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THE CATARRHAL CHILD                               51

are just as exposed to the spread of virus infection. Young children attend
nursery schools in greater numbers and from an earlier age and are thus
doubly exposed to infection. There are two main types of respiratory viruses.
The first type enter the cells of the respiratory tract where they multiply to
cause respiratory infections, and among these are the influenzal and para-
influenzal viruses, the adenovirus, the respiratory syncytial virus and the
rhinovirus. The second type enter the respiratory cells where they cause no
local trouble but spread by the blood stream to give rise to the exanthemata
such as measles, rubella, varicella, etc.

Allergy. Allergy is frequently hereditary in origin, and the child of two
atopic parents stands a 75 per cent chance of producing symptoms of nasal
allergy. In many cases this is a food allergy, where the allergen is often milk,
or an infantile eczema which may lead to nasal catarrh, and often ultimately
to hay fever or bronchospasm.

Antibiotics. The ready prescription of antibiotics for minor illnesses which
normally would recover without such therapy prevents the development of
the normal resistance of the child against such infections as the common cold
or sore throat. In this respect they create the very conditions that they might
be expected to prevent, the susceptibility of the child to upper respiratory
tract infections.

CLINICAL FEATURES. The complaints include nasal catarrh, frequent upper
respiratory tract infections which may proceed to lower respiratory tract
infections, sore throats, sore ears, lack of appetite, pallor, insomnia often
with spasms of non-productive coughing, and lack of normal growth and
development. There are many problems to be resolved in this history. Is
the undernourishment and poor appetite due to catarrh, or is the catarrh due
to poor appetite? Does the catarrh lead to sinusitis and bronchitis and even
bronchiectasis, or is the bronchitis the primary disease and the nasal catarrh
secondary to it? Is the insomnia due to nasal catarrh or to poor home condi-
tions with overcrowding in which the younger children get no peace to get to
sleep ? Is the pallor due to the catarrh or to the lack of fresh air in the house or
the lack of playing facilities in high-rise flats ? Is the allergy a true allergy or is
it a vasomotor condition engendered by parental anxiety or tensions being
communicated to the child?

From a more clinical aspect one must consider other factors which may
uncommonly predispose to nasal catarrh. Hypothyroidisrn may occasionally
play a part. Hypogammaglobulinaemia may rarely predispose to a susceptib-
ility to upper respiratory tract infections, giving rise to a condition known as
the antibody deficiency syndrome in which the child cannot produce a
sufficient natural resistance to infection. Mucoviscidosis may underlie a
frequency of upper and lower respiratory tract infections and should always
be suspected in intractable cases.

The catarrhal child should be thoroughly investigated by the family doctor
and the paediatrician to exclude these factors before treatment is undertaken,
or before he is examined by the laryngologist. If referral is made in the first
instance to an ear, nose and throat clinic the specialist should endeavour to
establish in taking the history that there is no general medical problem
requiring attention before recommending treatment, and especially before he
recommends surgery. The best results are achieved by a collaboration between
the two specialists.