During the last 2 years of COVID19 I had far fewer visits for children in the first 4-5 years, who got far fewer sick with colds, coughs, bronchitis and ear infections.

I was initially surprised by this rarefaction of studio visits, but then I realized why.

The reason was that, as a result of COVID19 and the consequent periodic closure of infant-toddler centers and schools, the young children did not go to school and therefore were not put in a position to be infected by the viruses and bacteria that normally run in school.

In fact, when children begin to go to the nursery or kindergarten and mix with other children (in groups of 10 and more), the chance that one of them will contract a cold and pass it on to the others is a very high possibility. This is because children touch each other and put their hands in their mouths and then through saliva and contact the viruses spin around much easier and faster.

By kindergarten syndrome, therefore, I am referring to the fact that children who go to nursery schools and schools contract diseases much more frequently for the reasons mentioned above.

These upper respiratory tract infections in themselves are not dangerous, but for some children (especially the youngest and most predisposed), there may be complications due to the ons


There is a fairly widespread habit of mistakenly calling bronchitis or “bronchitel1a” any persistent cough with a little phlegm. These are usually symptoms of a trivial upper respiratory tract infection, which is most often destined for spontaneous recovery. It is important to avoid this confusion and learn to recognize the symptoms of bronchitis or pneumonia in order to report them to the pediatrician promptly.

First of all, in these diseases the cough is much more frequent and irritating than usual and is often accompanied by retching that suggests pertussis. The child is then dejected and, if he is old enough to be able to express himself clearly, if he has pneumonia he complains of persistent pain in the chest or in the upper part of the belly. Since in these diseases the air cannot easily penetrate to the pulmonary alveoli, there is usually an obvious difficulty in breathing.

In other words, there is an increase in the frequency and depth of breathing: the child has breathlessness, like an asthmatic. Often, when you bring your ear closer to your mouth or chest, you hear a whistle or gurgling in small bubbles.

The presence of a more or less high fever is not a constant symptom and certainly it is not the most important. Instead, what gives an idea of ​​the severity of these infections is the intensity of the breathlessness and general malaise.

The cure

Treatment of bronchitis and pneumonia essentially consists in the use of an appropriate antibiotic, which is capable of killing the bacterium that causes the infection. To avoid relapses, the treatment should last at least ten days, even if it soon produces a marked improvement within a couple of days and it would therefore be tempting to stop earlier.

It is my habit to administer antibiotics by mouth, as this method is just as effective and certainly less unpleasant than injections, which are often used for no good reason. In addition to the use of antibiotics, it is good to make sure that the child suffering from one of these infections drinks plenty of fluids, so that the secretions can thin and can be expelled more easily.

A humidifier running for a few hours a day helps achieve the same purpose. In short, all in all, bronchitis and pneumonia, diseases that with their name awaken old fears, are treatable with a certain ease thanks to the action of antibiotics. However, when the child affected by one of these infections is in the very first months of life or in any case the breathing difficulty is really serious, hospitalization becomes necessary to cope with the complications that can occur in these circumstances.



When the parent suspects the presence of otitis, it is essential that this hypothesis be verified by the pediatrician with the help of the otoscope (the tool that allows you to look directly at the eardrum). Pressing under the earlobe to see if the baby feels obvious discomfort or pain is not a reliable test and cannot be used for a diagnosis of this disorder.

Consequences and complications of otitis media

I realize that I pay attention to otitis media that may appear disproportionate. However, apart from the very large frequency with which it occurs and which in itself would justify a lot of interest, what makes this disease noteworthy are the practical consequences it can have.

For example, think that every time a little secretion forms in the middle ear, the hearing capacity decreases at least in part and that it is attenuated even more if, as happens in acute otitis, the ear fills with pus. If the phenomenon continues for a long time, as happens in untreated recurrent otitis, there may be a decisive delay in the acquisition of language. Furthermore, a child who does not hear well cannot communicate effectively with peers, which makes his relationship life quite uncomfortable.

Such a situation, neglected for a long time, can affect the development of his personality, no matter if in the end hearing is fully recovered, as happens in most cases. There is also a small percentage of children in whom otitis, if not treated, becomes chronic and can cause permanent damage to the hearing function.

Another reason that makes ear infections worthy of particular attention is the possibility, fortunately rare, that the infection spreads to nearby structures. Thus, the mastoid bone (the small hard protuberance located behind the pinna of the ear) can be attacked by pus and require drainage. This complication, mastoiditis, manifests itself with painful swelling and redness behind the ear. Another complication of otitis media that today, given the use of antibiotics, has become extremely rare is the spread of the infection towards the inside of the skull up to the formation of a brain abscess.


Pinworms are a fairly common infestation of 4-10mm long white worms.

These worms live in the rectum where they eat and multiply, also escaping into the perianal area, where they leave microscopic eggs not visible to the naked eye.

The pinworm infestation causes a lot of itching and the child therefore often scratches himself, picking up the eggs with his hands. Babies, as we know, put their hands in their mouths, touch the hands of other children, allowing these worms to easily transfer to others.

The diagnosis can be made by looking closely at the baby’s skin near the anus or on underwear approximately 2 to 3 hours after falling asleep. “. This system consists in applying a transparent adhesive in the perianal area for a few seconds and then proceeding with the analysis through a microscope.


Work in progress.


This video will help you understand the meaning of the child’s symptoms and reactions:



If your older child has been suffering from constipation for years and always has hard and bulky stools to expel, refrain from using suppositories or enemas. If he has an anal fissure that bleeds from time to time, make him compresses with hot water and baking soda a couple of times a day and then spread some petroleum jelly, letting it go even a little inside the sphincter. This will help the hard stools come out without causing too much pain. 5. In addition, also in this case use malt or lactulose, gradually increasing the quantity until you get the result of softening the stools well. The little one, since you no longer force him to evacuate with the means I mentioned, slowly learns that it is better to evacuate as soon as he feels the urge.



For many of the children affected by this problem that I visited even when they were five or six years old, it was enough for the parents to stop worrying and tormenting them, so that everything would “miraculously” fall into place. If, on the other hand, your child is a teenager who has reached the stage of the boy described at the beginning of this chapter, I am afraid that you will have to resort to the help of a psychologist in order for the situation to be unblocked.

After the age of three we can speak of diarrhea even if the discharges are less than five or six a day, but the stools must be watery and not just a little soft. The child who really has diarrhea often also has a fever and appears “sick”, that is, he loses his usual vitality. Whether the stool is yellow, green or brown is of little importance. The color, in fact, depends on the amount of bile that the stool contains and on how this is modified by intestinal bacteria, which normally varies for physiological reasons.



Work in progress.