CHILDRENS PROBLEMS: THE CHEST

ASTHMA

Asthma is the broad term given to shortness of breath caused by narrowing of the bronchial tree (the main airways in the lungs) due to contractions of the muscles in the tubes and by excess excretion of the normal mucus production. This mucus is often thicker than normal and causes plugs in the already narrowed airways. Asthma can be acute or chronic and range from mild to severe. Minor upper respiratory tract infections can cause temporary asthma and simply may last for the few days of infection. Asthma attacks may be triggered by other lung irritants, such as airborne pollution, fog and humidity as well as certain intolerances to food, which can be very specific. Common triggers include caffeine, chocolate, cow’s milk products, wheat, oranges, nuts and eggs.

There has been a sixfold increase in childhood asthma in the last 20 years. Many hypotheses are put forward and I suspect that a genetic predisposition must be triggered by several factors, including air pollution, food (pollutants such as preservatives, additives and pesticides), an increase in our refined sugar intake, our increased use of vaccinations and antibiotics and climatic changes such as the loss of the ozone layer. Asthma must never be underestimated. It is a lethal condition and can come on very swiftly, causing fatal airway obstruction, especially in children. Doctors are very swift to diagnose asthma and encourage the use of bronchodilators (drugs that relax the muscle spasm and reduce mucus production), such as salbutamol.

Recognizing asthma

The power of pulling air into the lungs through the diaphragm and intercostal (rib cage) muscles is much greater than the power available to exhale. Asthma is actually most often caused by an inability to remove the carbon dioxide from the lungs rather than a difficulty in getting air in.

In mild to moderate asthma, therefore, you will see individuals pursing their lips in an attempt to blow out the trapped air. This and a respiratory rate of more than 15 inhalations per minute are the immediate tell-tale signs. A rattling in the chest, most easily heard through a doctor’s stethoscope, is usually present as the air is forced past the mucus plugs. However, asthma does not demand rattling. Wheezing is much more common, again caused by air being forced past the mucus obstruction.

Moderate to severe asthma will have all these signs plus a noticeable amount of panic on the part of the sufferer. Any suggestion of dizziness, blacking out or blueness around the mouth needs to be treated as a medical emergency.

Self-help for asthma is limited but works on the following principles:

Removing triggers

Learning breathing techniques

Dealing with acute attacks

Removing triggers

It is important to keep a journal or list of attacks. This should include times and recent events, foods and drink taken in the previous 24 hours and stress factors. If asthma attacks are occurring in conjunction with any particular input or event, these can be eliminated. Triggers such as coughs and colds require a naturopathic opinion on why the immune system is behaving incorrectly.

Learning breathing techniques

These are not applicable until the child is old enough to understand and learn different patterns. Dealing with acute attacks

At any sign of asthma bring the patient to the attention of your GP. In mild to moderate cases, resist the immediate use of bronchodilators until you have consulted with a naturopath.

At any suggestion of a moderate to severe asthmatic condition, take the drugs and obtain a complementary medical view afterwards.

Take the homeopathic remedy Aconite, potency 6, 12 or 30, two to four pills every lOmin, if the attack comes on suddenly; take Arsenicum album 6, four pills every 15min if the child is better with warm drinks, for attacks between midnight and 3am that are associated with restlessness; take Carbo vegetalis 6, four pills every 15min, if worse for talking and associated with a cough; take Natrum sulphuricum 6, four pills every lOmin, for attacks that come after 3am and when the child is holding the chest

Mix and keep aside the essential oils of lavender and chamomile. Place a few drops in steaming water and apply to the collar of the child or use as a steam inhalation. See Nasal congestion for the technique.

Ensure that any child with an asthmatic tendency is taking extra vitamin B6, vitamin C, magnesium and zinc. The amount is variable, depending on the child’s size, and is best prescribed by a naturopath.

If attacks are occurring in association with stress situations, then a child psychologist, preferably an art therapist, should be consulted.

COUGHS

Coughs and colds in infants are usually self-limiting and require little, if any, treatment. Remedies should be considered if a cold persists for longer than three days or the child is particularly unwell, in which case a physician should be consulted.

A cough, whilst distressing to listen to, is the body’s way of eliminating unwanted substances from the bronchial tree (the pipes leading to the lung tissue) and the alveoli (the lung tissue).

Cough with a sudden onset

The sudden onset of a cough may be caused by the inhalation of a foreign object. If the child is having difficulty in breathing, becoming red in the face or even blue, assume that an object has been inhaled.

RECOMMENDATIONS

Have somebody call an ambulance.

Gently but firmly open the child’s mouth by applying a pincer pressure to the jaw muscle and shine a light into the throat. If an object can be seen, try to extract it using your fingers. The use of an instrument such as tweezers should only be used if the child is asphyxiating (unable to breathe) or is blacking out.

Loose coughs

A cough that sounds catarrhal is usually associated with the production of excess mucus and is related to a cold. Unless the child is asthmatic, these coughs may last for weeks, especially through the winter season, but are associated with a healthy, happy and functional child and should not be taken too seriously.

RECOMMENDATIONS

Avoid cow’s products and refined sugars because these encourage mucus production.

Avoid dehydration by encouraging water intake because this keeps mucus from becoming too thick or tenacious.

A few drops of the oil of aniseed, cinnamon or hyssop can be used as an inhalation. See Nasal congestion for the technique.

Fresh ginger or thyme can be chopped and used as an inhalation as above.

One drop of lobelia per year of age in water or diluted juice, three times a day, can be most beneficial.

Refer to the remedies Antimonium tart, Sepia, Nux vomica or Pulsatilla, although others may be indicated.

Dry coughs

Dry coughs may indicate more serious problems, such as whooping cough, laryngitis, croup and tracheitis. A dry cough of sudden onset should alert one to the inhalation of a foreign object. Most dry coughs are viral and can be treated as follows.

RECOMMENDATIONS

Steam inhalations with linseed, liquorice or mullein oils, using the technique described for nasal congestion.

Vitamin C, lOOmg per foot of height three times a day.

Vitamin A, 300iu three times a day (for children aged six months or older). Give lOOiu three times a day until six months old.

A homeopathic remedy should be chosen from all the symptoms. Initially, however, the following remedies are masters at the quick cure: Aconite for a hard barking cough of sudden onset in a restless infant: Belladonna if the child is red, hot and has bursts of coughing that distress it particularly; Drosera if the child is being sick with the cough; and Sticta if the cough has a ring to it and is worse at night. Any of these should be given at potency 6 every 15min for lhr and, if improvement is forthcoming, every 2-3hr until the child is better.

CROUP

A dry cough that persists for longer than three days or disturbs the child’s sleep for more than two nights should be brought to the attention of a health practitioner. Croup is a spasm of the vocal cords and will improve if steam inhalations are encouraged. Boiling a kettle in the child’s nursery is an effective initial treatment. The dry cough of croup is alarming and inhibits the child’s breathing and must be brought to the attention of a physician immediately. A croupy cough is always associated with breathing difficulties and sounds like the call of a crow. It has a vibrant ringing quality, almost as if the child is calling whilst coughing.

Give Aconite 6, Hepar sulphuris calcarium 6 and Spongia 6 in rotation every 5min. If the child is not improving within half an hour, call the doctor or take the child to casualty.

If the child settles, contact your health practitioner as soon as possible, continuing to alternate the Hepar sulphuris calcarium and the Spongia every half-hour.

Avoid giving the child anything by mouth in case an anaesthetic has to be given to pass an intubation tube.

SUFFOCATION

Suffocation is the interference with the entrance of air into the lungs, which, if it persists, will result in asphyxiation.

Resuscitation of Infant or Child

Heaven forbid one ever should have to perform this technique, but all adults should know the procedure. The following steps are worth practising on a large doll or teddy bear: (a) Lie the child flat. (b) Gently tip the chin back until the throat is stretched straight. (c) Ensure that any obstruction at the back of the throat is removed.

If the child has not responded to this, then proceed to step (d): (d) Place your mouth over the infant’s mouth and nose. (e) Look at the child’s chest. (f) Breath until the child’s chest expands. Do not blow hard or for too long because this will overexpand and possibly damage the child’s lungs. (g) Count to three and repeat, stopping every five breaths to see if the child has started to breath spontaneously.

If the child has not responded after five inhalations, proceed to step (h): (h) Place two fingers to the side of and just above the Adam’s Apple. A pulse should be felt. If there is no pulse, place the forefinger and middle finger of one hand onto the child’s breast bone (sternum). (I) Apply pressure until firm resistance is felt and repeat five times. (j) Repeat steps (d) to (f) five times and then return to pushing the sternum five times. Alternate this until the child revives or the ambulance arrives.

Once the child has revived, give him/her one pill of Arnica 6 every 10 minutes. Nothing else should be given by mouth in case the child requires an anaesthetic.

RECOMMENDATIONS I • Pay special attention to the covering of a child, ensuring that it cannot entangle bedclothes around the head. • Be wary of pets, especially cats, that may rest on the warmth of the baby’s body. • See Asphyxia.

WHEEZING

Wheezing is a high-pitched sound created by inhaling or exhaling through a narrow tube. The narrowing may be caused by muscular contraction such as in asthma or by an inflamed mucous membrane as in asthma, bronchitis and pneumonia. If associated with crackles, the narrowing may be due to mucous production or fluid secondary to pulmonary oedema. WHOOPING COUGH

Whooping cough is characterized by spasmodic coughing bouts that can last up to lmin. As the child draws in breath there is the recognizable ‘whoop’, which is often associated with the expectoration of thick mucus and often vomiting. It is caused by a highly infectious bacteria known as Bordetella pertussis, which causes an inflammatory process within the air passages.

Whooping cough is a prolonged illness that develops over a two-week period and lasts up until six weeks. It is not a particularly dangerous condition unless contracted in the first year of life, when the coughing spasms not only interfere with feeding but are exhausting. A prolonged spasm may result in an inability to breathe, causing asphyxiation with brain damage or death. This is extremely rare and can, of course, happen with any infection.

Whooping cough is associated with the production of much mucus, which may plug airways rendering them ineffective or causing the lung tissue beyond to collapse.

A diagnosis is made by hearing the characteristic whoop, but this is not necessarily present. Culture can be made from a swab or sputum and antibodies may be measured.

There is no orthodox antibiotic that attacks this unusual organism so treatment is based on treating the symptoms, although the orthodox medical world would give antibiotics to prevent a secondary infection. One holistic concern is that by taking out some of the necessary healthy body bacteria we are reducing the competition and the ability to digest and absorb, thereby leaving the individual with a reduced immune system capacity.

Whooping cough is known to occur in epidemics and when it does it is generally quite aggressive because through our use of vaccinations we have been breeding more difficult strains to attack. The vaccination question is particularly relevant in the case of pertussis because, like all vaccinations, there is a positive and a negative aspect. The pertussis vaccine developed in the 1960s had a very high incidence of causing epileptic fits and, potentially, brain damage. Many Gps at that time quite rightly became reluctant to administer the vaccine, and this fear was passed on to generations of parents and doctors taught by this group.

The pharmaceutical industry has gone to great lengths to purify the vaccine and claims that it is quite safe now. The evidence suggests otherwise. There are many reports of continued problems and strong evidence to support the ineffectiveness of the vaccine. Some studies and plenty of anecdotal evidence, including comments from paediatricians, suggest that children vaccinated against whooping cough will actually fare worse than those who are not, should they contract the infection. It appears that the immunization is only partially effective but it convinces the body that it already has a defence mechanism and thereby delays the immune response. This continues to be a controversial subject but then so were the side effects of the measles vaccine until strong evidence of high risk was finally brought to light in July 1997.

Whooping cough needs to be treated aggressively and home treatment is not necessarily the best form. However, the help of a complementary medical practitioner is invaluable because if the condition persists it can lead to a weakened lung, which may give rise to problems throughout life.

See Coughs, Colds, Pneumonia and Fevers.

Treat appropriately.

Administer the homeopathic remedy Drosera 30 every 2hr if a whooping cough is suspected.

Use Drosera 200 as soon as symptoms alleviate, one dose each night for five nights. This potency may also be administered nightly for five nights if whooping cough is known to be in the area or your child’s school.

If Drosera does not seem to be controlling the situation, the next remedy to try is Pertussin 30 given every 3hr It would be best to consult a complementary medical specialist with homeopathic and herbal knowledge sooner rather than later.

Lobelia fluid extract, one drop per foot of height in a small amount of warm water, should be given three times a day and a teaspoonful placed in steaming water for inhalation.

Comfrey root, mouse ear and sundew (Drosera) are all established herbal treatments and should be discussed with a herbalist for the correct dosages. It is not wise to dose a whooping child without expert guidance.

If the child (or adult) is old enough and can appreciate the teaching of a breathing technique, a yoga, Qi Gong (Chi Kung) or meditation teacher should be able to give instructions.

Bed rest is essential, along with good nutrition and the supplements recommended for coughs or pneumonia should be reviewed .

The child should not return to school until well, even if there is a likelihood of falling behind. Firstly, the child may be contagious and, secondly, running around will make things worse and probably lead to more chest infections over the next formative years, leading to more missed school time.

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