In case you are wondering, we are in the height of viral illnesses in our community. As pediatricians, we see more RSV, influenza and other respiratory viruses spread through our patients more than any other time of year. Cough, runny nose, nasal congestion, sore throats, and fevers are all the rage this time of year and seem to be continuous from around Halloween through Easter. By Spring, many parents become concerned that their child has some sort of immune problem or underlying condition that precludes them to these illnesses. However, a more likely explanation is that your child’s immune system is still in development and exposure to winter viruses allows them the opportunity to make antibodies and build their system up. The unfortunate downside is having to endure the illness while their immune response is occurring.
Since the majority of these illnesses are viral and therefore have no cure and do not respond to antibiotics, what can you do? When do you worry? When do you take them into the doctor?
What can you do for viral illnesses?
The mainstay of treatment for a viral illness is supportive care. Since infants and young toddlers cannot have lots of over the counter medications, support is given in suctioning their nose of secretions and offering fever-reducing medication and lots of fluids. Infants under 6mos and over 2mos can have acetaminophen and older than 6mos they can have both acetaminophen and ibuprofen (see table for dosing). Giving medications helps them to feel better and be more responsive to drinking fluids. Infants and toddlers may not want to eat any solids for 2-3 days in the height of their symptoms and that is okay as long as they are drinking plenty of fluids that contain sugar and electrolytes (formula, breastmilk, and Pedialyte). They should be drinking enough to wet a diaper about every 6-8 hours. Suctioning their secretions helps with fluid intake as well. There are many suctioning devices available these days (nose-frida anyone?). Suctioning works best if you introduce a few drops of saline into the nose first and ensure good technique to get a good seal for maximum suckage. Also, loosening secretions with humidification can also be effective. Running a cool-mist humidifier in their room and/or taking them into the bathroom while running the shower and getting the room steamy also helps. Over the age of one, they can have honey and honey-containing cough syrups made for young children to soothe their raw throats. Avoid nasal decongestants, cough suppressants, and expectorants in young children.
When to Worry?
It is normal to feel a bit helpless watching your child feel miserable while fighting off their viral illness. Since all you can do is provide supportive treatment, it can feel like you’re not really doing anything. But, it can be very effective if done well! If your child does seem to be struggling more than usual, then your parental warning flags will go up. If their fever is spiking to the 105 range and is not coming down if they’ve had persistent fevers over 101 for more than 3-5 days, if they are struggling to breathe from their chest (breathing fast and hard), or their fluid intake is not adequate and they’re becoming dehydrated (no urine output in more than 8hrs and dry/cracked lips). These are more worrisome signs and can indicate they need more supportive care than you can provide at home. Please call your pediatrician’s office to get advice on what to do. Also, if your child seemed to be doing better after 4-5 days then suddenly takes a turn and fevers return and they seem worse, which may indicate a secondary bacterial infection occurring on top of their virus (such as pneumonia). If your child has underlying issues with their lungs (like asthma) or upper airway obstruction (large tonsils, adenoids, or a floppy larynx), they may be prone to having a harder time with viral illnesses. They may get croup, an exacerbation of their asthma, or bacterial ear infections and other airway infections. In those cases, you have to be even more diligent with your supportive care and adhere to their medications for their underlying conditions as much as possible. Asthmatics should be getting their rescue inhalers frequently during illnesses when their airways are stressed, it can prevent things from getting worse.
When do you take them into the doctor?
No one likes to wait in clinic waiting rooms filled with other boogery coughing kids for an hour or more waiting to be seen. But, this time of year that can be a reality. In most cases, if your child is demonstrating the ‘warning sign’ symptoms described above, it is usually best to bring them in. However, in order to avoid an unnecessary doctor’s visit, it is always good to call the office first and speak to a Medical Assistant or Nurse to get advice on what more you can do at home and, if they recommend being seen, where to go (office appointment, urgent care, or Emergency Room?).
Pediatric Walk-In Urgent Care
Downtown Billings Clinic Pediatrics
M-F 8 am-6 pm
Sat 9 am -1 pm
***Please call #238-2500 anytime and ask to speak to your physician’s office staff or after-hour staff whenever you are concerned about your child’s symptoms. It is recommended to call first before taking them into the walk-in urgent care to be advised on the best way to address your child’s needs.***