Have your kids ever had a coxsackievirus A16 infection?
Don’t think so?
What about Hand, Foot, and Mouth Disease (HFMD)?
Symptoms of Hand, Foot, and Mouth Disease
Hand, Foot, and Mouth Disease is a very common childhood disease that most of us end up getting at some point, typically before we are about five years old. At least you hope you do, because you don’t want to get it as an adult…
Most people are familiar with the classic symptoms of HFMD, which can include:
a few days of fever, often up to about 102 degrees F
red spots that can turn into blisters on the child’s palms (hand) and soles (foot), but often also on their knees, elbows, and buttocks
sores or ulcers in a child’s mouth which are often painful, causing mouth pain or a sore throat and excessive drooling
a reduced appetite, which can sometimes lead to dehydration
Symptoms which can last up to 7 to 10 days.
Although that’s the end of it for most kids, a few weeks after the other symptoms have gone away, some kids will have peeling of the skin on the child’s fingers and toes. They might even lose their fingernails and toenails (nail shedding). This is only temporary though, and new nails should quickly grow back.
To confuse matters though, like other viral infections, not all kids have classic symptoms when they get HFMD. Some don’t have a fever, while others don’t have the rash on their hands and feet, which can make it easy to confuse with other viral infections that cause mouth ulcers, like herpangina.
Some kids don’t have any symptoms at all, but surprisingly, they can still be contagious.
Facts About Hand, Foot, and Mouth Disease
HFMD is caused by the coxsackievirus A16 virus and a few other enteroviruses, including enterovirus 71 and coxsackievirus A6. Because more than one virus can cause HFMD, it is possible to get it more than once.
Other things to know about HFMD include that:
it is very contagious, especially if you have close contact with nose and throat secretions, fluid from blisters, and feces of someone infected with HFMD, especially during their first week of illness
the incubation period for HFMD, the time when you were exposed to someone to when you develop symptoms, is about 3 to 7 days
people with HFMD disease can continue to be contagious for days or weeks after their symptoms have stopped, although this isn’t a reason to keep them out of school or daycare. In fact, as long as they don’t have fever and feel well, kids with HFMD can likely go to daycare or school.
there is no specific treatment for HFMD, except symptomatic care, including pain relief, fever reducers if necessary, and extra fluids
unlike other viruses which are common in the winter, HFMD season is during the spring, summer, and fall
complications of HFMD disease are rare, but can include viral meningitis, encephalitis, and a polio-like paralysis
HFMD is not the same as foot-and-mouth or hoof-and-mouth disease that affects animals
Most importantly, to avoid getting HFMD, wash your hands after changing your child’s diaper, teach them to cover their coughs and sneezes, and don’t share cups or other personal items.
Although many of us had HFMD when we were kids, remember that there are multiple viruses that can cause it. When outbreaks occur and we see more cases in adults, it is likely because it isn’t being caused not by coxsackievirus A16, but by a less commonly seen enterovirus that we aren’t immune to, like coxsackievirus A6.
By most definitions, a person who is literate is well educated.
So a “Lyme literate” doctor is good thing, right?
What is a Lyme-Literate Doctor?
That you can get Lyme disease after a tick bite is well known by most folks, even if they don’t live in an area with a lot of confirmed cases.
Early symptoms are also well-known, including flu-like symptoms ( fever, chills, headache, fatigue, muscle and joint aches), swollen lymph nodes, and the classic erythma migrans rash.
Later symptoms of Lyme disease, when it isn’t treated right away, can include more rashes, arthritis, heart palpitations or an irregular heart beat, facial palsy, severe headaches and neck stiffness, nerve pain, and problems with short-term memory.
Fortunately, that there are many antibiotic regimens that can effectively treat Lyme disease, including amoxicillin, isn’t a huge secret.
So do you need to see a “Lyme literate” doctor to get diagnosed and treated if you think you have Lyme disease?
That’s actually the last thing you want to do.
The first thing you want to understand is that the term “Lyme literate” doctors is actually kind of ironic. These are not literate doctors, at least not in the sense that they are educated and practice evidence based medicine.
They are often alternative medicine providers who think that you can get Lyme disease anywhere, even if you don’t live in and haven’t traveled to an area with ticks capable of transmitting Lyme disease.
Many also diagnose folks with many different kinds of non-specific symptoms as having Lyme disease, especially because they misuse tests for Lyme disease as screening tests, or simply misinterpret the results. Tests that often lead to false positive results and folks getting misdiagnosed with chronic Lyme disease.
“Once serum antibodies to B. burgdorferi do develop, both IgG and IgM may persist for many years despite adequate treatment and clinical cure of the illness”
Murray et al. on Lyme Disease
They also often think that it is likely that if you have Lyme disease, then you are also likely to have many coinfections, including Bartonella or Mycoplasma. And that the Borrelia burgdorferi bacteria can hide in our bodies, creating persistent infections, even passing through breastmilk or causing congenital Lyme disease.
“You can access a variety of online resources and directories to locate doctors who are specifically trained in identifying and treating tick-borne illnesses. This is particularly important if you suspect that you may have Lyme disease since it is the most frequently misdiagnosed of all tick-borne diseases. Finding a Lyme-literate medical doctor (LLMD)—or a physician who is familiar with the vast range of symptoms that may indicate infection at various stages of the disease, as well as potential coinfections and other complexities—can help ensure that you get the right treatment, right away.”
IGeneX Inc. on How to Find Doctors Who Can Help with Your Tick-Borne Disease
Why does IGeneX Inc. want to help you find a Lyme-literate doctor? Maybe because IGeneX Inc. sells the tests that many Lyme-literate doctors use to diagnose Lyme disease and chronic Lyme disease! Tests that most other doctors don’t recommend doing.
“The controversy is a nice model for many similar controversies: the science doesn’t support the existence of the disease, but a dedicated group of activists, including some scientists and physicians, feel their extensive experiences more than make up for lack of data. What some of us have problems with is not only the lack of data, but also the willingness of people who believe in this to go about trying to prove it in unconventional ways, for example, relying on lab tests that are not validated.”
Lyme disease—who is credible?
Still, not everyone knows about Lyme disease.
And if you don’t mention a history of a tick bite, didn’t notice a tick bite (Lyme ticks are very small), or don’t have the classic erythema migrans rash, then diagnosis might be delayed.
you can prevent Lyme disease by avoiding tick bites and removing ticks as quickly as possible after they bite you, which is why it is important to do use insect repellent and do regular tick checks after spending time outdoors, especially if you were in wooded, overgrown areas or places with tall grass or unmarked trails.
just because you were bitten by a blacklegged tick, it doesn’t mean that you will develop Lyme disease. In general, only 2% of tick bites result in Lyme disease.
in most cases, ticks don’t need to be tested for Lyme disease, after all, even if the tick tested positive, it doesn’t mean that it transmitted the Lyme bacteria during a bite.
Lyme disease isn’t the only tick-borne disease that we are concerned about, so do tick checks even if you aren’t in a Lyme endemic area.
according to the American Lyme Disease Foundation, eight states, including Arizona, Colorado, Idaho, Montana, Nevada, North Dakota, Utah, and Wyoming, don’t have the Ixodes ticks that transmit Lyme disease
And know that in addition to your pediatrician, a pediatric rheumatologist or pediatric infectious disease specialist can help you if you think your child has Lyme disease. Unfortunately, late symptoms of untreated Lyme disease can be serious. That makes early diagnosis and the return of a Lyme disease vaccine important.
What about Lyme-literate doctors who say that they specialize in caring for patients with Lyme disease? Understand that the term “Lyme-literate” is simply a dog whistle for alternative medicine providers and websites who are likely to offer non-evidence based care.
It typically starts in late fall, peaks in mid-to-late winter, and can continue through early spring.
Cold and Flu Season Viruses
It’s important to understand that a lot more is going on, and going around, during flu season than just the flu.
That’s why it is likely more appropriate to think of flu season as just a part of the overall cold and flu season that we see during the late fall to early spring.
During cold and flu season, in addition to the multiple strains of the flu, we see diseases caused by:
respiratory adenovirus – can cause bronchitis, colds, croup, viral pneumonia, pink eye, and diarrhea
Human metapneumovirus (HMPV) – can cause bronchiolitis, colds, and viral pneumonia
Human parainfluenza viruses (HPIVs) – can cause bronchiolitis, bronchitis, colds, croup, or viral pneumonia
rhinovirus – the classic common cold
Respiratory syncytial virus (RSV) – can cause wheezing and bronchiolitis in younger children, but colds in older kids and adults
seasonal coronavirus – can cause colds, bronchitis, and viral pneumonia
norovirus – diarrhea and vomiting
rotavirus – diarrhea and vomiting, was much more common in the pre-vaccine era
That there are so many different respiratory viruses that can cause bronchiolitis, colds, croup, and flu-like illnesses helps explain why some kids get sick so many times during cold and flu season.
It also helps explain why some folks think they might have gotten the flu despite having been vaccinated, especially in a year when the flu vaccine is very effective.
Is It a Cold or the Flu?
So how do you know if you have the flu or one of these flu viruses during cold and flu season?
While the symptoms can be similar, flu symptoms are usually more severe and come on more suddenly.
Can’t you just get a flu test?
While rapid flu tests are fast and easy to do, they are likely not as accurate as you think.
“This variation in ability to detect viruses can result in some people who are infected with the flu having a negative rapid test result. (This situation is called a false negative test result.) Despite a negative rapid test result, your health care provider may diagnose you with flu based on your symptoms and their clinical judgment.”
Can you test for all of the other viruses that are going around during cold and flu season?
The real question is should you.
Like the rapid flu test, many pediatricians can do an RSV test in their office. But like many other viruses, there is no treatment for RSV and the American Academy of Pediatrics actually recommends against routine RSV testing. Whether your child’s test is positive or negative, it is not going to change how he or she is treated.
And the other viruses? Not surprisingly, there are respiratory panels that can test for most or all of these viruses. They also usually include flu and RSV.
The problem with these tests is cost. They are not inexpensive, and again, in most cases, the results aren’t going to change how your pediatrician treats your child.
And they all involve sticking a nasal swab far up your child’s nose…
What About Strep?
While strep throat can occur year round, it does seem to be more common in the winter and spring.
And while you can certainly have two different infections at the same time, such as strep throat and the flu, it is important to remember that the rate of strep throat carriers is fairly high. These are kids who regularly test positive for strep, even though they don’t have an active group A strep infection.
During cold and flu season, if kids routinely get a “strep/flu” combo test, it is possible, or even likely, that many of the positive strep tests are simply catching these carriers.
Remember that a cough, runny nose, hoarse voice, and pink eye are not typical symptoms of strep throat and are more commonly caused by cold viruses. Adenovirus is especially notorious for causing a sore throat, fever, pink eye, runny nose, with swollen lymph nodes = pharyngoconjunctival fever.
Kids who are likely to have strep throat usually have a sore throat, with red and swollen tonsils, and may have swollen lymph nodes, fever, stomach pain, and vomiting, but won’t have typical cold symptoms.
Why does it matter?
Viral causes of a sore throat don’t need antibiotics, while a true strep infection does.
And remember that none of the other cold and flu viruses need antibiotics either, unless your child gets worse and develops a secondary bacterial infection.
What to Know About Cold and Flu Season Viruses
Flu isn’t the only virus that is going around during cold and flu season. Many others can cause flu-like illnesses, croup, bronchiolitis, or just a cold.
When their kids have the flu, one of the first questions most parents have, after all of the ones about how they can get them better as quickly as possible, is how long will they be contagious?
How Long Is the Flu Contagious?
Technically, when you have the flu, you are contagious for about a week after becoming sick.
And you become sick about one to four days after being exposed to someone else with the flu – that’s the incubation period.
“Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.”
CDC on Information for Schools
That’s why the flu spreads so easily and it is hard to control flu outbreaks and epidemics once they begin.
Another reason it spreads so easily is that most people are contagious the day before they even begin to develop flu symptoms!
And again, they then remain contagious for another five to seven days.
When Can You Return to School with the Flu?
Does that mean kids with the flu have to stay home for at least seven days?
Not usually, unless they have a fever for that long, or severe flu symptoms, which is definitely a possibility for some kids with the flu.
“Those who get flu-like symptoms at school should go home and stay home until at least 24 hours after they no longer have a fever or signs of a fever without the use of fever-reducing medicine.”
CDC on Information for Schools
In general, as with many other childhood illnesses, you can return to school or daycare once your child is feeling better and is fever free for at least 24 hours.
Keep in mind that even if they don’t have a fever, if your child still isn’t feeling well and isn’t going to be able to participate in typical activities, then they should probably still stay home.
But Are They Still Contagious?
Many childhood diseases have contagious periods that are far longer than most folks imagine. That’s because we continue to shed viral particles even as we are getting better, and sometimes, even once we no longer have symptoms.
For example, some infants with rotavirus are contagious for up to 10 days and some with RSV are contagious for as long as 4 weeks!
Like the child with flu that doesn’t have a fever, that doesn’t mean that these kids have to stay out of school or daycare for that whole time. But since they are still contagious, it does raise the issue of what to do about non-essential activities.
Should you keep going to playdates after your child had the flu? How about the daycare at church or the gym?
In general, you should probably avoid non-essential activities while your kids are still recovering from an illness, even if they feel better, because they are likely still contagious.
Most parents have the expectation that their own kids won’t be exposed to someone who is sick in these settings.
So you probably don’t want to bring your sick kid to a playdate or birthday party, etc., even if he is already back in school or daycare.
And whether they have a cold or the flu or another illness, teach your kids to decrease their chances of getting sick by washing their hands properly, not sharing drinks (bring a water bottle to school), and properly covering their own coughs and sneezes. They should also learn to avoid putting things in the mouth (fingers or their pencil, etc.) or rubbing their eyes, as that helps germs that could have made their way onto their hands get into their body and make them sick.
What to Know About Staying Home When You Have the Flu
Although your child may be contagious with the flu for up to a week, your child only has to stay home from school or day care until they are feeling better and are fever free for at least 24 hours.
The incubation period or latency period is the amount of time between being exposed to a contagious disease and when you begin developing symptoms.
This is not the same as the contagious period or the time during which your child can get others sick.
Depending on the disease, the incubation period can be just a few hours or can last for several months. Knowing the incubation period for a disease can help you understand if your child is still at risk of getting sick or if he is in the clear — whether he is exposed to someone with strep throat, measles, or the flu.
“The incubation period is the time from exposure to the causative agent until the first symptoms develop and is characteristic for each disease agent.”
It can also help you figure out where and when your child got sick. For example, if your infant develops chickenpox, a vaccine-preventable disease, you can’t blame it on your cousin who doesn’t vaccinate her kids and who was visiting just three days ago. The incubation period for chickenpox is at least 10 to 21 days. So your child who is too young to be vaccinated likely caught chicken pox from someone he was exposed to a few weeks ago.
As we saw in recent outbreaks of Ebola and measles, a diseases incubation period can also help you figure out how long an exposed person needs to stay in quarantine. After all, if they don’t get sick once the incubation period is over, then they likely won’t get sick and can be released from quarantine.
Incubation Periods of Childhood Diseases
The incubation period for some common diseases includes:
Adenovirus – 2 to 14 days, leading to a sore throat, fever, and pink eye
vomiting after exposure to Bacillus cereus, a type of food poisoning – 30 minutes to 6 hours (short incubation period
Clostridium tetani (Tetanus) – 3 to 21 days
Chickenpox – 10 to 21 days
Epstein-Barr Virus Infections (Infectious Mononucleosis) – 30 to 50 days (long incubation period)
E. coli – 10 hours to 6 days (short incubation period)
E. coli O157:H7 – 1 to 8 days
Fifth disease – 4 to 21 days, with the classic ‘slapped cheek’ rash
Group A streptococcal (GAS) infection (strep throat) – 2 to 5 days
Group A streptococcal (GAS) infection (impetigo) – 7 to 10 days
Head lice (time for eggs to hatch) – 7 to 12 days
Herpes (cold sores) – 2 to 14 days
HIV – less than 1 year to over 15 years
Influenza (flu) – 1 to 4 days
Listeria monocytogenes (Listeriosis) – 1 day to 3 weeks, but can be as long as 2 months (long incubation period)
Mycoplasma penumoniae (walking pneumonia) – 1 to 4 weeks
Norovirus ( the ‘cruise ship’ diarrhea virus) – 12 to 48 hours
Pinworms – 1 to 2 months
Rabies – 4 to 6 weeks, but can last years (very long incubation period)
Respiratory Syncytial Virus (RSV) – 2 to 8 days
Rhinovirus (common cold) – 2 to 3 days, but may be up to 7 days
Roseola – about 9 to 10 days, leading to a few days of fever and then the classic rash once the fever breaks
Rotavirus – 1 to 3 days
gastrointestinal symptoms (diarrhea and vomiting) after exposure to Salmonella – 6 to 72 hours
Scabies – 4 to 6 weeks
Staphylococcus aureus – varies
Streptococcus pneumoniae (can cause pneumonia, meningitis, ear infections, and sinus infection, setc.) – 1 to 3 days
Whooping cough (pertussis) – 5 to 21 days
Knowing the incubation period of an illness isn’t always as helpful as it seems, though, as kids often have multiple exposures when kids around them are sick, especially if they are in school or daycare.
Conditions with long incubation periods can also fool you, as you might suspect a recent exposure, but it was really someone your child was around months ago.
Does your child get strep throat so often that you are thinking about getting his tonsils out?
While it is not uncommon for kids to get strep throat a few times a year once they are in school, it is even more common to get viral sore throats.
Strep throat, which can be treated with antibiotics, is caused by the group A Streptococcus (GAS) bacteria. And while a fast or rapid test can help determine if your child has strep throat or a virus, false positive (the test is positive, but the strep bacteria isn’t really making your child sick) results can sometimes confuse the picture.
Understanding Strep Throat
Before you can begin to understand why your child might be getting strep throat over and over again, you first have to understand strep throat and the current guidelines for diagnosing and treating strep.
“Diagnostic studies for GAS pharyngitis are not indicated for children less than 3 years old because acute rheumatic fever is rare in children less than 3 years old and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group.”
Infectious Diseases Society of America Guidelines
Strep throat is most common in children and teens between the ages of 5 and 15 years. While it might be possible for younger and older folks to get strep, especially if someone else in the house is sick with strep throat, since they aren’t considered to be at risk for acute rheumatic fever, it isn’t typically necessary to diagnose or treat them. It may surprise you, but strep throat does go away on its own – the main reason it is treated is so you don’t later develop rheumatic fever.
“Testing for GAS pharyngitis usually is not recommended for children or adults with acute pharyngitis with clinical and epidemiological features that strongly suggest a viral etiology (eg, cough, rhinorrhea, hoarseness, and oral ulcers).”
Infectious Diseases Society of America Guidelines
The classic symptoms of strep throat can include the sudden onset of a sore throat, fever, red and swollen tonsils (tonsillitis), possibly with white patches (exudate) and small, red spots (petechiae) on the roof of the child’s mouth, and tender, swollen lymph glands in their neck.
Kids with strep throat might also have nausea, vomiting, stomach pain, a headache, and a rash (scarlet fever).
Kids with strep throat will not usually have a cough, runny nose, hoarse voice, mouth ulcers, or pink eye with their sore throat. Those are symptoms that suggest a virus is causing the sore throat and they should not usually be tested for strep. This helps to avoid an unnecessary antibiotic prescription if your child tests positive, but really has a virus.
So basically, try to avoid over-testing for strep. But if your child does have strep throat symptoms and has a positive test, get an antibiotic that will clear the strep bacteria and finish all of your child’s prescription.
Avoiding Strep and Other Infections
Can you avoid getting strep?
As with other infections, the best way to avoid strep throat is to teach your kids to:
wash their hands properly
avoid close contact with people that are sick (for strep, that means until they have been on their antibiotic for at least 24 hours)
avoid drinking out of other people’s cups or glasses
consider taking a water bottle to school instead of drinking out of the water fountains
not touch their eyes or put objects (fingers, pencils, clothing, etc.) in their mouth, as that helps germs get in their body
cover their coughs and sneezes to avoid getting others sick
Most importantly, don’t wait until someone is sick in your home or lots of kids are getting sick at school to encourage your kids to avoid getting sick. By then, it will likely be too late.
Is Your Child a Strep Carrier?
If your child continues to get strep, especially if their strep test is always positive, it is likely time to consider that they may be a strep carrier.
“We recommend that clinicians caring for patients with recurrent episodes of pharyngitis associated with laboratory evidence of GAS pharyngitis consider that they may be experiencing >1 episode of bona fide streptococcal pharyngitis at close intervals, but they should also be alert to the possibility that the patient may actually be a chronic pharyngeal GAS carrier who is experiencing repeated viral infections.”
Infectious Diseases Society of America Guidelines
What does it mean to be a strep carrier?
It simply means that the strep bacteria are living or ‘hanging out’ in the back of your child’s throat. While that sounds bad, these strep bacteria aren’t causing any problems. They aren’t making your child sick, causing any symptoms, and don’t even make your child contagious.
“…the recovery of GAS does not establish causality. The tests do not distinguish carriage of GAS in a child with pharyngitis attributable to another cause from an acute infection caused by GAS.”
“Group A Streptococci Among School-Aged Children: Clinical Characteristics and the Carrier State” Pediatrics. 2004 Nov;114(5):1212-9.
The big problem with being a strep carrier is that whenever you have a strep test, these strep carrier bacteria will make the test positive, even if they aren’t what is causing your child’s symptoms.
This is often why people get diagnosed with strep and flu or strep and mono at the same time.
If you still don’t understand strep carriers, consider that if you go to almost any school and test every child, up to 20 to 25% of the kids will test positive for strep, even though they aren’t sick and have no symptoms. They are likely just strep carriers.
“We recommend that GAS carriers do not ordinarily justify efforts to identify them nor do they generally require antimicrobial therapy because GAS carriers are unlikely to spread GAS pharyngitis to their close contacts and are at little or no risk for developing suppurative or nonsuppurative complications (eg, acute rheumatic fever).”
Infectious Diseases Society of America Guidelines
What kind of efforts are they talking about? We sometimes hear about doctors ordering antibody tests, doing rapid strep tests and cultures on kids after they finish their antibiotics, testing everyone who lives in the house, or even testing the family dog.
None of this is usually necessary.
One thing that can be helpful is that if your pediatrician thinks that your child is a strep carrier, then instead of the more typical penicillin or amoxil antibiotics, they might treat your child with a stronger antibiotic, like clindamycin. This can help ‘knock out’ the carrier bacteria.
And then learn to be much more selective about getting strep tests, avoiding them if your child has more classic viral symptoms, like a cough and runny nose.
In addition to the idea of being a chronic carrier, there are other theories about why kids get recurrent strep throat infections, including:
antibiotic resistance – although this is thought to be rare or non-existent when it comes to the GAS bacteria and penicillin, amoxicillin, and cephalosporins. There is some resistance between azithromycin and strep, which is why it should only be prescribed if your child is allergic to the other antibiotics that are used to treat strep throat.
noncompliance – not finishing your antibiotic or not taking it as prescribed
influence of other bacteria – there are theories that other bacteria may be inactivating penicillin or amoxicillin (so you need a stronger antibiotic) or even that other beneficial bacteria help to kill the GAS bacteria, but may be gone if your child is frequently on antibiotics
you are starting antibiotics too quickly – some people think that if you don’t wait a few days and let the body start to fight the strep infection on its own, then it is more likely to come back
Or if your child had true strep throat symptoms, got well quickly after being on an antibiotic, but then got strep (with classic strep symptoms) again quickly, it is possible that it is just a new infection.
“We do not recommend tonsillectomy solely to reduce the frequency of GAS pharyngitis.”
Infectious Diseases Society of America Guidelines
If it is happening over and over again, consider the possibility that your child is a strep carrier and teach him or her how to avoid getting sick as much as possible.
Why not just get your child’s tonsils out? The problem is that many studies have shown that while this might help for a year or so, after that, these kids start getting strep just as much as they did before. So unless your child also has sleep apnea or has had complications of strep infections, like a peritonsillar abscess, you probably shouldn’t rush into a tonsillectomy.
What To Know About Recurrent Strep Throat Infections
Some other fast facts to know include that:
having tonsillitis does not automatically mean that your child has strep. Remember that viruses are an even more common cause of sore throats.
you can’t tell if someone has strep just by looking at their tonsils. Even having pus (white stuff) on their tonsils doesn’t automatically mean strep. Viruses can do that too. That’s why a rapid strep test, with a backup culture for negative tests, is important to make the diagnosis.
throwing out your child’s tooth brush every time they have strep isn’t necessary, after all, you don’t do that after they have other infections, do you? Instead, encourage your kids to routinely rinse their toothbrush after each use and replace it every 3 to 4 months.
Hopefully you have a better understanding of strep throat now.
Sore throat infections, including strep throat, are common, but remember to look for other answers besides just getting your child’s tonsils out if they get strep over and over.
Unfortunately, like most upper respiratory tract infections, the flu is not easy to treat.
What are Flu Symptoms?
While a cold and the flu can have similar symptoms, those symptoms are generally more intense and come on more quickly when you have the flu.
These flu symptoms can include the sudden onset of:
fever and chills
runny nose or stuffy nose
feelings of fatigue
And more rarely, vomiting and diarrhea.
In contrast, cold symptoms come on more gradually and are more likely to include sneezing, stuffy nose, sore throat, and mild to moderate coughing. A cold is also less likely to include a headache, fatigue, chills, or aches. And while either might have fever, it will be more low grade with a cold.
As with other infections, flu symptoms can be very variable. While some people might have a high fever, chills, body aches, constant coughing, and can hardly get out of bed, others might have a low grade fever and much milder symptoms.
That variability also applies to how long the flu symptoms might last. Some people are sick for a good 7 to 10 days, while others start to feel better in just a few days.
Treating Flu Symptoms
Although there aren’t many good treatments for the flu, that variability in flu symptoms makes it hard to even know if any you try really work.
For kids older than 4 to 6 years and adults, you could treat symptoms as necessary, including the use of decongestants and cough suppressants.
And of course, almost everyone might benefit from pain and fever relievers, drinking extra fluids, and rest, etc.
Treating the Flu
In addition to symptomatic flu treatments, there are also antiviral drugs that can actually help treat your flu infection.
These flu medications include oseltamivir (Tamiflu), zanmivir (Relenza), and peramivir (Rapivab). Of these, oral Tamiflu is the most commonly used. It can also be used to prevent the flu if taken before or soon after you are exposed to someone with the flu.
“If liquid Tamiflu is not available and you have capsules that give the right dose (30 mg, 45 mg or 75 mg), you may pull open the Tamiflu capsules and mix the powder with a small amount of sweetened liquid such as regular or sugar-free chocolate syrup. You don’t have to use chocolate syrup but thick, sweet liquids work best at covering up the taste of the medicine.”
FDA – Tamiflu: Consumer Questions and Answers
Unfortunately, these flu drugs are not like antibiotics you might take for a bacterial infection. You don’t take Tamiflu and begin to feel better in day or two. Instead, if you take it within 48 hours of the start of your flu symptoms, you might “shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza.”
At best, you are likely only going to shorten your flu symptoms by less than a day. And considering the possible side effects of these medications and their cost, they are often reserved for high risk patients, including:
children who are less than 2 years old
adults who are at least 65 years old or older
anyone with chronic medical problems, including asthma, diabetes, seizures, muscular dystrophy, morbid obesity, immune system problems, and those receiving long-term aspirin therapy, etc.
pregnant and postpartum women
anyone who is hospitalized with the flu
anyone with severe flu symptoms
That means that most older children and teens who are otherwise healthy, but have the flu, don’t typically need a prescription for Tamiflu. The current recommendations don’t rule out treating these kids though.
“Antiviral treatment also can be considered for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset.”
Antiviral Agents for the Treatment and Chemoprophylaxis of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP)
There is a lot of controversy surrounding the use of Tamiflu and other anti-viral flu medications, with some studies and many experts thinking that they should rarely be used, if ever, stating that they are not as useful as others claim. Others state that while they not perfect, they are all we have, and there is enough evidence to recommend their use.
Treating Hard to Control Flu Symptoms
Instead of learning about treating hard to control flu symptoms, which might require medical attention, it is probably much more important to learn how to recognize these severe flu symptoms that might be hard to control.
Your child’s flu might be getting worse and require quick medical attention if you notice:
fast or hard breathing
complaints of chest pain
that it is hard to wake up your child
irritability to the point that your child is not consolable