How Much Sickness Is Too Much?

By Diane Arnaout, M.D.

Wheeeeeeeeee---oooohhhhhh.

I don't know how else to start this respectful and loving post for our immune system other than with a joyful and exhausted noise.

Your kids are so sick (so often) right now that I lately find myself reassuring parents all day about what's normal and what isn't when it comes to how much sickness is "too much sickness".

I have the biggest crush on our immune system. It is absolutely amazing to behold the genius of its design, when you really think about it.

It is truly a "system". A whole team of different types of cells and organs that are pretty stellar at spotting different kinds of enemies and neutralizing them quickly. The immune system is armed and ready in your skin, your mouth, your gut, your bones, your blood - pretty much all your organs.

(My fave is the B lymphocyte. That little guy makes antibodies - our memories of infections or vaccines in the past that help us to quickly remember and kick microbial butt in the future.)

1) You are teeming - I mean TEEMING with microorganisms. Every centimeter of your body (some crevices more than others) and insides is absolutely SATURATED with fungus, bacteria, and viruses. Your skin, your mouth, your guts, your groin, your nostrils. Your immune system is working constantly to keep trillions of bad boys in check, all at the same time. I read somewhere that the average adult has 2-6 POUNDS of bacteria living in and on them.

2) Your kid's pacifier? Covered in a few trillion microbes. Let that sink in. So when you ask me if those three vaccines are "too many shots at once"? I'm gonna stare at your kid's pacifier and give you a little lecture about how beautifully our immune systems can handle a few trillion antigens at once (and those 7 antigens in the shots ain't no biggie).

3) If newborns had mature immune systems, they would basically attack their mother's cells as being foreign. For this and other reasons, they're born with a muted immune system that rapidly starts to develop over the first few weeks of life. This is why we have to be so careful with them. Mama actually gives baby certain forms of passive immunity for awhile to cover the gaps while baby's immune system starts to develop. This is also why we have to wait a few months for the first batch of vaccines - the antigens just may not be remembered very well if we give them too early.

4) Children in daycare (yes, even one or two days a week, or that in-home daycare with two other kids, or that church daycare they're only in for 2 hours on Sundays) get sick pretty often.

This is especially true if the kiddos that have gotten good at crawling, walking, and picking things up - they grab their friends' toys and chew on them often. They don't cover coughs or sneezes.

It's called "the daycare drip" for a reason.

It is not uncommon for children in childcare to have a runny nose pretty much constantly for months and months. When I first became a community pediatrician, I was sick for 8 months straight.

I call it "ocean waves" of weekly drippy nose and varying degrees of coughing. And they're often picking up more than one virus at a time. Each virus lasts 7-10 days. And they often overlap.

5) MANY of the symptoms of sickness can be caused by the immune system, and not the germ!

- Fever? Thank your immune system for this helper! Read my love letter to fever here (and tips on when to worry). 

- Runny nose? The body makes sticky mucus to keep the germ more controllable and in the nose, so it can't go down to the lungs.

- Congestion? The body sends lots of blood to the area you breathed in the germ, so that the immune system can start the fight there.

- Body aches? Quit running around. You need to rest so your body can fight. And sometimes your body needs to make you slow down.

- Vomiting? Your body perceived a new threat in the stomach, and is trying to get it OUT!

6) Coughing is how we keep the snot from getting into our lungs. It cleans things up for us so we can get it up, swallow it, and poop it out. It is our friend. We want to see a child in the office if their cough has gone unchanged or worsened after 10-14 days, is making them vomit often, makes them wheeze, or if they seem to be struggling to breathe sometimes. Or if you're just plain ole worried.

7) So when is a kid “sick too often”? Well, honestly it's not a simple answer that i can summarize in a paragraph - sometimes, doctors just have a feeling. In general, I start to worry about immune system dysfunction or deficiency when a child has many invasive bacterial infections each year - like pneumonias, bone infections, or ear and sinus infections that are severe and numerous. Children that are hospitalized more than once in a year for a troublesome infection tend to worry me. Kids who need to be on many antibiotics throughout the first few years of life (think monthly for more than a year) make me scratch my head sometimes, too. Often these children aren’t growing well or thriving.

8 ) "So can I 'boost' my kid's immune system with this amazing supplement I found online?" Okay, you guys (and a few corporations making millions off of the worry of parents) are gonna hate me for this - but there is no magical "booster" for the immune system other than vaccines. We need good sleep, a decent diet, and exercise to keep our immune system balanced.

You actually DON'T WANT an over-reactive immune system - that only leads to different kinds of trouble.

So if your kid's a picky eater, pop a multivitamin in them daily or every other day to fill in the gaps, assure they're getting good sleep, keep stress low, wash those hands, get your vaccines, and enjoy some time outside running around in the fresh air and sunlight.

Hope this helps you understand why I totally nerd out over the immune system sometimes.

Talk with your doctor if you think your kiddo is getting sick too often. It's honestly a conversation that will help you feel better as your doc knows your child best.

Now if you'll excuse me I need to lay face-down on my yoga mat.

-Hugs! Dr. Diane