Managing Children’s Immunity

 Managing Children’s Immunity

The development the human immune system starts early in foetal life and continues its maturation process throughout infancy and early childhood. Because young children’s immune systems are still developing, they are more prone to catching communicable illnesses than older children and adults.

The common cold, for example, is the most cited reason for absence from school or work, and the most common reason people visit the doctor. While an adult who is not in contact with children can expect to suffer through about two or three episodes throughout the year, children and parents are likely to experience significantly more. In fact, young children may catch six to twelve colds a year.[1]

Whilst infections are a normal part of growing up, it is hard for parents to watch their child suffer. It can also lead to frustration and financial stress due to lost work days while staying at home looking after a sick child.

A Look at Common Childhood Infections

Another reason that young children come down with frequent infections is because the viruses and bacteria that cause them spread easily and rapidly from person to person in crowded, closed spaces such as daycare centres, preschools and schools. Common childhood infections include:[2]

Colds and flu

Colds are caused by a large number of viruses and characterised by a sore throat, stuffy or runny nose, watery eyes, mild fever, headache and cough. The symptom profile of flu is similar to that of a cold, but can be more severe, usually has a rapid onset, and can include symptoms such as chills, higher temperatures, aches and pains, and vomiting. Children sick with the flu are recommended bed rest, adequate hydration and fever management.

Both conditions usually resolve by themselves, but symptoms such as; difficulty in breathing or drinking, fever that lasts for more than 2-3 days or comes back after resolving, blue lips or nails, ear ache, or being lethargic or more irritable than usual may require a visit to a healthcare practitioner.


Croup is a viral infection that affects the voice box and the airways, making it hard for the child to breathe. It is most common in toddlers, but can also affect older children. Croup may start off with symptoms similar to a cold, but will progress into a cough that sounds like a seal’s bark. Using a humidifier can help the child breathe easier. Steam treatment may also be helpful.

A doctor should be seen straight away if the child is struggling to catch a breath, cannot speak because of lack of breath, makes a harsh rasping or hoarse sound when breathing (stridor), drools or has trouble swallowing.


Sinusitis is an inflammatory condition affecting the lining of the nose and sinuses. It may be viral or bacterial, or accompany allergies such as hay fever. Children with sinusitis present with nasal discharge, daytime cough, and may complain of symptoms such as pain or tenderness around the eyes, cheekbones or upper teeth and severe headache.

The advice of a healthcare practitioner is required if the child does not feel better after 3-4 days of treatment, has severe pain or develops a sudden high fever.

Strep throat

A common bacterial infection in children and teens, strep throat causes pain in the throat, swollen, tender glands in the neck, headache and fever and may need to be treated with antibiotics.


Pneumonia is an infection of the lungs that often occurs a few days after the onset of a cold. Symptoms may include a cough with shortness of breath, fever, loss of appetite and low energy levels. In more severe cases shaking chills, chest pain and difficulty breathing may be seen. Antibiotics are prescribed if the infection is of bacterial origin.

Ear infections

Otitis media, or middle ear infection, is a very common infection in young children and is often seen secondary to an upper respiratory tract infection. The symptoms – predominantly pain – are due to fluid build up that causes pressure on the eardrum.

Acute otitis media often clears up on its own, but sometimes the fluid can stay in the ear causing trouble hearing. Fluid build up in the ear can also be as a result of allergies.


Impetigo is a bacterial skin infection that is characterised by small blisters that become oozing, yellow and crusty. The lesions often appear on the face, but can be found anywhere on the body.


Commonly known as pinkeye, conjunctivitis is an infection of the white part of the eye and can be caused by viruses, bacteria or chemicals, or may accompany an allergy. Conjunctivitis caused by a bacteria or viruses spreads easily at school or daycare.

Diarrhoea and vomiting

Also frequently encountered during childhood are gastrointestinal infections, characterised by vomiting and/or diarrhoea. These can be caused by many different pathogens, including viruses and bacteria. Most are self-limiting, but it is very important to ensure that the child stays hydrated.

Enhancing a child’s resistance to infections

The best approach in supporting immune function – in children and adults alike – is following a comprehensive plan involving lifestyle, stress management (if applicable), diet, nutritional supplementation and the use of botanical medicines.


  • Avoid exposure to cigarette smoke and environmental toxins.
  • Participate in regular exercise.
  • Maintain a healthy body weight.
  • Ensure adequate sleep – sleep deprivation has consistently been shown to impair different components of immune function.
  • Stress management – it was recently reported that 1-2 children in every Australian classroom are too anxious to enjoy life.[3] What is more, these problems often go unnoticed by parents and teachers.
  • Take steps to avoid infections, such as frequent hand washing.


The health of the immune system is greatly affected by a person’s nutritional status. Factors that reduce immunity include: nutrient deficiencies, excessive sugar consumption and consumption of allergenic foods.[4]

Dietary factors that enhance immune function include all essential nutrients and antioxidants. Thus, consistent with good health, optimal immune function requires a diet that:

  • is rich in fresh fruits and vegetables, grains, seeds and nuts
  • excludes junk foods, excessive amounts of saturated fats and refined sugars
  • has adequate protein
  • has plenty of pure water.

Supplements and Botanical Medicines

Having access to effective natural remedies in the early stages of illness can be a key determinant of how quickly the illness lingers. Proactive use of specific remedies can shorten the duration and potentially reduce the likelihood of the illness developing into something more sinister.

Sambucus nigra (elder)

The use of elder as a medicine dates back to antiquity. In 400 BC, Hippocrates referred to the elder tree as his “medicine chest”; other classical healers, such as Dioscorides and Galen, regarded elder as one of nature’s greatest healing plants.[5] Traditional uses include fever management, colds and flu, chronic nasal catarrh, sinusitis and to increase resistance to illness.[6]

Modern research supports the traditional uses of elder with studies showing antibacterial, antiviral (including against influenza viruses) and immune stimulating effects.[5,7] In vitro activity against the H1N1 virus (swine flu) has also been reported.[8]

Clinical studies have demonstrated a significant reduction in duration and severity of illness:

Patients with three or more flu-like symptoms who started taking an elderberry extract within 24 hours of onset of symptoms reported a significant reduction in symptoms after 48 hours, with 28% being symptom free. This was in stark contrast to the patients in the placebo group in whom the symptoms were either unchanged or worse.[6]

Within two days, 93.3% of elderberry-treated patients experienced a significant improvement in symptoms, and complete resolution was achieved by 90% of the group within two to three days. The placebo group did not experience similar improvement or resolution until day six.[9]

Where treatment was initiated within 48 hours of symptom onset, flu symptoms decreased significantly in the elder-treated group by the third or fourth day versus seven-to-eight days in the placebo group.[6]

Elderberry is often used together with vitamin C and zinc to support the natural process of recuperation.[5]


Quercetin, a naturally occurring flavonoid in a wide variety of fruits and vegetables, has many applications in natural medicine. In relation to infections, its antioxidant, anti-inflammatory, immune modulating and antiviral properties are of great value.

Research suggests multiple mechanisms for the antiviral effects of quercetin. Cell culture studies have shown that quercetin can reduce the infectivity of target cells and block viral replication at an early stage of multiplication for several respiratory viruses, including adenoviruses, coronaviruses, rhinoviruses, respiratory syncytial virus, parainfluenza virus type 3 and SARS.[10]

Vitamin A

Vitamin A plays a fundamental role in immune health. Together with the skin, the mucosal lining of the airways, digestive and genitourinary tracts form our first line of defence against infection. Vitamin A and its metabolites help to maintain the structural and functional integrity of these cells. Moreover, vitamin A plays a central role in the development and differentiation of lymphocytes involved in the immune response.[11]

Vitamin A deficiency impairs normal regeneration of mucosal barriers and it is these changes, together with diminished function of neutrophils, macrophages and natural killer cells, that are presumed accountable for the increased mortality seen in vitamin A-deficient infants and young children in many areas of the world today.[12]

Vitamin A supplementation has been reported efficacious in ameliorating impaired immune function in well-nourished children suffering from vitamin A deficiency.[13]

Vitamin C

Vitamin C, a potent antioxidant, is highly concentrated in leukocytes and is used up rapidly during infection, presumably to prevent oxidative damage. It is thought that reduction of free radicals will prevent DNA damage to immune cells and thereby maintain their functional and structural integrity.[14]

A large review of studies has found that regular vitamin C consumption reduces the duration of common cold episodes in children.[15]

Vitamin D

Vitamin D is a potent immune system modulator. There is considerable evidence that the active form of vitamin D (1,25-dihydroxyvitamin D) has a variety of effects on immune system function, including enhanced innate immunity and inhibition of the development of autoimmunity.[16]

Many of the effects of 1,25-dihydroxyvitamin D are mediated through the vitamin D receptor (a nuclear transcription factor known as VDR). VDR is expressed in several types of immune cells, including monocytes, macrophages, dendritic cells and activated T cells.[17]

In several observational studies, lower 25(OH)D (a pre-hormone to 1,25-dihydroxyvitamin D) serum levels have been associated with increased risk of respiratory infection in adults, children and infants.[18] 25(OH)D deficiency has also been connected to increased severity of acute lower respiratory infection in children.

Vitamin D deficiency and is emerging as major paediatric health issue in both Australia and New Zealand.[19]


Zinc affects multiple aspects of immune function and a clear link has been established between zinc deficiency and an increased susceptibility to infections. Human studies have observed that even a mild zinc deficiency can elicit changes in immune status.[20]

Used prophylactically, supplemental zinc is associated with shorter duration of cold symptoms, decreased severity of symptoms and a reduced incidence of colds in children.[21,22]

Probiotics Approximately 70% of our immune system resides in our gut.[23] Probiotics can be effective as bolstering immunity by boosting the healthy populations of friendly bacteria that regulate important immune defence chemicals, such as secretory IgA.[24]

Taking a broad spectrum probiotic, and/or sacharomyces boulardii can help support immune function and is a simple preventative measure, particularly for children. In fact, one study found that simply taking a probiotic could reduce the number of days off from illness, and a reduction in the spread of respiratory infections in a daycare setting.[25]


Infections account for many days of lost work and school and are one of the leading reasons for visits to the healthcare practitioner. Numerous natural therapeutics exert immune-enhancing and anti-pathogenic properties and therefore support the body’s natural defences against infections. Collectively these therapies are noted to reduce the incidence of infections and shorten duration as well as the severity of symptoms, in children and adults alike.



  1. Cold and flu. Lung Foundation Australia. [Link]
  2. Common childhood infections. American Academy of Paediatrics 2005. [Link]
  3. Anxious kids suffer in silence: professor. Nine News 20 June 2014. [Link]
  4. Murray MT, Pizzorno J. The encyclopaedia of natural medicine, 3rd ed. NY: Simon & Schuster, 2012.
  5. Krawitz C, Mraheil MA, Stein M, et al. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med 2011;11:16. [Full Text]
  6. Engels G, Brinckmann J. European elder. HerbalGram 2013;97:1-7. [Link]
  7. Kinoshita E, Hayashi K, Katayama H, et al. Anti-influenza virus effects of elderberry juice and its fractions. Biosci Biotechnol Biochem 2012;76(9):1633-1638. [Full Text]
  8. Roscheck B Jr, Fink RC, McMichael MD, et al. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry 2009;70(10):1255-1261. [Abstract]
  9. Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms of an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1995;1(4):361-369. [Abstract]
  10. Davis JM, Murphy EA, McClellan JL, et al. Quercetin reduces susceptibility to influenza infection following stressful exercise. Am J Physiol Regul Integr Comp Physiol 2008;295(2):R505-509. [Full Text]
  11. Higdon J. Vitamin A. Micronutrient information center, Linus Pauling Institute 2003. [Link]
  12. Stephensen CB. Vitamin A, infection, and immune function. Annu Rev Nutr 2001;21:167-192. [Abstract]
  13. Lin J, Song F, Yao P, et al. Effect of vitamin A supplementation on immune function of well-nourished children suffering from vitamin A deficiency in China. Eur J Clin Nutr 2008;62(12):1412-1418. [Full Text]
  14. Field CJ, Johnson IR, Schley PD. Nutrients and their role in host resistance to infection. J Leukoc Biol 2002;71(1):16-32. [Full Text]
  15. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2013;1:CD000980. [Link]
  16. Higdon J. Vitamin D. Micronutrient information center, Linus Pauling Institute 2004. [Link]
  17. Drake VJ. Nutrition and immunity. Micronutrient information center, Linus Pauling Institute 2010. [Link]
  18. Sundaram ME, Coleman LA. Vitamin D and influenza. Adv Nutr 2012;3(4):517-525. [Full Text]
  19. Munns C, Zacharin MR, Rodda CP, et al. Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Aust 2006;185(5):268-272. [Abstract]
  20. Roxas M, Jurenk J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev 2007;12(1):25-48. [Abstract]
  21. Kurugöl Z, Akilli M, Bayram N, et al. The prophylactic and therapeutic effectiveness of zinc sulphate on common cold in children. Acta Paediatr 2006;95(10):1175-1181. [Full Text]
  22. Das RR, Singh M. Oral zinc for the common cold. JAMA 2014;311(14):1440-1441. [Full Text]
  23. Vighi G, Marcucci F, Sensi L, et al. Allergy and the Gastrointestinal System. Clin Exp Immunol 2008 Sep;153(1):3-6 [Full Text]
  24. Macpherson A, Slack E. The functional interactions of commensal bacteria with intestinal secretory IgA. Curt Opin Gastroenterol 2007 Nov;23(6):673-8 [Abstract]
  25. Hatakka K, Savilahti E, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ 2001;322:1327 [Full Text]


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Kids snacks

Fritter faces

Makes 10


  • 4 medium zucchini, grated
  • 2/3 cup self-raising flour
  • 2 eggs, lightly beaten
  • 1 1/2 tablespoons roughly chopped fresh basil leaves
  • 250g reduced-fat fresh ricotta cheese, crumbled
  • 2 tablespoons  grapeseed oil
  • 1 small carrot, peeled, grated
  • 1 tablespoon frozen corn kernels
  • 1 small red capsicum, halved lengthways, sliced


  1. Squeeze excess liquid from zucchini. Combine zucchini, flour, egg and basil in a bowl. Add ricotta. Mix until just combined (mixture will appear quite lumpy).
  2. Heat oil in a non-stick frying pan over medium heat. Spoon 1/4 cup batter into pan, spreading slightly with a spatula. Repeat to make 3 rounds. Press carrot into batter to resemble hair, corn for eyes and capsicum for a smile. Cook for 2 to 3 minutes until browned underneath and top just set. Turn. Cook for 1 to 2 minutes or until fritters are cooked through. Transfer to a plate lined with paper towel. Cool. Repeat with remaining batter, carrot, corn and capsicum. Serve.


  • To freeze: Place cooked fritters, in a single layer, in an airtight container between sheets of baking paper. Freeze for up to 2 months. Thaw at room temperature for 30 minutes before serving.

To reheat: Microwave 1 fritter on medium (50%) for 30 seconds to 1 minute or until heated through.

Frozen fruit skewers

You’ll need 4 bamboo skewers.

Ingredients (serves 4)

  • 12 seedless red grapes
  • 2 small oranges, peeled, quartered
  • 8 strawberries, hulled


  1. Thread grapes, orange quarters and strawberries onto skewers.
  2. Wrap each skewer in plastic wrap. Place in a snap-lock or freezer bag. Freeze overnight or until fruit is frozen. Serve.

Fruity fleet

Preparation Time

10 minutes

Ingredients (serves 2)

  • 1/2 cup alfalfa sprouts
  • 1/4 rockmelon
  • 3 thin slices of peeled pineapple
  • 1 thin slice of watermelon
  • 3 slices of unpeeled kiwifruit


  1. Divide alfalfa sprouts between serving plates. Cut rockmelon in half lengthways to make the boats. Scoop out seeds. Place each boat on the alfalfa. Cut pineapple in half and thread each onto a bamboo skewer. Insert the base of 3 skewers along the centre of each boat to make the sails. Cut watermelon into 6 small triangles. Stick onto the top of each skewer to make flags. Cut kiwifruit in half and stack at one end of each boat.

Baked cinnamon ricotta drizzled with honey and berries

Preparation Time

15 – 60 minutes

Cooking Time

40 minutes

Ingredients (serves 4)

  • 300g fresh ricotta
  • 1/4 cup (55g) caster sugar
  • 1 egg, lightly whisked
  • 1/4 cup (60g) natural vanilla yoghurt
  • 1/2 tsp ground cinnamon
  • 1 tsp vanilla-bean paste
  • 150g punnet raspberries
  • 120g punnet blueberries
  • 1 ripe fig, cut into wedges
  • 2 tbs honey


  1. Preheat oven to 160°C. Brush two 1-cup (250ml) dariole moulds with melted butter to lightly grease.
  2. Combine the ricotta and sugar in a medium bowl and stir until smooth. Add the egg, yoghurt, cinnamon and vanilla and stir until well combined. Spoon evenly into prepared moulds and smooth the surface. Place on an oven tray.
  3. Bake in preheated oven for 30-40 minutes or until light golden and just set. Remove from oven. Set aside for 15 minutes before turning out onto a plate to cool completely for 30 minutes.
  4. Place the ricotta on a serving platter. Top with berries and fig wedges and drizzle with honey.