Fortunately, the recall is limited to just 3 lots of Infants’ Ibuprofen Concentrated Oral Suspension that were made by Tris Pharma, Inc. and sold under the Equate, CVS Health, and Family Wellness brands and sold at Wal-Mart, CVS, and Family Dollar stores.
If you have the recalled Ibuprofen, don’t use it. Contact Tris Pharma for a refund.
And seek medical attention if you think your child got too much Ibuprofen and is having any symptoms, especially nausea, vomiting, epigastric pain, or more rarely, diarrhea.
Fortunately, getting extra Ibuprofen is not usually as dangerous as getting extra Acetaminophen.
Although, of course, neither is good! Be careful when dosing your kids and be sure they need it first.
Oh, and yes, at least in this case, store brand Ibuprofen at Family Dollar and Wal-Mart is the same as store brand Ibuprofen at CVS…
More on Infants’ Ibuprofen Concentrated Oral Suspension Recall
What do you think of when you think of alternative medicine?
“…there’s no such thing as conventional or alternative or complementary or integrative or holistic medicine. There’s only medicine that works and medicine that doesn’t. And the best way to sort it out is by carefully evaluating scientific studies – not by visiting Internet chat rooms, reading magazine articles, or talking to friends.”
Paul Offit, MD on Do You Believe in Magic
Do you think of acupuncture, Ayurveda, homeopathy, Reiki, or reflexology?
And do you wonder if they really work?
Evidence Based Medicine, or No?
Unfortunately, there are many things that parents do for which there is absolutely no evidence that they can actually help their kids.
Some parents are even encouraged to do them by well meaning pediatricians, who may not know the latest evidence about:
exposing jaundiced babies to sunlight – not only does it not work, unless they were in the sun all day long (this is done in some parts of the world, but under tinted windows to block UV and infrared light), it isn’t very practical and the AAP advises against it
changing your child’s toothbrush after they have strep throat – a study has shown it is not necessary
alternating Tylenol and Motrin – it isn’t necessary, promotes fever phobia, and can be dangerous if you mix up the times or dosages
putting kids on a BRAT diet when they have diarrhea – not necessary and doesn’t help kids get better any faster
For other therapies, your pediatrician isn’t likely to recommend them unless they are a so-called integrative or holistic pediatrician.
“Attaching the word “therapy” to the back end of an activity is an attempt to give it a status it may not deserve – and that status is subsequently used to garner insurance coverage, hospital resources, consumer patronage, and research dollars. It is also used to constrain how we think about an intervention – implying that perhaps there is some specific mechanism as work, when none need exist.”
chiropractic care of newborns and infants – understand that chiropractors don’t adjust real dislocations or misalignments in your spine, but instead manipulate what they think are subluxations that block the flow of energy that prevent your body’s innate ability to heal itself from working. Since these subluxations can’t be seen on xray, it makes you wonder why they chiropractors do so many xrays, doesn’t it?
craniosacral therapy (osteopathy) – has to do with tides and rhythms of cerebrospinal fluid, which these practitioners think they can feel and manipulate…
homeopathic “medicines” for teething, colic, gas, and the flu, etc. – do you know what’s in Oscillococcinum, the homeopathic flu medicine? It’s a mix of the pancreatic juice, liver, and heart of a duck, although it is diluted so many times, it is only the memory of those substances that remain in the little pills you take. How does that help treat your flu symptoms?
hypnosis and hypnotherapy for pain, anxiety, and insomnia – hypnosis might work as a distraction technique, but there is no good evidence beyond that
magic socks – please don’t make your kids wear ice-cold socks at night, either with or without first covering them with Vicks VapoRub. It’s as helpful as putting a raw, cut onion in their socks, which your shouldn’t do either…
Have you tried any of these therapies on your kids?
If you have, do you understand that they “work” by way of meridians (acupuncture), the memory of water, like cures like, and law of the minimum dose (homeopathy), energy and spinal fluid tides (craniosacral therapy), manipulating energy fields in your hands or feet (reflexology), and spiritual energy (Reiki)?
What’s the Harm of Trying Alternative Treatments?
But even if you don’t go to a holistic pediatrician that recommends any of these therapies that don’t work, does your pediatrician discourage you from trying them?
If they do, how strongly?
Do they say it isn’t going to work, so don’t do it, or do they use more permissive phrasing?
The American Academy of Pediatrics, for example, tells parents that amber teething necklaces don’t work and pose a risk for strangulation and choking, but then gives advice for “parents who choose to use these necklaces.”
Since they don’t work, why not just tell them to save their money and not use them?
“Rather than getting distracted by alluring rituals and elaborate pseudoscientific explanations for how they work, we should focus on maximizing the non-specific elements of the therapeutic interaction, and adding that to physiological or psychological interventions that have specific efficacy.”
Steven Novella on EMDR and Acupuncture – Selling Non-specific Effects
In addition to kids actually being harmed by many of these alternative therapies and by missing out on real medicine that could have helped them, putting so much focus on these non-evidence based “treatments” is a waste of time and money that could go towards really helping people.
Did you know that just because your younger child is pulling at their ears, it doesn’t automatically mean that they have an ear infection?
It could be teething, an over-tired infant or toddler, or a kid with a cold and their ears are popping because of congestion.
Understanding common, and some not so common symptoms of pediatric diseases can help make sure that your kids get diagnosed and treated quickly.
Symptoms of Classic Pediatric Diseases
Most parents are familiar with the more classic pediatric diseases and the signs and symptoms that accompany them, such as:
Appendicitis – classically, it starts with pain near the belly button, which quickly worsens and moves to the lower right side of your child’s abdomen. Appendicitis is not always classic though
Croup – often starts in the middle of the night with a seal bark cough, heavy breathing that sounds like wheezing, and a hoarse voice
Diabetes – type 1 diabetes is classically associated with polydipsia (drinking a lot), polyuria (frequently urinating large amounts), and weight loss
Ear infection – in addition to ear pain, fussiness, or tugging at their ears, kids with an ear infection will usually have cold symptoms, or at least might have had a recent cold, with a cough and runny nose
Fifth disease – red cheeks that appear to be slapped followed by a pink lacy rash on a child’s arms and legs that can linger for weeks
Hand, foot, and mouth disease – caused by the coxsackievirus A16 virus, kids with HFMD classically have ulcers in their mouth and little red blisters on their hands and feet. They might also have a fever and a rash on their buttocks and legs.
Hives – hives or whelps are raised, red or pink areas on your child’s skin that come and go, moving around over a period of three to four hours and are a sign of an allergic reaction. Unfortunately, unless your child is taking medicine or just eat something, it can be hard to find the allergic trigger. You often don’t need to though, as hives can also just be triggered by viral infections and might not come back.
Impetigo – honey colored crusted areas on your child’s skin that are a sign of a bacterial infection
Ringworm – a fungal infection that can appear on a child’s skin (tinea corporis), feet (tinea pedis), groin (tinea cruris), nails (tinea unguium), or scalp (tinea capitis)
Roseola – another viral infection, this one is caused by human herpesvirus 6 (HHV-6) and 7 and causes a high fever for three or four days, and then, as the fever breaks, your child breaks out in a pinkish rash. The rash starts on their trunk, spreads to their arms and legs, and is gone in a few days.
Swimmer’s ear – the tricky part about recognizing swimmer’s ear is that you can get it anytime you get water in your ear, not just after swimming, leading to pain of the outer ear, especially when you push or tug on it.
Symptoms of Uncommon Pediatric Diseases
Although not necessarily rare, it is often uncommon for the average parent, and some pediatricians, to be familiar with all of the following conditions unless they have already been affected by them.
Why should you know about them?
Some are medical emergencies. Missing them could lead to a delay in seeking treatment.
Others, while they might not be emergencies, often lead parents to seek treatment, but it might not necessarily be the right treatment if someone doesn’t recognize what is truly going on with your child.
Acanthosis nigricans – dark thickened (velvety textured) skin often found on the back of an overweight teen’s neck, and sometimes in their armpits and other skin folds, and which can be a sign of type 2 diabetes
Anaphylaxis – while a severe allergic reaction like anaphylaxis is not easy to miss, getting proper treatment is sometimes difficult. This life-threatening reaction requires an epinephrine injection as soon as possible, something that some parents and even some emergency rooms seem hesitant to do.
Bell’s Palsy – children with Bell’s palsy develop a sudden weakness or paralysis of the muscles of one side of their face. Fortunately, the symptoms usually begin to resolve in a few weeks.
Breath holding spells – a young child having a breath holding spell will actually pass out! While it sounds scary, since they follow a typical pattern, either the child is crying forcibly (cyanotic breath holding spell) or something painful happened suddenly (pallid breath holding spell), and they quickly wake up and are fine, you hopefully won’t panic if you ever see one.
Cat scratch disease – after a bite or scratch from an infected cat or kitten, a child will develop a few lesions at the scratch site, but will also develop enlarged lymph nodes nearby – typically their armpit or neck if they were scratched on the arm.
Cyclic vomiting syndrome – possibly related to migraines, children with cyclic vomiting syndrome have repeated episodes of intense nausea and vomiting, sometimes leading to dehydration, every few weeks or months
Diabetes insipidus – like type 1 diabetes, kids with diabetes insipidus urinate a lot and drink a lot, but it has nothing to do with their blood sugar. It can follow a head injury or problem with their kidneys.
Encopresis – kids with encopresis have soiling accidents, sometimes leading parents to think that they have diarrhea. Instead, they are severely constipated and have small amounts of liquidy stool involuntarily leaking into their underwear after getting passed large amounts of impacted stool.
Erythema multiforme minor – triggered by infections and sometimes medications, kids with EM have a rash that looks like hives, but instead of going away, they just keep getting more spots, some of which look like target lesions. The severe form of EM, erythema multiforme major is fortunately rare.
Geographic tongue – a curiosity more than a condition, children with geographic tongue have bald areas on their tongue where the papilla have been lost (temporarily). The name comes from the fact that the shapes of the bald areas vary in size and shape and they move around. They are not painful, although parents typically don’t notice them until they look in their child’s mouth when they complain of a sore throat or other problem.
Henoch-Schonlein Purpura (HSP) – episodes of HSP typically follow an upper respiratory tract infection, when kids develop a rash (palpable pururpa), stomach aches, arthritis (joint swelling and pain), and more rarely, kidney problems. The rash is distinctive – red dots (petechiae) and a hive-like rash that looks like bruises.
Hemolytic Uremic Syndrome (HUS) – follows a diarrheal illness with E. coli, in which toxin from the bacteria causes bleeding (from low platelets) and anemia (destruction of red blood cells) and can lead to kidney damage.
Intussusception – colicky abdominal pain (severe pain that comes and goes) and loose stools that are filled with blood and mucous (red currant jelly stools) in young kids, typically between the ages of three months and three years
Kawasaki disease – it is important to recognize when a child might have Kawasaki disease, because early treatment might help prevent serious heart complications from developing. The initial signs and symptoms of Kawasaki disease can include a prolonged fever (more than five days), swollen lymph glands, pink eye (without discharge), rash, strawberry tongue, irritability, swelling of hands and feet, red and cracked lips, and as the fever goes away, skin peeling.
Nephrotic syndrome – kids with nephrotic syndrome have swelling (edema), around their eyes, on their legs, and even their belly. All of the swelling causes them to quickly gain weight. Because, at first, the swelling is worse in the morning and gets better as your child is up and about, it might be mistaken for other things that cause swelling, like eye allergies. Nephrotic syndrome won’t get better with eye drops though.
Night terrors – most common in preschoolers and younger school age children, kids with night terrors ‘wake up’ in the early part of the night screaming and are confused and impossible to console, because they are really still asleep. The episodes are not remembered the next morning and are often triggered when kids are off their schedule or under extra stress.
Nursemaid’s elbow – you are walking with your toddler and all of a sudden he gets mad, drops to the ground while you are holding his hand, and then he refuses to move his arm or bend his elbow. Did you break his arm? It’s probably a radial head subluxation, which your pediatrician can usually easily reduce.
Obstructive sleep apnea – although many kids might snore normally, with obstructive sleep apnea, the snoring will be loud, with pauses, gasps, and snorts that might wake your child up or at least disturb their sleep.
PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections is characterized by OCD and/or tics that appear or suddenly worsen after a strep infection.
Peritonsillar abscess – a complication of tonsillitis, it can cause fever, severe throat pain, drooling, a muffled voice (hot potato voice), and swelling on the side of one tonsil, pushing the uvula towards the other side
Pica – while many younger kids put things in their mouth, kids with pica crave and eat all of those non-food things. Since it can be a sign of iron-deficiency, talk to your pediatrician if you think that your child might have pica.
Pityriasis rosea – kids with pityriasis rosea have a rash that starts with a herald patch (looks like a ringworm) and is then followed by a lot of small, oval shaped red or pink patches with scale on their trunk. The rash, which may be a little itchy, can last for up to 6-12 weeks.
POTS – teens with Postural Orthostatic Tachycardia Syndrome have dizziness, fatigue, headaches, nausea, difficulty concentrating and other symptoms related to alterations or dysfunction in the autonomic nervous system (dysautonomia).
Pyloric stenosis – since so many infants spit up, it is not uncommon for the parents and pediatricians to sometimes delay thinking about pyloric stenosis when a baby has it. Unlike reflux or a stomach virus, with pyloric stenosis, because their pylorus muscle becomes enlarged, no food or liquid is able to leave their stomach and they eventually have projectile vomiting of everything they try to eat or drink. It is most common in babies who are about three to five weeks old.
Scalded skin syndrome – unlike typical bacterial skin infections, with scalded skin syndrome, exotoxins that certain Staphylococcus aureus bacteria cause the skin to blister and appear burned, with eventual skin peeling
Stevens-Johnson Syndrome – a rare skin reaction that can be triggered by medications, beginning with flu like symptoms, but then progressing to a blistering rash that includes their mouth and eyes.
Testicular torsion – if one of the testicles twists around the spermatic cord, it can cut off blood flow and quickly lead to permanent damage. Sudden, severe pain and swelling often make it easy to recognize this medical emergency, but sometimes the pain comes on more slowly or the pain is dismissed as happening from trauma, epididymitis, or torsion of the appendix testis.
Toxic synovitis – typically following a viral infection, kids with toxic synovitis have hip pain and limping for a few days, but otherwise seem well, without high fever or other symptoms
Vocal cord dysfunction – often misdiagnosed as asthma, especially exercise induced asthma, and other things, kids with vocal cord dysfunction often have episodes of repeated shortness of breath, chest tightness, wheezing, and coughing – just like asthma. They don’t improve though, even as more asthma medicines are added, which should be a red flag that they don’t have asthma and could have vocal cord dysfunction instead.
Volvulus – a volvulus occurs when the intestines twists on itself, cutting off blood blow. In addition to severe abdominal pain, these kids often having vomiting – typically of a green, bile looking material (bilious vomiting). Green vomitus can also be a sign of other intestinal obstructions, but all would be a medical emergency.
Is knowing about these conditions always helpful?
No, especially if you don’t know what a ‘seal bark’ or ‘hot potato voice’ sounds like or what ‘red currant jelly’ looks like, but it likely shouldn’t hurt to get a little more educated about the diseases that could be causing your child’s symptoms.
What to Know About Recognizing Symptoms of Pediatric Disease
Having the internet and access to Google doesn’t make you a doctor. Get real medical advice if you think that your child is sick and has symptoms that have you concerned. It does help to know which symptoms to be concerned about though.
That’s usually what comes to mind when people find a tick on their child or if they simply think about tick-borne diseases.
It is important to know that there are many other diseases that can be caused by many different types of ticks though, from anaplasmosis to tularemia. And since these ticks and the diseases they transmit are fairly regional, it is easy to be unfamiliar with them if you don’t live in their specific habitats.
That can especially be a problem if, for example, you are from Hawaii, where tick-borne diseases aren’t a big issue, and you travel for a camping trip to Oklahoma and your child is bitten by a tick. Will you or your doctor know what to do if your child develops symptoms of Rocky Mountain spotted fever?
How To Remove a Tick
Fortunately, if you find a tick on your child, you can decrease their chance of getting sick if you remove it quickly. That makes doing daily full body tick checks important.
At least 36 hours.
“Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.”
CDC on Preventing Tick Bites
After removing the tick, wash the bite area and your hands with soap and water and observe your child over the next few weeks for symptoms of a tick-borne disease.
Symptoms of a Tick Bite
Although some of the symptoms of tick-borne diseases are specific to the tick that bit your child, some other symptoms are common to all of them, including:
muscle aches and joint pains
Like spider bites, tick bites are usually painless. That often leads to a delay in actually figuring out that a tick has bitten your child, which makes it important to do frequent tick checks if they are doing anything that could expose them to ticks.
Many people are also surprised at how many different diseases can be transmitted by ticks, including:
Anaplasmosis – transmitted by the black-legged tick (northeast and upper midwestern United States) and the western black-legged tick (Northern California). May not cause a rash.
Babesiosis – transmitted by the black-legged tick (northeast and upper midwestern United States). Can cause severe hemolytic anemia.
Colorado Tick Fever – a viral infection that is transmitted by the Rocky Mountain wood tick (western United States, especially Colorado, Utah, Montana, and Wyoming). Can cause meningoencephalitis.
Ehrilichiosis – transmitted by the lone star tick in southcentral and eastern US.
Lyme disease – transmitted by the blacklegged in the northeastern U.S. and upper midwestern U.S. and the western blacklegged tick along the Pacific coast. Erythema migrans rash or Bull’s eye rash.
Powassan disease – a viral infection that is transmitted by the black-legged tick (northeastern United States and the Great Lakes region). Can cause biphasic illness, with children appearing to get better and then the symptoms reappearing again.
Rocky Mountain spotted fever – transmitted by the American dog tick, Rocky Mountain wood tick, and the brown dog tick in the U.S. Causing a classic petechial rash on the wrists, forearms, and ankles, which can then spread to the trunk.
Rickettsia parkeri Rickettsiosis – transmitted by the Gulf Coast tick in the eastern and southern United States.
STARI (Southern Tick-Associated Rash Illness) – “transmitted” by the lone star tick (central Texas and Oklahoma eastward to the the whole Atlantic coast). Children have an expanding “bull’s eye” lesion at the tick bite, like Lyme disease, but the cause is unknown.
Tickborne relapsing fever (TBRF) – spread by multiple soft ticks in the western United States which live in rodent infested cabins and can cause relapsing fever – 3 day episodes of fever, in between 7 days stretches in which a child might be fever free, over 3 to 4 weeks.
Tularemia – transmitted by dog ticks, wood ticks, and lone star ticks or by handling a sick animal, including wild rabbits, muskrats, prairie dogs, and domestic cats. Can cause an ulcer at the site of infection.
364D Rickettsiosis – transmitted by the Pacific Coast tick in Northern California dn along the Pacific Coast.
And although it can be helpful to know about all of the different tick-borne diseases and their symptoms, you should basically just know to seek medical attention if your child gets sick in the few weeks following a tick bite.
What to Know About Ticks and Tick Bites
Of course, it would be even better to reduce your child’s risk of getting a tick-borne disease by avoiding ticks in first place, including limiting his exposure to grassy and wooden areas, wearing protective clothing, using insect repellent, treating your dogs for ticks, taking a shower within two hours of possibly being exposed to ticks, and doing frequent tick checks.
In addition to avoiding ticks, it is important to know that:
Tick activity is seasonal, with adult ticks most active in spring and fall, and the smaller nymphal ticks more active in late spring and summer.
Tick bites that lead to tick-borne diseases are often not noticed because they are usually painless and are often caused by nymphs, the immature, smaller forms of a tick. So while you might be thinking about a large, adult tick when you are asked about a recent tick bite, a nymph is tiny (about 2mm long) and might even be missed.
Testing (on your child), including antibody tests, can be done to confirm a diagnosis of most tick-borne diseases, but keep in mind that testing can be negative early on. You also shouldn’t wait for results before starting treatment in a child with a suspected tick-borne disease. Testing is usually done with either indirect immunofluorescence antibody (IFA) assay or enzyme immunoassay (EIA) tests.
It is usually not recommended that you have a tick that has bitten your child be tested for tick-borne diseases. Even if the tick was positive for something, it wouldn’t mean that it transmitted the disease to your child.
Experts don’t usually recommend that people be treated for tick-borne diseases after a tick bite unless they show symptoms. The only exception might be if the tick was on for more than 36 hours and you were in an area with a high risk for Lyme disease.
Although doxycycline, one of the antibiotics often used to treat tick-borne diseases, is often restricted to children who are at least 8 years old because of the risk of side effects, it should still be used if your younger child has Rocky Mountain spotted fever, ehrlichiosis, or anaplasmosis.
You should also know that most old wives tales about ticks and tick bites really aren’t true. You should not try to burn a tick that is biting your child with a match, paint it with nail polish, or smother it with vaseline, etc. Just remove it with tweezers and throw it away in a sealed bag or by flushing it down the toilet.
What to Do If a Tick Bites Your Child
Don’t panic if a tick bites your child. You have up to 36 hours to remove it, before it is can likely transmit any diseases to your child, like Lyme disease or Rocky mountain spotted fever.
Don’t let these every day parenting issues freak you out even more.
Be prepared for when you child eats a bug, has a night terror, or wakes up barking like a seal.
Breath holding spells – in a typical breath holding spell, a young child cries, either from a tantrum or a fall, etc., and then holds his breath (involuntarily) and briefly passes out. Although it sounds scary and the episode might look like a seizure, these kids usually quickly wake up and are fine after. Kids who have breath holding spells are often prone to repeated spells though, so you do want to warm other caregivers so they don’t freak out if your child has one. Eventually, kids outgrow having them.
Febrile Seizures – parents often describe their child’s first febrile seizure as ‘the worst moment of their life.’ Febrile seizures typically occur when a fever rises rapidly, but although they are scary, they are usually brief, stop without treatment, don’t cause any problems, and most kids outgrow having them by the time they are about five years old.
Nosebleeds – a nosebleed that doesn’t stop is certainly scary, but with proper treatment, most nosebleeds will stop in ten to twenty minutes (if not sooner), even if your child wakes up in the middle of the night with a bloody nose for what you think is no reason.
Night terrors – often confused for nightmares, a child having a night terror will wake up in the early part of the night yelling and screaming, which is why parents think their child is having a nightmare. The scary thing though, is that their child will be confused, likely won’t recognize you, and might act terrified – and it all might last for as long as 45 minutes or more. Fortunately, night terrors are normal. Your child likely won’t even remember what happened the next morning. And they eventually stop.
Eating a Bug – “Kids eat bugs all the time. Few if any symptoms are likely to occur.” – that’s a quote from the National Capital Poison Center, who must get more than a few calls from worried parents about their kids eating bugs. Or finding the evidence later – when you see a dead bug in their diaper…
High Fever – pediatricians have done a lot of education about fever phobia over the years, but parents often still get scared that a high fever is going to cause brain damage or hurt their child in some other way. Try to remember that fever is just another symptom and doesn’t tell you how sick your child is.
Playing Doctor – even though it’s natural for young kids to be curious about their bodies, the average parent is likely going to be scared and upset if they “catch” their kids playing doctor. Understand that it is usually a normal part of child development and don’t turn it into a problem by making it into more than it is.
Hives – a child with classic hives might have a red raised rash develop suddenly all over his body. And since hives are very itchy, that child is probably going to be miserable, which can make hives very scary, even though without other symptoms (like vomiting or trouble breathing), they typically aren’t a sign of a serious allergic reaction. The other thing about hives that can be scary is that even when they go away with a dose of Benadryl, they often come back – sometimes for days, but often for weeks. And your pediatrician might not be able to tell you what triggered them.
Croup – your child goes to bed fine, but then wakes up in the middle of the night with a strange cough that sounds like a barking seal, has a hoarse cry, and it seems like he is wheezing. Scary, right? Sure, but if you realize he probably has croup and that some time in the bathroom with a hot shower (getting the room steamy can often calm his breathing), you’ll be ready for this common viral infection.
Choking – while choking can be a life-threatening emergency, most episodes of choking aren’t. In addition to learning CPR and how to prevent choking, remember that if you child “is still able to speak or has a strong cough” then you may not have to do anything, except maybe 911 if he or she is having some breathing difficulties. It is when your child is choking and can not breath at all (and can’t talk and isn’t coughing) that you need to quickly react and do the Heimlich Maneuver while someone calls 911.
Even with a little foreknowledge and preparation, many of these very common pediatric issues are scary. Don’t hesitate or be afraid to call your pediatrician for more help.
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.
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.
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.
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
There are many viruses that can cause a cold, which means that your kids can get a cold every few weeks or months, and year after year.
And unfortunately, there is no cure or vaccine to prevent your kids from getting these colds. That often leads parents to try and look for ways to help their kids feel better when they have a cold.
Before trying to treat your child’s cold, you have to figure out when they have a cold.
Colds are often misdiagnosed as allergies, sinus infections, and even the flu.
That shouldn’t be too surprising when you look at the classic cold symptoms, which can include:
a runny nose – with clear, yellow, or green drainage (green doesn’t mean that it is a sinus infection!)
coughing – often from post-nasal drip
sore throat – often from post-nasal drip
a low grade fever (usually under 102.2F or 39C) for the first few days
mild body aches
That’s right, you can have a fever with a cold!
Most importantly, understand that cold symptoms typically worsen over the first three to five days and then gradually get better over the next seven to ten days. So they can easily last for a good two weeks, although you can expect improvement in that second week.
Treating Cold Symptoms
So how should you treat your child’s cold?
A pediatrician I once worked with when I was a student used to recommend “soup, suckers, and showers.”
However, since treating the symptoms won’t help the cold go away, you could do nothing at all. While that might seem harsh, keep in mind that colds go away on their own and most of the things that we do to treat cold symptoms don’t actually work all that well.
Still, if your child has a cold and doesn’t feel good, some soup and popsicles (suckers) couldn’t hurt. Nor could some time in the bathroom with the door closed and a hot shower going, so your child can breath in the steam (while being supervised).
What about cough and cold medicines?
Because of the risk of serious, sometimes life-threatening side effects, since 2007, cough and cold medicines have carried the warning “do not use in children under 4 years of age.” So anything you find over-the-counter for younger kids now is either homeopathic (diluted to nothing) or just has honey as its main ingredient.
Treating Hard To Control Cold Symptoms
What else can you do to help control your child’s cold symptoms?
You could try:
Letting him continue with his usual activities, including going to daycare or school, if he doesn’t have a fever and isn’t overly bothered by his cold symptoms.
Encouraging your child to drink extra fluids.
Using a cool mist humidifier.
Spraying a saline spray or nose drops into your child’s nose.
Suctioning your younger child’s nose with a bulb syringe after using saline nose drops. Keep in mind that even with specialty gadgets, like the NoseFrida, you can’t do deep suctioning like they do in the hospital, so any benefits will be very temporary. And this type of suctioning is for symptomatic relief, it won’t help your child get better any faster.
Suctioning your younger child’s nose with a bulb syringe without saline nose drops.
Encouraging your older child to blow his nose, although since this is mainly to help him feel better and won’t help him actually get better any faster, don’t nag him too much or cause a meltdown if he doesn’t want to do it.
Giving your child an age appropriate dose of acetaminophen or ibuprofen to reduce fever and/or any aches and pains.
While there are cold and cough medicines for older kids, over age four to six years, and nasal decongestant sprays (like Afrin and Neo-Synephrine) for kids over age six years, there isn’t a lot of evidence that they work. They definitely won’t help your child with a cold get better any faster, so make sure they are at least helping him feel better if you are using one of them.
Even the popular cold and cough medicines with guaifenesin to thin mucus or long-acting cough suppressants probably don’t do much or anything to help your kids feel better and certainly won’t help them get better faster.
What about prescription cough and cold medicines? Most were forced out of pharmacies by the FDA several years ago because they were never actually approved or evaluated to treat cough and cold symptoms. And the American Academy of Pediatrics has long been against the use of cough suppressants with narcotics, such as codeine.
Most importantly, do see your pediatrician if your infant under age three months has a fever (temp at or above 100.4F or 38C), if your older child continues to get worse after three to five days, or isn’t at least starting to get better after 10 days of having a cold.
And avoid asking your pediatrician for an antibiotic when your child just has a cold. Antibiotics don’t help colds get better faster.
What To Know About Treating Hard To Control Cold Symptoms
Perhaps the only thing more frustrating than having a cold, is having a child with a cold and feeling helpless that you can’t do more to control their cold symptoms.
More Information About Treating Hard To Control Cold Symptoms