When you’ve got young kids, it can seem like a constant cycle of back-to-back bugs. But why do kids get sick so much, and can you do anything to help?
We talked to Dr Jenna Macciochi, an immunologist and university lecturer with 20 years’ experience of immune system research, who also has two young boys.
Catching colds and tummy bugs is a normal part of childhood
It’s understandable to worry when your kids get poorly. “That’s a normal anxious response of all parents,” says Macciochi – but she reassures that it’s normal for kids to get sick. “It’s perfectly normal to get a few bugs a year, even as an adult – around four to six mild, self-limiting infections is very normal. For children it’s a bit more. It’s normal for your child to get maybe eight to 10 infections a year. Nothing serious, we’re talking colds, flu or a sore throat, maybe a tummy bug,” she says.
Children’s “immune systems are still developing”, she explains. “We’re born with an immature immune system – it needs to kind of learn and develop as we age. For kids, particularly pre-school age kids, this process is really still actively happening.”
Another thing is simply greater exposure to infectious bugs, as kids tend to spend a lot of time in close quarters together. This doesn’t mean we need to panic or keep them cooped up at home, but it’s helpful to accept that this is just part and parcel of parenting.
Good handwashing is key
That said, there are things that can help. “No matter how many times I tell my kids about hygiene, they’re never the best hand-washers!” says Macciochi – and this is another big reason why kids get sick so much.
Good hand-hygiene is one of the most important things we can do to reduce the spread of infections, so it’s really worth encouraging kids to be thorough, consistent hand-washers, every time they use the bathroom and before preparing or eating food.
Should your child use antibacterial hand gel? “From my side, what we know is that good old handwashing with soap and water, where you get a good lather – and it’s actually the friction and motion of rubbing your hands together that gets rid of the germs – is more than sufficient,” says Macciochi.
Try to ‘feed’ their immune system
While we often talk about ‘boosting’ immune systems, we’re better off understanding how we can help set kids up for long-term healthy immune function.
As Macciochi mentioned, children’s immune systems are still developing – and there is a “window of opportunity” that occurs mainly in the first three years of life (“it trails off after age five”) where our diets can make a big difference.
During this “window” our gut microbiome (the eco-system of trillions of microorganisms, including bacteria, that lives in our guts) is also still developing, and as Macciochi explains, this “is really a big educator of our immune system”.
Not always easy with kids – who Macciochi acknowledges can be “intrinsically fussy and stubborn eaters” – but a healthy, balanced diet can “feed” the microbiome and help make it as diverse and healthy as possible.
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🦠 ARE WE TOO CLEAN? . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ 🦠 We are starting to get a clearer scientific answer to this question which has been floating around the arena of chronic inflammatory diseases (e.g. allergy & autoimmunity) since the late 1980’s when Professor of Epidemiology David Strachan devised the ‘Hygiene Hypothesis’. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ 🦠 The “Hygiene Hypothesis” proposed to explain the observation that allergic diseases were less common in children from larger families from rural areas with more contact to animals. It became a theoretical framework to investigate how improved hygiene, changes in lifestyle, agriculture and urbanisation make us ‘too clean’. Meaning that our immune system comes into contact with certain microbes LESS often or LATER in life than before. Because microbes ‘educate’ our immunity from the moment we are born (particularly age 0-5), this lack of germ exposure was considered to increase risk of chronic inflammatory diseases. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ 🦠 Epidemiological studies continue to confirm the protective effect of large family size & growing up on a farm to development of allergies. But the hygiene hypothesis has been largely been overthrown by the new updated “Old Friends” Hypothesis (2003) based on data collected over the last 60 years. We now know that the vital microbial exposures needed to educate the immune system are not colds, measles and other childhood infections, but rather microbes already present in our environment from birth. Particularly microbes living in our environment (rural vs. urban) and on the food we eat (fruit and veg are a natural source of probiotic bacteria themselves). These bugs don’t cause infections but pass through us giving a beneficial effect & many of which we will acquire as friends that live on us and in us as our microbiome. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ 🦠 For centuries we have considered all germs as bad, but considering we live in a microbial world, most of the microbes around us are actually old friends. How can we cultivate good relations with these ‘old friends’ to reduce our risk? Like many things in immunology, the answer is “it’s complicated. [cont. in comments]
“[For kids] I don’t think you need to think about probiotics and fermented foods so much, but trying to give them a varied diet with as much fibre as possible,” she says. “Often people think about fibre as being like All-Bran or just cereals, but actually fibre is mostly fruit and vegetables, beans, pulses and legumes. Think about diversity of plants as much as possible, as that’s so important for the gut and will help them support immune development in a healthy way.”
Get them out in nature
We can support immune development further, says Macciochi, by encouraging kids to roam in nature too. “The environment we live in does play a part in our microbiome,” says Macciochi. “So I would recommend trying to get your kids out into green spaces. Let them play, get dirty, breathe in the fresh air – and then wash their hands before eating of course. Get them into parks and green space as much as possible.”
Avoid antibiotics unless they’re really needed
Macciochi suggests “avoiding antibiotics unless they are strongly suggested by the doctor. But I think most GPs nowadays are more on this, and know antibiotics should only be reserved for the bacterial infections that really need them.”
Antibiotic overuse is a serious global health concern, as bugs can become resistant to them. They can be bad news for the gut microbiome too, damaging ‘good’ bacteria as well as targeting the nasties. Your pharmacist or GP will be able to advise on medicines for kids and soothing symptoms.
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Antibiotics kill bacteria, not viruses. You may have seen public health messaging to this effect, that we shouldn’t expect prescriptions for antibiotics when we have colds & flu. Using antibiotics in this way can cause antibiotic resistance & won’t do the slightest thing to help your viral infection. But there may be another reason for not taking antibiotics unless strictly necessary. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ Taking antibiotics could actually make you more susceptible to catching the viruses that cause colds & flu in the first place, and you may suffer them worse. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ WHY? Antibiotics indiscriminately kill bacteria, both bad and good. This means they can put a dent in your own microbial community. Once you do this, unexpected things can happen to your immunity. The presence of healthy bacteria can actually improve the body's ability to attack & destroy those cold/flu causing viruses. The immune system is activated differently if the gut does not have a healthy microbiome. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ Studies show that different antibiotic treatments administered separately or in combinations may lead to different changes in the bacterial community, and these changes correlated with vulnerability to the viral infection. It seems that antibiotic use could increase susceptibility to any virus that is controlled by T-cell immunity, and that's many of them. While more research is needed to confirm the findings, its important to remember the collateral impact of our history of antibiotic use to the future of our immunity more broadly. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ The big question is to what degree the microbiome outweighs other factors in disease progression, such as age, genetics, prior viral exposures and other diseases a person might have. In other words, does a person's microbiome play a larger role than these other factors in how bad a viral infection will be. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ If someone is sick with a bacterial infection and prescribed antibiotics, they absolutely should take them. Some doctors prescribe antibiotics for viral infections such as colds and the flu as an extra precaution to prevent a subsequent bacterial infection #antibiotics #colds #health #wellbeing #immunity
Check in with your GP if you’re concerned
Some kids will naturally fare worse than others with the coughs and sniffles too (our immune systems are unique and respond differently), but it’s always a good idea to get things checked out with the doctor if you’re concerned.
“If you did have a child that was tending to really get sick a lot, it might be a red flag for a problem that hasn’t been discovered yet,” says Macciochi. “[This could be] vitamin deficiency, or an immune deficiency – sometimes people are born with one part of the immune system not working properly due to a genetic abnormality but it often doesn’t get picked up for a while.”