Cold, Flu, and RSV in Children

This is a guest Post by Katie Coyle. Please see her bio at the bottom!

The good news is that we are halfway through cold and flu season!  The bad news is that we still have a solid two months to go. In this post I will share with you, as a mom and a pediatric nurse, some of the things you can do to prepare for and treat common childhood viruses at home.  

Listen to the full podcast interview with Katie HERE!

Last month, Brittany shared with you all some great ideas for ways to avoid illness during the winter months.  You can review that podcast episode here. She has some great tips! But no matter how careful you are, your kiddos will end up getting sick.  It can be such a helpless feeling to watch them struggle. While there aren’t a lot of medications or things that we can give little ones, I do have some helpful tricks to share.  

Our twins were born prematurely in 2011 in the middle of sick season so I got plenty of practice putting these ideas to use during their first year of life!  I also have worked in both inpatient and outpatient pediatric settings so I’ve seen a lot of viruses in the last ten years. I hope this information is helpful to you as a parent.  

Colds

Most common cold viruses follow a similar pattern:  2-3 days of fever followed by up to two weeks of congestion and up to three weeks of coughing.  Most pediatricians recommend that symptoms that last longer than that be evaluated. (Note: This post is for general information purposes, certainly if you are ever worried about your child or have specific questions, you should consult their provider). 

Fevers

During the fever period, the only medication that is safe for babies under six months of age is Tylenol.  After six months of age either Tylenol or Ibuprofen (also called Motrin or Advil) are considered safe. I always keep both on hand during the winter months.  After making midnight runs to the store, I learned that some things are worth always having on hand!

Treatment of fevers can be a subjective topic.  I always tell parents to focus more on how their child looks and is acting than the number on the thermometer.  Some children have a fever of 103 and other than rosy cheeks, they are energetic and bouncing around. Other children at 101 are lethargic, borderline dehydrated and needing to be evaluated.  Pay closer attention to how your child looks than to their temperature.  

As a general rule, low grade temperatures (under 102) do not necessarily need to be treated.  There is some benefit to running a fever as it’s part of the body’s natural immune response to fight off a virus.  However, if your child isn’t drinking well or can’t rest because they’re uncomfortable, in my opinion, it’s worth a dose of Tylenol for everyone (including you, mama!) to get a little rest. 

It is worth your money to invest in a good thermometer.  Any time you call to talk to an advice nurse, that will be one of their first questions.  The most accurate way to check a temperature is rectally. In babies under three months we may recommend this, especially since a fever in a young baby can be more serious.  For older children, it’s typically acceptable to check an under-the-arm temperature. Ear and forehead thermometers are often less accurate; they can be very impacted by which side of the face the child was sleeping on, etc.  Personally, I use a forehead thermometer to check my children if they are asleep so I don’t need to wake them. If I feel concerned about the reading I get, I will wake them up to do a re-check under the arm or rectally.

Coughing

During the coughing/congestion phase of a virus there are two things that can be really helpful; a humidifier and a way to suction your baby’s nose.  Running a humidifier in the room where they are sleeping can be very helpful with nighttime coughing.  If your kiddo is having coughing fits or spells it can also be beneficial to sit in a bathroom with the shower running on hot and the door closed.  This provides some instant humidity which can help calm the coughing fits. Good nasal suctioning (you can use saline drops beforehand to loosen up the snot!) can be really helpful, especially before bed and before feedings.  

Medications

There are no medications that are considered safe under age six for coughing or congestion.  There are several reasons for this but the main one is that coughing is actually a protective reflex.  We don’t want to suppress coughing in little ones because it helps them to keep their airway clear. If your child is over one year, they can have honey. Honey can be soothing and helpful for sore throats and coughs. 

I’ve also found, just by trial and error with my own three children, that eliminating dairy products when they are congested/coughing is extremely helpful.  Dairy creates a lot of extra mucous and can lead to additional coughing.  You can track this for your own kiddo really easily by just monitoring their coughing/congestion for 1-2 hours after eating dairy.  See if you notice an increase in congestion. If so, it may feel worth it to you to cut back or eliminate dairy while they are sick.  If your baby is formula fed and under one year of age, they should keep taking their normal bottles. Their hydration is the most important factor!  But cutting out any additional cheese/yogurt can still be helpful.

For most common viruses there is very little that can be done other than keeping your child comfortable and waiting it out.  Antibiotics are not effective in treating cold viruses. However, you should always take your child in to be evaluated if you worry that they are having difficultly breathing.  This includes breathing really hard or fast, having coughing spells that aren’t relieved by humidity/suctioning/drinking fluids, wheezing or having any changes in their coloring.  Viruses can develop into pneumonia or other infections. I always make sure to review with my patients that concerning changes in breathing should always be evaluated.

RSV

A quick note about respiratory syncytial virus (RSV).  RSV is an infamous virus and many parents are very fearful about their children contracting this particular virus.  The fears are not unfounded – RSV can be a particularly rough virus. However, for most healthy and term children, it presents no different than any other cold/respiratory illness.  The symptoms are similar – cough, nasal congestion and fevers.

  For young infants (under 3 months) and babies born prematurely, extra precautions and assessments may be necessary.  While there is no specific medications or treatment, babies who are struggling with RSV may need to be hospitalized for oxygen support and suctioning to keep their airways clear.  However, most healthy children will never even know that they have RSV! The only way to know is to do a lab nasal swab and send it for testing. In most cases, this testing isn’t necessary as it won’t change the course of treatment.  Most often RSV is treated at home just like any other virus – with fluids, Tylenol/ibuprofen , humidity and suctioning.       

Final Thoughts

I hope this information is helpful!  It is really hard to have sick kids. Our twins are now in third grade and are sick very rarely but we now have another child who is a toddler.  She’s had back-to-back viruses this winter that have been brutal. I was laughing with my husband the other day and telling him that I’d forgotten just how hard the young years are!  When you’re not sleeping and everyone is tired and irritable the days can just be so long.  Know that you are absolutely not alone.  These young years are beautiful and they are also exhausting.  I promise it gets easier as they get older!  I’m reminding myself of that truth on a regular basis too right now.  And take heart, spring is on the way.

I do some blogging and sharing of materials I create over at www.nursemomshop.com – I’d love to have you stop by and say hi in that space too! 

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