Dr. Harley Rotbart’s GERMBlog™

In Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C.), I devote an entire chapter (Chapter 12) to helping parents interpret the news and react to the health scares du jour.

As you may recall from my GERMBlog entry of 10/25/07 (and from Chapter 9 of Germ Proof Your Kids) the “hygiene hypothesis” holds that kids’ excessive cleanliness in modern times may account for the upsurge in diagnoses of asthma and other immune-mediated diseases. The hypothesis theorizes that if kids don’t get enough dirt and germ stimulation of their immune systems, those systems may develop abnormally and result in asthma, allergies, etc. As I noted in the earlier blog and in the book, there is a gaping hole between the theory and proof. Just because two “truths” exist (it is true that there is more asthma in today’s kids, and it is true that kids today are cleaner than in previous generations), doesn’t mean the two are related or that one causes the other. The two “truths” may, in fact, be coincidental to each other (termed an “epiphenomenon” – see Chapter 12 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections ).

Well, here’s another theory to explain the increase in asthma – also, I might add, unproven. In a report that got a bit of press coverage last week, kids in the U.S. have been found to have a higher rate of worm infestations than ever suspected. Worms like toxocariasis (roundworms that pass to kids from pets and the soil that pets hang out on) may infest as many as 23% of poor urban kids. That is important news, and a public health issue, indeed. But the author goes on to say that perhaps that high infestation rate explains the upsurge in asthma diagnoses also seen among poor urban kids!

So, now you have it both ways. Too clean may cause asthma and too much exposure to dirt may cause asthma. Both make headlines, neither has been proven true so far. Read Chapter 12 of Germ Proof Your Kids . It’ll help you see through the flimsy science in the news, and it will help you sleep better at night.

And wash your kids’ hands when they come inside from playing in the dirt.

Some weeks it’s hard to keep up with all the GERM news. That’s why I write Dr. Rotbart’s GERMBlog! Here’s a summary of what we learned about germs this week alone:

Sinus infections

A study of adults with symptoms of sinus infection found results nearly identical to those we’ve known about with kids – antibiotics don’t change the course of the disease. The adult patients who received antibiotics recovered from their symptoms in the same two-week time frame as patients who took placebo (“sugar pill”). Antibiotics are over-prescribed for many minor infections, including those that are usually due to viruses. In the case of sinus infections, most cases will get better with symptomatic treatment only – mist, pain relievers (ibuprofen or acetaminophen), plenty of fluids and “the tincture of time”. Studies in kids have previously shown the same thing – antibiotics don’t make kids better sooner than placebo. For much more about sinus infections and the appropriate (and inappropriate) reasons for antibiotics, see Chapters 3 and 5 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).

Grandma’s Honey Cure

Over-the-counter cough medicines don’t work in kids (see Chapter 8 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008)), and pose a risk for side effects and for accidental overdose (because kids like the taste of some of these products and will drink from an open bottle left in reach). Grandmothers have long known that honey (in tea, in milk, or straight up) makes kids with coughs and colds feel better. A study this week proves that, again, Grandma is right. Honey performed better than cough medicine or no treatment at all in easing the cough and helping kids sleep through the cough. (A warning though – honey should not be given to kids under 15 months of age because of the risk of botulism!)

I love these stories – that’s why Chapters 9-12 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008) are devoted to evaluating the scientific basis for Mom’s and Grandma’s wisdom. In fact the Introduction to the book is titled: “The Germ Theory vs. My Mom’s Theory”.

Why Flu Loves Winter

The seasonality of infectious diseases has always plagued (pun intended) doctors, scientists, and parents. Why is there a “cold and flu” season? Why do “summer viruses” cause “summer colds”? Where do the germs “go” when they are “off-season”. For the answers to some of these questions, see Chapters 2 and 3 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008). This week, another answer may have been discovered. It turns out that in guinea pig studies, flu virus is more easily transmitted from one animal to another in low air temperatures and low humidity. The virus itself that causes flu (influenza virus) is more stable in colder temperatures, and is transported in the air more efficiently when the air is cold and dry. The virus gets into the air by being sneezed or coughed there by someone who has the infection; the virus then travels for short distances in the small droplets of mucous that emerge from the cough or sneeze.

So, now you know – it’s not a coincidence that flu season is flu season. There’s much more about flu in Chapters 2, 3, and 6 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008)), including the important differences between flu and Bird Flu.

It’s no secret that kids share everything, including germs. But there is a secret to keeping kids healthy over the holidays and year round!

Hand washing is the single most effective strategy in reducing the spread of infections. From the bathroom to the classroom, from the kitchen to the playground, hand washing protects kids of all ages – and even saves lives. Here’s how to keep the sniffles, sneezes, coughs, and stomach flu away from your home this holiday season (from Chapter 9 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008)):

1. Teach your kids how to wash (and dry):

Kids typically spend less than 5 seconds washing and leave the sink with their hands dripping wet. A 20-30 second wash and thorough drying will reduce the germ load by as much as a 1000-fold. Teach your kids to wash until they finish singing “Twinkle-twinkle little star” or the “ABCs”; this makes your job easy because both songs have the same tune and last exactly 20 seconds each! Use lots of water and lots of rubbing with soap to create a good lather – include the wrists, between the fingers, and around the nails – followed by lots of water again.

How kids dry their hands is also important; the drier the hands, the fewer the leftover germs. Use clean towels (paper or cloth) and thorough rubbing; electric dryers aren’t as effective in germ reduction.

2. Understand the differences in soaps and sanitizers:

Simple soap doesn’t kill germs; it cleans hands mechanically, lifting and washing away dirt and organic material that contain germs. But, simple soap works. Studies in day care and schools show that the rates of diarrhea, vomiting illnesses, respiratory infections, and absent days are reduced dramatically by simple soap and water washes.

Products that kill germs include alcohol-containing “hand sanitizers”, and antibiotic-containing “antibacterial” soaps. Alcohol kills many germs on contact, and has been incorporated into “rubs”, rinses, foams, and gels that don’t require water, making them ideal for your purse and the glove box in the car. These are safe products, but will sting if used on cuts or scrapes.

As many as 3/4 of all liquid hand soaps are labeled “antibacterial” because they contain an antibiotic. Antibacterial soaps lower germ counts on kids’ hands better than simple soaps – but the benefits in reducing actual infections are unproven. Fortunately, it does not appear that these soaps result in resistant germs. The absence of an advantage of antibacterial soaps, and the theoretical risks of increasing resistance, prompted an FDA Advisory Panel to recommend against these products for home use, in favor of simple soap.

Liquid soap in a dispenser is less likely than bar soap to itself become contaminated with the very germs we’re trying to protect kids from.

3. Teach kids when to wash:

Germs get on your kids’ hands from contacts with other people, animals, and inanimate objects. The kids then touch their eyes, nose, or mouth and the germ invades and causes infection. Good luck teaching kids not put their hands in their own or each other’s eyes, noses, or mouths, so strategically timed hand washing is the next best option. Here are the 10 most important times to wash:

1. After playing with a sick friend or sibling (or after handling things that a sick child might have handled – like in the doctor’s waiting room
2. After using the bathroom (use the hand towel to turn off the sink and open the bathroom door).
3. Before eating
4. After high-fiving the opposing team at the end of a sports competition (or any other mass-handshaking event like the receiving line at a wedding or graduation).
5. After recess
6. After school or day care
7. After playing with animals or in areas where animals hang out
8. After playing outside
9. After blowing your nose, or coughing into your hands. Although your kids cannot “give themselves an infection” by contact with their own secretions, this is a very considerate gesture that protects other kids from the germs on your kids’ hands.
10. Before bedtime

Many studies have proven that effective strategies for hand washing, like those mentioned above, will keep your kids healthier over the holidays – fewer respiratory infections and fewer gastrointestinal infections. And when the holidays are over, continue using the “secret” and your kids will miss less school and day care, and you’ll miss less work

For much more about ways that personal hygiene, household hygiene, and community hygiene can protect your family from infections this winter and year round, see Chapter 9 in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).