Child, be careful

This is the 4166th article of Da Yi Xiao Hu

We often like to call children the "little sweethearts" of their parents. With the World Cup getting more intense and the winter vacation approaching, parents should not forget to remind their children to pay attention to their little sweethearts.

The proportion of a child's liver in the human body during infancy is much greater than that of an adult's liver in the human body. During this period, the blood storage and blood flow of the liver, the largest "chemical factory" in the human body, are also much higher than those of normal adults. The liver is the largest digestive gland in the human body. In addition to secreting bile to assist digestion, it also needs to store glycogen, vitamins and other essential energy and substances for the human body. At the same time, it also undertakes many complex tasks such as synthesis, biotransformation, metabolism, coagulation, detoxification, and immunity. As an organ that "works more for the capable", the liver does more work and consumes more. It also has a higher need for oxygen and its own oxygen content. Therefore, the liver is an organ that is easily invaded by external factors (especially pathogens) and has abnormal functions. In recent years, the incidence of hepatobiliary diseases in my country has been high, and there is even a trend of increasing year by year.

Infection is the main cause of abnormal liver function in children. The most common pathogen is viral infection, mainly cytomegalovirus. Other common infections include bacterial infection and mycoplasma infection. When it comes to infection, many parents will think of "anti-inflammatory" and "antiviral", etc. Don't be anxious. Blind medication will put a greater burden on the child's liver and kidneys.

At present, Western medicine mainly treats causal treatment and liver protection for children's "sick" liver function. Ribavirin is often used for viral infections in children. When treating respiratory syncytial virus and viral upper respiratory tract infections in infants and young children, a small dose of spray is generally used for external use, and ganciclovir can also be used for viral infections in children. If the child is infected with bacteria, third-generation or fourth-generation cephalosporins are generally used, because this type of cephalosporin has less effect on children's liver and kidney function than other types of antibiotics. When children are infected with mycoplasma, azithromycin granules with higher compliance in children are often used clinically. If a child's liver function is abnormal, timely treatment is required. Unexplained liver function abnormalities require further genetic screening and genetic metabolic disease testing, and even liver puncture tissue biopsy to clarify the cause and treat it.

From the perspective of traditional Chinese medicine , we often hear the saying that "staying up late hurts the liver." "There is indeed a basis for the saying that staying up late hurts the liver." Shen Jian, chief physician of the Department of Pediatrics at Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine, explained, "The Yellow Emperor's Classic of Internal Medicine mentions the theory that 'when a person lies down, blood returns to the liver'. The twelve meridians can correspond to the twelve hours. The Chou time we are talking about is the period from 1 to 3 o'clock in the morning, which happens to be the time when the liver meridian is on duty. If you don't fall asleep at this time, you will have the harm of long-term staying up late, which will damage your essence and blood. In addition, we traditional Chinese medicine believe that 'hair is the rest of blood', and the liver is responsible for storing blood. Combined with the theory that 'eyes receive blood and can see', it can explain why staying up late leads to many problems such as hair loss and dry eyes." In addition, excessive drinking, overeating, greasy diet, and taking medicine indiscriminately will affect the liver, which is even more detrimental to the long-term development of children. For example, the emptiness of the blood sea in women leads to scanty menstruation, which in turn affects conception, and the deficiency of liver and kidney in men affects the essence of the same source, leading to infertility. These behaviors that damage liver yin can also easily lead to hyperactivity of liver yang, causing problems such as dizziness, red eyes, tinnitus, irritability, and anger.

When children feel unwell, smart parents should understand that the use of liver protection drugs should be based on the existence of hepatitis, fatty liver and other problems. If the transaminase value is abnormal, and the liver disease is diagnosed based on medical indications, the child should go to the hospital for standardized treatment instead of self-medication. It is also important to note that some parents still have the wrong understanding that "letting children take Chinese patent medicine to treat diseases and keep fit when they are not sick". "All medicines are three-point poisonous". Whether it is Chinese medicine, Chinese patent medicine or Western medicine, long-term use will have certain toxic side effects. For example, Isatis root granules, children's lung clearing pills, children's lung heat cough oral liquid, children's heat quick clearing oral liquid, children's heat clearing cough oral liquid, children's cold tea, children's cold granules, Qingkailing oral liquid, heat clearing and detoxification oral liquid, cold and fever granules, etc. contain Isatis root, but long-term use of Chinese patent medicines containing Isatis root may damage the kidneys, cause internal bleeding and damage the hematopoietic function. Chaihu is contained in Chinese patent medicines such as Xiao Chaihu Tablets, Xiao Chaihu Granules, Chaihu Oral Liquid, Chaihu Shugan Pills, Xiaoshi Antipyretic Syrup, Ganmao Qingre Granules, and Sinusitis Oral Liquid. Its main ingredient, bupleurum saponin, can cause adrenal hypertrophy and thymus atrophy, reduce the body's immune function, and may also damage the kidneys. Some drugs also use cinnabar in the preparation process. Although the ordinary water temperature for decoction of Chinese medicine cannot convert cinnabar into toxic mercuric sulfide, the current "Chinese Pharmacopoeia" stipulates that the daily dosage of cinnabar is 0.1-0.5 g, which should not be excessive, and should not be taken for a long time in small amounts to avoid the accumulation of heavy metals in the body caused by mercury-containing medicinal materials. Based on the principle that "talking about toxicity without considering the dosage is a hooligan", it is necessary to emphasize again that children need the guidance of specialists when taking medicines. They must not blindly take medicines as a matter of course, and when taking medicines for a certain period of time, they should cooperate with the review of liver and kidney function to achieve early detection.

It is worth noting that the current smoking rate of boys aged 10 to 14 in my country is 1.51%, which is higher than the average level in developed countries. About 180 million children are exposed to secondhand smoke. A 2020 Shanghai survey on the smoking situation of residents aged ≥15 in Minhang District and the current status of media publicity of tobacco hazards information showed that the average awareness rate of tobacco hazards-related knowledge among residents aged ≥15 in Minhang District, Shanghai was 70.83%, and it is also necessary to focus on the personalized formulation of tobacco control publicity methods and adaptive content. At the same time, the liver is also the main organ for metabolizing alcohol, and acetaldehyde among the metabolites of alcohol is the most damaging to the liver. Mild cases damage liver cells and increase liver enzymes. Severe cases cause irreversible damage to liver cells, leading to alcoholic liver disease. Children generally do not take alcohol actively or for a long time, but some medicines or drinks may contain alcohol (ethanol). Children may take them without understanding the ingredients, especially when taken with drugs, which may cause damage to the liver.

Dear parents, in order to take care of your little darlings, you should "drink less, stay up late less, get angry less, watch less electronic products before going to bed, eat more fruits and vegetables, eat less heavy food, exercise more, and take less random medicines" on daily basis.

Author: Yuan Ying, Department of Pediatrics, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Master's student. Research direction: Children's spleen and stomach diseases and endocrine diseases.

Editor-in-chief and tutor of the column: Shen Jian, Department of Pediatrics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, chief physician, doctor of medicine, master's supervisor. National TCM inheritance and innovation talent of the Central Administration. Vice Chairman of the TCM Children's Health Care and Health Committee of the World Federation of Chinese Medicine Societies. Co-founder of the "Da Yi Xiao Hu" medical communication think tank, and editor-in-chief of "Cute Baby Development".