Category Archives: Pediatrics 101

Cold or Flu? How to tell if your child has a simple cold or the flu

girl blowing noseThe flu is still a serious illness, especially for small infants and anyone who has a weakened immune system or asthma. For most healthy kids who contract influenza, they will be very sick for a few days and then recover fully, but every year, a few healthy children and teens become seriously ill from influenza.  Vaccination is key to preventing widespread flu outbreaks, however, what if your child was not immunized this year.  You may begin to worry about every sniffle. wondering is this the flu or just a simple cold. Here are some guidelines to help you tell the difference.

The common cold lasts about 9-10 days and is sometimes described as three days coming, three days here and three days going. The first three days your child may have a fever. In infants and toddlers the temperature might reach 103-104, but after giving some acetaminophen or ibuprofen, the temperature will be lower and your baby will seem better. In older children there might be a low-grade fever or none at all.  But here comes the runny nose. A cold always causes a runny nose, but the flu usually does not.

During the middle phase of a cold, a child may develop a cough because of the congestion from the nose, however it will not be a deep or hacking cough as we see when a child has the flu, and usually there is no chest pain. During this time the fever is usually gone, and your child might be back to their activities, despite the runny nose and mild cough.

The final three days is when the mucous starts to thicken and become crusty. At this point it’s just wiping the nose and using humidifiers to help your child breathe easier at night.

The symptoms of flu are very specific and include high fever (usually lasting 4 – 6 days), sore aching muscles, generalized weakness, headache, pain behind the eyeballs, a sore throat and hacking cough.

The uncomplicated flu lasts 7 – 10 days and does not respond to antibiotics.Your pediatrician can decide if an antiviral such as oseltamivir (Tamiflu) would be appropriate.  Treatment includes plenty of fluids, bed rest and acetaminophen or ibuprofen for fever, headache and body aches.  For cough, try a mixture of honey and lemon (if older than 1 year), non-caffeine teas. Some studies even suggest that chicken soup has some merit. Try to avoid OTC cold medicines, especially in children younger than 2 years of age. Remember, to prevent Reye’s syndrome, a potentially fatal illness, never give aspirin to your child or adolescent with the flu. Consult your pediatrician or family physician if your child has difficulty breathing, chest pain, a cough that is preventing them from sleeping, or a prolonged fever.


girl with feverHaving a baby or small child with a high fever is a common cause for anxiety in parents and a frequent reason to call the doctor for guidance.   Here are answers to some common questions and some advice on how to make your child more comfortable when they have a fever.

Is Fever Dangerous?
Fever is a person’s normal response to infection and is often the very first sign that an illness is starting.The first thing to remember is that fever, in and of itself, is not dangerous. It is the body’s way of fighting an infection. High fever caused by illness does not cause brain damage. For children with temperatures less than 105, the degree of the fever is not always related to the seriousness of the illness. Temperatures of 103-105 are quite common in children. This means that you can have very high fevers with a simple cold or stomach virus and low temperatures for more serious illnesses. It also means that it is unnecessary to record the exact numbers of temperature, i.e., 104.2. An approximate range is more useful to the doctor and for you to determine a response to medication. Hallucinations occur in some children with high fevers (usually greater than 104). The child may say they see things which aren’t there, or may sing or act strangely. These symptoms should resolve quickly as the fever responds to treatment and the temperature is brought down.

If fever (T100.8 or greater) occurs in infants younger than 3 months, call your doctor immediately for the baby to be seen.

How Do I Take my Child’s Temperature?

Many products are marketed today to measure an infant or child’s temperature, but the gold standard is a digital thermometer.  In small infants, the only reliable method for taking a baby’s temperature is to use a digital rectal thermometer. It is safe and accurate. Color strips for the forehead, or ear thermometers do not work well in small infants.  For older children, the oral thermometer or one placed under the armpit works well and is an economical option, but you can also use thermometers which measure the temperature of the inner ear. Placing your hand on a forehead will work as well as strips that change color.

How Do I Know If a Fever Is Serious?
The best way to tell is by observing how the child looks and acts, especially after the fever is brought down by medicine. No one looks great with a high fever, but after treatment with acetaminophen, ibuprofen, or a lukewarm bath, the child should look a bit brighter. If a baby can suck on a bottle, or nurse, make eye contact, or maybe even smile at a familiar face, then the illness is probably nothing serious at that time. If the baby is very lethargic, avoids eye contact, has no moments of playfulness or interest in faces or objects, then the illness may be more serious. For older children the same guidelines apply. However, once a child can talk, he or she can describe how he or she is feeling and what hurts. If your child has a severe headache or stiff neck, severe abdominal pain, an unusual rash, severe sore throat or drooling, severe cough, chest pain, earache, or pain with urination, you should call your doctor’s office regardless of the child’s temperature.

I’m Afraid My Child Will Have a Convulsion!
Convulsions ( or seizures) occur with rapidly rising fevers in about five percent (5%) of children between the ages of 6 months to 6 years. Watching your child have a convulsion is very frightening for parents.  The child, however, will have no memory of the convulsion and if there are no other complications, no long term effects or brain damage. These “febrile convulsions” occur as the fever rises rapidly within a few minutes to a height usually close to 105. The child becomes stiff and may turn blue around the mouth, as arms and legs begin to jerk. The eyes are usually turned to one side of the body. The convulsion usually only lasts about five minutes and the child will be sleepy for a while after awakening. If your child should have a convulsion, the local rescue squad should be notified after you have removed the child from any dangerous surroundings. Usually the convulsion is over by the time help arrives, but the rescue squad can be helpful by communicating with your doctor or the nearest hospital.

How Long Does a Fever Last?
Fevers that accompany most viral illnesses last 3-4 days. There are exceptions to this rule and some viruses, like influenza or mononucleosis, can cause fever for up to 10 days. If there is a bacterial infection present-i.e., ear infection, Strep throat, pneumonia, urinary tract infection-the fever may be present for more than the usual 3 days. So the presence of fever and the number of days your child has had the fever is important to relay to the doctor. Also, it is normal for temperatures to increase late in the day. The child who seems better in the morning may be looking and feeling worse by late afternoon.

Why Do We Treat a Fever?
If fever is the body’s way of responding to (and possibly fighting) infection by raising the temperature of the body, then why do we treat fever? The answer is that regardless of the cause of the fever, fever makes an infant or child uncomfortable. So doctors will treat fever to make the infant or child more comfortable.

Should We Always Treat a Fever?
If the temperature is greater than 101 and your infant or child seems uncomfortable, then treating the fever is indicated. If your child is “running around” and playing with a 103 temperature, you may not need to treat the fever at that time.

How Do We Treat a Fever?
Doctors treat fever in two ways: by treating the underlying illness when possible, and by treating the fever directly. Our role as physicians is to diagnose and treat the underlying illness which is causing the fever. Viral illnesses do not respond to antibiotics, so those illnesses need time and supportive care.

Your role as parent is to treat the fever directly. There are three common ways to treat fever:

1. Acetaminophen (Tylenol, as well as generic forms) is the most common medicine used to treat fever today. It is very useful in reducing fever and relieving pain. It does not work as well as aspirin or ibuprofen for inflammation and muscle and joint aches; however, it is a safe drug to use, and has minimal side effects. Aspirin should never be used in children and adolescents because of the risk of Reye’s syndrome.

Acetaminophen comes in a variety of forms, including infant drops, children’s elixir and suspension, chewables, swallowable tablets, and caplets. It also is available in suppository form. This can be useful when a child is vomiting or refusing to take the drug by mouth.

2. Ibuprofen (Children’s Advil, Children’s Motrin), available in liquid form, chewable and swallowable tabs, is another useful treatment for fever in infants and children. As an anti-inflammatory, it is also useful for pain. The advantages to using ibuprofen over acetaminophen are less frequent dosing (every 6 hours, as compared to every 4 hours) and perhaps a better response for treating very high temperatures (over 104).

3. Non-medical treatments include bathing the child in a lukewarm bath. The trick is to lightly rub the water over the child’s body to help evaporate the heat. It is best to do this 30 minutes after giving acetaminophen or ibuprofen to avoid chilling. Drinking lots of cool fluids will help bring down body temperature. Increasing the amount of fluids is also necessary in infants and children with fever because they can become dehydrated more quickly. Dressing the child in light cotton underwear and pajamas and the infant in a t-shirt or onesie over a diaper will help prevent the temperature from rising higher.

What Shouldn’t I Do?
Avoid heavy layering of clothing. Avoid high room temperatures indoors in winter and high temperatures outdoors in summer. Avoid space heaters. Avoid alcohol rubs or baths with alcohol. (Children have had convulsions from alcohol toxicity absorbed through the skin.) Avoid aspirin (and products which contain aspirin/salicylates, such as Pepto-Bismol) to avoid Reye’s Syndrome.

Sore Throats

The winter months are a time of sharing germs in the classroom and at home and the season of sore throats and runny noses. How can a parent tell if they need to bring their child to the pediatrician for a sore throat. Here are some of the basic facts you will need to know…

What causes a sore throat ?
There are a variety of causes. Most are caused by viral or bacterial infections that invade the throat and cause redness and swelling of the tonsils and surrounding tissue, causing pain. A sore throat can also be caused by allergies with an associated post-nasal drip that irritates the throat. A bacterial sinus infection also can cause similar problems, as infected mucous drips into the throat. Other potential causes include irritation from cigarette smoke or dry air in a home.

What is “strep” throat?
Although most sore throats are viral and not caused by bacteria, strep throat is the exception. It is caused by the streptococcus bacteria and is the most common bacterial infection of this area. It requires treatment with antibiotics.

How can I tell if my child has strep throat or just a cold?
The signs and symptoms of strep throat infection are a painful throat, usually accompanied by fever and swollen, enlarged tonsils and lymph nodes that you often can feel on the side of the child’s neck. Other symptoms can include headache, abdominal pain, vomiting, pain in the back of the neck, joint pain, muscle pain or a fine red rash. Other rashes that strep can cause are hives and a very red swelling of the groin area.

Why does the doctor do a throat culture?
The strep test or throat culture is needed because even to the best examiner, many illnesses can look similar to strep throat. Many viruses-especially mononucleosis or adenovirus-can produce a red throat with swollen tonsils covered with a white coat of infected pus. Many more viruses can produce a red throat and fever. Not all of these illnesses require treatment with antibiotics, and in fact antibiotics may make things worse.

My children hate strep tests. Isn’t there an easier way?
The only way to test for strep is to obtain a swab of the secretions on the tonsils. The only way doctors can do that at present is to use a long Q-tip to obtain the material. Even with the best technique it can still cause your child to gag or even vomit after the procedure. Your support during the procedure can really help a child tolerate the swab.

What’s the difference between the short and long strep tests?
The quick strep or rapid strep test is a screening test. Using a reaction between the antigens taken from the throat swab and the antibodies for strep in the kit, we can find a positive strep infection 85% of the time. However, this method is not fool proof and should always be backed up by an overnight culture of the throat swab material.

How do I know if I need to bring my child in for a throat culture?
If your child has a sore throat with a fever and any of the symptoms listed above, she or he should be tested for strep. If your child has a cold, cough, laryngitis or hoarse voice, it is less likely that he or she has strep. However, if your child continues to complain for more than 3-4 days about the throat please call your doctor to discuss whether or not your child needs to be seen.

If it’s so obvious, why do we have to bring our children in for a strep test?
The strep test or throat culture is needed because even to the best examiner, many illnesses can look similar to strep throat. Many viruses-especially mononucleosis or adenovirus-can produce a red throat with swollen tonsils covered with a white coat of infected pus. Many more viruses can produce a red throat and fever. Not all of these illnesses require treatment with antibiotics, and in fact antibiotics may make things worse.

I have heard that babies can’t get strep. Is this true?
For unexplained reasons, babies and young toddlers rarely get strep. No one is exactly sure why this is so, however, there may be age differences in our immune systems. It is not impossible for infants to get strep infections, however, and your doctor may test for it, especially if there is a close family member with a strep infection or an outbreak in a day care center.

If my one child has strep, why not treat all my children?
It is not thought to be a good idea to treat asymptomatic children for strep. For one thing it may be unnecessary use of antibiotics, as not all children exposed will get the strep infection.

Why does my child get repeated strep infections?
The strep bacteria remain sensitive to most penicillin or erythromycin antibiotics. True resistance is rare. If treatment failures occur, it may not be that the antibiotics aren’t working, but rather because, after a strep infection is treated, the enlargement of the tonsils continues for some time. These enlarged tonsils are like “catcher’s mitts” for whenever the next child in class coughs the strep bacteria nearby. Some researchers also believe that other bacteria that live in our throats may act to decrease the strength of the antibiotic. If your child is having repeated strep infections, your pediatrician will discuss the treatment options with you.

What can I do to make my child feel better?
Regardless of the cause of the sore throat, the pain can be treated with acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). Depending on the age of the child, lozenges or ice pops can also be helpful to ease the pain. Providing a humidifier or cool mist vaporizer in your child’s bedroom is also helpful in reducing the dry air which can aggravate any sore throat. If the doctor prescribes antibiotics, follow the directions completely. It’s important to treat strep infections for a full ten days to prevent rheumatic fever, a rare complication of strep infections.

When to Call the Doctor

One of the hardest questions a parent faces is when to call the doctor. Here is a simple way to answer it — “Whenever you are concerned about your child’s health or well-being.”

This is a good rule to follow when deciding whether to call your pediatrician or family practitioner’s office. It is essential that you have a physician’s office that encourages your questions and provides an atmosphere for you to feel comfortable asking any question, no matter what the question is. You should never be made to feel badly for calling or asking any questions.

In this article, we will look in more detail at the issues surrounding how parents can better decide when it may be time to call the doctor. For a summary, click on the links below:

* When to call the Rescue Squad
* When to call Poison control
* When to call the doctor

Parents have to learn to be parents, and new mothers and fathers will feel particularly anxious about their new babies. They have to learn about the routine care of their infant, as well as how to handle common problems and illnesses. This is a learning process and part of the training is done through phone consultations with the staff at your pediatrician’s office. As a parent gains more experience and the confidence that goes with it, they will find that they need to call less.

Raising and caring for children is a process of education. Most parents do not have medical training. Some problems seem very serious to the parent, but the pediatrician knows that there is nothing to worry about. On the other side of the coin, parents may not always know when something that seems trivial is really an important sign of a problem.

Reading basic health information about children can help you become aware of what problems may arise and what you can do at home first. Take notes when your physician or their staff gives advice. Don’t be afraid or embarrassed to ask questions when you think of them in the office. If the doctor has left the room, tell the nurse you have one more question.

The age of the child is important as well in deciding when to call the doctor . A general rule is that the younger the child, the more urgent is the question. For example if a 3-year-old has a fever, this may not be as urgent as a 3-month-old with a fever is. Never underestimate your parental instincts. Parents know their children best. They often know that something is not right, even before it is obvious to someone else. If you are worried, we as physicians need to be concerned.

Parents sometimes wonder if they ask too many questions or if they are overanxious about a problem. An experienced and sensitive pediatrician or nurse will pick up on this and will discuss where this anxiety may be coming from. For example, a parent who expresses concern about frequent bruising or enlarged lymph nodes may really be concerned about the possibility of cancer. It is not until asked directly by a physician that they usually admit this. Once they have voiced their real concern, it can be addressed properly and hopefully, their mind set at ease.

Another frequent situation that arises at the doctor’s office is when a parent appears to be worried about a variety of small problems. The reality is that there are often some major social problems occurring at home which the parent has difficulty discussing. Sometimes the question that is not asked is as important as the question that is asked. Physicians are trained to recognize these situations and in turn, do what they can to offer support and guidance.

Lastly, remember that nothing can replace a good relationship with the physicians and the nurses in your doctor’s office. As time goes on and you get to know and understand one another, knowing when to call the office will become a natural response.

When to call the Rescue Squad
There are some problems when it is best to call the Rescue Squad first. Make sure the phone number is posted near every phone in the house.

  • Severe difficulty breathing, especially with blue coloring, or after choking.
  • Serious injury (especially with massive bleeding, obvious broken bones, or severe head trauma with loss of consciousness.)
  • Electrical shock or burn
  • Allergic reaction (especially with difficulty breathing, airway swelling or wheezing, or any of the above with hives)

When to call Poison Control
AND REMEMBER TO CALL POISON CONTROL FIRST AFTER AN INGESTION. Then follow instructions on whether to call your doctor’s emergency line or go directly to the Emergency Room. Post the number for POISON CONTROL right near every phone. You can find this number in your local phone book or at The American Association of Poison Control Centers.

When to call the doctor
1. You should call your physician’s office or page the doctor on call immediately for the following problems:

  • Any infant under 3 months with fever. (100.5 or greater taken rectally)
  • Any infant who is acting very irritable and lethargic, or inconsolable. (no periods of alertness, no sucking, no eye contact.)
  • Any child with fever of 105 or greater.
  • Any child with a fever lower than 105, but who appears “toxic”. (unresponsive, lethargic, won’t smile, decreased eye contact.) or with redness and swelling of the eyelids, jaw, or any joint in the body.
  • Difficulty breathing (due to anything other than a stuffy nose)
  • Wheezing (with rapid respirations, cough, or deep movements of the chest & neck muscles with a breath, especially in an anxious child)
  • Croup (especially in an anxious child or if croup symptoms are unresponsive to steam or cool air)
  • Stridor (a noise made by an infant or child on inspiration)
  • Severe abdominal pain
  • Forceful vomiting (projectile or with blood, especially in an infant)
  • Explosive or bloody diarrhea
  • Signs of dehydration (decreased urination or wet diapers, dry mouth, no tears, sunken eyes.)
  • Head trauma (especially if there was any loss of consciousness or vomiting afterwards.)
  • Stiff neck (especially in an ill appearing child or child with fever.)
  • Severe headache (especially when accompanied by fever or with any visual changes, balance disturbances, or loss of the use of a limb or inability to walk)
  • Severe pain anywhere on the body.
  • Animal or human bites (especially if the skin is broken)
  • Hives over a large area of the body (especially if there are any swollen joints)

2. You should call the office within a day:

  • Asthma (known asthmatic with mild symptoms or those not responding to the usual treatments)
  • Cough (accompanied by chest pain, fever, or lasting more than a week)
  • Fever lasting more than 3 days
  • Sore throat with fever, pus on tonsils, swollen glands.
  • Earache in an older child, or concern that your infant may have an ear infection (cries whenever they are laid down, bats at ear, disrupted sleep)
  • Diarrhea (if you have not received instructions on what to do or if what you are doing is not working.)
  • Vomiting (for longer than 24 hours or if what you are doing is not working or your child seems to be getting worse.)
  • Eye infections.
  • Rashes or skin infections (including impetigo, ringworm, diaper rash)
  • Hives (without difficulty breathing or wheezing, or swelling of joints)
  • Poison ivy (with swelling of face, eyes, or covering large area of body)
  • Pain or burning on urination.
  • Abdominal pain
  • Chicken pox complications or questions
  • Lyme Disease (Lyme rash, fever, joint pain)

3. You should call the office to discuss the following non-urgent problems or to make an appointment:

  • Symptoms that have been going on for some time like frequent headaches, frequent abdominal pain, bedwetting, rashes, constipation.
  • Concerns regarding emotional or behavioral problems, or problems in school.
  • Concerns regarding your child’s growth or development.