Fevers are common in children. They are probably the number one reason for after hour phone calls to the doctor. Many parents feel panicky when the thermometer indicates fever. So what should you do?
First, and most important, don't panic! Keep trying to think logically and stay calm. Your sick child needs you to be able to make rational decisions. Understand that if the temperature is under 100.5 F, then it is not actually a fever, and you should simply monitor the situation. Also remember that fever can be helpful in fighting some infections.
Fever is a sign that your child's body is reacting to an infection. When there is a fever we try to figure out if the infection is a serious one. The fever itself won't hurt your child, but a serious infection can be a cause for concern. If your child has a fever, but is older than three months of age and is looking and acting just fine, you do not automatically need to call the doctor. Fairly normal behavior and energy level often mean the fever is caused by a more minor infection.
Here are some things to think about. If your child is under three months of age and has a rectal temperature of 100.5 or higher, you should probably call the doctor. You could consider unwrapping your baby, making sure that too many blankets isn't the problem. In general, though, for an infant under three months old with a fever, you should call.
If your child is over three months of age, then her behavior and appearance are important in evaluating how serious of an infection it is. There is no automatic temperature at which you should "panic" and rush to the ER. 103, 104, and 105 F are all "high" fevers. When the fever is high you also need to consider how sick your child looks. If they are very irritable or lethargic, it is more concerning.
When I am called about a child's high fever I frequently ask parents to give a dose of ibuprofen or acetaminophen, and then reassess their child in an hour. If she feels and looks much better with such a simple intervention, then it may be ok to wait until the next day before bringing her in. The goal of using anti-fever medicine is not to bring the temperature back down to normal, but to temporarily bring it down a little and to make your child feel better. It is a good sign if something basic like acetaminophen or ibuprofen can make a big difference in how your child feels.
Giving a cold bath is kind of dramatic and old-fashioned. I don't usually recommend it because I don't think it would be very soothing to already feel awful with a high fever and then get plunged into icy water. Cool wet washcloths on the forehead and back of the neck will be much more comfortable for your child.
106 F or higher makes me think of heat stroke, so at that level you should call or take your child to the hospital. 103 F and higher, in addition to a lethargic or irritable child who does not improve with acetaminophen or ibuprofen, would be another reason to call or have your child evaluated right away.
In addition, with any level of fever (that's 100.5 or higher) when your child is also very irritable or lethargic and not improving with anti-fever medicines, you should consider calling or taking your child in.
A child who is lethargic and irritable is usually not smiling, not eating and drinking, is very sleepy or won't stop crying or moaning. The child can be very restless or almost impossible to comfort and console. When the doctor asks about "lethargic" she does not mean that your child just wants to sit around and watch TV, or that they seem a little more tired than usual.
When there is a fever, this is what you should do:
Before you call the doctor, take a few seconds to think clearly about your child and his fever. What other symptoms does he have? What illnesses was he exposed to? How long has he been sick? Can you help him cool off by undressing him, using cool cloths on the forehead and neck, and giving him anti-fever medicine? Did you give the right amount of ibuprofen or acetaminophen, and did you give the medicine enough time to work? Was there improvement in his appearance, mood, discomfort, and energy level?
If you are reassured by improvement in your feverish child's appearance, then you may be able to manage this at home for the time being. You could make an appointment in the next day or two if the fever doesn't go away. If you continue to be quite concerned and worried about your child even after trying some things to help them feel better, then don't wait to check in with the doctor.
Disclaimer: As usual, my advice in this blog is general and may not apply to your specific situation, or to your child's special circumstances. This blog is not intended to be a substitute for the personal attention your own doctor can provide.
Showing posts with label bacterial infections. Show all posts
Showing posts with label bacterial infections. Show all posts
Monday, September 12, 2011
Thursday, January 13, 2011
Strep throat?
How can you tell if your child has "strep throat?" I'll give you some things to look for, and some information for you to think about in determining when your child should be evaluated by a doctor.
As always, please keep in mind that I intend my blog, and this information, for general and informational use. It cannot, and is not intended to replace the attention of your own personal pediatrician. You should not try to diagnose your child or expect treatment based upon what I am writing in my blog! If your child is ill and you need more information or evaluation then you should contact your child's doctor.
Strep throat is a bacterial infection caused by a bacteria called Streptococcus pyogenes. It is contagious through respiratory secretions or saliva, has an incubation period of three to six days (that's how long it takes to get sick after being exposed to the germ), and is treated with antibiotics. After a person has taken antibiotics for 24 hours they are no longer consider contagious to others. A quick test can be done in a doctor's office to detect strep, or a culture can be done over several days in a laboratory.
The classic symptoms of strep throat are the sudden onset of a sore throat, headache, stomachache, and fever, without any symptoms of a cold such as a runny nose or cough. Sometimes there is a stuffy nose, but it is not usually runny. Some people do not have a fever with strep throat. The location of the throat pain tends to be more in the back of the mouth, not as much in the front of the neck. It hurts to swallow. Sometimes the voice sounds as if there is some swelling in the back of the throat--not like you are losing your voice or have laryngitis, but more of a sound of fullness there.
In strep throat the throat is often very red, with swollen tonsils. Sometimes there are red dots on the back of the palate, near the uvula. Sometimes there are whitish spots on the tonsils. "Glands" (actually lymph nodes) in the neck can be swollen and hurt to touch. If you are checking your child's throat and neck at home it is good to have some experience looking at your child when she is not ill. Healthy children have throats that are normally somewhat red, and many children who are not ill have tonsils that can look big, or lymph nodes that can be felt during an exam.
A sore throat that is pretty significantly associated with cold symptoms such as a runny nose or cough is less likely to be caused by strep. This kind of non-strep sore throat is often located in the front of the neck, lower in the neck, worse in the morning, and is improved after drinking fluids or being out of bed for a while. Coughing can make this kind of sore throat worse.
Infants and toddlers can get strep throat, and may not have classic symptoms. In younger children like these there can be prominent cold symptoms along with the fever. There is often a history of exposure to strep throat from an older sibling or in daycare.
In general I tell my patients' families they should have their child checked at the doctor's office during regular office hours if they think she has strep throat. Antibiotics for strep throat will help your child recover more quickly, and reduce how contagious your child will be to others. Rarely, an untreated strep infection can affect the heart or the kidneys. Antibiotics can help prevent these complications.
Strep throat is not usually an emergency. Treating the infection within seven days of the start of the symptoms is the goal in order to help prevent complications from strep. Confirming the diagnosis with a strep test before treating with antibiotics is best for your child. An evaluation in the doctor's office is the best way to ensure your child is treated properly, that he does not receive unnecessary antibiotics and risk the development of bacterial resistance to antibiotics, that the correct antibiotic at the right dose is chosen for your child, and that there is no other explanation for your child's symptoms that could be better treated in a different way.
Making an appointment for your child to be evaluated for strep throat within a day or two of the onset of symptoms usually "catches" the infection early enough to keep your child comfortable. If your child is very ill (repeated vomiting, appears very ill, is dehydrated, has a "stiff" neck, seems delirious, or has other symptoms that really worry you) then you should not wait to contact the office. It would be unlikely that an antibiotic would simply be "called in" for your child, more likely an evaluation in some type of health care setting will be recommended.
Another interesting tidbit about strep throat is that, even though it is a contagious illness, at least 75% of family members will not become ill from strep throat when someone at home has the condition. For that reason we do not automatically treat exposed family members with antibiotics.
Even if someone has all the symptoms sometimes they do not have strep throat. There is a virus called Adenovirus that can appear very much like strep throat. "Mono" (more correctly termed infectious mononucleosis) can look a lot like strep throat, too. "Mono" is caused by the Epstein Barr virus. You may remember that viruses like these cannot be cured with antibiotics. Instead your child's own immune system will fight off the germ and treatment will involve rest, fluids, and symptom relief--but not an antibiotic.
As always, please keep in mind that I intend my blog, and this information, for general and informational use. It cannot, and is not intended to replace the attention of your own personal pediatrician. You should not try to diagnose your child or expect treatment based upon what I am writing in my blog! If your child is ill and you need more information or evaluation then you should contact your child's doctor.
Strep throat is a bacterial infection caused by a bacteria called Streptococcus pyogenes. It is contagious through respiratory secretions or saliva, has an incubation period of three to six days (that's how long it takes to get sick after being exposed to the germ), and is treated with antibiotics. After a person has taken antibiotics for 24 hours they are no longer consider contagious to others. A quick test can be done in a doctor's office to detect strep, or a culture can be done over several days in a laboratory.
The classic symptoms of strep throat are the sudden onset of a sore throat, headache, stomachache, and fever, without any symptoms of a cold such as a runny nose or cough. Sometimes there is a stuffy nose, but it is not usually runny. Some people do not have a fever with strep throat. The location of the throat pain tends to be more in the back of the mouth, not as much in the front of the neck. It hurts to swallow. Sometimes the voice sounds as if there is some swelling in the back of the throat--not like you are losing your voice or have laryngitis, but more of a sound of fullness there.
In strep throat the throat is often very red, with swollen tonsils. Sometimes there are red dots on the back of the palate, near the uvula. Sometimes there are whitish spots on the tonsils. "Glands" (actually lymph nodes) in the neck can be swollen and hurt to touch. If you are checking your child's throat and neck at home it is good to have some experience looking at your child when she is not ill. Healthy children have throats that are normally somewhat red, and many children who are not ill have tonsils that can look big, or lymph nodes that can be felt during an exam.
A sore throat that is pretty significantly associated with cold symptoms such as a runny nose or cough is less likely to be caused by strep. This kind of non-strep sore throat is often located in the front of the neck, lower in the neck, worse in the morning, and is improved after drinking fluids or being out of bed for a while. Coughing can make this kind of sore throat worse.
Infants and toddlers can get strep throat, and may not have classic symptoms. In younger children like these there can be prominent cold symptoms along with the fever. There is often a history of exposure to strep throat from an older sibling or in daycare.
In general I tell my patients' families they should have their child checked at the doctor's office during regular office hours if they think she has strep throat. Antibiotics for strep throat will help your child recover more quickly, and reduce how contagious your child will be to others. Rarely, an untreated strep infection can affect the heart or the kidneys. Antibiotics can help prevent these complications.
Strep throat is not usually an emergency. Treating the infection within seven days of the start of the symptoms is the goal in order to help prevent complications from strep. Confirming the diagnosis with a strep test before treating with antibiotics is best for your child. An evaluation in the doctor's office is the best way to ensure your child is treated properly, that he does not receive unnecessary antibiotics and risk the development of bacterial resistance to antibiotics, that the correct antibiotic at the right dose is chosen for your child, and that there is no other explanation for your child's symptoms that could be better treated in a different way.
Making an appointment for your child to be evaluated for strep throat within a day or two of the onset of symptoms usually "catches" the infection early enough to keep your child comfortable. If your child is very ill (repeated vomiting, appears very ill, is dehydrated, has a "stiff" neck, seems delirious, or has other symptoms that really worry you) then you should not wait to contact the office. It would be unlikely that an antibiotic would simply be "called in" for your child, more likely an evaluation in some type of health care setting will be recommended.
Another interesting tidbit about strep throat is that, even though it is a contagious illness, at least 75% of family members will not become ill from strep throat when someone at home has the condition. For that reason we do not automatically treat exposed family members with antibiotics.
Even if someone has all the symptoms sometimes they do not have strep throat. There is a virus called Adenovirus that can appear very much like strep throat. "Mono" (more correctly termed infectious mononucleosis) can look a lot like strep throat, too. "Mono" is caused by the Epstein Barr virus. You may remember that viruses like these cannot be cured with antibiotics. Instead your child's own immune system will fight off the germ and treatment will involve rest, fluids, and symptom relief--but not an antibiotic.
Wednesday, November 17, 2010
Get Smart About Antibiotics
Did you know that this week has been deemed "Get Smart About Antibiotics Week?" As a health care provider I am supposed to help educate the public about the proper use of antibiotics. You might wonder why it's important to educate people other than health care providers about when to use an antibiotic. After all, isn't it up to me (and other prescribers) to decide when to write a prescription? As you will see, it's not always that easy. I need YOUR help to prescribe antibiotics appropriately!
First of all you need the basic information. Germs cause infectious illnesses like colds, flu, strep throat, pneumonia, sinusitis, conjunctivitis (pinkeye), bronchitis, croup, etc. Many of these germs are viruses, some are bacteria. Viruses cause most of the coughs and colds we see all winter. They are contagious, can cause fevers, coughs, runny noses, green and yellow mucous, sore throats, body aches, red eyes, and other symptoms. They are not treatable (except for a very few, specific, viruses--and these don't cause cold symptoms) with antibiotics. If you take an antibiotic and you have a virus it will not help you get better. It probably won't even help prevent you from getting a bacterial complication later. In fact, an unnecessary antibiotic is more likely to cause problems for you later by making the bacterial organisms already living in you more able to resist the effects of an antibiotic.
Wow, that sounds really good, even easy. Don't take an antibiotic if you have a virus. Don't prescribe an antibiotic if your patient has a virus. Simple. Done. No worries.
It is up to me to decide, and at the same time, sometimes it isn't. You might be surprised to learn that there are some grey areas when it comes to prescribing antibiotics. Some illnesses are clearly bacterial. Others are clearly viral. And then there are some which could be either, or are probably from a virus, but could be from a bacteria. And, because of these uncertain types of illnesses, there are some situations in which it can be just easier to write a prescription than to explain why one might not be needed, or why the parent will have to bring the child back in a few days if things get worse. Don't be too shocked. Did you really think we (doctors) are beyond influence?
So what should I do in the following situation? My patient has missed several days of school. Dad had to take time off work to bring her to the office. They have a $30 copay for an office visit. She has been sick for at least a week with a cough and low-grade fever. I diagnose bronchitis, because I can hear the phlegm and mucous in her lungs. Yet I don't think it is pneumonia because most of this clears with her cough. I know that about 85% of the time, bronchitis is likely to be caused by a virus (this is true). There is nothing I can do to determine if I am dealing with a virus or bacteria. It could develop into pneumonia, but usually doesn't. Still, there is no way to tell if it will, or not. This is a grey area!
I can hear my professors in medical school saying "NO ANTIBIOTIC is needed in this situation. Have the patient return in a few days and recheck her. Educate the family about the proper use of antibiotics." Then I look at my patient and her family and explain my dilemma. They might say "What do you recommend, Doc?" Or "What would you do if it were your daughter?" Or "We'll take the antibiotic, because we can't afford to miss more work or school." Or "Can we just have the prescription? We can't afford another copay." Or "Last time this happened you didn't let us have the antibiotic and we ended up in the ER because she developed pneumonia." And then, the unspoken reproach, not said but seen in the family's facial expression, "We've been waiting for you for an hour and you're going to send us home with nothing?"
Another common scenario is that of a toddler who has had a runny nose and cough, and now a low-grade fever plus difficulty sleeping. Examination reveals some fluid behind both ear drums. This is called serous otitis media, and is not usually caused by a bacteria. It is just fluid in the middle ear, building up because of all the congestion. It probably has an 80% chance of clearing on its own, without ever needing antibiotics. However, let's say in this case the little one has already had six full blown ear infections in the last eight months. We could just be days away from another one. Ideally I should not prescribe an antibiotic, but should have the patient return for rechecks (as a toddler he won't be able to let us know in a reliable way if he is feeling worse) and give the antibiotic if I start seeing pus in the middle ear. Then I am obligating the family to take more time off of work, pay additional copays, and possibly have difficulty scheduling the follow-up appointment(s).
I'm here to tell you that sometimes, as the one prescribing the antibiotic, faced with the above scenarios, it's easier just to write the prescription.
I try to do as much education as I can--about the strong possibility that what I am looking at is a virus, my uncertainty that an antibiotic would be helpful, the possible need for a follow-up appointment. If I don't give an antibiotic prescription I am often asked "Can I just call back for a script if things get worse, or will they make me come in?" Sometimes I can agree to just call something in if things get worse--but in the case of a small child or infant I can't safely do that. Occasionally I will give a prescription and extract a promise from the family not to fill it for 48 hours, then only if nothing has improved. I have started to write an expiration date on those prescriptions as I have noticed they sometimes get filled a month later, for a totally different illness! I don't think that's a good idea at all--at that point how do I know an antibiotic is needed, let alone if it's the right one?
An antibiotic is not a back up plan or a safety net, "just in case." Antibiotics don't "ward off" complications of viruses. They have no magic. An antibiotic will work only in a very specific situation: when the infection is caused by a bacteria and the antibiotic is the correct one for that particular bacteria.
As a parent you can help by not asking for, expecting, or even wanting an antibiotic when your child has a virus. That could mean waiting a little longer before making an appointment to check out minor symptoms like a runny nose or slight cough. It could mean a statement when you come in for an appointment such as "I know it could just be a virus, but we wanted to make sure we weren't missing anything." It could mean educating yourself a bit about common cough and cold viruses, understanding that symptoms from these viruses easily last two weeks (and sometimes three!), mucous color doesn't mean much in terms of diagnosing a virus versus a bacterial infection, and being willing to simply comfort your child as the cold symptoms run their course.
Hey, look--I know it's frustrating to have a sick child and not have anything you can do to make it get better faster. I have three children of my own, remember? I know the grey areas make it even harder to know what to do. I can offer you my pledge--to treat your children the way I would want my own children to be treated, to communicate to you what I am thinking, and why, and to try my hardest to do what is best for your child. I need your pledge that you will try to want what is the best thing for your child, to understand and listen to what I am saying, and not just to extract an antibiotic prescription from the appointment. I want you to trust me, work with me, communicate with me. I will work with you!
The CDC has a website about antibiotics. I can't get the linking option to work on my blog--but you can type this in yourself.
www.cdc.gov/getsmart
First of all you need the basic information. Germs cause infectious illnesses like colds, flu, strep throat, pneumonia, sinusitis, conjunctivitis (pinkeye), bronchitis, croup, etc. Many of these germs are viruses, some are bacteria. Viruses cause most of the coughs and colds we see all winter. They are contagious, can cause fevers, coughs, runny noses, green and yellow mucous, sore throats, body aches, red eyes, and other symptoms. They are not treatable (except for a very few, specific, viruses--and these don't cause cold symptoms) with antibiotics. If you take an antibiotic and you have a virus it will not help you get better. It probably won't even help prevent you from getting a bacterial complication later. In fact, an unnecessary antibiotic is more likely to cause problems for you later by making the bacterial organisms already living in you more able to resist the effects of an antibiotic.
Wow, that sounds really good, even easy. Don't take an antibiotic if you have a virus. Don't prescribe an antibiotic if your patient has a virus. Simple. Done. No worries.
It is up to me to decide, and at the same time, sometimes it isn't. You might be surprised to learn that there are some grey areas when it comes to prescribing antibiotics. Some illnesses are clearly bacterial. Others are clearly viral. And then there are some which could be either, or are probably from a virus, but could be from a bacteria. And, because of these uncertain types of illnesses, there are some situations in which it can be just easier to write a prescription than to explain why one might not be needed, or why the parent will have to bring the child back in a few days if things get worse. Don't be too shocked. Did you really think we (doctors) are beyond influence?
So what should I do in the following situation? My patient has missed several days of school. Dad had to take time off work to bring her to the office. They have a $30 copay for an office visit. She has been sick for at least a week with a cough and low-grade fever. I diagnose bronchitis, because I can hear the phlegm and mucous in her lungs. Yet I don't think it is pneumonia because most of this clears with her cough. I know that about 85% of the time, bronchitis is likely to be caused by a virus (this is true). There is nothing I can do to determine if I am dealing with a virus or bacteria. It could develop into pneumonia, but usually doesn't. Still, there is no way to tell if it will, or not. This is a grey area!
I can hear my professors in medical school saying "NO ANTIBIOTIC is needed in this situation. Have the patient return in a few days and recheck her. Educate the family about the proper use of antibiotics." Then I look at my patient and her family and explain my dilemma. They might say "What do you recommend, Doc?" Or "What would you do if it were your daughter?" Or "We'll take the antibiotic, because we can't afford to miss more work or school." Or "Can we just have the prescription? We can't afford another copay." Or "Last time this happened you didn't let us have the antibiotic and we ended up in the ER because she developed pneumonia." And then, the unspoken reproach, not said but seen in the family's facial expression, "We've been waiting for you for an hour and you're going to send us home with nothing?"
Another common scenario is that of a toddler who has had a runny nose and cough, and now a low-grade fever plus difficulty sleeping. Examination reveals some fluid behind both ear drums. This is called serous otitis media, and is not usually caused by a bacteria. It is just fluid in the middle ear, building up because of all the congestion. It probably has an 80% chance of clearing on its own, without ever needing antibiotics. However, let's say in this case the little one has already had six full blown ear infections in the last eight months. We could just be days away from another one. Ideally I should not prescribe an antibiotic, but should have the patient return for rechecks (as a toddler he won't be able to let us know in a reliable way if he is feeling worse) and give the antibiotic if I start seeing pus in the middle ear. Then I am obligating the family to take more time off of work, pay additional copays, and possibly have difficulty scheduling the follow-up appointment(s).
I'm here to tell you that sometimes, as the one prescribing the antibiotic, faced with the above scenarios, it's easier just to write the prescription.
I try to do as much education as I can--about the strong possibility that what I am looking at is a virus, my uncertainty that an antibiotic would be helpful, the possible need for a follow-up appointment. If I don't give an antibiotic prescription I am often asked "Can I just call back for a script if things get worse, or will they make me come in?" Sometimes I can agree to just call something in if things get worse--but in the case of a small child or infant I can't safely do that. Occasionally I will give a prescription and extract a promise from the family not to fill it for 48 hours, then only if nothing has improved. I have started to write an expiration date on those prescriptions as I have noticed they sometimes get filled a month later, for a totally different illness! I don't think that's a good idea at all--at that point how do I know an antibiotic is needed, let alone if it's the right one?
An antibiotic is not a back up plan or a safety net, "just in case." Antibiotics don't "ward off" complications of viruses. They have no magic. An antibiotic will work only in a very specific situation: when the infection is caused by a bacteria and the antibiotic is the correct one for that particular bacteria.
As a parent you can help by not asking for, expecting, or even wanting an antibiotic when your child has a virus. That could mean waiting a little longer before making an appointment to check out minor symptoms like a runny nose or slight cough. It could mean a statement when you come in for an appointment such as "I know it could just be a virus, but we wanted to make sure we weren't missing anything." It could mean educating yourself a bit about common cough and cold viruses, understanding that symptoms from these viruses easily last two weeks (and sometimes three!), mucous color doesn't mean much in terms of diagnosing a virus versus a bacterial infection, and being willing to simply comfort your child as the cold symptoms run their course.
Hey, look--I know it's frustrating to have a sick child and not have anything you can do to make it get better faster. I have three children of my own, remember? I know the grey areas make it even harder to know what to do. I can offer you my pledge--to treat your children the way I would want my own children to be treated, to communicate to you what I am thinking, and why, and to try my hardest to do what is best for your child. I need your pledge that you will try to want what is the best thing for your child, to understand and listen to what I am saying, and not just to extract an antibiotic prescription from the appointment. I want you to trust me, work with me, communicate with me. I will work with you!
The CDC has a website about antibiotics. I can't get the linking option to work on my blog--but you can type this in yourself.
www.cdc.gov/getsmart
Friday, November 5, 2010
Norovirus in Kalamazoo
Our office received a "Health Advisory" from the Kalamazoo County Health & Community Services this week. It announces laboratory-confirmed cases of Norovirus in Kalamazoo County. Norovirus is the new, official name for viruses previously known as Norwalk viruses. Noroviruses have been responsible for relatively large outbreaks of vomiting and diarrheal illnesses on cruise ships, in schools, and in day care centers.
My factual information in this blog comes directly from that Health Advisory, and a fact sheet about Norovirus from the Michigan Department of Community Health, Communicable Disease Division, 201 Townsend Street, CVB-5th floor, Lansing, Michigan. The advice on oral rehydration is the general advice I and my colleagues at Trestlewood Pediatrics give to parents whose children are suffering from a vomiting and diarrheal illness.
Noroviruses are contagious viruses that cause stomach and intestinal illnesses in people. These kinds of illnesses are often incorrectly referred to as "stomach flu" or "flu". Actually, the correct term is gastroenteritis. Gastroenteritis has no relation to influenza (correctly termed "flu"), which is primarily a respiratory illness.
The most common symptoms of a norovirus infection are nausea, vomiting, diarrhea, and abdominal cramps. They occur 10 to 48 hours after exposure to the germ. Other symptoms can include fever, chills, headache, muscle aches, and fatigue. The symptoms last 1 to 2 days, and can be very severe for some people. Dehydration is the most worrisome problem that can result from a Norovirus infection. This would occur if the sick person cannot drink enough fluids to replace what they are losing in vomit and diarrhea.
Treating Norovirus infections means replacing fluids and waiting for the symptoms to subside. There are no antibiotics or vaccines for Norovirus. Fluid loss should be replaced with clear liquids. The best fluids, especially for children five and under, are oral rehydration solutions such as Pedialyte. Sports drinks are not a good substitute because they have too much sugar. Diluted juice or water could also be given, but preferably to an older child. Infrequently a child may need to see a doctor to determine if intravenous fluids are needed.
When orally rehydrating an infant or young child you may need to give them the oral rehydration solution in a syringe. Wait one hour after the last vomiting episode, and then syringe feed Pedialyte 1 to 2 teaspoons (5-10 ml) at a time every ten minutes for two hours. Set a timer on your stove so you can stay on track.
If vomiting starts over, wait an hour and start the oral rehydration process again. If your child tolerates 5 to 10ml every ten minutes for two hours, you can then let them have more at a time (maybe 20-30ml every 15 minutes). Continue with only clear liquids for at least half the day. If everything is going well after that you could try a little milk, or one small cracker or piece of cereal. Start over if they vomit again. Don't let your pathetic little sick child sweet talk you into giving them food or milk until you know they are tolerating the clear liquids quite well. If you introduce food or milk too soon you will set everything back by hours because it will almost certainly induce more vomiting. Crackers do NOT settle the stomach of a vomiting child. First go slowly with oral rehydration solutions such as Pedialyte. Don't let your child refuse the Pedialyte, give it to them in a syringe, as if it were medicine.
The nice thing about Pedialyte is that it can be partly absorbed from the stomach (instead of having to travel all the way to the intestine first)--so even if some of it gets vomited back up, some will still be absorbed. This is not true of sports drinks, water, or juice.
The most interesting thing about Noroviruses is how very contagious they are. They are quickly spread from person to person, by ingesting contaminated food and drink prepared by infected food preparers, by touching contaminated surfaces and then touching the mouth, or having direct contact with an infected person and then touching the mouth before washing hands. Stool and vomit from an infected person is definitely contaminated with norovirus. In some cases undercooked oysters or drinking water contaminated with sewage have been the cause of an outbreak.
If you have norovirus, you are contagious from the time you start feeling ill or nauseated until at least 3 days after recovery. The contagious period after recovery can last as long as two weeks for some people.
Good hand washing with SOAP AND WATER is important to prevent further spread of the virus. Infected people should not prepare food, work in nursing homes, or take care of patients while they have symptoms, and for three days after the symptoms are gone. Children may return to school and daycare when the diarrhea and vomiting is gone. Then hand washing with soap and warm water must be strictly enforced. Alcohol based hand sanitizers do NOT work against norovirus. Soap and warm water is the best way to eliminate the germ from your hands. A household chlorine bleach-based cleaner should be used to disinfect contaminated surfaces.
So, wash your hands with soap and water, disinfect your surfaces with some kind of bleach solution, don't go to work or school if you become nauseated, vomit, and/or have diarrhea, and don't return to work for three days after you are better if you have a job preparing food or taking care of patients. Don't return to school until vomiting and diarrhea have stopped, and then use careful handwashing methods with soap and water. Have some Pedialyte on hand, or know where you can get it. Stock up on medicine syringes in case you must force feed the Pedialyte. And wash your hands again.
Please call your own personal pediatrician for more specific advice for your child. My blog is meant to provide you with general information, and is not a good substitute for the personal attention your own doctor can provide.
The Michigan Department of Community Health norovirus cleaning and disinfection guidelines, as well as other information, are available at the following link. Once at the main web site, click on the icon for Health and Services, then type Norovirus into the search box.
www.michigan.gov
My factual information in this blog comes directly from that Health Advisory, and a fact sheet about Norovirus from the Michigan Department of Community Health, Communicable Disease Division, 201 Townsend Street, CVB-5th floor, Lansing, Michigan. The advice on oral rehydration is the general advice I and my colleagues at Trestlewood Pediatrics give to parents whose children are suffering from a vomiting and diarrheal illness.
Noroviruses are contagious viruses that cause stomach and intestinal illnesses in people. These kinds of illnesses are often incorrectly referred to as "stomach flu" or "flu". Actually, the correct term is gastroenteritis. Gastroenteritis has no relation to influenza (correctly termed "flu"), which is primarily a respiratory illness.
The most common symptoms of a norovirus infection are nausea, vomiting, diarrhea, and abdominal cramps. They occur 10 to 48 hours after exposure to the germ. Other symptoms can include fever, chills, headache, muscle aches, and fatigue. The symptoms last 1 to 2 days, and can be very severe for some people. Dehydration is the most worrisome problem that can result from a Norovirus infection. This would occur if the sick person cannot drink enough fluids to replace what they are losing in vomit and diarrhea.
Treating Norovirus infections means replacing fluids and waiting for the symptoms to subside. There are no antibiotics or vaccines for Norovirus. Fluid loss should be replaced with clear liquids. The best fluids, especially for children five and under, are oral rehydration solutions such as Pedialyte. Sports drinks are not a good substitute because they have too much sugar. Diluted juice or water could also be given, but preferably to an older child. Infrequently a child may need to see a doctor to determine if intravenous fluids are needed.
When orally rehydrating an infant or young child you may need to give them the oral rehydration solution in a syringe. Wait one hour after the last vomiting episode, and then syringe feed Pedialyte 1 to 2 teaspoons (5-10 ml) at a time every ten minutes for two hours. Set a timer on your stove so you can stay on track.
If vomiting starts over, wait an hour and start the oral rehydration process again. If your child tolerates 5 to 10ml every ten minutes for two hours, you can then let them have more at a time (maybe 20-30ml every 15 minutes). Continue with only clear liquids for at least half the day. If everything is going well after that you could try a little milk, or one small cracker or piece of cereal. Start over if they vomit again. Don't let your pathetic little sick child sweet talk you into giving them food or milk until you know they are tolerating the clear liquids quite well. If you introduce food or milk too soon you will set everything back by hours because it will almost certainly induce more vomiting. Crackers do NOT settle the stomach of a vomiting child. First go slowly with oral rehydration solutions such as Pedialyte. Don't let your child refuse the Pedialyte, give it to them in a syringe, as if it were medicine.
The nice thing about Pedialyte is that it can be partly absorbed from the stomach (instead of having to travel all the way to the intestine first)--so even if some of it gets vomited back up, some will still be absorbed. This is not true of sports drinks, water, or juice.
The most interesting thing about Noroviruses is how very contagious they are. They are quickly spread from person to person, by ingesting contaminated food and drink prepared by infected food preparers, by touching contaminated surfaces and then touching the mouth, or having direct contact with an infected person and then touching the mouth before washing hands. Stool and vomit from an infected person is definitely contaminated with norovirus. In some cases undercooked oysters or drinking water contaminated with sewage have been the cause of an outbreak.
If you have norovirus, you are contagious from the time you start feeling ill or nauseated until at least 3 days after recovery. The contagious period after recovery can last as long as two weeks for some people.
Good hand washing with SOAP AND WATER is important to prevent further spread of the virus. Infected people should not prepare food, work in nursing homes, or take care of patients while they have symptoms, and for three days after the symptoms are gone. Children may return to school and daycare when the diarrhea and vomiting is gone. Then hand washing with soap and warm water must be strictly enforced. Alcohol based hand sanitizers do NOT work against norovirus. Soap and warm water is the best way to eliminate the germ from your hands. A household chlorine bleach-based cleaner should be used to disinfect contaminated surfaces.
So, wash your hands with soap and water, disinfect your surfaces with some kind of bleach solution, don't go to work or school if you become nauseated, vomit, and/or have diarrhea, and don't return to work for three days after you are better if you have a job preparing food or taking care of patients. Don't return to school until vomiting and diarrhea have stopped, and then use careful handwashing methods with soap and water. Have some Pedialyte on hand, or know where you can get it. Stock up on medicine syringes in case you must force feed the Pedialyte. And wash your hands again.
Please call your own personal pediatrician for more specific advice for your child. My blog is meant to provide you with general information, and is not a good substitute for the personal attention your own doctor can provide.
The Michigan Department of Community Health norovirus cleaning and disinfection guidelines, as well as other information, are available at the following link. Once at the main web site, click on the icon for Health and Services, then type Norovirus into the search box.
www.michigan.gov
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