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Tuesday, December 18, 2012

Oh, what a (sick) season!

photo source: Shutterstock
This cold and flu season has started early and hit hard! The number of kids we are seeing with severe illness, such as prolonged fevers (over 5 days over 101.5F) and difficulty breathing, are not typical for this time of year. On more than one occasion we have tried to admit a sick child, only to be told there are no available beds. While we are familiar with this in January, this started in November and is more common this month. I feel the need to review a few helpful tips.

What are we seeing right now? A bit of everything. Fever. Vomiting. Diarrhea. Strep throat. Influenza (fever, cough, sore throat, body aches). Bronchiolitis (from RSV and other viruses). Pneumonias. Asthma flare ups. Sore throats from viruses. Whooping cough. Mild colds and coughs. Basically, if you ask if it's going around, chances are the answer right now is "yes".

Wash hands and surfaces! First and foremost is control of spreading infection. You never know when someone is shedding a virus before they feel sick. If you are taking care of sick kids, you are at risk of getting sick along with them. Wash hands and surfaces often. Don't share food and drinks, even with your family! Avoid touching the eyes, nose, and mouth. These are where germs enter to make you sick! When's the last time you cleaned your phones and keyboards?

Fever can be a good thing. We worry in infants under 3 months, those who are immune compromised, or those that are not up to date on vaccines ~ they should always have a medical exam with fevers. If a fever lasts longer than 3-5 days kids should also be seen. For everyone else, we treat symptoms, not the thermometer. If a child is playful at 101F, no need to treat other than pushing fluids and watching carefully. Usually by 102F kids start feeling body aches and feel better with treatment. Watch your child's symptoms, don't worry about the actual degree on the thermometer. Use either acetaminophen or ibuprofen, but most pediatricians don't recommend alternating. Follow dosing charts for weight, and if weight is not known, use age. For dosing charts, see our Medication Dosing page.

Stay home if sick. Again, this is paramount for controlling the spread of all the germs. Don't try to mask symptoms with a fever reducer so you can send kids to school or you can go to work. Stay home and rest!

Never underestimate the power of water. If there is vomiting, an electrolyte drink in small volumes frequently is best. For most colds and coughs, simply drink more water. If there is congestion, runny nose, or cough, add water to the air with a vaporizer or humidifier while you sleep. Even if you have a home humidifier, using an additional one in the bedroom helps. Use saline in the nose. Drops are okay for infants. Older children and adults can learn to flush the nose with saline. Check out Nasopure for tips on learning how to do this and videos to see that it's not as bad as it sounds. (I am not associated with or paid by Nasopure. I just like their product.)

Antibiotics don't make viruses go away any faster. Please don't ask for a prescription if cold and cough symptoms just started within the past 10 days. Unless there is an identified infection requiring antibiotics, they won't help. Even some things we often treat with antibiotics don't need them. Many ear infections and sinus infections are viral and will resolve without antibiotics. At your office visit ask about the need for antibiotics if your child has one of these infections.

We cannot make any diagnosis over the phone. As descriptive as you are on the phone, there is no substitute for examining a child. I encourage people to go to their medical home as often as possible and use other urgent care centers or emergency rooms for true urgent/emergent needs. Going to the same office for sick visits helps to track infection rates to identify kids who might need another treatment, such as ear tubes for frequent ear infections. Even if you get good care elsewhere, it is hard to keep track of dates they were sick and which medicines were used. With most pediatricians open extended hours these days, it is usually possible to be seen by someone you know and trust in a familiar setting.

Some illnesses need multiple visits. I know this is time consuming (and expensive with many insurance plans) but illnesses progress, symptoms change, and exams change. Just because your child was seen a day or two ago and it was "just a cold" doesn't mean it won't progress into an ear infection, pneumonia, or dehydration over time. Unless your child is really sick, you don't need to bring them in at the first sign of a runny nose or fever. Try home therapies first. Coming in early doesn't stop the progression of illness. Preventative antibiotics are not recommended, even if your child has a history of frequent ear infections.

We are in the middle of a whooping cough epidemic. Unfortunately whooping cough can mimic mild colds at the beginning, but the cough can last for several months if not treated in the first couple weeks. A small percentage of people who have been vaccinated still develop whooping cough, though it may be milder it is still contagious. If you child has been exposed to whooping cough and develops any cough, visit your doctor for evaluation and treatment. If your child develops a cough that is followed by a whoop or a cough followed by vomiting, he or she should be evaluated for whooping cough. Be sure kids and all care givers are up to date on vaccine. Typical pertussis vaccine is given at 2, 4, 6, and 12-18 months, 4-6 years, and 11 years. If not given at 11-12 years of age, the Tdap should be given to all teens/adults once. Get vaccinated!

Our influenza season has started earlier than usual and is predicted to be a bad season. Flu vaccines are the best prevention against influenza, so yearly vaccination for all over 6 months of age is recommended. We gave more influenza vaccine than ever in our office this season, but we are out of stock. If your family has not been vaccinated, check with your health department and other locations offering flu vaccines.

If you need information on treating specific illnesses, use our tips on Illnesses and Symptoms, but please see someone at your usual physician's office as well if you are concerned.