Diseases Of The Nose Throat And Ear

CHAPTER 10
THE CATARRHAL CHILD

Nasal catarrh and a history of frequent colds in children are commonly
encountered in general practice and in the outpatient clinics of both
paediatricians and otolaryngologists. The history varies a great deal, depend-
ing upon the insight of the parents, and it may not be a simple matter to
reduce a rambling story to clinical facts. It all too often happens that the
parents form preconceived and perhaps inaccurate ideas and will stress some
parts of the history and minimize or omit others. Yet an accurate history is
essential, and is best obtained by the family doctor from his knowledge of the
family, the house and the illnesses of the child and the siblings.

PREDISPOSING FACTORS. Certain factors may predispose to the problems met
with in the catarrhal child.

Environment. This includes the occupation, financial status and intelligence
of the parents; the size, hygiene, surroundings and structure of the house; the
nourishment, overcrowding and cleanliness of the children; the previous
illnesses of the parents and the children, etc. Chronic catarrh in the child is
more often, but by no means exclusively, found in the poor, who live in
overcrowded conditions, often in areas polluted by smoke, and whose diet is
unsatisfactory from the point of view of balance and vitamin content. It may
be argued that much is being done by slum clearance and the welfare state to
improve the housing position, but the increase in population housed in
modern high-rise flats may not in fact be an improvement, and overcrowding
still exists. It may also be argued that with an improved standard of living
poor nutrition should be less common than previously, but the increased cost
of living may mean that a diet sufficiently rich in protein and vitamins is still
impossible to achieve, and may be aggravated by the increasing problem of
the working mother. The Smoke Abatement Act has reduced one type of
pollution, but this has been replaced by a polluted atmosphere from exhaust
fumes which affect the small child more than the parents. There are families
who appear to regard nasal catarrh as normal, and who never train their
children in nasal hygiene. It has been argued that to sniff back nasal secretion
is as effective as to blow it out into a handkerchief, but an appreciable
percentage of children appear to do neither effectively, and secretion is allowed
to run down the upper lip or to lie in the nasal cavities.

Virus infections. These are brought into the home from buses, trains,
factories, offices, schools, supermarkets, etc. by parents or older children,
and such infections may be increased in virulence by passage through several
hosts. The overcrowding and lack of fresh air in the home increase the chance
of infection spreading, and this is especially true during epidemics of upper
respiratory tract infections of virus origin. Indeed, at the other end of the
social scale, the families living in an atmosphere of overhot central heating