Always Sick

by Kenny
(Los Angeles, CA, USA)

My 5 years old daughter is sick every 2 to 3 weeks for as long as I can remember.

She has seen her doctor often and he always says that it is normal in some kids.

I cannot help to think that there is something else going on here that is not being tested for or perhaps not thought of.

Her symptoms are mostly flu like - fever, congestion, weakness and fatigue. Couple this with seasonal and cat allergies and she has just been miserable.

She is otherwise normal in all aspects like learning, development, body type - perhaps a little tall for her age but nothing unusual.

I feel I need to get more answers. I'm concerned that there maybe something else that need to be looked at.

Please do let me know what you think. Thank you.

The Expert, Ren Chats, Answers -

The evaluation of a patient with frequent infections requires a careful history and physical examination.

Percentile shift in weight or height on age and sex specific growth charts unveils the chronic diseases of childhood.

Repeated respiratory track infections often point towards underlying Immune Deficiency. History of delayed separation of the umbilical cord and poor wound healing further emphasis the likelihood of primary immune deficiency.

Children suffering from deficient power to combat infections are usually well until 7–9 months of age, because of the antibodies they get from the mother during the third trimester of their intra uterine life.

Even with a well-functioning immune system, upper respiratory tract infections are very common (4-6 episodes/year) in children under 5 years of age.
Children attending child-care centers and those with school-aged siblings at home can have even more frequent episodes of infection owing to increased exposure to infectious agents.

Children with an intact immune system and no other predisposing factors typically handle these infections well, with rapid resolution of bacterial infections using appropriate antibiotics.

Factors that contribute to the risk of infections during childhood.

1. Primary immunodeficiencies are generally the result of genetic defects. Therefore extensive family history is also extremely important.

2. Cigarette smoking during pregnancy can jeopardize the developing respiratory system of the unborn baby leading to wheezing problems during infancy.

3. Passive tobacco smoke inhalation in the home is associated with an increased number of infections, and is a contributing factor to allergy and asthma symptoms.

4. Allergies cause chronic inflammation of the airways that can mimic recurrent or chronic upper respiratory infections. Allergic reactions can also facilitate the adherence of pathogens to the respiratory epithelium and thus promote infections.

5. Asthma-related cough

6. Cystic fibrosis, especially when respiratory tract infection is accompanied by symptoms of malabsorption or nasal polyps.

Application of basic screening tests will permit the clinician to determine the need for further more detailed laboratory testing and referral to a clinical immunologist.

For the children with repeated respiratory tract infection, their blood can be tested for the presence of antibodies to common respiratory viral agents such as influenza A and B, Mycoplasma, respiratory syncytial virus, adenovirus, and the parainfluenza viruses.

Plain X-ray of the chest would reveal the infiltrations in the lungs caused by such infections.