How to Protect Children With Asthma From Enterovirus D68

by Cora Rivard, N.D.

Many parents are concerned about the current outbreak of Enterovirus 68, particularly those who have children with asthma. While most who are infected suffer nothing worse than mild cold symptoms, a small percentage of children will experience more serious complications. However, there is much we can do as parents towards preventing these complications from happening. As a naturopathic doctor, I am writing this article to help parents use natural medicine strategies effectively to protect their children, with a conscious focus for those with asthma. While I use the following techniques to help guide my own patients, this information should NOT be taken as medical advice for the reader, and should not replace the advice of your trusted family doctor, pediatrician or asthma specialist, who knows your child’s history and needs best. This article focuses on prevention of infection from most respiratory viruses, including those such as Enterovirus 68 (EV-D68):

1. Make sure children with asthma are up to date with immunizations
. While there is no vaccine for this particular virus, there are vaccines for pertussis (DTaP and Tdap), influenza, and pneumococcal vaccines (PSV23), which can help protect a child with asthma from dangerous complications of these illnesses. An interesting note is that certain natural medicine techniques outlined below, particularly vitamin D and probiotics, have been shown in studies to significantly improve a child’s immune response and protection from vaccinations. If possible, it is desirable to get these vaccines during a time of year when colds and flu viruses are generally not as active, as children are more likely to get symptoms of a viral illness in the 2 weeks following an immunization. This also goes for the weeks following any pediatrician visits, because, let’s face it, doctor’s offices are a great place for viruses to mingle! If you need to make appointments to see your child’s doctor, try to get the first appointment slots in the morning, especially on a Monday, to reduce exposure. Fewer sick patients in the hours before your visit means fewer viable viruses on surfaces and fewer sneeze/cough droplets in the air.

2. Have a plan of action for preventing inflammation. Have a discussion with your child’s pediatrician, allergist or pulmonologist about the best way to prepare and dose medication should they become ill. It is important to prevent inflammation in the lungs that can occur with even common viral illnesses, this is key to preventing complications. In addition to rescue medications, I like to recommend botanical medicines that can be used at the first appearance of cold symptoms to soothe airway reactivity and inflammation. A couple examples are: bromelain (taken away from food) and tumeric. (It is recommended to use herbs only under the direction of a professional knowledgeable in their actions, safe use and dosage.) Giving extra vitamin C can also be a good support, 250mg or more per day depending on age.

3. Improved lung fitness. Keep kids active. Regular aerobic activity (to tolerance) during the school months helps kids to improve their tolerance to exercise-induced asthma as well as their tolerance to other triggers. Using game exercises such as blowing through a straw (examples: keeping a feather afloat, or paper ball races across the floor) can also help improve and protect lung function. Ask your pulmonologist for advice on specific exercises that are appropriate for your child’s condition and ability.

4. Vitamins D and A. AAP recommendations are for 400IU per day for children for vitamin D, but I think 600IU is a better recommendation for those 4 and older. The 600IU recommendation level for children aged 1-18 is supported by the Institute of Medicine (IOM), which sets the U.S. government’s official nutrient guidelines. That’s about the equivalent of six glasses of fortified milk. To supplement,  I recommend that my patients use the D3/cholecalciferol form as it is the most easily absorbed. A multivitamin that contains direct vitamin A (not just beta carotene), is also a good choice for helping the mucus membranes to block viral infection. I like cod liver oil for kids; it is the one way to take supplementary vitamin D and A in a natural form. When choosing a cod liver oil, I am very picky due to concerns over heavy metal contaminants in fish. The only two brands I trust for reliable third party screening for contaminants in every batch, and for sourcing fish from the safest ocean areas, is Carlson’s and Nordic Naturals. (Carlson’s can be found in many health food stores, Nordic Naturals can be purchased online, eg. Amazon- Nordic Naturals Actic-D orange or strawberry flavor.) Use half the recommended dose for an adult for a child over the age of 2. Beware: cod liver oil does have a strong taste, and the fishy smell is difficult to remove from clothing in the case of a spill.

5. Zinc: Finding children’s multivitamins that contain enough zinc is challenging. Ideal children’s supplements should contain at least 3-5mg daily, take daily with a meal throughout the cold and flu seasons. Zinc levels are often low in those who have an over-reactive/allergy-prone immune system. This over-reactivity blazes through the body’s zinc stores, which then increases general allergic reactivity, which makes children more prone to becoming infected by viral illnesses- a nasty cycle.

6. Avoid excess sugar: especially when a lot of viruses are circulating. A sugary dessert or snack can interrupt your child’s body’s ability to mount a defense to an infection for hours after a single sweet treat!

7. Sleep. Getting enough sleep is crucial. Stick to your child’s routine and be especially careful about participating in activities that will upset this routine during cold and flu seasons. Poor sleep is one of the biggest risks for getting sick, even if you do everything else right.

8. Combining natural medicines: Probiotics, especially those containing lactobacillus cultures, help protect children with asthma in 2 ways. First, taking probiotics helps to direct the activity of the immune system away from an allergic response, and towards a more viral defense response. Second, it has been shown in studies to protect children and adults from respiratory infections, as well as a host of gastrointestinal infections. These organisms have a syngergistic protection effect when taken with elderberry, a botanical anti-viral. (see #10 for a great elderberry tea recipe.)

9. Wash hands often. Washing with soapy, warm water is always better than hand sanitizers. I recommend that patients use coconut oil as a hand cream/oil in the winter months as it is a fantastic antibacterial, limiting growth even against C. difficile and staph infections. I don’t know how it does against viruses…but worth a shot. Tip: because coconut oil hardens in winter-time room temperatures, try this: liquify a small block of virgin coconut oil in a pan over low heat. Pour into a bowl and whip it with a mixer until light and fluffy. Spoon into a couple of small jars and use throughout the winter. (I also like to add in a little vitamin E oil and vanilla extract before mixing.) Voila! You now have an awesome-smelling, all-natural antimicrobial hand and body cream. Use daily after washing hands or showering.

10. Honey. Kids who take a teaspoon of (real) honey daily enjoy a reduction in incidence and duration of upper respiratory infections. (don’t ever give to children under 1). It also works as a great cough suppressant, and helps to loosen mucus. Tip: add honey to the following recipe for an immune boosting winter Red Tea (with hibiscus and elderberry). Thanks to Maria Noel Groves, clinical herbalist and owner of Wintergreen Botanicals, LLC in Allenstown, NH, for the recipe. And, “A Market” in Manchester has bulk hibiscus and elderberry available for purchase- I called ahead to confirm!

Red Tea
This tart, fruity tea soothes sore throats and helps fend off viral infections.

  • 2 teaspoons hibiscus
  • 1 heaping tsp elderberry
  • 16 ounces boiling water

Steep for five minutes, strain, sweeten with honey and cool.

Another elderberry favorite I have is Sambucus Immune syrup by Nature’s Way: I give my own child one teaspoon daily at the first sign of infection, or whenever we know we’ve been exposed to someone who is sick. Taking it with food makes it easy on the stomach, and it tastes quite good.

11. Children with asthma should avoid swimming in indoor pools while sick, or during high seasons for upper respiratory infections. The chlorine may cause irritation of the lungs. There is also a byproduct formed when chlorine and chemicals in body sweat and urine combine that is especially irritating to the airways of children. Frequent exposure to indoor swimming pools actually increases risk of asthma in children, and worsens symptoms in those who already have it.

*A note about fish oil: while fish oil can be helpful for some patients, I generally don’t recommend taking it without good reason during the fall and winter months. Fish body oil has different properties than cod liver oil; it has inflammation-modulating properties that can be helpful at times, but it can also increase the rate of infection from respiratory viruses. Those inflammatory pathways actually help protect from the initial stages of infection. Cod liver oil does not have this effect, and is instead protective.


Centers for Disease Control and Prevention, Q&A about Enterovirus D68

Recipes For Immune Teas and Winter Health by Maria Noel Groves/Wintergreen Botanicals, from Tea Magazine Jan./Feb. 2013

Micronutrient Chart for Children ages 4-13, Linus Pauling Institute:

Article from the American Academy of Pediatrics website: Many Children have Suboptimal Vitamin D Levels

American College of Allergy, Asthma,and Immunology: Time in Chlorinated Pool Ups Teens’ Asthma Risk

WebMD News: Chlorine in Pools May Cause Breathing Problems


Did you find this article useful? Would you like to see more like it?  If so, please support my work by leaving your feedback and comments below, sharing this article with others, and most importantly, discussing these topics with your friends, your family, your coworkers and your doctors. I know that it is a jungle out there when looking for valid information about natural medicine topics. I have a passion for writing, and I hope to help as many people as possible to better care for themselves and their families with the information presented in these articles.

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