Childhood diseases are a significant public health concern in South Africa. Despite modern advances in medicine and healthcare access, child mortality (death) occurs at a high rate, especially in new-borns and children under 5 years old. Many childhood illnesses occur commonly and are relatively easy to treat, while others are rare and difficult to treat. Childhood diseases and disorders can be developmental, usually present at birth, resulting in physical, mental, or emotional/behavioural disability, or they may be acquired, meaning they develop some time after birth. Childhood diseases can be communicable (aka- infectious), meaning they can be passed from one person to another, or non-communicable, meaning they are not contagious and can’t be passed from person to person. Many childhood diseases can be treated with non-medication treatments such as physical aids (glasses, canes, wheelchairs, hearing aids, etc.), physical therapy, occupational, and psychotherapy/cognitive-behavioural therapy. Others may require surgical correction or treatment with medication. Many childhood illnesses are caused by viruses and are self-limiting, meaning they will resolve on their own after a few days or weeks. Other childhood infectious diseases can be treated with anti-infective medications such as antibiotics, antivirals, and antifungals. Some childhood diseases will require long-term medication treatment.
Common childhood developmental disorders include Tourette’s Syndrome, Autism Spectrum disorders, attention-deficit hyperactivity disorder (ADHD), Foetal Alcohol Spectrum disorders, language disorders, learning disorders, hearing loss, and vision loss. Many of these conditions cannot be treated with medication or can be treated effectively without the use of medication. However, there are several medications that are used to help control symptoms in many childhood developmental disorders. They work best when combined with other types of treatments.
Most medications used to treat ADHD are stimulants. They work by acting on chemicals in the brain and help children to focus and ignore distractions to help control their behaviour. Examples include methylphenidate, dexmethylphenidate, amphetamine salts, dextroamphetamine, and lisdexamfetamine. There are also extended-release forms of these medications for easier, once-daily dosing. Other, non-stimulant, medications used in the treatment of ADHD include guanfacine, clonidine, and atomoxetine. Guanfacine and atomoxetine are also often used to help treat Tourette’s Syndrome. Other medications that may be used to help manage symptoms of developmental disorders such as Tourette’s, autism spectrum disorders, learning disorders, and foetal alcohol spectrum disorders include antidepressants and anti-anxiety medications (ex.-sertraline, citalopram, escitalopram, fluvoxamine, fluoxetine, bupropion, trazodone, venlafaxine, duloxetine, mirtazapine, amitriptyline), antipsychotic medications (ex.-chlorpromazine, haloperidol, risperidone, aripiprazole, quetiapine), and mood stabilizers/anti-convulsants (ex.-lithium, valproic acid, carbamazepine, lamotrigine).
Blood disorders often seen in children include haemophilia (inherited “free bleeding”), blood clots, and Thalassemia (an inherited blood disorder of low haemoglobin/red blood cells). Haemophilia is caused by a deficiency in one or more clotting factors in the blood. It is treated with blood transfusions (when blood loss occurs), replacement of clotting factors derived from blood or in a lab, and medications used to help control bleeding/form clots. Examples include desmopressin, emicizumab, and aminocaproic acid. Treatment for thalassemia usually consists of blood transfusions when needed. People who receive frequent blood transfusions may develop too much iron in their blood, which can be treated with medications called iron chelators. Examples include deferasirox and deferoxamine. Thalassemia patients may also receive B-vitamin supplements, such as folic acid.
Medications for the treatment of blood clots are called anticoagulants. These are commonly called “blood thinners,” but don’t actually thin the blood. They decrease the action of clotting factors, making it harder for the blood to form clots. Examples of these medications are heparin, warfarin, and enoxaparin (also called low molecular weight heparin or LMWH). Many children who develop blood clots have a clotting disorder and may need to take these medications long-term to prevent blood clots.
Childhood cancers are treated with chemotherapy medications. These work to destroy cancer cells in various ways such as preventing cancer cells from getting the hormones they need to grow, helping the immune system to fight cancer cells, and changing how cancer cells grow and multiply. The specific type of chemotherapy medication and regimen will be determined by an oncologist (specialized cancer doctor) based on the type and stage of cancer, and other patient-specific factors. Some examples of chemotherapy medications include vincristine, doxorubicin, dactinomycin, pembrolizumab, rituximab, cytarabine, cyclophosphamide, and imatinib mesylate.
Some common and significant viral illnesses that affect children in South Africa include the common cold, influenza/ “flu”, COVID-19, chickenpox, measles, mumps, rubella, and Hand, Foot, and Mouth Disease. Many viral illnesses cannot be treated with antiviral medications and will usually go away on their own. However, some viruses can be very serious and deadly, and treatment with antiviral medications can help lessen the severity of symptoms and the duration of illness. Antiviral medications work by targeting specific parts of the viral life cycle, stopping the virus from reproducing and multiplying in the body. Examples of antiviral medications used for the treatment of influenza include oseltamivir, zanamivir, and peramivir. Examples of antiviral medications used for the treatment of COVID-19 include remdesivir and ritonavir/nirmatrelvir (age 12 and up). An antiviral sometimes used in the treatment of severe cases of chickenpox is acyclovir.
Infections of the ears, throat, and sinuses (air passages behind the nose, forehead, and cheekbones) are common in children. These may be caused by viruses or bacteria. In the case of viral infection, antiviral medications and antibiotics do not help treat the infection, but some over-the-counter medications such as pain/fever relievers (ex.- ibuprofen, acetaminophen), cough suppressants (ex.- dextromethorphan, guaifenesin), and antihistamines (ex.- diphenhydramine, chlorpheniramine, loratadine, cetirizine) can help treat symptoms. Bacterial infections need treatment with antibacterial medications/ “antibiotics.” Antibacterial medications commonly used in children with ear infections, sinus infections, and streptococcal pharyngitis (“strep throat”) include amoxicillin, penicillin, cephalexin, cefdinir, and azithromycin.
Parasites are organisms that live on/in another living creature, including protozoa (Malaria is an example of a disease caused by protozoans passed via mosquito bites), worms, and lice. Parasitic diseases usually require treatment with an antiparasitic medication. Examples of oral medications used to treat parasitic infections in children include ivermectin, chloroquine, hydroxychloroquine, quinine, mefloquine, azithromycin, metronidazole, paromomycin, pentamidine, praziquantel, and albendazole. Topical treatments for parasitic diseases such as lice and scabies include permethrin, lindane, and malathion.
Meningitis is infection/inflammation in the tissues and membranes surrounding the brain and spinal cord. It can be very serious and life-threatening. Meningitis may be caused by viruses or bacteria, and rarely, fungi or parasites. Usually, viral meningitis is milder and self-limiting (will go away on its own after a few days to weeks) and does not require treatment with antiviral medications. Antiviral medications that may be used in severe cases of viral meningitis caused by herpes or influenza include acyclovir, oseltamivir, and peramivir. Bacterial meningitis is a medical emergency that requires treatment with antibiotics/antibacterial medications, usually intravenously (IV) in a hospital. Examples of antibiotics used in the treatment of bacterial meningitis include ceftriaxone, cefotaxime, ampicillin, gentamicin, and vancomycin. In cases of suspected or confirmed fungal meningitis, examples of antifungal medications that may be used include fluconazole, micafungin, and amphotericin B.
Childhood obesity is a growing problem in South Africa. This is largely due to poor access to nutritious food. Being obese or overweight can increase the risk of life-threatening health conditions such as diabetes and heart disease, even in children. While healthy eating and physical activity are the best solutions for weight loss, in severe cases when diet and exercise alone are not effective, medication may be added to the treatment regimen. It is important that medication for weight loss in children is only used under the strict supervision of a doctor. Most of the time, children under age 12 will not receive medication therapy for obesity, but some children aged 8 and above who have other health risks may be candidates for medication. Possible medications that your child may be prescribed for obesity include orlistat, metformin, exenatide, semaglutide, topiramate, lisdexamfetamine, and phentermine (16 and older).
Lung diseases that are common in children in South Africa include pertussis (whooping cough), tuberculosis (TB), pneumonia, and asthma. TB, pertussis, and pneumonia are lung infections that can cause cough, shortness of breath, fever, and weakness/tiredness. Pneumonia can be viral or bacterial while TB and pertussis are caused by bacteria. Asthma is a non-infectious lung disease that can cause wheezing, shortness of breath, and coughing because of airway constriction, usually in response to a trigger such as an allergen or infection. These lung diseases can cause significant respiratory distress and be life-threatening. In fact, pneumonia is a leading cause of death in children under 5.
Medication treatment for asthma depends on the severity of the disease. Mild asthma with occasional attacks can usually be managed with the use of a “rescue inhaler” containing medications called beta-agonists that work by relaxing the airways- albuterol or levalbuterol. Asthma that is more severe with more frequent attacks may be treated with daily use of inhaled corticosteroids that work by decreasing inflammation in the lungs. Examples include fluticasone, budesonide, beclomethasone, mometasone, and triamcinolone. Long-acting beta agonists may also be used to help control asthma symptoms. Examples of these medications include salmeterol and formoterol. There are combination inhalers available that contain both inhaled corticosteroids and long-acting beta agonists. Other medications that are sometimes used in asthma include theophylline, montelukast, and antihistamines (ex.- cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine) to help control allergies that trigger asthma attacks.
Treatment for pertussis, TB, and bacterial pneumonia requires antibacterial medications. Antibiotics used in the treatment of pertussis include azithromycin, clarithromycin, erythromycin, and sulfamethoxazole/trimethoprim. It is important that pertussis is treated early in the course of the disease to prevent progression to severe symptoms. Treatment for tuberculosis is long-term, for 4 to 9 months, depending on the bacterial strain and severity of the disease, and uses 2 or more medications at one time. Medications that may be used for TB treatment include moxifloxacin, isoniazid, rifampin, rifabutin, rifapentine, pyrazinamide, and ethambutol. Antibacterial medications that may be used to treat pneumonia include ampicillin, gentamicin, amoxicillin/clavulanate, azithromycin, clarithromycin, ceftriaxone, cefotaxime, vancomycin, and clindamycin. Viral pneumonia is usually milder and does not require antiviral treatment, but in cases caused by influenza, influenza antivirals may be used.
Diarrhoea is a leading cause of illness and death in children under the age of 5 in South Africa. Deaths usually occur due to dehydration (loss of body water). Most cases of diarrhoea are caused by bacteria or viruses, and rarely, protozoa. Viral diarrhoeal diseases (ex.- Rotavirus, Norovirus) cannot be treated with antiviral medications, but many cases of bacterial diarrhoea can be treated with antibacterial medications to prevent severe illness, dehydration, and death. In all cases of diarrhoea, the child must be given fluid replacement. Breastfed babies should continue breastfeeding when they have diarrhoea. Oral rehydration solutions are available, either already prepared, or in the form of powders that are mixed with water. It is important to make sure that the water is clean, as contaminated water is often a major cause of diarrhoeal illness. In many cases, especially in viral illness, rehydration solutions to prevent dehydration are the only recommended treatment for diarrhoea in children. Routine use of anti-diarrheal medications is not recommended because diarrhoea is the body’s way of getting rid of the pathogen causing the illness. However, in severe cases, an anti-diarrhoeal medication may be used to help prevent severe dehydration. Examples of anti-diarrhoeal medications include loperamide, kaolin pectate, and diphenoxylate/atropine.
Bacterial infections causing diarrhoea (ex.-Shigella, E. coli, Campylobacter, Salmonella) do not always need antibiotic treatment. However, in cases of severe illness or bloody diarrhoea (usually a sign of Shigella infection, which is common in South Africa), antibiotics should be given. Ceftriaxone, azithromycin, ciprofloxacin, and metronidazole
Medication side effects that are common and expected may include nausea, mild diarrhoea, constipation, headache, dizziness, and fatigue/tiredness. Severe side effects include bleeding, allergic reactions, and suicidal thoughts (particularly with antidepressants). Signs of bleeding include unusual bruising, frequent bleeding from the nose and gums, pink, red or brown urine, coughing up blood, blood in vomit (can be bright red, pink, or coffee-ground appearance, and bloody stools (may appear red or black and tarry in appearance). Signs of allergic reaction include rash, hives, swelling, shortness of breath, wheezing, and vomiting. If your child experiences shortness of breath or wheezing, or a combination of allergic reaction symptoms, seek medical help right away.
Many childhood infectious diseases can be prevented with good hygiene measures such as frequent handwashing, masking, avoiding contact with people who are sick, and safe food handling practices. There are also many childhood vaccines available to help prevent illnesses such as measles, mumps, rubella, pertussis, pneumonia, COVID-19, flu, rotavirus, and meningitis. Talk to your child’s physician about what vaccines your child should receive and the appropriate time to get them. It is important that your child has routine check-ups and takes any medications exactly as prescribed. Usually, the best medical care for childhood diseases includes medications, regular medical visits, and other treatments including physical, occupational, and cognitive-behavioural therapy. It is also very important that your child gets plenty of sleep, exercise, and eats a healthy diet.