A Question of Health

For how long must I stay away from my grandchildren to avoid giving them my cold?

The big catch

The big catch

Q. For how long does a cold remain infectious? I am a grandmother with grandchildren aged three and two. Up until now I have been very lucky, having had no colds for the past three years. But I have one now - a rather severe one. I very much enjoy spending one day a week with them, but the last thing I want is to give them my cold. Could you let me know for how long I should stay away?

A. Colds are viral infections, and you are contagious as long as the viruses are present in your nasal secretions. The best estimate is that you can begin passing on a cold about 24 hours before you get symptoms yourself. You remain infectious for about five days from the beginning of your symptoms. These figures are not precise, because different colds are caused be different viruses, and some may hang around longer than others. Most people think that colds are spread through the air, by tiny droplets that get sprayed around when you cough and sneeze. Some research has shown, however, that the easiest way to spread a cold is by touching someone who has a cold. An innocent handshake, or sharing a telephone with someone who has a cold, may be more likely to pass the virus on than coughing without covering your mouth.

Stopping steroids

Q. My brother has been taking steroid tablets for his asthma and nasal polyps for quite a few years. He has had nine operations to sort out the polyps, only for them to return. He has been told that he will have to stop the steroids, which have made his face fill out. He duly stopped them, only to run out of energy on a massive scale. He visited a homeopath, who said she could probably help him, but that he would have to "detox" first for six months. As he has a demanding job, he declined and is now back on steroids. You recently wrote that it is safe to take a steroid nasal spray more or less indefinitely. Is it safe for my brother to continue with his steroids or not?

A. There is a big difference between a steroid nasal spray and steroid tablets. A steroid nasal spray has far fewer side effects than tablets, because the active steroid is sprayed directly on to the lining of the nose. This type of local treatment prevents most of the steroid from getting into the bloodstream, and therefore avoids the potentially harmful side effects of steroids. When someone takes steroid tablets, however, the steroid enters the bloodstream and affects the whole body. The fact that your brother started to develop a "moon face" is a sign that his whole body was receiving a high dose of steroids. This will never happen with a steroid nasal spray that is taken in the recommended dose, even if it is used for many years. Your brother's loss of energy is nothing to do with needing to "detox". It was caused by the inability of his body to adjust to life without steroids. People who have been taking steroid tablets for a long period of time need to stop using them very gradually, to allow the adrenal glands (which are suppressed by the steroids) to resume their ability to produce natural steroids. Before stopping his steroids again, he should discuss a gradual withdrawal regime with his doctors.

Scratching season

Q. Every winter my skin begins to itch. When March arrives, the itch begins to subside, and by the time spring is here it has completely gone. This has been going on for many years, and no one has ever been able to explain why this happens.

A. Itchy skin in the winter is a well-recognised symptom, which carries the exotic name of xerosis or xerotic eczema. In plain English, this means that the skin gets dried out in the winter. When the skin cells get dried out, they begin to curl at the edges. This causes some cracking and sometimes even allows infection to get into the skin. But more commonly, it just makes the skin itchy. There are several reasons why the skin gets drier in the winter. If you live in a centrally heated house, the air will be drier in the winter than in the summer. If you take hot baths with soap or bubble bath, your skin will lose some of its natural moisturising oil. And as people get older, their skin is less able to hang on to moisture. The commonest place for winter itching to occur is on the legs, but it can affect any part of the body.

HAVE YOUR SAY: READERS WRITE

HM, a teacher for 30 years, thinks pushchairs can influence education:

Teachers now see many more children with communication difficulties than in the 1970s and 1980s, partly because pushchairs are forward facing. Parents don't interact with their children so much at home any more, either. This has prompted the Government to make speaking and listening more prominent in the curriculum.

ST from Cheshire chooses which way her baby faces:

Our children (three and 10 months) first preferred facing backwards,then changed their preference to facing forwards. This problem was easy to solve with a Mamas and Papas Travel System pushchair. This consists of a chassis on which you can fix the seat facing either way. I know that many other companies provide similar systems.

Send your questions and suggestions to A Question of Health, 'The Independent', 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions