"There are no harmless diseases." Pediatrician Sergei Butriy - about delusions that only harm the health of children

1. There are non-dangerous diseases like whooping cough and chickenpox. And it is better to get sick with them in order to develop immunity.

No. To develop immunity, you need to be vaccinated. Saying that getting sick is a less risky option than getting vaccinated is a direct and clumsy lie. Organizing chickenpox, measles and any other "parties" when healthy children are brought to visit the sick is barbarism and child abuse, for which one wants to punish.

There are no harmless diseases. Yes, windmill and whooping cough occur quite often, but usually do not proceed severely. And people remember many acquaintances who themselves or together with the child fell ill easily and flaunted it. The same patients whose child suffered chickenpox or whooping cough severely underwent a long hospitalization (possibly even the intensive care unit) and rehabilitation, or, moreover, died from these infections, are reluctant to talk about their experience. They are crushed by grief, guilt and spend all their free energy on treating the complications of the disease.

As a result, people consider the rarer to be dangerous. meningococcus simply because the media likes to write about him (here deaths and complications are on everyone's lips). And the lethality of the generalized form is 20%, every fifth sick person dies. But children suffer and die from very many infectious diseases, and vaccinations have been developed for only a small part of them, and precisely for those that are most dangerous and socially significant.

IN national calendar no optional vaccines. But they are not enough. I would introduce several additional vaccinations: against rotavirus, chicken pox, meningococcus, and in endemic regions also against hepatitis A and tick-borne encephalitis.

The phrase “it’s better to get sick” is a direct legacy of the anti-vaccination propaganda. Thinking about why vaccines are not needed anymore, antivaxers find small studies that have found a casuistic reduction in the risk of oncology or some other benefit. These studies are generally of very poor quality, have not been supported by larger, more rigorous studies, and cannot be applied in clinical practice. But their names sound spectacular, and it is convenient to throw them at an opponent-doctor when you use the forbidden rhetorical device "Gish's gallop", as if the number of false arguments can affect their quality.

2. The child will get sick if it is easy to dress him and give him something cold to drink and eat.

15 years ago, when I was still a senior student at a medical university, I listened to a lecture by Vladimir Kirillovich Tatochenko, in which he said the legendary phrase: "Children do not catch colds, they get infected." Then this idea was relatively fresh and revolutionary and did not germinate well in the heads of doctors and parents. Now, it seems, many people already know that there is no separate phenomenon of “cold” without viruses and bacteria.

Parents get tired of frequent SARS in a child, they do not tolerate the uncertainty “Will you get sick again? When?”, they want to reduce the risks. From all these factors, the ritual of wrapping and warming is born. It is enhanced by a cognitive distortion called "confirmation bias”: when a child got his feet wet and didn’t get sick, it’s not remembered; when he got wet and got sick, it’s very memorable and broadcast further.

From the point of view of modern science, hypothermia, if it increases the risk of a viral infection, is very insignificant. This can be neglected. And, of course, every pediatrician knows a lot of meticulously wrapping and warming families in which children get sick, if not more often, then at least on a par with barefoot children greedily swallowing ice cream.

3. Multivitamins are essential

It is difficult to understand where such love of parents for multivitamin complexes came from. I think there are many factors: and the desire to make SARS at least a little rarer in preschoolers, and the temptation of the idea of ​​giving health in the form of a pill, and anxiety, and aggressive marketing of this type of drug ...

But the reality is that a modern child, eating more or less tolerably, has almost no chance of beriberi, and multivitamins are needed only in this case.

It is important to artificially add to food only vitamin D and iodine (in iodized salt or separately in tablets). Everything else should be prescribed by a doctor for specific indications, and there is no item “so that you don’t get sick so often” in the list of these indications.

4. Temperatures above 38.5℃ need to be knocked down

Before the popularization of paracetamol and non-steroidal anti-inflammatory drugs, the temperature was not brought down by anything other than physical cooling methods. This is when an ice towel is placed on the forehead, and the second one cools in a basin of water in order to take the place of the first one in 2 minutes.

When antipyretics became popular, parents began to strive to bring down to 36.6 ℃ any increase. Then the doctors came up with such a compromise: well, at least do not lower it to 38.5 ℃. This figure is taken from the ceiling, because anything over 39 usually scares parents a lot, and anything under 38 is unlikely to be connected with anything serious.

I usually teach my parents not to lower temperature, as long as the child tolerates it normally, even if it is 39.3 ℃. And vice versa: it is worth giving the drug if the child has 37.3 ℃, but at the same time severe chills and malaise.

The temperature, which must be lowered at all costs, starts after 42 ℃. But anything above 40℃ still deserves a certain amount of alarm even without other red flags. This means that you need to contact the doctor, and he will already decide: is it worth just waiting or should the treatment be changed.

5. Frequent nosebleeds indicate serious health problems

In winter, the complaint of nosebleeds is one of the most popular in the pediatrician's office. It is difficult to say why a particular child often has a nosebleed, but it is almost always safe, and the doctor only needs to explain this and reassure the family.

Dry air at home during the heating season, thinner mucous membranes in children, the habit of picking your nose and many other factors can lead to bleeding up to 20 times a week. And it usually does not harm health.

I'm starting to freak out and investigate in one of these cases:

1. The child's nose bleeds for a long time - 20 minutes, despite adequate measures to stop bleeding.
2. Too much blood - more than 100 ml at a time or in total per week.
3. Not only the nose, but also scratches, cuts, a wound after taking blood from a finger bleed for more than 10 minutes, and bruises too large or in places that are difficult to bruise.

6. Poor parenting is to blame for mental illness in children

This is again an attempt to look for simple explanations for complex phenomena. In the early days of autism research, for example, there was the “refrigerator mother” hypothesis. She explained the occurrence of the disorder through a lack of love, attention and care for the child. Fortunately, it was quickly refuted.

The roots of this phenomenon, I believe, in some religious beliefs that bad things happen only with bad people. This kind of guarantees that if we follow the commandments, then this cannot happen to us, God will not allow it.

Reality, of course, is more complicated. Bad things happen to the nicest people, and parenting has an embarrassingly small impact on children's mental health.

7. With a delay in speech development, you do not need to do anything, it will pass by itself

There are two extremes, and both are harmful. Ignorance 10 words in 1 year is not a problem in itself. But their knowledge is also not a guarantee of neurotypical (normal) development.

Speech delay is a very non-specific symptom. Sometimes it does not say anything at all, and sometimes it is the first signal of a serious illness or disorder. There are many options here, and you can’t write instructions for parents for each.

Perhaps the most universal advice is to write down everything that does not fit into the normal development of the child, everything that confuses and worries, into a separate list and dump all questions and concerns on the pediatrician during inspection. It is up to him to decide whether this is a puzzle of some serious problem (and whether an additional examination by a neurologist or child psychiatrist) or until there is nothing to worry about - we observe and deal with standard developers.

8. A child with ADHD will learn to be attentive on his own

It's difficult here. On the one hand, many children with ADHD will learn, yes. Either the symptoms will become objectively weaker with age, or those suffering from them will develop a system of life hacks that will help them be more effective and more focused.

But, on the other hand, while the child fills these bumps and learns from his own mistakes, he can get serious complexes, anxiety, depression, low self-esteem, dependence on drugs, getting into bad company, losing all the warmth from family relationships or relationships with friends.

I would not like to let it take its course, especially when the diagnosis has already been made. There are effective strategies for helping families and children. At a minimum, this is psychoeducation (reading specialized books and websites, group psychotherapy, communities of parents and doctors united by a common diagnosis, and so on). As a maximum - medications, psychotherapy, inclusive education and upbringing, support and assistance to the family.

9. Frequently ill children have a weak immune system

Doctors and patients understand completely different things under the phrase "weak immunity." Doctors define it by frequent and severe bacterial complications of SARS, and not by SARS themselves. They call it immunity weakened by cancer chemotherapy, or AIDS, or a congenital defect in cellular or humoral immunity, or a removed spleen, and so on. It's a synonym immunodeficiency, congenital or acquired.

In everyday life, they say about the weakness of the immune system when they want to emphasize the low resistance to infections, the tendency to frequent SARS. But this is wrong, primarily because a truly weak immune system directly threatens the life of a child, while frequent SARS do not.

The second thing that is important to emphasize here right away is that everyday “weak immunity” is almost impossible to strengthen. Tempting multivitamins, immunomodulators, folk remedies, or hardening have little or no effect on overall resistance to infections.

In fact, medically speaking, weak immunity is “raised” or “strengthened” by a very serious methods. For example, daily prophylactic use of an antibiotic until the age of 5 years (with remote spleen), monthly transfusion of intravenous immunoglobulin (with a congenital defect in humoral immunity) and etc. But serious methods have serious side effects, so the game should be worth the candle.

10. Herpes viruses are the cause of general weakness, prolonged subfebrile temperature, pain in the head and abdomen, nausea, and so on.

This myth, unfortunately, was launched and supported by the doctors themselves. Not all, but those of us who do not tolerate the state of uncertainty themselves, who are poorly versed in somatoform disorders, as well as those who are not very good at communicating with difficult families.

Many patients, mostly but not limited to early adolescence, are prone to persistent and debilitating non-specific complaints. This is a separate large group. Children suffer and cannot study, parents take them to dozens of doctors, force them to take hundreds of analyzes and tests. In the end, there is a doctor who prescribes PCR or ELISA for viruses of the family herpes.

Tests show carriers (simply because many people have them and usually don't matter) or even active shedding of these viruses, and the doctor attributes all the symptoms to that. And so he prescribes pointless, unproven, and unsafe treatments for these viruses, and families begin to hope that this will help.

But this is not medicine, this is an imitation of violent activity. Such methods devalue the work of doctors and undermine their credibility. The only thing that can be advised here to both doctors and parents is to do more self-education and remember that complex problems rarely have simple causes. Well, patients should still try to trust doctors more.

11. After infectious mononucleosis, you do not need to sunbathe and play sports

You don't need to sunbathe afterwards. A tan (especially repeated sunburn) is one of the strongest and most studied risk factors for melanoma, a highly aggressive skin cancer. However, previous mononucleosis does not increase these risks further. I don't know where this myth came from.

Everything is more or less clear about the ban on sports for a year. In some children, due to EBV infection, the liver and spleen become so enlarged (temporarily and reversibly), that at the peak of this increase from a blow to the stomach or from shaking, very rarely, there are ruptures of these organs. However, sports should be banned precisely for those whose liver and spleen are enlarged to an impressive size, and not for everyone.

12. Before vaccination, you need to take an immunogram or analyzes of blood, urine, feces

Many parents are very afraid of vaccination and want to make sure. For example, it is better to examine the child before vaccinations, take antihistamine, to administer vaccines not simultaneously, but separately.

However, all of these strategies have no evidence of effectiveness. All current international vaccination recommendations prescribe to administer vaccines at the same time, several drugs per visit, and report that no examinations or drug preparation are needed before this. The exception is known and obvious health problems in a particular child. For example, severe immunodeficiencies, life-threatening allergic reactions to previous administration of the same vaccines, some progressive neurological diseases, drugs that change the effect vaccines.

Excessive and unreasonable examinations not only do not reduce the risk of complications from vaccination, but also increase the likelihood that the child will die at all. will not be vaccinated. After all, the more conditions you need to fulfill before vaccination, the fewer families will overcome this obstacle course. So, these examinations directly harm the child.

Much in modern medicine (and science in general) is counterintuitive, causing surprise, distrust, or even indignation of parents. But if you ask the doctor the question "Why?" and study the evidence, you can get rid of most of the misconceptions and cognitive biases. And it will only bring benefits.