We have lately seen, children presenting with recurrent viral illnesses ever since the schools have re-opened after the pandemic. We see daily consultations from paranoid parents who are frustrated with recurrent fever episodes in their children. Many blame it on their poor immunity and request us to do something to "boost" up their immunity.
Immune system is complex and comprises of cells, molecules and chemicals that circulate in the blood, line body cavities and traverse through solid organs (brain, liver, lungs etc.) to protect them against anything abnormal. This defense is not only against foreign pathogens, but also against abnormal cell growth in the body(e.g. cancer cells). When a child is born, he hardly has an immune system of his own, he is protected from the environment through good substances that are passed through the placenta in utero and also continuously provided through breastmilk by the mother. As the child grows, so does his immune system. Immune system reaches its maturity by adolescence. Immune system follows a principle of immune memory- once it has encountered and tackled a pathogen, it will remember it for a long time. when the body encounters the same pathogen again, it will mount a much stronger immune response against it and tackle it without causing much damage to the body. This is also the principle behind vaccination.
For the immune system to get stronger, it needs exposure to pathogens. This happens when kids are exposed to different environments like parks, day-care, kindergarten, and schools. Every kid carries a unique microbial flora in his throat and skin and when kids play together, they get exposed to a range of micro-organisms. Some of them are harmless while some of them can cause infections. But all of them are doing one common thing: they are increasing the immune memory of the body against those microbes. During the pandemic, kids were locked down at home with their parents and hardly moved around. They had stopped going to school and there was no physical interaction with their other friends. Therefore, the age-according early exposure to the variety of antigens did not happen. Now that the schools have re-opened, not only the kids are learning new things, even their immune system is gaining "memory" against a variety of antigens. Kids falling sick is a natural by-product of the same.
We are also seeing some children with post Covid-19 hyperinflammatory syndrome called Multisystem Inflammatory Syndrome in Children (MIS-C) wherein fever goes on for many days. While most viral fevers should go away in 5-7 days, this fever continues in spite of multiple antibiotics. Children can have other features resembling Kawasaki disease like rash, redness of eye, redness of mouth and high inflammatory parameters. Some of these children can also have cardiovascular complications as discussed earlier. This condition needs a high index of suspicion and early detection, so as to prevent any major cardiovascular complications.
Coming to the question of immunity boosters; there is absolutely no need for an immunity boost for children. Rather an overactive immune system can cause rheumatological problems in children (as previously discussed). For boosting the immunity of their children, my advice to the parents will be to remember 4 basic needs of a good immune system:
1. Balanced diet comprising of adequate proteins and vitamins.
2. Good sleep of 6-8 hours daily
3. Daily exercise
4. Hand hygiene
If these things are followed, there is no reason why the immunity of any immunocompetent child should be weak. No immunity boosters (as advertised in the market) have any proven role in strengthening of the immune system. Early childhood infections are important for building up your immunity and vaccinations are of utmost importance in preventing life threatening infections later on in life.
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