It's Flu Season!

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It is flu season (and has been since December)! The media tells us that influenza (flu) is on the decline. Maybe so--but there is still plenty of it out there. 

Friday in the office I evaluated 8-10 children with flu-like symptoms: sudden onset of high fever, cough, body aches, headache, runny nose, sore throat, and fatigue. They all looked miserable, with fever and sometimes chills, slightly glassy and reddish eyes, cough, and exhaustion.

Flu looks different from a cold. Kids with the flu are not usually smiling and perky in the office. Sometimes there is vomiting and loose stools--but these are just part of the whole picture, not the main symptoms.

Flu vaccines ARE helping this year--though we have had a few break through infections even in those who were immunized. Overall, the majority of children with confirmed influenza have not had their flu shots. Even if the vaccine did not completely prevent the flu, the symptoms in the immunized have been less severe and lasting for a shorter amount of time.

The high fever, cough, body aches, headache, runny nose, sore throat, and fatigue that come with the flu often last for a full week. It is important to be sure the patient gets enough fluids throughout their illness so they do not become dehydrated. Rest is also important. People with flu and fever should not go to school or other activities. Even if the fever comes down with some ibuprofen or acetaminophen the patient is still contagious to others and needs to rest to achieve a full recovery.

Medication for the flu includes Tamiflu, an antiviral antibiotic. In cases of influenza, if started within the first 24-48 hours of the symptoms, it can reduce the severity and length of the symptoms. Unfortunately, Tamiflu suspension tastes terrible and it has been quite difficult for parents to get their young children to take it. In addition, sometimes Tamiflu can be hard to find in the community. Tamiflu is not as good for flu as amoxicillin is for strep throat--it's definitely not an instant cure. Although pediatricians are encouraged to prescribe it for flu patients, I have found parents have a very difficult time getting it into their children. I tried it with my own kids a few years ago, and it is not a happy memory (as the doctor did not succeed in getting her own children to take it!).

Get a flu vaccine for your children if you are able to do so. Keep your children at home, resting, and drinking lots of fluids if they have the flu. Go to the doctor's office early in the illness if you think your child might benefit from Tamiflu. Good luck, I hope it's over soon!

Teething Gel Might be Harmful

Concerned about teething pain?  You might consider simply using a teething ring or toy.  Some toys can be chilled in the freezer so the baby has something cold to bite on.  As a last resort you could try an occasional dose of acetaminophen. 

I think teething pain is overestimated.  It's easy to blame fussiness, a temper tantrum, difficulty falling asleep, drooling, chewing on things, and picky eating on teething.  Babies always show lots of behavior that we call "teething" such as drooling, mouthing things, and biting on objects.  Older kids also get new teeth (after their baby teeth fall out).  They don't complain that much when their adult teeth come it.  I don't think I've known them to need teething gel.

Teething gels contain benzocaine, which is a topical anesthetic.  Rarely, young children have a condition which can cause them to have a life threatening reaction to these anesthetics.  If the tube of gel is left accessible to a young child they may ingest too much, making such a reaction worse.  A few years ago a patient in my pediatric practice almost died when she ingested a tube of teething gel and developed the life-threatening condition of methemoglobinemia. 

I don't think the benefit of the teething gel is worth the risk it may pose for an infant or young child. 

Here is a link for more information:
FDA warns parents on using benzocaine to relieve pain of teething babies | Drug Store News

 (And, in case you were wondering, teething does not cause a "fever-level" temperature--so if the temperature is over 100.5 degrees F, then think about an illness!)

As always, the information in this blog is not meant to provide personal medical advice or treatment for any individual--for that you will always need to rely on your own personal pediatrician!

What to do with a Fever

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.

Flu and Flu Symptoms

High fever? Chills? Cough? Body aches? Glassy, filmy, reddish eyes? Sore throat? Runny nose? If you have all or quite a few of these symptoms you might have "the flu." Flu, or "influenza" is a respiratory illness that makes people feel really sick. It is not to be confused with gastroenteritis (what many people call "stomach flu"), a completely different kind of infection. Flu shots help protect against influenza, but not against gastroenteritis.

Influenza is "going around" right now. We have seen quite a few cases in our office in the last two weeks. Children look miserable, listless, flushed, and weak. They cough, have high fevers, and complain of sore throats, body aches, and chills. The infection comes on pretty suddenly and hits hard. Most of the cases we have seen in the office have been in children who did not receive a flu vaccine. However, this week I have had two patients with confirmed influenza A who were vaccinated last fall. While this does not seem fair, it does happen sometimes.

The treatment for flu is almost always supportive care, which means making your child as comfortable as possible by controlling the fever and ensuring adequate fluid intake. In addition, monitoring for signs of bacterial complications of flu (such as an ear infection or pneumonia) is important. A high fever can persist for 5 to 7 days. Sometimes there is nausea and vomiting, although these are not the main symptoms of influenza.

Clear liquids, especially Pedialyte given 1 tsp at a time every ten minutes, are the best home treatment to prevent dehydration when a child is vomiting. Acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) will help keep a fever more manageable and a feverish child more comfortable. In my experience these medications often do not bring a high fever down to normal. Remember that the fever is not harmful to your child and is actually helping her body fight the infection. However, it makes the sick person feel awful and look terrible, so it is usually worth the effort to treat a fever.

In general it is safest to use one medication to control a fever--either acetaminophen OR ibuprofen. For a limited period of time (less than 24 hours) and a very high fever (over 103) I sometimes recommend alternating these two medications. However, too much medicine on an empty stomach CAN make things worse (nausea and vomiting, for example).

Cough and cold medications (especially decongestants such as pseudoephedrine or phenylephrine, as well as cough suppressants such as dextromethorphan) are NOT recommended for children under age six because research shows they do not work any better than placebo (fake medication), and because there have been a number of overdose cases due to the use of combination products (medicines with acetaminophen plus cough and cold products) in young children.

I sometimes recommend the night time use of the antihistamine diphenhydramine (Benadryl) alone for a smaller child with a bad runny nose and cough. Even this can cause problems such as irritability and wakefulness. At my own home I am likely to use home "remedies" to clear a congested nose and make sleep easier. These would include a steamy shower, saline nose drops, elevating the head of the bed a bit, and clear liquids to drink.

If your child looks really ill, and ibuprofen or acetaminophen do not "perk him up", then we should evaluate him in the office. Similarly if he is appearing dehydrated, (with a dry mouth, lack of tears, sunken eyes, absent or severely decreased urine output, cold hands and feet) then we should also evaluate in the office. If the high fever persists beyond 7 days, we need to see your child. And if you are very worried about your child, or there are concerning symptoms other than those I have described then you should call or bring your child in to be checked. Please remember that my blog is intended to be informational, and cannot take into account every individual situation, or replace the personal attention of your own doctor.

There are medications to treat influenza (not stomach "flu", remember?). In reality we use these only sometimes, as they carry their own risks of side effects, are not palatable (Tamiflu liquid tastes terrible), must be started very early in the illness, and are not extremely effective. Primarily we use medications like Tamiflu for children with underlying medical conditions (at risk for severe complications of flu) to either treat flu in the early stages or prevent flu in cases of household exposure. Hopefully all of these children with severe underlying illness have already been vaccinated for flu!

How do you distinguish influenza from strep throat? Strep is the other illness that is "going around" right now. The classic symptoms of strep throat are sudden onset of fever, sore throat, headache, and stomachache, usually in the absence of cold symptoms such as cough or runny nose.

I have previously written blogs about both strep throat and flu, so you could check those out for more information. And remember, you are the expert when it comes to your child. This blog is here to be helpful in providing general information to you, it is not designed or intended to diagnose or make treatment recommendations for specific children, illnesses, or situations. That kind of individual attention can only come from your own personal pediatrician!