特别策划：医聊连线030期
医脉通携手各学科临床医生，解答疾病诊疗「十万个为什么」，为广大患友及家属提供就医指导。
本期 车頔
广东省妇幼保健院儿童保健科 主治医师
本期要点
1. 什么是上呼吸道感染？
2. 什么是下呼吸道感染？
3. 如何判断是否有反复呼吸道感染？
4. 如何有效提升孩子的免疫力？
导语
今年是后疫情时代的第一个冬季，支原体，流感，新冠，呼吸道合胞病毒，腺病毒等等多种病原体组团来袭，多地儿科门诊人满为患。
门诊不少家长都满面愁容的问医生：“最近孩子老生病，一波未平，一波又起的，到底该如何做，才能提高孩子的免疫力呢？”
首先，我们家长需要了解，儿童反复的呼吸道感染并不等于免疫力低下，只有在1年内上呼吸道感染与下呼吸道感染的次数增多，并且超过了一定范围，临床上才会认为存在反复呼吸道感染（RRTIs）。
▍什么是上呼吸道感染？
主要包括鼻、咽、喉部的急性炎症，也是常说的普通感冒，70-80%是由病毒感染引起的，也是2岁以下儿童较为常见的疾病。
▍什么是下呼吸道感染？
是在气管、支气管及肺部等各个部位发生了感染，如急性气管支气管炎、支气管肺炎等等。下呼吸道感染是比上呼吸道感染严重的多的，有需要住院治疗的可能性。
▍什么是反复呼吸道感染？
至于反复呼吸道感染，在临床上也是有标准的，家长们可以参照如下标准来自我判断:
2岁以内，每年上呼吸道感染超过7次，下呼吸道感染（反复气管支气管炎/反复肺炎）超过2次；
2～5岁，每年上呼吸道感染超过6次，下呼吸道感染（反复气管支气管炎/反复肺炎）超过2次；
5岁～14岁，每年上呼吸道感染超过5次，下呼吸道感染（反复气管支气管炎/反复肺炎）超过2次。
况且，后疫情时代也有其特殊性。疫情这3年，大家都非常重视呼吸道疾病的防护，保持社交距离，严格佩戴口罩，停工停学，居家隔离，这有效的降低了全民呼吸道疾病的发生率，但也使得大家体内抵抗病原体的“抗体”水平趋于下降，产生“免疫负债”。一经全面放开，大家的免疫系统都要面临“打怪升级”，来重新提升体内的抗体水平。
▍如何有效提升孩子的免疫力？
可以从以下几个方面入手：
1. 接种疫苗
疫苗接种是预防感染性疾病最经济有效的方式，可以帮助孩子建立完善的免疫屏障。即便不能完全避免某种病原体的感染，也可以减轻疾病感染的严重程度，缩短病程。
如新冠病毒疫苗、流感疫苗、肺炎球菌疫苗，以及新近获批的呼吸道合胞病毒（RSV）疫苗等，家长们都可以结合自身情况，主动为孩子们接种，以预防相应的呼吸道感染性疾病。
2. 均衡的膳食营养
生长发育越好的孩子抵抗疾病的能力越强。孩子的日常饮食需要包括充足的蛋白质，全谷物食物及新鲜的蔬菜水果等。优质的蛋白质是合成抗体的原材料。
平时可以多给孩子烹饪一些色彩丰富，营养均衡的餐点，保证食物的多样性。注意纠正挑食偏食的不良习惯，减少摄入添加糖、饱和脂肪酸和钠含量较高的精加工食品。
3. 规律作息、睡眠充足
睡眠对儿童的成长至关重要。充足的睡眠有助于恢复身体机能，增加免疫力。推荐儿童每天睡眠时间：3月龄及以下每日睡眠时长13～18h，4～12月龄每日睡眠时长12～16h，1～2岁每日睡眠时长11~14 h，3~5 岁每日睡眠时长10~ 13 h。
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4. 适当的户外运动
户外运动可以增强孩子体质，提高孩子对气温变化的适应能力，改善消化吸收，维持孩子良好情绪。无论是步行、骑车、打球、跳绳，还是简单的户外亲子游戏都有效，婴儿可以做婴儿操，爬行等。
5. 保持良好的卫生习惯
如勤洗手，用物品玩具定期消毒，避免到人流密集、空气不流通的地方，减少二手烟的接触，都可以降低呼吸道疾病的发生率。如果孩子有经口舔咬、脏手揉眼睛，挖鼻孔等不良习惯，也要及时纠正。
6. 必要时的药物辅助
当孩子反复发生呼吸道感染，并且影响到生长发育的时候，可以在医生的建议下，进行有针对性的药物调理。
本期专家
车頔医师
广东省妇幼保健院儿童保健科 主治医师
从事儿童保健及儿科的临床，教学，科研工作10余年。广东省儿科住院医师规范化培训基地带教老师，格里菲斯发育评估量表注册评估师。
擅长低体重儿，小于胎龄儿的生长发育监测，早产儿、高危儿，外科术后患儿的临床营养支持。食物过敏疾病的营养管理和脱敏治疗。儿科呼吸及消化常见病及多发病的诊治。
主持中疾控国家妇幼保健中心“母婴营养与健康研究项目”1项，参与国家级及省级科研课题3项。
作为主要研究者之一，参与并管理多项多中心GCP临床试验。
已发表SCI论文数3篇，中文文章十余篇。
问诊可覆盖疾病的整个康复过程，相当于身边有个贴心可靠的家庭医生。针对病情变化，你可多次提问，获得医生循证规范的解答。
参考文献
[1] 儿童反复呼吸道感染临床诊疗路径(2022版).孙金峤.[J].
[2] 李敏, 曹玲.儿童反复呼吸道感染治未病干预指南[J].北京中医药, 2023, 42(11): 1191-1196.
[3] 中华人民共和国国家卫生和计划生育委员会.WST579‑2017 0岁~5岁儿童睡眠卫生指南[S].北京: 国家卫生和计划生育委员会, 2017.
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#191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .85);--weui-FG-HALF: rgba(255, 255, 255, .65);--weui-FG-1: rgba(255, 255, 255, .55);--weui-FG-2: rgba(255, 255, 255, .35);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) .wx-root,body:not(.pages_skin_pc) body{--appmsgExtra-BG: #F7F7F7}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) .wx-root[data-weui-theme=dark],body:not(.pages_skin_pc) body[data-weui-theme=dark]{--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) .wx-root[data-weui-theme=dark],body:not(.pages_skin_pc) body[data-weui-theme=dark]{--appmsgExtra-BG: #121212}}@media screen and (min-width:1024px){body:not(.pages_skin_pc)body:not(.pages_skin_pc){background:var(--weui-BG-2)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root[data-weui-mode=care]:not([data-weui-theme=light]),body:not(.pages_skin_pc) body[data-weui-mode=care]:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .85);--weui-FG-HALF: rgba(255, 255, 255, .65);--weui-FG-1: rgba(255, 255, 255, .55);--weui-FG-2: rgba(255, 255, 255, .35);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root:not([data-weui-theme=light]),body:not(.pages_skin_pc) body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) 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59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--discussInput-BG: rgba(255, 255, 255, .03)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--nickName-FG: #959595}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 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