Tag: dehydration

When to Call Your Pediatrician – COVID-19 Edition

As pediatricians encourage kids with cold symptoms to stay home, it becomes important for parents to know when to call their pediatrician.

Parents should always feel that they can call their pediatrician when their kids are sick, but that call might not get you a quick visit now that we are concerned about COVID-19.

Why not?

Folks realize that this doesn't actually include a test for COVID-19, right? They are just going to tell you that you have the symptoms of COVID-19 after you tell them your symptoms. As we all start using telemedicine visits more and more in the next few weeks and months, you are still best off scheduling a video visit with your own health care provider.
Folks realize that this doesn’t actually include a test for COVID-19, right? They are just going to tell you that you have the symptoms of COVID-19 after you tell them your symptoms. As we all start using telemedicine visits more and more in the next few weeks and months, you are still best off scheduling a video visit with your own health care provider.

Although we don’t think that kids typically develop serious COVID-19 symptoms, they probably do still get sick and can be contagious to others.

That makes it important to keep them home if they have any symptoms of COVID-19, which unfortunately, can mimic most of the other viral infections that kids get.

When to Call Your Pediatrician – COVID-19 Edition

As more and more pediatricians limit who they will be seeing in their offices, it becomes even more important that parents learn to recognize when their kids have mild symptoms that can safely be treated at home and when they might have urgent problems that need medical attention.

Many pediatricians are encouraging patients with fever and respiratory symptoms (URI, cough, runny nose, difficulty breathing) to stay home and are instead providing phone/virtual consultations.
Many pediatricians are encouraging patients with fever and respiratory symptoms (URI, cough, runny nose, difficulty breathing) to stay home and are instead providing phone/virtual consultations.

Fortunately, while many parents have gotten used to running to their pediatrician as soon as their kids have a fever, sore throat, diarrhea, or cough, most of these symptoms are caused by viral infections that go away without treatment.

And parents should understand that their pediatricians are still available! Most of us likely won’t be able to see everyone as quickly and easily as we usually do, but the kids who get triaged to stay at home without being seen will almost certainly be those who don’t need to be seen.

Recognizing the signs of a more serious infection will also help you trust your pediatrician’s judgment on home care so that you don’t rush to an urgent care, where they might not be triaging kids with COVID-19 symptoms and are seeing everyone who comes in.

So how do you know if your child has a mild viral infection or if it is something more serious?

Ultimately, you might need to call your pediatrician, but it might help to know that:

  • fever itself is not a disease and how high a temperature gets doesn’t tell you how sick your child is. Unless you have an infant under 2 months old with a rectal temperature at or above 100.4°F (38°C) – which is always a medical emergency – your otherwise healthy (no chronic medical problems) older child with a fever doesn’t necessarily need treatment or a visit to the doctor, as long as they are drinking and aren’t irritable and aren’t having trouble breathing etc.
  • a sore throat with a runny nose and cough is typically caused by a virus and not strep throat. On the other hand, if your child has the sudden onset of a sore throat and fever, with red and swollen tonsils (tonsillitis), possibly with white patches (exudate) and small, red spots (petechiae) on the roof of their mouth, and tender, swollen lymph glands in their neck, then they might have strep and should have a strep test.
  • the flu, although it can be a life-threatening disease, especially in those who are high risk, typically goes away on its own after 5 to 7 days of fever, runny nose, and cough. Unless they are at high risk for flu complications, kids don’t necessarily need a flu test or Tamiflu, so don’t necessarily need to visit their pediatrician when you think they have the flu.
  • a runny nose, even if it is green or yellow, doesn’t mean that your child has a sinus infection and needs antibiotics, unless the symptoms are lingering for ten or more days or the child has severe symptoms
  • ear pain doesn’t mean that your child has an ear infection and even when your child does, a 2-3 day watching period before starting antibiotics is becoming the standard of care because the great majority of ear infections go away on their own
  • a cough, even if has been lingering for a week or two, doesn’t mean that your child needs antibiotics, as most kids with coughs simply have bronchitis, which will eventually go away
  • diarrhea can be a sign of a food intolerance or an infection, typically a stomach virus. Either way, you can likely treat your child at home, unless your child has high fever and bloody diarrhea or is dehydrated.
  • vomiting, especially when it is accompanied by diarrhea, is also often associated with gastrointestinal infections, and can respond to proper rehydration techniques

Of course, if your child has a chronic disease, like diabetes, asthma, or cystic fibrosis, etc., then even mild symptoms might put them at high risk for serious disease and you shouldn’t hesitate to call your pediatrician any time they get sick.

What are some other “red flag” type things parents should look for? In general, you should seek quick medical attention if your child has viral symptoms and:

  • is truly lethargic, which means that they are hard to wake up and not that they are just sitting on the couch watching Netflix instead of running around the house
  • has vomiting or diarrhea that has led to dehydration – dry mouth, few tears, only urinating a few times a day, etc
  • has vomiting with severe stomach pain
  • is breathing fast and hard, which could be a sign of pneumonia
  • has a fever and a purplish rash
  • is not at all playful or consolable
  • is not eating or drinking anything

On the other hand, even if your child has a fever, runny nose, cough, and sore throat, if they are also sometimes playful and drinking, then you likely have less reason to need an immediate visit to the doctor.

What if it’s COVID-19?

Again, most kids are not at big risk to get severe COVID-19 symptoms, so the main reason to see your pediatrician about COVID-19 would be to get tested to help know if you need to quarantine your child. Unfortunately, as most people are aware, testing is still very limited. Your pediatrician likely does not have the ability to test kids yet.

What about well checks and vaccines and other visits to your pediatrician?For that info, you will have to call your pediatrician.

And see if they are set up to do telemedicine yet.

More on Calling Your Pediatrician – COVID-19 Edition

Treating the Flu and Hard to Control Flu Symptoms

In addition to basic symptomatic care for your child’s flu symptoms, including the fever, cough, and runny nose, etc., Tamiflu can be an option to treat high risk kids with the flu.

It is much easier to prevent the flu with a flu shot than to try and treat the flu after you get sick.
It is much easier to prevent the flu with a flu shot than to try and treat the flu after you get sick.

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
  • dry cough
  • chest discomfort
  • runny nose or stuffy nose
  • sore throat
  • headache
  • body aches
  • 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
  • signs of dehydration because your child won’t drink any fluids
  • that your child is complaining of being dizzy or is feeling lightheaded

You might also need to seek medical attention if your child with the flu was getting better, but then worsens again, with the return of a fever and more severe coughing, etc.

What to Know About Treating the Flu and Flu Symptoms

In addition to basic symptomatic care for your child’s flu symptoms, including the fever, cough, and runny nose, etc., Tamiflu can be an option to treat high risk kids with the flu.

And remember that it is recommended that everyone who is at least six months old should get a yearly flu vaccine.

More Information on Treating Hard to Control Flu Symptoms

Treating Hard to Control RSV

RSV is never really easy to control for infants and toddlers, as there is no treatment or cure, but fortunately, most kids do not have severe symptoms that require hospitalizations.

With a cough, wheezing, and trouble breathing that can linger for weeks, all RSV infections probably seem like they are hard to control, especially since up to 2% of kids, mostly high-risk infants, with RSV require hospitalization.

Still, it’s important to remember that for many kids, RSV is just a cold.

Understanding RSV

Since there is no cure or treatment, it is best to learn to protect your kids from RSV.
Since there is no cure or treatment, it is best to learn to protect your kids from RSV.

The first thing to understand about RSV is that it isn’t a disease.

Instead, RSV, or the respiratory syncytial virus, can cause many different kinds of upper and lower respiratory infections, ranging from the common cold and croup to bronchiolitis and viral pneumonia.

And almost all kids get sick with RSV at some point during the first few years of their life, especially if they are in daycare.

Fortunately, although RSV can cause life-threatening infections, especially in high-risk infants, the great majority of  children get over their symptoms without any special treatments.

And infants who are the most high risk, including premature babies who were born at less than 29 weeks, can get five monthly doses of palivizumab (Synagis) during RSV reason to reduce their chances of getting sick. Infants with hemodynamically significant heart disease or chronic lung disease of prematurity can also get palivizumab.

Treating RSV

Many of the classic treatments for RSV have now fallen out of favor with pediatricians. In fact, the American Academy of Pediatricians now advises against using albuterol breathing treatments, epinephrine, steroids, or chest physiotherapy (CPT) for infants with RSV bronchiolitis.

What’s left?

Not much, except pushing your child to drink and treating cold symptoms as possible.

The AAP even advises against routinely testing kids for RSV. That makes sense, since there is no treatment, kids can sometimes be contagious for 3 to 4 weeks, long after they have returned to daycare without symptoms, and other viruses can cause similar symptoms.

Instead, if your child has symptoms of RSV, especially if she was around someone else with RSV symptoms about two to eight days ago or is simply in daycare during RSV season (usually November to April), then it is safe to assume that your child has RSV.

Also understand that antibiotics have no role in the treatment of uncomplicated RSV infections. RSV is a virus. Antibiotics do not work against viral infections.

Going to Day Care with RSV

Since many kids who get RSV are in day care, the million dollar question often becomes, when can my child with RSV go back to day care?

“Most minor illnesses do not constitute a reason for excluding a child from child care, unless the illness prevents the child from participating in normal activities, as determined by the child care staff, or the illness requires a need for care that is greater than staff can provide.”

AAP Red Book 2015

Although I once had the manager of a day care argue with me that a child needed to test RSV negative before being allowed back into her day care, kids can usually go back, even if they still have cold symptoms, as long as they:

  • don’t have a fever for 24 hours
  • don’t have any trouble breathing
  • are not fussy or irritable

Since these kids will likely be contagious, the AAP recommends that “In child care centers, good hygiene practices should be used by the staff and the children, including frequent and thorough hand washing.”

Treating Hard to Control RSV

If your child has RSV symptoms and isn’t getting better, ask yourself these questions and bring the answers to your pediatrician or seek quick medical attention:

“Some youngsters with bronchiolitis may have to be hospitalized for treatment with oxygen. If your child is unable to drink because of rapid breathing, he may need to receive intravenous fluids.”

American Academy of Pediatrics

  • Do you think your child’s symptoms are hard to control, not because they are getting worse, but rather because they are lingering for several weeks, which can be normal when young kids have RSV?
  • Does your newborn or infant under two or three months have a fever (temperature at or above 100.4F/38C)?
  • Is your child having trouble breathing, such as breathing fast or hard, with chest retractions (chest caving in), nasal flaring, trouble catching his breath, or a non-stop, continuous cough?
  • Do you see any signs that your child isn’t getting enough oxygen, including that “his fingertips and the area around his lips may turn a bluish color?”
  • Is your child dehydrated, with less urine output, dry mouth, or no tears?
  • Does your child have any medical problems that put her at higher risk for a severe RSV infection, including extreme prematurity, having complex heart disease, chronic lung disease of prematurity, or immune system problems?
  • Is your child lethargic, which doesn’t simply mean that he is just playing less, but rather that he is actually hard to wake up and is maybe skipping feedings?

If your child with RSV is getting worse, although there aren’t any special treatments to make the RSV infection go away, supportive care is available to help your child through it, including IV fluids and supplemental oxygen. Those who are most sick sometimes end up on a ventilator to help them breath, and tragically, some infants with RSV die.

What To Know About Treating Hard to Control RSV

RSV is never really easy to control for infants and toddlers, as there is no treatment or cure, but fortunately, most kids do not have severe symptoms that require hospitalizations.

More Information About Treating Hard to Control RSV

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Treating Hard to Control Vomiting and Diarrhea

Even when they don’t linger, it can be frustrating for parents to treat their kids with vomiting and diarrhea. Get the latest treatment recommendations to help you get through these very common infections quickly.

Kids get vomiting and diarrhea for many reasons, but it is most often caused by a stomach virus.

Whatever the cause, even if it is something your child eat or food poisoning, you will want to know how to best manage your child’s symptoms to help them feel better quickly and prevent them from getting dehydrated.

Vomiting and Diarrhea

Although most people associate vomiting and diarrhea with the “stomach flu,” the flu virus doesn’t usually cause vomiting and diarrhea.

Instead, there are a number of other viruses, bacteria, and parasites that do, including:

  • rotavirus – a vaccine-preventable disease
  • norovirus – the “cruise ship virus,” but very common elsewhere too
  • Salmonella, Shigella, E. coli – food poisoning, animals
  • C. diff – associated with recent antibiotic use
  • Cryptosporidium – drinking contaminated water, swimming pools, water parks

If necessary, especially when diarrhea is associated with severe symptoms or is lingering, stool tests can be done to figure out the specific cause. Fortunately, diarrhea and vomiting often goes away on its own fairly quickly and these tests aren’t necessary. What will likely be necessary is keeping your child well hydrated until these symptoms stop.

Treating Vomiting and Diarrhea

For most kids with vomiting and diarrhea, you can:

  • continue breastfeeding on demand
  • continue their normal diet (feed through the diarrhea), including baby formula or milk, if they just have diarrhea and no vomiting or only occasional vomiting, giving extra fluids every time your child has diarrhea (about 3 ounces if your child is under 22 pounds and about 6 ounces if they are over 22 pounds)
  • forget about eating and concentrate on drinking if your child has a lot of vomiting, but start by offering very small amounts of fluid, perhaps starting with a teaspoon (5ml) every 5 or 10 minutes, and then slowly working your way up to a tablespoon (15ml) and than an ounce (30ml) or two over a few hours
  • take a break from drinking for 30 minutes if your child has a set back and begins vomiting again, and restart at 5ml, slowly working your way back up again as tolerated
  • watch closely for signs and symptoms of dehydration, including weight loss, decreased urine output (fewer wet diapers or going to the bathroom less often), no tears, or dry mouth with no saliva or spit, etc.

In general, when talking about fluids, we mean an oral rehydration solution, like Pedialyte. If your older child won’t drink Pedialyte, you can offer something like Gatorade, but keep in mind that sports drinks have more sugar, so can sometimes make diarrhea worse.

But do you really make your child eat and feed through the diarrhea if he doesn’t want to? Of course not. The idea is that you don’t restrict your child’s diet if they want to eat. If they are complaining of a stomach ache, just don’t feel good, or feeding them their regular diet makes the diarrhea or vomiting worse, then move to more bland food.

Treating Hard to Control Vomiting and Diarrhea

What if your child continues to have vomiting and diarrhea?

You should still avoid treating your younger child with over-the-counter remedies to stop diarrhea, including those with loperamine (Imodium) or bismuth subsalicylate (Kaopectate).

A prescription medication, Zofran (ondansetron), might be appropriate for some children with persistent vomiting who are at risk of getting dehydrated.

If your child has persistent vomiting and diarrhea, ask yourself these questions and share the answers with your pediatrician:

  • Does your child have any symptoms that might require immediate medical attention, such as high fever, bloody diarrhea, severe headache, severe abdominal pain, or signs of moderate to severe dehydration?
  • Has your child with chronic diarrhea (diarrhea for more than four weeks) been losing weight, had fever, or regular stomach pains?
  • Does your otherwise well toddler have chronic, watery diarrhea even though no one else has been sick, a possible sign of Toddler’s diarrhea?
  • Do you have any pets or contact with pets that could put your child at risk for a Salmonella infection, including turtles, lizards, snakes, and frogs?
  • Has your child visited a farm or petting zoo, which puts him at risk for a Salmonella or E. coli infection?
  • Did your child recently take an antibiotic, which puts him at risk for a C. diff infection?
  • Has your child been drinking raw milk or other high risk foods?
  • Has your child traveled recently, which puts him at risk for traveler’s diarrhea?
  • Did you put your child on the BRAT diet (bananas, rice, applesauce, and toast) even though they were eager to eat?
    Have you tried giving your child a probiotic?
  • Does your child now only have diarrhea after drinking milk, perhaps a sign of a temporary lactose deficiency?
  • Is your child better, with much less vomiting, but you are just frustrated that the diarrhea hasn’t gone away yet?
  • Is your child better, with much less vomiting, but you are just frustrated that she is still vomiting at least once each day?

While you should certainly call your pediatrician if your child’s symptoms are lingering, remember that almost everything about the idea of the “24 hour stomach flu” you have heard is probably wrong. In addition to the fact that it isn’t caused by the flu virus, the symptoms typically last more than 24 hours, at least in kids. The vomiting may get better in 24 hours, but diarrhea can easily linger for a week or two.

It is also important to keep in mind that most causes of vomiting and diarrhea are very contagious and can easily spread through the whole house if you aren’t careful. Remember to always wash hands, rinse fruits and vegetables, clean and disinfect contaminated surfaces, and don’t share food or drinks, etc. If you just do it when your kids are sick, it will be too late, as many illnesses are contagious even before you show symptoms.

What To Know About Treating Hard to Control Vomiting and Diarrhea

Even when they don’t linger, it can be frustrating for parents to treat their kids with vomiting and diarrhea. Get the latest treatment recommendations to help you get through these very common infections quickly.

More Information On Treating Hard to Control Vomiting and Diarrhea