Q: My five and a half years old son is getting recurrent cold and sore throat. Every two to three months, he gets an attack of streptococcal pharyngitis. My son otherwise is a healthy child with no other problems. Why does he get cold and sore throat so frequently?

A:All children as they grow up get colds as they are exposed to new viruses in day-to-day life. They are protected by maternal antibodies for first six months of life. After first two years, they will get six to eight upper respiratory tract infections every year till they are six or seven years old. Then the attacks start reducing and drop down to two or less every year as their body matures. However, even in these subgroups some children get more attack than others. Various factors that can cause cold and sore throat are: Congenital:

1. Cold catcher families - There are some families where the infections occur more frequently. This could be due to immune deficiency general or specific.
2. Hereditary diseases - Cystic fibrosis, immotile cilia syndrome and other such diseases can cause recurrent upper and lower respiratory tract infections. Fortunately they are rare.
3. Structural abnormalities - Any abnormality of facial skeleton which causes obstruction to breathing can lead to recurrent infections. Presence of concha bullosa, haller cells and paradoxical curved middle turbinates can cause recurrent colds.

1. Bottle feeding - It is best to breast feed the child. The mother’s milk provides best mix of nutrition, emotional stability and protective chemicals. Bottle fed babies are more prone to infections of lower and upper respiratory tracts. Often the hygiene of bottle fed babies is the hygiene of the Ayah and the cleaning of bottle, nipple etc may not be adequate. Breast feed till six months, solid foods after six months and avoid allergenic food like egg and peanut butter till one year.
2. Bad hygiene - If the child is given bath in infected or dirty water and his nose and face is cleaned by used towels, it can transfer infection from previous user to the child Use of clean water is recommended with use of antiseptic soaps.
3. Polluted environment - If a child is brought up in an overcrowded space or as happens in children of daily wagers where a child is left on the ground on a Hussein bag they often have a discharging nose all the time. This is true of children in ghettoes and urban slums.
4. Cuddling by infected adults - Most adults love children and if they have cold the child can get it from cuddling and kissing. In India we do not dare ask the visitors to avoid lifting and cuddling of child. Culturally we do not want to sound rude. It is in best interest of the child, that those with infections do not transmit it to child.
5. Day care centres - It has been seen that if children or put in day care centres as both parents are working tend to get more colds and ear infections. This is mostly due to transmission from other children as viruses from families may be different to which child has no immunity.
6. Play schools - It is very common in cities that children are bundled of to play schools at two or three year’s age. Their immunological system is not mature enough to fight bacteria and viruses to which they are exposed and hence get recurrent infections of nose and throat.