of appetite, lethargy, a reddening of the throat, and swelling of the tonsils, it is expected that the child will overcome the illness with their own resistance. Because these symptoms are associated with a viral infection, treatment should not involve antibiotics or injections. If the child's immune system is weak, bacterial agents may settle in a space where viruses are present. Consequently, conditions such as sinusitis, otitis media, pneumonia, and bronchitis may be observed. This is due to the potential of opportunistic microorganisms to easily cause infections. In this situation, we can say that antibiotic treatment is necessary. In children infected with viral illnesses, the immune system is in a state of battle. Some children can overcome this battle in 1-2 days, while others may take up to 10 days. However, there is no scientific evidence to indicate that children who recover quickly have a stronger immune system than those who take longer. Every child—especially those under 5 or 6 years of age—has a chance of experiencing fever or infection at least once. However, in a child who frequently suffers from tonsillitis, is bedridden as a result, or even has bronchitis and pneumonia, recurring diarrhea, osteomyelitis (bone inflammation, joint inflammation) that is not commonly seen in a normally healthy individual, and recurrent meningitis, bronchitis, and pneumonia raise the question, ‘Is there weakness in the immune system?’ In such cases, and especially in children who are developmentally lagging behind their peers, further evaluations may be necessary.”

One Glass of Milk Protects Children Daily

Dr. Ayşe Sokullu and Dr. N. Kemal Akpınar emphasize that a daily glass of milk is essential for bone development, overall health, and growth in height, especially in elementary school-aged children. “If the child does not have a specific reaction to milk, they should be supported with one glass of milk a day. A second glass of milk can be given if the child wants it; however, more than that should be avoided as it may lead to loss of appetite as well as constipation or anemia,” they said.

Nutritional Recommendations for Infection Prevention

To strengthen the immune system in school-aged children:

• Breakfast should always start the day, including some carbohydrates, proteins, and fats. Suitable options include fruit yogurt, a cereal mix, or homemade cake that is not overly sugary. It is also important to sweeten breakfast to meet daily calorie needs; molasses and honey can be part of the menu.
• In winter, especially, fruits rich in fiber like pears, vitamin C-rich citrus fruits, and at least one type of green leafy vegetable (such as spinach, chard, broccoli, or parsley dishes) should be included in their diet.
• At least one dairy product, such as cheese, milk, or yogurt, should be preferred. Additionally, yogurt should not be consumed alongside iron-rich foods; otherwise, the iron content of the food will decrease.
• Although cornflakes contain sugar, they can be consumed in moderation.
• Beneficial herbs like mint can be added to meals.
• Ready-made packaged foods and candies should be avoided (children should not be allowed to watch junk food commercials).
• Children who do not spend much time in the sun should receive vitamin D support.
• Foods rich in Omega 3, such as fish, should be eaten twice a week, but there is no obligation to take Omega 3 tablets throughout the winter. During special times, stressful situations like exams, or periods of nutritional disorders, fish oil and Omega 3 supplementation can be provided.
• Dried fruits and nuts should be included in their diet.