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Colds, Flu, Fevers

By Dr. Paul Roumeliotis

DEAR DR.PAUL: My seven-year-old son always gets sick during the flu season. He then gives his cold to the rest of the family. Is my son too young to receive the influenza vaccine? Will it prevent him from getting sick during the flu season? Thanks.

PEDIATRICIAN DR.PAUL Answers: You bring up several very important points. First, just like you, a lot of my patients tend to use the terms "a cold" and "the flu" as if they were the same thing. The common cold, caused by any one of 250 viruses, causes cough, a stuffy nose or runny nose for a few days with or without fever. Many people wonder why can't we find a cure for the common cold. The reason is that it is very difficult to know exactly which virus is causing a particular cold. As well, even if we could track the particular virus, we do not have effective anti-viral medications for these viruses. So, unfortunately, the treatment is what we refer to as "symptomatic", that is to relieve symptoms. We recommend including drinking plenty of fluids, humidity, rest and, on occasion, acetaminophen for fever. The "flu", caused by the Influenza virus, is a potentially more serious infection. The flu often begins like a cold, but there are usually associated fever, body aches and generally feeling quite lousy. In older people or in children with underlying chronic medical conditions, Influenza infection can potentially be fatal, usually complicated by pneumonia. Each year a different strain or type of Influenza virus arrives, often from Asia. Fortunately, in most cases, we can now accurately predict which strain will arrive each season and prepare a vaccination to prevent infection. Healthy children do not need to be vaccinated. However, children with severe asthma or other chronic medical conditions are at higher risk of developing complications. These children need to be vaccinated. The decision to vaccinate a child should be made with your physician. It is important to realize that the flu vaccine protects only against the influenza virus and not against the other viruses that cause the common cold. So, getting the flu vaccine will not necessarily prevent you from getting a cold caused by other viruses. As most people have heard, new anti-viral medications are now available to treat influenza infections. As with most newly-released medications, they are not yet approved for use in children. The best approach for the cold an the flu in children is still common-sense= prevention. Flu viruses are usually spread from person to person by nasal (respiratory) secretions. Being enclosed in one area with many children the situation at school and at day care - allows germs to spread easily. Washing ones hands frequently, especially after contact with the mouth or face area, has been shown to decrease the spread of viruses. It's a great idea to teach children this approach at an early age, so that it becomes a good preventative habit.

CROUP IS COMMON IN YOUNG CHILDREN

DEAR DR.PAUL My son had a bit of a cold and it seemed to get better however, last night he started coughing and breathing different. The cough seems dry, rough and sounds bark-like. Could this be croup? How common is croup among children and do adults ever get it?

PEDIATRICIAN DR.PAUL Answers: Croup is caused by an inflammation (swelling) of the upper airway (larynx or voice box and the trachea or windpipe). The inflammation is usually due to a viral infection, and is a common condition in young children. Typically, viral croup begins with a cold that slowly develops into a characteristic "seal-like" barking cough and a high-pitched, raspy noise when breathing in, known as "stridor". The stridor often gets worse with physical activity. Most children with viral croup have a low-grade fever. The potential problems of croup depend on how much the upper airway is blocked by the swelling. The more the airway is blocked, the more the child's breathing is labored and in general the less active the child becomes. Additionally, an important sign of difficulty breathing is that he may stop eating or drinking. Croup usually worsens at night, lasts for three to four days and usually subsides on its own. In children with mild croup, the treatment approach is simple: exposure to cold, humid air. You can do this in two ways: open up a window or simply bundle the child up and take him outside. Another way is to let the shower run, preferably with cold water, and to let the child sit in the bathroom to breath in the cold humid mist. Usually, children start to breathe more easily within 15 minutes of exposure to cold, humid air. During the rest of the croup illness a cold-water humidifier or vaporizer in the room during the night can also help. The cough and stridor of croup may be quite scary, but fortunately most cases are mild, and need no other treatment or medical intervention. However, in the most serious cases, a child may have so much difficulty breathing that he is not getting enough oxygen into the blood. In this situation, the child will need to go to the hospital. Signs that a child needs immediate medical attention include: stridor that is getting louder with each breath, inability to speak because of lack of breath, labored breathing, pale or bluish mouth or fingernails, stridor at rest, and/or drooling. At the hospital, the child will be evaluated and given oxygen if necessary. Although there are no specific medications for croup, steroid injections and adrenaline-like inhaled preparations are used to help children with severe croup. These medications act to decrease the swelling of the upper airway. Another type of croup is called "spasmodic croup". In this case, the child gets a cold, rarely with fever, and then the typical "croup" begins. In some cases spasmodic croup may begin suddenly without any preceding cold symptoms. Unlike viral croup, spasmodic croup usually recurs, can occur in older children and is thought to be related to allergies. Viral croup is more common in children less than five years of age. Croup is very rarely seen in adults.

FEVER IS A SYMPTOM, NOT AN ILLNESS OR CONDITION

DEAR DR.PAUL: How long is a fever safe in a child of 13 months? The fever was as high as 103°F (39.5°C). Antibiotics were started on the 4th day and the fever disappeared on the 7th day. Thank you.

PEDIATRICIAN DR.PAUL Answers: Your question and concerns are shared by many parents, in whom fever is a source of anxiety. Fever is a symptom and not a diagnosis or a medical condition. The most common cause of a fever in children is an infection, mostly viral but in some cases bacterial. One of the challenges we have in evaluating children with fever is trying to determine the cause, or at least to make sure it is not due to a bacterial infection. This distinction is important, as viral infections do not need antibiotic treatment, but bacterial infections usually do. So the signs and symptoms that we keep an eye on in children with fever are clues to the cause. In general, the younger the child, the sicker looking the child and/or the longer the fever persists, the higher the chance of a bacterial infection. As important as the degree of fever, is how a febrile child generally looks. I personally worry more about a sick looking child with a low fever, than a very well, active child with a higher fever. Having said that, most children with fever do not need antibiotics. Your situation sounds like it was more than just a virus. In fact, parents should consult their doctor if the fever persists beyond 4 days, even if a child is not sick looking. The antibiotics were likely given to fight a bacterial infection, like an ear, sinus or chest infection. Importantly, once on antibiotics, the fever does subside right away. It usually takes at least a full 48 hours of antibiotic treatment before the fever falls completely. The normal body temperature is usually 98.6°F(37°C). A child is said to have a fever depending on how the temperature is taken. If the temperature is over: 100.4°F(38°C) rectally, 100°F(37.8°C) orally or 99°F(37.2°C) axillary(armpit), the child is considered to have a fever. Lowering the temperature with Acetaminophen (Tylenol or Tempra) can help your child feel better and less irritable. Aspirin(acetylsalicylic acid) should not be used. It usually takes up to 60-90 minutes for the fever to go down. If this doesn't work, then the child could be given a luke warm sponge bath. Do not use cool or cold compresses or baths and never use alcohol sponging. Here are some hints (alarm signs) on when to call your doctor about your child's fever: -if the fever is higher than 103°F(39.5°C) or -if your child appears unwell or unusually ill (this applies even when there is no fever) or -persistent fever or -if your child is less than 6 months of age My bottom line is that fever is usually not dangerous, and can be handled at home. Understanding the possible causes of fever and knowing what alarm signs to look for in a febrile child, is a great source of comfort to many of my patients.

Information provided on this site is designed to be an educational aid only. It is not intended to replace the advice and care of your child's physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition, always consult a physician.

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