I would like to ask you three questions to see if you can tell me: (1) What are the most common diseases seen in pediatric clinics? (2) What are the most common complaints of children seen in pediatric internal medicine? (3) What are the most common diseases seen in pediatric internal medicine inpatient units?
The parents’ answers are very correct, as most babies have similar medical experiences. Indeed, the most common diagnosis presented by doctors in pediatric outpatient clinics is a respiratory infection, accounting for 42%-75% of cases. When babies come to the clinic, the most common symptoms reported by parents to doctors are cough, fever, stuffy nose and runny nose. Pneumonia accounts for 35-65% (first place) in pediatric inpatient units.
In this course, I will analyze the characteristics of the physiological anatomy of the pediatric respiratory tract and focus on a problem that is of great concern to mothers nowadays but can go into a misunderstanding if they do not pay attention to it: how should children do a good job of scientific protection in hazy weather to avoid or reduce the damage caused by haze?
I. Physiological and anatomical characteristics of the pediatric respiratory tract
As we all know, pneumonia is a frequent and serious infectious disease worldwide, which is particularly harmful to children. According to the World Health Organization, about 700,000-1 million children under the age of 5 die each year from diseases caused by pneumococcus globally, which is more likely to cause child death than any of HIV, malaria, or measles, and accounts for about 20% of all deaths in children under the age of 5; pneumonia claims the life of a child about every 15 seconds globally; and 2 million children die from pneumonia each year, 98% from developing countries. Pneumonia is the “number one killer” of children’s health.
So why are children (especially those under 5 years of age) prone to respiratory infections and pneumonia? First of all, it is necessary to understand the physiological and anatomical characteristics of the pediatric respiratory tract (because children are not a simple miniature of adults).
1. Anatomical features: narrow lumen, tender mucosa, rich blood vessels
The nasal cavity of infants and young children is short, without nasal hair, the mucous membrane is tender, rich in blood vessels, the sinuses are poorly developed, the sinus opening is large, easy to be infected; the eustachian tube is wide, short, straight and horizontal, so nasopharyngitis is easy to invade the middle ear and cause otitis media; the larynx is narrow and funnel-shaped, laryngitis is easy to obstruct and cause asphyxia, spasm and inspiratory dyspnea and hoarseness. The poorly developed elastic tissue of the lungs, rich vascularity, vigorous interstitial development, and small number of alveoli make it relatively more blood but less gas, which is not only easy to infect, but also easy to cause interstitial pneumonia, pulmonary atelectasis and emphysema.
2, physiological characteristics: small lung capacity, small compensatory force
Infants and children are diaphragmatic breathing, so the respiratory muscles are easily fatigued. Compared with adults, the reserve capacity of all respiratory functions is lower. Lung volume, for example, refers to the maximum exhalation volume after a deep inspiration, which is affected by the strength of respiratory muscles, the degree of lung tissue and airway patency and the elasticity of the thorax, and is also related to size, gender, age and other factors. It is about 50-70ml/kg for children and 3 times greater for adults than for children according to body surface area. In short, the respiratory potential of infants and children is poor, once the lung tissue lesions or pleural damage, etc. can make the lung capacity significantly reduced.
3. Immune characteristics: poor cilia movement, poor cough reflex, low immunoglobulin, low macrophage function
The non-specific and specific immune functions of the pediatric respiratory tract are poor. Therefore, the respiratory tract has poor ability to resist foreign invasion, and once the disease develops, the condition changes quickly, progresses rapidly and is more critical.
II. What is PM2.5?
The main components of the haze that we are concerned about are sulfur dioxide, nitrogen oxides and respirable particulate matter these three, of which the first two are gaseous pollutants, respirable particulate matter is the culprit of aggravating haze weather pollution. They are combined with fog to make the sky instantly gray and hazy.
Atmospheric pollution mainly refers to the pollution caused by dust, powder and particulate matter in the atmosphere, which is what we usually call PM (particulate matter). For example, PM2.5 is the particulate matter in the atmosphere with a diameter less than or equal to 2.5 microns, also known as lungable particulate matter. PM2.5 has a small particle size, which is both a pollutant itself and a carrier of heavy metals, polycyclic aromatic hydrocarbons and other toxic substances, so it is rich in a large number of toxic and harmful substances, and has a long residence time and long transport distance in the atmosphere, thus having a great impact on human health and the quality of the atmospheric environment – –Hazy weather caused by fine particulate matter is far more harmful to human health than dust storms!
According to environmental quality monitoring standards, PM particles larger than or equal to 10 microns can usually be blocked outside the human nasal cavity, PM at 2.5 microns to 10 microns can enter the upper respiratory tract, but can also be discharged through sputum or blocked by the internal velvet of the nasal cavity, PM less than 2.5 microns will not be easily blocked and will directly enter the bronchi and alveoli. The World Health Organization recommends that the annual average PM2.5 concentration in the air should not be higher than 10 micrograms per square meter.
PM2.5 is harmful to children’s health
1. Causes congenital defects in fetus If exposed to heavily polluted air for a long time, the effect of PM2.5 on fetal development is that it may brand the DNA of the newborn with a special biochemical “brand”, and the high concentration of fine particulate matter pollution may affect the development of the embryo. Many national and international studies have shown that perinatal and low weight infants, intrauterine growth retardation, and congenital functional defects are associated with concentrations of atmospheric particulate matter. With the development of technology and the improvement of resuscitation techniques for critically ill children, the neonatal mortality rate is not decreasing but increasing, with the mortality rate of some urban neonates being 2.58 times higher than that of rural neonates, which makes us think why the mortality rate of neonates in cities with more developed medical technology and equipment is higher than that in rural areas, does the danger of air pollution occupy an important place? Unclean air can cause such great harm to the fetus, then the mother-to-be must pay attention to the prevention of air pollution on the baby may cause potential harm.
2, causing intellectual disabilities in children Although nature also produces PM2.5, but mainly from human emissions of gaseous pollutants. In these pollutants there are elements such as sodium, magnesium, calcium, aluminum, iron, etc., but also heavy metal elements such as lead and arsenic, which mainly originate from human pollution. Among them, lead poisoning will affect the growth and intellectual development of babies. Now, indoor environmental pollution can lead to lead poisoning and thus affect the intellectual development is a generally accepted fact among parents, and has attracted the full attention of everyone. When decorating, mothers will choose all kinds of good, expensive and big brand decorating materials to avoid lead poisoning in children, however, mothers ignore another important source of lead poisoning in babies – outdoor air pollution, of which PM2.5 is an important culprit.
There are many sources of lead in PM2.5, some lead comes from coal-fired emissions, some from lead non-ferrous metallurgical emissions, if you live in a city where both of these emissions are very weak, there is another important source namely fuel emissions, car exhaust emissions, and soil dust emissions. Due to the different seasons, the lead content in PM2.5 will also be different. Babies’ resistance is weak, and if they often inhale car exhaust for a long time during the peak commuting period, it may also cause lead poisoning in babies, and even affect their intellectual development.
3.Inducing respiratory diseases in children
As I have already mentioned, babies’ respiratory immune function is poor, and because children’s respiratory cilia movement is poor, they cannot effectively remove dust and foreign matter, so babies are prone to respiratory infections. 75% of the particles below 2.5 microns are deposited in the alveoli. We can imagine that getting sand in the eyes can lead to eye inflammation if not cleaned in time. Deep in the respiratory system, which is also a sensitive environment, fine particulate matter stays as a foreign body for a long time and can likewise inflame the respiratory system. The smaller the particulate matter in the atmosphere the greater the damage to the baby, this is because the size of the particles determines where the particles end up in the body and the degree of damage to the body. PM2.5 can be deposited directly in the lungs, where smaller particles can also penetrate through the lungs into other organs. The lungs have a self-purifying function during gas exchange that will expel PM2.5 from the body, but it usually takes weeks or even a month for this inefficient self-purification function to occur, meaning that toxic particles of PM2.5 will be in contact with sensitive lung tissue for a long time.
Children have a faster metabolism, exercise more, breathe more frequently than adults, need more air per unit weight than adults, are less able to resist disease, and spend more time outdoors; therefore, children are more affected and more severely affected by air pollution than adults. Long-term follow-up studies at home and abroad have found that short-term exposure to high PM2.5 will lead to changes in lung function and increased incidence of asthma in children; while long-term exposure will induce chronic respiratory diseases in children and is associated with late neonatal mortality caused by respiratory diseases. Although the specific mechanism of PM2.5’s respiratory effects is not clear, its short- and long-term effects have been confirmed in many countries. Moms and dads must take all kinds of precautions to help their babies keep a good health first.
Four, haze weather precautions
1, hazy weather does not advocate opening windows in the morning and evening ventilation: it is best to wait for the sun to come out and then open the windows to ventilate.
2, wear a mask outside: If you go out, it is advisable to wear a mask, which can effectively prevent dust particles from entering the body. Although there are many people who wear masks on hazy days, there is a learning curve on what kind of masks to wear in the face of PM2.5. In the face of small particles of only 2.5 microns, ordinary cotton gauze masks do not play much of a role in addition to blocking dust and psychological effects, no matter how thick the cotton gauze mask you wear. The literature records that medical N95 masks can block 95% of the particles of 0.3 microns, pm2.5 masks in addition to dust, anti-pm2.5 mask fabric using Conlon fibers, but also can kill “super bacteria”, so this mask for PM2.5 burst weather is also effective. The elderly and people with cardiovascular disease should avoid wearing it because it is a professional anti-virus aerosol mask with good airtightness, and it is easy to feel dizzy due to breathing difficulties and lack of oxygen after wearing it. If you want to wear this mask, you should not wear it for too long, when you feel uncomfortable to take it down in time.
3, home must do three things: wash face, rinse mouth, clean nasal cavity
Teach you a simple and easy to learn to clean up the nasal cavity: wash your hands, hold warm water, gently absorb the water with your nose and quickly blow your nose, repeat a few times, the nasal cavity is clean of all the dirty things. It is worth noting that when cleaning the nasal cavity, be sure to gently absorb water to avoid choking and coughing.
4, appropriate amount of vitamin D supplementation.
Winter fog, less sunlight, due to insufficient ultraviolet radiation, vitamin D generation in the human body is insufficient, some people will also produce mental laziness, depression and other phenomena, if necessary, some vitamin D supplementation.
5, a light diet and drink more water.
Foggy day diet is advisable to choose light, easy to digest and vitamin-rich food, drink more water, eat less stimulating food, eat more fresh vegetables and fruits, which can not only replenish a variety of vitamins and inorganic salts, but also play a role in moistening the lungs to remove dryness, expectorant and cough, spleen and kidney.
It is recommended to eat more vitamin-rich vegetables and fruits, such as grapes, oranges, purple kale, purple potatoes, tomatoes, etc. Enoki mushroom and pumpkin have anti-allergy effect; snow pear stewed lily can achieve the effect of lung moistening and anti-virus; fungus in addition to the prevention of cardiovascular disease, can also play a role in cleaning the stomach; winter consumption of silver fungus, lotus seeds, lily, etc., has the effect of lung clearing, lung moistening and lung nourishing.
6, hazy days less go out, should not be morning exercise:.
Hazy weather is the cardiovascular disease patients “health killer”, especially the elderly with respiratory and cardiovascular disease. Because the fog when the air pressure is low, the oxygen content in the air has decreased, people are easy to feel chest tightness, the morning damp cold fog will also cause cold stimulation, can easily lead to vascular spasm, blood pressure fluctuations, increased heart load, etc.. At the same time, some pathogens in the fog can cause headaches, and even induce hypertension, cerebral hemorrhage and other diseases. Therefore, the elderly and infirm should not go out in foggy days and avoid morning exercises in foggy days to avoid danger. When returning from an outing, you should immediately wash your face and bare skin.
Hazy weather not only greatly affects the public travel, but also is an invisible killer of life and health. Haze is more harmful to children, parents must take their children to do protective measures. And parents themselves, for the sake of a healthy body, please do not sacrifice health in exchange for the so-called good life. So to cure the haze, we should start from me – drive less, travel green, plant more trees, protect the forest, protect the environment, and create a green home for our future generations!