pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Night Cramps, Sore Throats and Mould

[A “worried mum” from the UK is concerned about her four-year-old son’s multiple health problems: sore throats, antibiotics, mold and night cramps.]

My 4 year old son has had swollen tonsils on and off since he was about 8 months old, 2 years ago was the worst when he woke up late in the evening screaming and his mouth had blood coming out of it. He went to hospital and was given diffalin spray with his antibiotics this worked well. I worry about my 4 year old as its the 4th or 5th time he has had antibiotics this year. Three weeks ago he came down with a cold, temperature, sore throat, I treated him three days with 5ml calpol and then 5 hrs later nurofen, as each time he is ill this is what the doctor says to do. On the 4th day I took him to the doctors and was given phenoxymethyl-penicillin one 5ml spoonful four times a day. He was given no calpol or nurofen due to no temperature. The doctor pointed out he had swollen glands too and that should go in about three weeks. The antibiotics stopped his cold, sore throat and horsey cough. I have taken him back to doctors, the doctor has now said that he has got pharangitus, his glands are still up and his tonsils are swollen a bit. We have been given the same antibiotics, he has also got his horsey cough back, cold but no temperature. The doctor has said to go back after his antibiotics. I feel my son is having too much antibiotics and also calpol and nurofen. I have used all these things since he been a baby due to colds and temperatures. I always use calpol or nurofen for my son when he wakes in the night screaming due to pains in his right knee and back of his leg [night cramps], I know my son is in pain as he rolls around the bed crying and this can last for up too half hour. The doctors have said growing pains, its not nice to feel helpless when your child is constantly not well. I live in a damp house, which things have had to be thrown away due to becoming mouldy, i have to clean things in my cupboards as after a while there is growth things we use to cook and eat our dinner from, i clean my bathroom and have to clean walls due to mould starting. Could this be affecting his health. Im a very worried mum and don’t know what to do to help my child.… Vanessa L. J.

Wow, where to begin. Well, like the movie English nanny (Julie Andrews) always says: “let’s begin at the very beginning – a very good place to start.” I do have to say that although I understand all the words and concepts you use in your question, I’m still a bit baffled about specific diagnoses. Although the human body is the same all over the world, and pretty much works the same, the “practice” of medicine (and the use of lay terms) do differ and sometimes even greatly.

Sore Throats

I have no reason to believe that UK children are too much different than ours in the US; who, on average, contract around ten illnesses per year – most in the winter, more in the first 8-10 years of life, most of them viral and more if they have parents who smoke any tobacco products. So, the average ten-year-old has had 100 illnesses – pretty much all of them short, self-limited, virally caused and therefore not responding to antibiotics. And, all of this can be considered “normal.”

Of the medicines you reference, I only recognized one (the penicillin). I needed to look up all the others because they are not sold in the US; but, as it turns out, do have their counterparts here. Calpol is similar to our acetaminophen and nurofen similar to our Ibuprofen.

Acetaminophen and Ibuprophen are antipyretics and analgesics, for fever and pain, and can be used in children. Neither “cause” any of the symptoms you are concerned about and can be used symptomatically all through life.

Diffalin [I assume you meant difflam] is a “locally-acting non-steroidal anti-inflammatory drug with local anesthetic and analgesic properties for pain relief and anti-inflammatory treatment of inflammatory conditions of the mouth and throat” – a topical analgesic (for pain) similar to our Cepacol. Merely a medication which can be taken internally on mucous membranes.

Antibiotics

Phenoxymethyl-penicillin is one of the first types of antibiotics invented and marketed. It’s very cheap and has been around long enough for a lot of bacteria to have developed resistance to it. It is not widely used for children’s ear infections in the US due to the resistance to it by the “bugs” which cause ear infections – the most common bacterial complication of a viral cold.

Tonsils are usually very small in infants, increase in size through childhood then “melt” away through adolescence. Sometimes their “melting” is uneven leaving bumps and crypts on their surface (which can then catch food particles.) They, along with the “glands” in the neck, are tissues which store the body’s cells that are designed to fight infection. Therefore when the body gets infected, even with a virus, they might increase in size as they become “active.” Tonsils can become infected themselves (tonsillitis) with a bacteria that we call “strep” which IS often treated with penicillin.

Which of these many scenarios your child has is not clear to me from your questions; however, we too have children with many illnesses. A difference would be that here, children are usually treated with an Ampicillin like medicine.

The disease known as a “cold” is always caused by a virus which cannot be treated by antibiotics – so doctors should NOT give you the impression that antibiotics are to treat “colds.” They can’t. It’s my belief that every doctor who prescribes an antibiotic should inform the parent clearly the SPECIFIC disease they are using the antibiotic for.

From your description I cannot tell for sure, except to guess that there may have been an assumed tonsillitis treated with penicillin. In the US, we perform a “strep” test in the office and only if it is positive do we use antibiotics. I’m assuming (hoping) that your boy’s doctor is examining his eardrums at each visit because Otitis Media IS an illness that can develop after a cold which IS treated with antibiotics (but, as I’ve said, not usually with “plain” penicillin in the US).

Viral colds and allergies DO often cause drainage of mucous down the back of a child’s throat when they are lying down. That irritates the mucous membranes in the nose and throat which can then ooze a small amount of blood. Nose bleeds are common in upper respiratory infections (URIs) of children; which, at night, would drain down the back of his throat into his mouth. That is perhaps what happened to your son.

Mold

Mold (mould) is definitely a problem and can be quite severe in sensitive individuals. In the US there has been an entire industry crop up to deal with “toxic mold” and the guys usually come into the house with white “hazmat” suits and cordon off the entire area while they attempt to eradicate it. So, I’m not entirely sure what specific “mould” issue you are describing.

Living in the US, if my cupboards were continually getting moldy I would be dismantling the cupboards and walls to try and rid the problem. Mold could definitely be a cause of continued and recurrent respiratory symptoms in anyone, especially children. Often there’s wheezing and other “allergic” type symptoms. In the US they call it a “toxic house” and it can be very costly to eradicate or rebuild.

Again, your description doesn’t “translate well” to our experience here. At very least it seems your physicians should be talking to you about dehumidifiers and other measures of mold control and eradication so I would suggest having a discussion specific about that.

Night Cramps

Dampness however is probably not related to any of the night pain or cramping you describe in your boy. That is the one symptom you describe which is very common to what we see in the US and is called “night cramps” relating to “pes valgo planus” (PVP) – flat feet. Sometimes there is also some tibial torsion where the toes turn either inward or outward as well. It often occurs a bit more pronounced in one leg over the other.

Having flat feet requires that a child’s leg muscles work extra hard to maintain balance through a normal gait. All that extra work commonly causes pain, often during the night, in a child. There is no such thing as a “growing pain,” a term usually used by physicians when they don’t have a “real” answer. I do have to say that a large number of physicians, even pediatricians, don’t look for, or understand, problems of the feet and lower leg.

PVP is the first thing I would have your pediatrician check for because your description is very “classic” for the problem. Orthotics (placed in the shoe) are the corrective answer. Cowboy boots also often solve the child’s problem because of their great arch support, and are often cheaper than orthotics if they work.

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