Tag: runny nose

Treating the Flu and Hard to Control Flu Symptoms

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

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 Cold Symptoms

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.

Cold Symptoms

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
  • sneezing
  • watery eyes
  • a low grade fever (usually under 102.2F or 39C) for the first few days
  • mild headaches
  • 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

Most cough and cold medicines should not be used in kids under age four to six years.
Most cough and cold medicines should not be used in kids under age four to six years.

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

Treating Hard To Control Allergies

Allergies (hay fever or allergic rhinits) are common in kids.

That makes it a good idea to learn how to control your child’s allergies.

What Triggers Your Child’s Allergy Symptoms?

There are several good reasons to try and figure out what your child’s allergy triggers are, including that it can help you:

  1. avoid the trigger – stay away from cats if your child is allergic to cats
  2. minimize the trigger – control dust mites in your home if that is a trigger
  3. know to give your child her allergy medicine before she will be exposed – start medicines before fall allergy season if she is allergic to ragweed

That doesn’t mean your child needs an allergy test though. You can often figure out what triggers your child’s allergies if you are mindful of the pattern of her symptoms (year round vs seasonal), what she is doing or exposed to when they worsen, and by checking pollen counts on both good and bad allergy days.

Allergy Medicines for Kids

Unfortunately, simply trying to avoid allergy triggers isn’t usually enough.

Most kids with allergies also take one or more of these medicines, many of which are now available over-the-counter, without a prescription:

  • short acting antihistamines – Benadryl (can be sedating)
  • long acting antihistamines – Allegra, Claritin, Zyrtec
  • non-antihistamines – Singulair
  • steroid nasal sprays – Flonase, Nasacort, Nasonex, Omnaris, Rhinocort
  • antihistamine nasal sprays – Astelin, Astepro, Patanase
  • allergy eye drops – Pataday, Zaditor

And to work best, your child should likely start his allergy medicines before his allergy season and take them every day.

Treating Hard To Control Allergies

So what do you do when these allergy medicines don’t control your child’s allergies?

The first thing you likely want to do, and something many people overlook, is to make sure that your child’s symptoms are really caused by allergies. Remember, just because your child has a runny nose, it doesn’t mean that he has allergies. Or even if he often has allergies, it doesn’t mean that allergies are causing every runny nose. If your child has a runny nose and congestion and allergy medicines aren’t working, then he may just have a cold.

If your child does have allergies and they are just hard to control, then you might want to:

  • review your allergy trigger control methods (allergy proof dust covers on mattresses, no mold in house, keep windows closed in the car, etc.)
  • consider if you are triggering your child’s allergies even more, for example, dust mites and mold like humidity, so a humidifier in your child’s room would not be a good idea if your child is allergic to dust mites or mold
  • make sure your child is taking the correct dose of his allergy medicine
  • make sure your child is taking the correct medication for his allergy symptoms, keeping in mind that antihistamines don’t treat congestion, but Singulair (montelukast) and steroid nasal sprays do
  • try a different allergy medicine, although tachyphlaxis reportedly doesn’t occur with antihistamines – they shouldn’t become less effective over time
  • try a combination of medicines, for example, a long acting antihistamine plus a steroid nasal spray
  • try a different combination of medicines, for example, Singular plus an antihistamine nasal spray
  • make sure your child is able to avoid second hand smoke
  • consider that your child could have vasomotor rhinitis or nonallergic rhinitis
  • ask about allergy testing, which can be done by your pediatrician (blood tests at almost any age) and/or a pediatric allergy specialist (blood or skin tests)

A pediatric allergist can also be helpful in diagnosing and managing your child’s allergies, especially if you think your child needs to start oral (sublingual immunotherapy) or shot (subcutaneous immunotherapy) allergy preventative treatments.

What To Know About Treating Hard To Control Allergies

Allergies can be hard to treat and control in kids, but they can often be managed if you understand how to avoid common allergy triggers and use allergy medicines properly.

For More Information On Treating Hard To Control Allergies