Caring for Kids…at Billings Clinic

Viruses in the New Year’s air

Every year we ring in the New Year with a myriad of seasonal viruses.  The ones we are seeing already in full force in the Pediatrics Department are influenza and croup.  This is the pediatricians’ busy time of year!


As many of you may have heard, the most common circulating strain of influenza virus is a “drifted” (mutated) H3N2 strain that is not in this year’s trivalent or quadrivalent flu vaccines.  Nearly every state in the union is currently affected by this Influenza A virus. Even though this year’s flu vaccine may not provide much protection against this particular strain, we still recommend seasonal flu vaccination to protect against those other strains (Influenza B, etc) that might become more prevalent as the season progresses. Please still get your flu shots/mists!

Influenza is a nasty virus that causes a rather sudden onset of high fever, sore throat, body aches, cough, and congestion along with some nausea and occasional vomiting.  Many people mistake the “stomach flu” for influenza.  There has been some GI viruses going around the community as well these last couple months causing vomiting and diarrhea, but this is not influenza (it is probably strains of norovirus).

Influenza makes you feel like you’ve been hit by a Mack truck.  Those of you who’ve had it in the past, or currently suffered through the holidays with it, know flu is more than just a common cold.  You are usually incapacitated and spend a few days in bed. The fever is worse in the first few days then it breaks with another several days of runny nose and cough.  You are most contagious during those first few days, but can shed the virus for a good week.

People with chronic health conditions, pregnant women, elderly people, and young children are at the highest risk for complications from influenza. These rare complications can include severe respiratory compromise requiring hospitalization for oxygen or other breathing support.

Treatment is usually supportive home care with plenty of fluids, rest, and ibuprofen.  But, there is an antiviral medication that can be prescribed by your doctor to shorten the course and severity of the illness if given within the first 48 hours of symptoms.


The other viral condition that has filled our offices and waiting rooms most recently is croup.  Croup can be caused by many respiratory/cold viruses (most commonly it is parainfluenza) that produce swelling around a child’s voice box and windpipe (trachea).  This swelling worsens at night when the body’s cortisol levels (stress steroids) go down.  Often, this results in a sudden midnight awakening of raspy breathing and seal-like barking producing sounds you’ve never heard your child make.  This phenomenon is common in children because their airways are smaller. This “Darth Vader” sound goes by the medical term “stridor,” which is different from wheezing. Since croup affects the airway, it can be scary because your child will feel as though he/she can’t breathe, which triggers a panic attack in both you and him/her!  Taking the child into the bathroom and running a hot shower to fill the air with steam or bundling up and going outside to breathe the cold winter air might be enough to reduce the swelling so your child can go back to sleep.

In rare instances, a child is unable to turn the corner with these measures or the cough is severe enough (turning blue, etc) that emergency response is required.  In these cases, a breathing treatment of epinephrine and some steroids is given and sometimes a child is even hospitalized.  This is rare, though, and most cases are treated with supportive home care and are self-limited.  Because it is a virus, there are no antibiotics that will treat it, but kids usually get better on their own in about a week.  Occasionally, your doctor may prescribe some oral steroids given in the clinic or at home to curb the midnight swelling so symptoms aren’t as bad.

Prevention of these and other viruses goes back to the basics.  Frequent hand-washing (especially before eating or before touching your mouth/nose/eyes), eating right, getting plenty of sleep and exercise, and avoiding close contact with sick people this winter are important measures.  Getting the flu vaccine is still recommended.  Happy New Year and I hope you stay clear of the viruses in 2015!

Michelle Pierson, MD

Hi! My name is Michelle Pierson and I am a wife, mom, and general pediatrician at the Billings Clinic. I am excited about this blog and the opportunity to reach out to parents in my hometown of Billings. Growing up here and raising my own kiddos in this community gives me some perspective on how we can take care of our children's health with the resources we have in the region. I get great joy from my family and job, and a good piece of chocolate cake! A good book and "cuddle time" with my kids on the couch rank up there pretty high too.

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