As parents, we all look forward to spring. In some parts of the country, it may seem to stretch out forever, with remnants of winter and cold rain intruding regularly. Nonetheless, the return of spring flowers, blooming shrubs and trees, and green leaves and grass is always welcome. It’s a favorite time for taking photos of children outside among the flowers. Near our home in Greenville, North Carolina, there is a wonderful wooded area that is filled with daffodils. On warmer days, the adjacent roadside is always filled with cars and the woods with little ones and their photo-happy parents.
Parents are often dismayed to find that, after these outings, their children begin sneezing, coughing, rubbing their eyes and otherwise appearing uncomfortable. It’s no secret that spring allergens (the things that we are allergic to) are the culprit, usually in the form of tree and weed pollens, and later grass pollens. They are often made worse by eye-rubbing, which inoculates large amounts of the pollen into the eyes and interferes with the normal cleansing effect of tears. Since tears drain from our eyes into our noses, we add to the already problematic nasal congestion.
The treatment is simple. There are numerous antihistamines that are effective, the preferred ones being those that are non-sedating and long-acting. For all children over the age of 2 years, most of these are FDA-approved and available without prescription. Among them are cetirizine (brand name Zyrtec), loratadine (brand name Claritin) and fexofenadine (brand name Allegra.) All are available as low-cost generics at your local pharmacy.
While following the dosage label is quite acceptable, parents should check with their pediatric professional about correct dosage and use, especially when symptoms are frequent or prolonged. Some children and teens may have more severe eye itching and require daily treatment with a prescription eye drop.
I try to work with parents to help children reduce eye-rubbing by offering them an alternative—gently rubbing the eye with a damp washcloth. Older children can learn to do this for themselves. Children with more severe nasal symptoms may require a daily or twice daily prescription inhaled nasal steroid. These are safe and minimally absorbed into the bloodstream. They should only be used in children under the supervision of a medical professional.
For some allergic children, cough is a prominent symptom. This is usually due to asthma, though there are other causes. Any child with a persistent cough, no matter what the season, should see a doctor for evaluation. Children with asthma usually do not audibly wheeze. They cough and cough and cough. The cough is often worse at night or shortly after an exposure to the offending allergen(s). And they are often noticeably short of breath and cough much more with exercise. Seeing a medical professional when these symptoms are present is imperative. Occasionally, children who have never had recognizable asthma symptoms may develop severe cough and shortness of breath. This is a medical emergency and warrants immediate attention.
Asthma treatment and long-term management may be relatively simple or quite complicated. The mainstay for the child with intermittent or severe asthma is the “rescue inhaler,” an inhaled bronchodilator usually administered using a medically prescribed spacer to enhance delivery of the medication into the airways.
Children with persistent asthma are managed also with a “daily controller.” This is usually an inhaled steroid, but has no effect on acute symptoms. It is meant to reduce airway inflammation, which is present in all people with asthma, and thus prevent flare-ups of the disease. Every child with asthma should have an asthma care plan which outlines how parents can monitor symptoms and take appropriate action depending on their severity. These should be reviewed at least annually or when management recommendations change. Likewise, school-aged children should have separate rescue inhalers for use at school, and the school should have a copy of each child’s care plan.
Finally, persistent asthma can be closely linked to nasal allergy symptoms. Sometimes, control of asthma can be significantly enhanced by careful management of nasal allergies. In any case, the use of these medications can improve a child’s quality of life, something we all want for our children. Happy spring!