It’s cold and flu season. It is very likely that at least half of your family will be affected by some sort of cold virus this winter and spring by culprits like Adenovirus, Influenza A or B, and Rhinovirus.
Symptoms can assume a spectrum of severity from one-two days of malaise, minimal upper respiratory symptoms and low grade temperature elevations to 10-21 days of extreme fatigue, debilitating cough, congestion and fevers. Most of the time, we recover uneventfully without much thought or worry. Sometimes, like in 1918 during the Spanish Flu pandemic, 20 million people can die.
During this time of year, pediatricians see 10-15 cases of this per day, and become extremely adept at recognizing those children with simple viral infections and those with potentially life-threatening illnesses. The problem is, infections like Influenza can present with the same symptoms as other, more serious illnesses like encephalitis, meningitis and brain abscess. So how do you, as the parent, learn these tricks to help you realize when to come in and when to keep your child home in bed?
First, pediatricians are parents too, and we understand that sometimes it’s hard to not visit the doctor, especially in our healthcare system where there is no cost to you to come in with the exception of time, decrease in school attendance and dealing with the front gate. We are only human, and our children are our most cherished possessions.
How do pediatric providers help parents overcome this anxiety? One way is through our experience. We see approximately 100 patients per week, 4,000 patients per year. This experience has taught us many things. Allow me to share a few very important medical sayings with you-first, common things happen commonly. The longer I practice medicine, the more I realize this is undeniably true.
Our immune system is one of the most complex systems in the world, and we respond effortlessly to numerous infectious and non-infectious challenges on a daily if not hourly basis. Second, when you hear hoof beats, think of horses, not zebras. This is another challenge for all of us, especially those of us who know just how many bad things are out there. And, the media has scared most of us to death with stories of parents waiting too long and children dying, frightening disease outbreaks with a complete list of symptoms that remarkably match the symptoms our child currently has, and all of the resistant super-bugs lurking in our daycare centers, hospitals and clinics.
So, what is the best way to assess your child in a home setting? First, take a look at your child. What does your gut tell you? What is your first instinct? Make a mental note of this.
Second, work from head to toe and make a list of your child symptoms.
Then, assess things like your child’s urine output and fluid intake. For infants, how many wet diapers in last 24 hours? Older children, how many times have they urinated? Are they still drinking? Did your infant wake-up with a wet diaper? How is his or her appetite? Energy level? I talk often about the three “P’s” in assessing children; are they Playing? Partaking in fluids and food? Peeing and Pooping? In nearly all cases, those children who were doing all of these were rarely seriously ill.
With all of this information, when should you call for an appointment? This one is tough. Remember when I asked you to go with your gut? If your first instinct says “my child doesn’t look right,” call our clinic and speak to a nurse or go to your nearest emergency room. You can always talk to one of our awesome and dedicated nurses, the backbone of our clinic. Often time, you can get expert nurse triage advice and save yourself a trip to the clinic.
Remember to let the nurses know what your gut tells you, what you found for symptoms and your child’s urine output, appetite and energy level. The more information you can tell us, the better we can determine if your child needs to be seen acutely, routinely or emergently at an ER. In general, the following conditions should be seen in an emergency room:
▪ Loss of consciousness;
▪ Headaches with fevers and stiff neck;
▪ Accidental drug ingestion;
▪ Broken bones;
▪ Severe abdominal pain;
▪ Uncontrolled bleeding;
▪ Infants under three months with fever for any reason;
▪ Uncontrolled vomiting; and
▪ Suspected sexual or physical abuse.
This brings us to the next topic-what is the best way to treat a child with a cold? I remember when I was a kid in the 60’s and 70’s, bell-bottoms, Beatles, black and white TV and I had a cold-I received a lot of love, bedrest, and good old fashioned Vicks vapor rub. Believe it or not, for the common cold the American Academy of Pediatrics still recommends these tried and true remedies as they have proven to be the most effective way of reducing the discomfort associated with the common cold.
In fact, when one balances the risk and benefits of these treatments with the modern medicines of today “A cough syrup for every cough,” or a cold medicine with a decongestant/cough suppressant/pain reliever, it becomes vividly clear which treatments we as pediatricians will likely recommend. Elevate the head of the bed, use a vaporizer or humidifier, try Vicks vapor rub and PUSH fluids. Motrin and Tylenol are great for pain and high fevers. Sucrets or Chloraseptic are excellent for sore throats, as are salt water gargles.
Vitamin C and Echinacea have not been shown to be any more effective in shortening the duration of or mitigating the symptoms of the common cold than the above therapies. Benadryl before bed has been shown to be effective in decreasing secretions and therefore coughing, allowing for better sleep.
When does the common cold go bad? In other words, when should you worry? Parents should bring their children in to see us when there is persistent vomiting or diarrhea, poor fluid intake or urine output, significant ear pain, rashes develop or your child is not behaving appropriately. Fevers are not an indication to bring a child in to the clinic. Our bodies increase their core temperatures in an effort to make the body environment inhospitable to the viruses. Unless a child appears uncomfortable, it is a better idea to let the fever do its job than try and fight it. So what’s the best way to reach us?
In today’s ever-connected world, your pediatric clinic is typically a mouse click or phone call away. The nurse advice line 256-9355, Option 1, is a great way to access care either on base or off-base at an urgent care facility. TRICARE Online allows you to book an appointment without having to call the clinic. MiCare messaging allows you to speak with your primary care manager team and obtain information on how best to handle your child’s illness.
Of course, reaching out to the clinic directly and speaking to one of our highly qualified nurses can also put your mind at ease, so don’t be afraid to drop us a telephone consult. We are here to get you through the 2016-17 winter.