Eight-year-old Ahmad (not his real name) was a picture of joy, he was going home. No more rashes. No more itch. No more hospital stay. What a relief after a traumatic two weeks which first saw rashes break up, then spread, clump together like hives, and make him itch all over.

Over a period of 11 days, he had been taken to see three doctors but his condition did not improve. Only after his parents decided that he had to see a pediatric specialist that he was diagnosed with Urticaria Rash or commonly called Hives, a condition triggered and worsened by the haze.

After the second day of admission, his condition improved and was discharged the following day. Just when he thought everything was fine, the rashes appeared when he reached home. The air quality as a result of the haze brought the hives back and Ahmad was back in the hospital again.

In the same hospital was six-month old Mei Choo (not her real name), who just three weeks ago developed a cough and the condition worsened even after seeing several doctors. The cough was so bad that she could not take her regular feed of milk. In the hospital, it was detected that she had lung infection and her condition, aggravated by the haze, had developed to Bronchitis and Pneumonia.

Prolonged haze and the accompanying poor air quality have been commonly known to cause respiratory problems but it can be hazardous to those with sensitive skin too. It can rain blows on particularly children who are more susceptible to worsening conditions than adults.

The small particles that cause haze are composed of microscopic solids or liquid droplets that are so small that they can get deep into the lungs and cause serious health problems. When inhaled, they can enter the bloodstream and get absorbed by underlying tissue, potentially interacting with other compounds and substances in the body.

Due to their greater respiratory rate, children breathe a proportionately greater volume of air than adults. As a result, children inhale more pollutants per kg of body weight. Children’s physiological vulnerability to air pollution arises from their narrower airways and the fact that their lungs are still developing. Irritation caused by air pollutants that would produce only a slight response in an adult can result in potentially significant obstruction in the airways of a young child.

Malaysia uses API (Air Pollutant Index) to calculate air quality in the region.  A reading of 0-50 is considered ‘good’, 51- 100 ‘moderate’, 101-200 ‘unhealthy’, 201-300 ‘very unhealthy’. A reading above 300 is ‘hazardous’. API readings take five things into account: ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2) and sulphur dioxide (SO2), and particulate matter with a diameter of less than 10 micron (PM10). PM10 is the dominant pollutant in haze, and this is what is mostly measured to determine the API reading. The naked eye can in general only see particles larger than 40 microns.

How does the haze affect the young?

Exposure to the haze can harm the nose, lungs, and eyes of young children and result in the following signs and symptoms:

  • Dry cough
  • Itchy eyes/ nose
  • Rashes
  • Wheezing
  • Dry/ sore throat
  • Reduced effort tolerance
  • Worsening of underlying medical condition such as asthma, and skin allergies

Considering that children are more susceptible and prone to respiratory and skin discomfort, it is advisable to take the following precautionary measures to protect them from the haze:

  • Stay indoors and reduce outdoor activities as much as possible
  • Take a shower once they are back from exposure to outdoor
  • Keep home clean by mopping the floors to reduce indoor particles
  • Change children’s  beddings more frequently to prevent inhaling particles during sleep
  • Use an air purifier if available preferably one with HEPA filter
  • Drink plenty of water
  • Keep windows and doors closed and keep the air conditioner filters clean
  • Seek medical attention immediately  if symptoms are not improving
  • Adult who smokes should not do it indoors
  • Kids who are on medication should remain compliant to pre-existing medication for their underlying medical condition

Older kids should wear a N95 masks when outdoor and exposed to haze. Children generally do not like to put on masks for a longer period as they find it suffocating. The N95 masks with a small window by the side will be more suitable as they do help to ease the discomfort and feel of suffocation.

The N95 mask is, however, not suitable for younger kids with smaller face because it does not fit perfectly and will not be adequate to offer appropriate protection.

While it is advisable for children to wear a mask outdoor during a haze, NEVER put on a mask on babies and young toddlers as they can restrict the child’s breathing.

In addition to these precautionary measures, parents should always monitor their children’s condition closely particularly those who start to develop respiratory and skin conditions so that they do not worsen as the case of Ahmad and Mei Choo.

In cases where the allergy or rash do not subside or improve after three days, please consult a doctor. And in cases of respiratory problem or where lung infection has developed, also consult a specialist if conditions do not improve especially if the child is not active or the appetite is not better within 48 hours after consumption of medications.

Parents are also advised not to treat symptoms with over the counter medication and antibiotics from pharmacies because the dosage for medications varies according to age group.

Note: Dr Joyce Loo is a Consultant Paediatrician of Manipal Hospitals Klang. This article is courtesy of Manipal Hospitals Klang. The information provided is for educational and communication purposes only.

Hazards Of Haze To Children
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