It’s A Virus

“It’s a virus.” We all love this answer (NOT!). When your kid is sick for the up-teenth day and you are starting to feel the heat at work, what you really want when you bring your kid to the doctor is for it all to go away. We’ve all been there. It’s hard to keep everything together on a GOOD day. And throwing in a virus is not welcome. Read on for more on this frustrating diagnosis.

“So you don’t know what it is then.”

Well, not exactly.  There are gazillions of different viruses. And they are constantly shifting, changing, and mutating. (If you want a quick refresher course on what viruses are, you can read more about it in this Khan Academy introduction.

There are lots of tests to identify exactly WHICH virus. But here’s the thing. Tests are expensive. And many take days to come back. By the time you know your child’s cold was caused by a rhinovirus, they’re already improving. Health care costs are expensive. Most of the doctors I know work really hard to use your resources wisely.

It is much preferred to order expensive tests only when the answer has the potential for changing what we do and how we treat.

Being able to say which subtype of adenovirus your child has is not really all that helpful. Often, there are specific clues that will tell us the most likely culprit.  And many times, the big offenders change by season. But knowing you have a metapneumovirus instead of a coronavirus isn’t useful information. Neat. But not useful.

“So there’s nothing you can do?”

Not exactly. There is nothing we can do to make a virus go away sooner than it is going to go. There ARE things we can do to help our kiddos feel better. Tylenol (acetaminophen) and Motrin (ibuprofen) can help bring down fevers. Check with your doctor on proper dosing for your kid. Saline spray can help break up thick mucous in your child’s nose. Honey will help a cough. Warm liquids soothe a sore throat. Extra snuggles give reassurance. Check out my Cold and Flu Survival Guide for a list of items to keep on hand.

Sometimes time and patience is the best medicine. And sometimes doing “nothing” is the best thing you can do. I know it’s not what you want to hear. And I know it is small consolation, but I don’t like to say it either.

It’s your pediatrician’s job to tell you what you need to know, not what you want to hear.

And please understand that we desperately want your kiddo to feel better sooner too. But wants don’t always change reality and we can’t always have what we want. (Darn it, my parents were RIGHT!!)

“Can’t you just nip it in the bud?”

Nope, afraid not. I have nothing at my disposal to make a viral infection go away sooner. If your kiddo is in the first day or two of a virus, it is probably going to get worse. You don’t like it. I don’t like it. But that’s how it goes sometimes.

Antibiotics are not helpful for viruses. They help bacterial infections. And antibiotics are not without side effects. Rashes, upset stomach, diarrhea, vomiting. And if that’s not enough, we have resistance to antibiotics to contend with.

As parents (and pediatricians) we can give supportive care. Keeping your kiddo hydrated and comfortable is that best thing we can do.

“But Susy’s kid did this exact same thing and then it turned into an ear infection”

Our bodies work hard to fight off viruses. Most of the time, the infection fades away and we go back to our normal everyday lives. But sometimes we end up with what docs refer to as “secondary infections.”

Secondary infections are infections that grab hold while we’re already knocked down from something else. They’re not all bacterial. It’s completely possible to come down with a stomach bug while fighting off a cold.

But some secondary infection are bacterial. Ear infections and pneumonia are a couple that can be bacterial secondary infections. (Although both of these also have viral forms as well.)

Unfortunately, there is no way to predict which of our kids will go on to have a secondary infection. So if that fever is hanging on past 5 days or they were improving and now they’re sick again, get them checked out.

“I brought my kid to the doctor and they did nothing and said he had a virus.”

Sometimes value comes from ruling OUT and not ruling IN.  A diagnosis of a virus means that the ears aren’t infected. There is no strep throat. The lungs are clear and there is no pneumonia. There are no swollen organs.  There is no evidence of cancer.

It is easy to be worried as a parents. Many of us are parents too. Sometimes the doctor part of my brain has to talk down the parent part of my brain. I get it. But sometimes “doing nothing” is the absolute best thing to do.

What questions do YOU have about viruses?

 

Cold and Flu Survival Guide

It’s that time of year. Viruses and colds everywhere. This time of year can be a source of frustration with sick kids and hectic schedules. There is no way to make these unwelcome house guests exit your home any more quickly, but there are things we can do to make your kid more comfortable. Is your house stocked and ready for the season? Get prepared with your own personal cold and flu survival guide.

Tissues

When the noses start running, you are going to need these in your life. Make sure you’ve got an extra couple boxes stashed away in the event of a whole family virus-fest. Several sick kids, a sick spouse, and only 1 box of tissues isn’t going to be fun.

There are other options to replace the traditional kleenex if you are so inclined. Try a roll of the extra soft toilet paper to do the trick beautifully for less expense.  Or if you’re feeling experimental, you can try flannel handkerchiefs. Turns out, you can find these on Etsy in all kinds of pretty patterns. (I have flowers and robots…allergies at my house are NOT nice.) Or you can make them yourself if you are good with a sewing machine. (I am not.) Bonus points here for washing and re-using.

Vaseline

True, a tub of vaseline isn’t going to make your cold go away faster. But it WILL keep your nose and lips blissfully un-chapped. Once you start reaching for the tissues, dab a little of this on your nose and lips to prevent chafing. A little goes a long way. It doesn’t burn so kids won’t fight you.

Saline spray

This is the number 1 item to have in your house for cold and flu season. Grab a handful and stick them in a drawer somewhere. Saline does magical things to thick snot. It loosens mucous so that it drains more easily and you can blow it out more easily. But it also helps decrease inflammation in swollen tender nasal tissues.

A couple squirts in each nostril can really help you feel better. Saline is safe even in brand new babies. And you can use it as needed and every hour if necessary. But if you have an infant with a cold, go easy on the bulb suction. Using suction more than a couple of times a day can really irritate the sensitive tissue inside the nose and in some cases will make the congestion worse. Save the bulb suction for gobs of snot.

Considerations for saline..  1. generic saline is fine. 2. Label the saline container with the name of its user. (I understand that we’re family and all, but I don’t want to share boogies with my kids…) 3. If you’re having issues with the large tip working well with your little kid, you can try something like Simply Saline (link below)…  it can be found everywhere. And it has a tiny tip which works better for tiny nostrils. Warning to all though… apparently there is a form of this with eucalyptus which I purchased on accident once. Youngest daughter did not appreciate minty freshness on the inside of her already irritated nose… you’ve been warned.

Warm drinks

Hot tea with honey is great for soothing sore throats. The steam helps open up swollen nasal passages. And the warm liquids help soothe the throat and melt away mucous. Peppermint teas can especially help open things up. If your kiddo isn’t a tea drinker, you can also try apple cider or hot cocoa. The effects will be similar.

Honey

If your kiddo has an annoying cough and is over a year old, try some honey. A teaspoon of honey works better than most over the counter cough syrups without the medicine side effects. If you need more convincing, you can check out this study which was published in a 2012 Pediatrics publication. I love honey for my kids’ coughs. We don’t own a single cold medication.

Water

This should go without saying, but you need lots of fluids when you are sick. Blowing out gallons of snot is not good for keeping you hydrated. You will feel a lot better if you are hydrated. So bottoms up on that water.

Pedialyte

For little squirts who have upset tummies, pedialyte is the best for replacing fluids. It has less sugar than sports drinks. There are now many flavors to choose from and you can even get it in popsicle form.  Which makes anything more palatable.

Soups

There is something to be said for chicken noodle soup to help you feel better when you’re sick. The individual ingredients are not magical. But the combo definitely works. The salty chicken broth helps keep you hydrated. Warm soup going down the back of your throat soothes tickly throats and helps break down mucous in the back of your throat. Steam from the soup helps loosen mucous in your nasal passages. Granny was definitely right on this one. Soup does help you feel better when you’re not feeling well.

Heating pack/Ice pack

Last Christmas, I made my children fleece rice-filled heating packs. They are soft and fuzzy and you pop them in the microwave when you want them. They were a hit. Cold toes? Rice pack to the rescue. Chilled? Same. Just feel icky and need some comfort? You know the drill. Turns out, these are great for helping you feel better. True, they don’t make your virus go away any more quickly than it’s going to go. But they do provide comfort. And that’s what we need when we have a nasty virus.

By the same token, a cool pack can also help your kiddo feel better. My little squirt prefers a cold pack for a headache. Tylenol can also help, but she reaches for the cold pack as well.

A cozy blanket and extra hugs

Colds and flu (and other viruses) are going to happen. And we are probably not going to appreciate their presence when we do get them. Although they are certainly an inconvenience, they are also a reminder to slow it down and take care of ourselves. So curl up on the sofa with your kiddos and give them some extra snuggles. A little comfort goes a long way when your littles are sick

I hope that this cold and flu season treats your family kindly. Remember that most viruses can be treated at home. But if your little one seems much sicker than expected, they are having trouble breathing, funky rashes, or not keeping down fluids, get them checked out. If you’re not sure, call your doc for advise and next steps.

 

Mental Health in Your Kids

We often worry about our children’s physical health. Are they sick? Do they get sick too often? Are they growing well? But sometimes, it is what we can’t see that is more concerning. What about your child’s mental health? Have you checked in with them lately? How is their inner world doing?

How Was Your Day?

This is probably the most common question asked of school aged kids each day. And if your kids are like most, especially as they get older, you will get a stock answer in response to your stock question…  “Fine.” Not a super helpful or informative answer.

There is a whole lot that happens during the school day for your youngster.  (As there is for you as well!) Sometimes, they’re tired too. Rehashing the entire day’s events is just too difficult. Do you REALLY want the entire day’s play-by-play? I’m pretty sure my family doesn’t want mine. So if you really want to know what’s going on in their world and get insight into their mental health, we have to rephrase our questions.

Rephrasing your questions

Instead of asking your kids how their day was, try asking details about their day.

1. Did anything interesting happen at school today?

2. What did you eat for lunch?

3. How are your friends doing?

4. Tell me something cool that happened today.

5. Anything today make you REALLY mad?

6. Is there anything happening with your classes or other kids that is really bothering you?

The point of these questions is to get to know your child better.  What makes them tick?  What stresses them out? Are there things that really spark their emotions? How do THEY think school is going?

Validate their emotions

Growing up can be hard.  Emotions swirling. Most kids don’t come equipped with the tools for managing big emotions. Help them acknowledge what exactly it is that they are feeling. You don’t have to fix it. And you don’t have to agree with it. “I can see that you are really upset about this” lets them know that you understand what they are experiencing. When our kids feel heard, it helps them feel safe. And a valued member of the family.

Be a sounding board for working thru problems

Sometimes, our kids need us to be a sounding board so they can figure out where to go next. Sometimes they need us to offer suggestions. But it’s best not to jump to the conclusion that they want us to fix things. After all, part of growing up is learning to work thru your own problems. Here are some phrases to consider when having these conversations.

  1. What do you think you should do?
  2. What do you think might happen if you do that? Is that what you want?
  3. Do you need help thinking through other possibilities?

What if you have concerns?

If you are concerned that there is something going on with your kid, you may need to ask more pointed questions. Look for changes in diet or sleep. Avoidance of activities with friends. Avoiding the family. Or moodiness that is out of character. Let them know that you’ve noticed a recent change in their behavior and make sure they know that you are there if they need to talk.

Remember that being your child’s safe person does not magically happen during the teenage years. If you want them to talk to you as a teenager, you need to start laying the groundwork early. Don’t avoid the uncomfortable conversations when they are little. Practice being open-minded. And practice letting them vent without fixing. It will get easier with time.

Remember that looking out for your child’s mental health is not an overnight skill.  Keep an open mind and heart and stay present. Great connections take time 🙂

Fever: What it is and When to Worry

We all worry about our kids when they are sick. And high fevers are scary. But there is a lot of misinformation out there on what a fever is and when we need to worry. Stay tuned for what is (and isn’t!) a fever and when you need to worry.

What is a Fever

Fever is a body temperature of over 100.4 degrees Farenheit (38 degrees Celsius). This is true for everyone. Body temperatures vary throughout the course of the day. Sometimes they are higher and sometimes they are lower. Some folks run normally at 97.0.  Others run lower.  Some run at 99 degrees. Regardless of what your “normal” is, a fever is STILL considered 100.4 and above.

How should you take your child’s temperature?

The most accurate way to tell if your baby or child has a fever is with a rectal or oral temperature reading. Unfortunately, temporal, ear, and under arm readings are often inaccurate.

Babies

In babies, the only way to accurately check for fever is with a rectal thermometer. Many rectal thermometers read very quickly and are marked to let you know how far to place the thermometer. This will not hurt your baby. And once you get over your unease, it will not hurt you either. Unfortunately, temporal, ear, and under arm readings are often inaccurate. If you are nervous about checking your baby’s temperature via rectal thermometer, check out How to Take a Child’s Temperature put out by Healthychildren.org. A rectal temperature over 100.4 is a fever.

Older kids

After 3 years old, many kids do well with an oral thermometer. Make sure you use a different thermometer than the one you used for rectal temps.  Label them if necessary. Digital thermometers read very quickly and you can get a good read in under a minute.  The thermometer sits under your child’s tongue. An oral temperature over 1o0.4 is a fever.

What about axillary (under the arm) temps? Many schools use axillary temps to screen students who are feeling bad. We used to routinely add a degree to underarm temps. But now we do not. When your doctor asks about fevers, just tell them the number your thermometer registered and then tell them how you took it. An axillary temperature over 100.4 is a fever.

Temporal thermometers are another option for taking your kid’s temperature. These are quick and easy to use. And they can be great screening tools for kids down to 3 months of age. But if you keep getting a different number on it, or they seem much hotter than it is reading, try a rectal or oral temperature instead. A temporal thermometer reading over 100.4 is a fever.

What if my newborn has a fever?

If your baby is under a month old and has a fever of 100.4 or higher, they need to be seen. If this happens while the clinic is open, call your pediatrician and get in. After hours, call the doctor’s after hours line.  Newborns with fevers MUST be evaluated urgently. Do not give Tylenol, get them seen. If you can’t get in with your doctor, go to the emergency room. Newborns can get very sick very fast and with very few other signs of illness.

What if my infant or toddler has a fever?

Babies get sick sometimes.  If your infant (under 3 months) has just had immunizations and has a fever, it is generally safe to treat the fever and keep an eye on them. But if they are acting sick and have an unexplained fever, get them checked out. Your doctor will have a lower threshold for worry in a young infant with fever.

If your baby is between 3 months and 3 years and feels warm or is acting ill, it is reasonable to check their temperature. As above, over 100.4 is a fever. But not all fever is reason to worry. If your 2-year-old has a fever of 102 and is leaping over the furniture, they are ok. It is totally fine to keep an eye on them at home for a few days and see how things play out. The most common cause of fevers in our kiddos is a virus. And there are LOTs of different viruses.

Fever in and of itself is not dangerous. It IS a sign that our bodies are fighting off something. It is a good rule of thumb to treat the kid and not the fever. So if your kid has a fever and is perfectly normal, leave them alone. And if your kid has a fever and is really not acting well, has a rash, or other concerning symptoms, or is not improving with Tylenol or ibuprofen, get them checked out.

What if my infant or toddler’s temperature is REALLY high?

If your child has a high temp (>104) or at any point with a lower temp is really not acting like themselves, they need to be seen. Most kids who are acting fine between doses of fever reducer do NOT need to go to the emergency room. If you think your child needs to go to the ER, call your doctor to discuss. Most pediatricians try to keep kids out of the ER if at all possible. The ER is designed to take care of emergencies. And although a fever may feel like an emergency, in most cases, it is not. So you may be waiting a while.

What if my school-aged kid has a fever?

School-aged kids get sick. They touch everything and are very hands-on in all they do. (mostly, they are gross… at least, mine are!) Many times, it is completely fine to keep an eye on them for a few days. However, for severe symptoms or fevers that last longer than 5 days, it is best to get your kiddo checked out.

Concluding thoughts

Fevers are no fun. But they are a common part of routine childhood illnesses. So knowing when to worry is important. Nearly always, it is how your little one is acting that is the most important factor in an illness.

1. Fever 100.4 or higher in a baby under a month is an emergency. They need to be checked out ASAP.

2. Most fevers are more bothersome than a cause for concern. But if your kid is not acting right, they need to be seen.

3. Kids who have persistent fevers (>5 days) need to be seen.

4. Fever is 100.4 or higher.

5. Kids with fever > 104 need to get checked out.

I do hope that this has cleared up some confusion about fevers. Stay tuned for a coming post on viruses. Gotta love cold and flu season!