Ask The Professional: The Pediatrician


Ask-The-Professional---Guide-to-Cold-and-Flu-Season

Last year during the cold and flu season, Olive got sick – really, really sick.

I would say that out of the winter months, Olive was sick for about 90% of the time. She had gotten a cold first, then before she had fully recovered, she caught the flu. She had a 8 day fever at one time, and it spiked to 105F. It was difficult. We took a long flight to Singapore, and she caught the stomach flu there – and returned and caught another cold. It was miserable – she was losing weight and so uncomfortable, and I was beside myself with worry because she had been sick for so long that I was convinced she had some autoimmune disease that we had not discovered yet.

She was fine….it was just a really, really awful cold season.

As a parent, one of the hardest things about your child being sick is that you don’t have a clear idea on what’s “acceptable”, and what is considered an urgent symptom. I know that I spent many nights worrying about whether I should be taking Olive into urgent care, or just letting her sleep it off. To make things a little better for me this season, I reached out to Olive’s pediatrician, Dr Marinda Tu. I wanted her to put together a little guide for me to read, to make sure I knew what was normal, and what needed further attention. I wanted to share this with you today (and since it’s so in depth, i’ll be splitting it up into two installments) . I hope everyone is prepared for this cold and flu season, and if you’re in doubt, please contact your own pediatrician, like I did.


 

Ask-The-Professional---Marinda-tu

As a pediatrician, one of my main jobs is to reassure parents that their child is going to be OK and that they are doing no harm to their children.  In California, the cold and flu season sets in around January and usually runs through the end of March (although for many, it may seem like there are colds going around all year long).  As a result, I find myself discussing with parents how to get their child to feel more comfortable during this time of illness, and when to watch out for something more serious.  Of course not everything will work for every child, but in general, the average healthy child will recover and get better in time.  It just really seems like forever before they get better because of the poor sleep, grumpiness, decreased appetite and the high likelihood that you, as a parent, will also get sick.

WHEN YOUR CHILD HAS A FEVER:

Fever is the first issue to address.  This usually causes the most stress for parents.  In general, fever can last up to about 72 hours for a typical viral illness.  And yes, even a viral illness can cause high fever up to 104!  I really march out the full 72 hours before I start to worry (it may be a span of over 4 days, say if fever started on Sunday at 2 am).  Sometimes after the 72-96 hours of fever, it may still be there, but much lower grade (under 101) as it is defervescing.  If any child has fever over 102, for over the 96 hour point, he or she should be evaluated.

When children have fevers, especially a high one, most look quite ill and are lethargic.  They have no appetite.  It is important to treat with Ibuprofen of Acetaminophen and with the correct dose for their weight.  Once the fever comes down, the kids feel much better and may even smile and eat a little bit.  It is always important to encourage the liquid intake during these colds and not worry too much about the food intake.  Their appetites will improve once they are feeling better.  Other cooling measures include a tepid bath, thin layers and cool compress to the head.

For infants who are not vaccinated and have a fever (over 100.4 is technically defined as fever) they need to be seen, especially those that are under 30 days old.  As a pediatrician, when the infants are receiving their vaccines, we are less worried about the more serious bacterial infections like meningitis, bacterial sepsis and pneumonias when they have a high fever.

If you can wait to see your pediatrician for high fevers, that is most ideal, as we tend to be more comfortable with fevers and don’t do blood testing or urine tests for all fevers, as opposed to an Urgent Care Clinic.  Make sure your child is comfortable and see your pediatrician the next day.  Of course if it is the weekend and you are really worried, you may have to go to an urgent care of ER, but if you can avoid it at all possible, try to wait it out that 72 hours, especially if your child perks up after the fever reducing medications.

One last note about a rebound fever, which is when the fever comes back again after it has been gone for a few days.  You should take the child to be checked when this occurs for fear of a secondary bacterial infection like an ear infection or pneumonia.  When kids are getting better, we should not see worsening during this recovery time.  If we do, it’s ideal to check the child.

WHEN YOUR CHILD HAS A COUGH & CONGESTION:

Most common colds come with coughing and congestion; not all have fever.  These symptoms can linger for up to 2 weeks!  What we are looking for is that there is improvement in these symptoms as they fade away.  Usually, the cold start with a watery clear runny nose and then the cough sets in.  There may be a sore throat as well, but this sore throat is worse in the morning when they wake up, and improves later in the day.  For the first 3 days, the symptoms will worsen and peak on the 3rd or 4th day.  That is usually when the kids feel the worst.  They also cannot sleep as well because of the coughing and congestion.  After this point, there should be an improvement of symptoms.  The last cough to go is the one before bed and the one when they wake up.  The nasal mucous will thicken and be more yellow or green.  That does not necessarily mean that they have a bacterial infection.

When your child is over 4 years old, you can give over the counter (OTC) medications like Mucinex, Robitussin, Delsym or other cough and cold preparations.  Dosages are usually on the box.  For younger children, I usually just use Benadryl and your pediatrician can let you know the appropriate dosage for Benadryl for your child.  Humidifiers will help at nighttime as well and of course, if the child cannot blow their nose yet, try the nasal saline drops with the bulb suctioning (Note: when over 15-18 months, can’t do this anymore, they are too strong and won’t let you usually so they just have to suffer through.)  There are also homeopathic remedies you can try in infants that are over 12 months because most of them have honey in them (ie: Zarbees).

If we’ve had the cough and cold symptoms for a week and the cough is not improving, (especially if the child is still hacking a lot all day and night), they should be seen.  We also will watch for wheezers or asthmatics who may need breathing treatments.  When the child cannot breathe well or seems to be panting, this definitely warrants a visit to the doctor office.  Babies who are breathing a breath a second and showing their ribs when they breathe need to be seen as well.  Also, during the recovery time (2nd week of cough and congestion), symptoms should be improving and not getting worse.  If you feel your child is worsening, take them in to be evaluated as well.

Lastly, there is a virus called Croup that has a characteristic seal-barky cough that occurs mostly in the nighttime. Usually, cool mist humidifier will help with this type of cough.  There are times though that the child is really bad at night and warrants a trip to the urgent care or ER for oral steroids or breathing treatments as well.


Thanks Dr. Tu!

I’ll be sharing the 2nd installment next week, where she discusses other illnesses and symptoms that we should be watching out for this cold and flu season!

Stay healthy, you guys!

 

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