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Question
Hello Doctor - My son is 2yr old. He gets cold&Cough very frequent(once a month approx). He also gets breathing and wheezing problem along with it. This is happening since 1 yr now. Our pediatrician gives combination of levoline 0.63 / Dualin, sometimes budesal / duolin, sometimes Budecort /levolin. Another issue is after this wheezing problem, boy gets hyperactive ( not sure coz of nebulizer OR Wheezing). It is very difficult time of 2-3 days to handle. Doc has suggested 1 month course of Budecort 0.5 once a day and Montair once a day. Is this allergy ? what could be done to avoid hyperactivity of child ? Does too much of nebulozer could have sideeffect as we are giving from such a age ? Doc says - this problem should go on its own after 5-6 yrs ... Are we on right track ?

Thanks,

Answer
Hi Rajat,

Every child in 1-6 years of age group suffers from frequent cough/ cold. These children, especially in lower side of this age group can have 6-8 episodes of cough/ cold every year. The frequency of these episodes is even more during change of season and when the toddler starts going to day-care (creche)/ play school/ school, since there are a number of children (all in this vulnerable age-group) in a room that facilitates spread of infection. These episodes appear similar, but in fact there are more than 200 viruses that can cause similar symptoms. Hence, technically these infections are not "same" but by different viruses. Recovery can be fast with some viruses, while prolonged course (occasionally even upto 3 months) with others. The frequency of these episodes decreases somewhat at ~ 5-6 years of age (when the child has unfortunately already suffered from most of these viruses.

Some children, like your son, are prone to wheeze during these infections and some of these require neblizations. Nebulization is very safe as the dose give via nebulizations is 100 times less than the same medications orally. Moreover, since the medicines are given directly where action is required (lungs), side effects are also much less than with oral medicines.

Chillren with very frequent significant episodes of wheezing are sometimes prescribed budecort and/ or Montair (monteleukast), as these medicines have PREVENTIVE role.

Thus, your doctor seems to be on right track.

I don't think that hyperactivity is because of wheezing or nebulization. Please make sure  (discuss with your doctor) that he is really "hyperactive" and not just "cranky" because of illness. Such crankiness is very common in children of this age group. Secondly, hyperactivity is known but rare side-effect of anti-allergic medicines, which might also have been prescribed to your son. Anti-allergic medicines cause sedation in most individuals, but are known to have "paradoxical effect" of hyperactivity in some children. Please discuss the possibility of this with your doctor.

Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846

Pediatrics

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Dr. Puneet Kumar

Expertise

I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query requiring specific diagnosis of a particular subject.

Experience

I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 15 years of experience in the field.

Organizations
Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (http://www.kumarchildclinic.com)

Publications
(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. http://www.pediatricsciences.com/issue/view/1050000010 (f) Regular column, “How do I treat” in Pediascene (www.pediascene.com) (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 (http://www.pediascene.com/page.php?cid=6&catid=9&id=132 ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

Education/Credentials
After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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