The flu!
Not surprisingly, we are seeing a TON of flu right now. As a reminder, influenza is a respiratory illness with primary symptoms of fever and cough. We've been seeing high fevers, often in the 103-105 range. The good news is that kids who've been vaccinated for influenza are having shorter, more mild courses of illness.
Some common questions we're hearing:
What temperature is an emergency?
There's really no fever that is an absolute emergency. We care much more about how a child looks and acts than the number on the thermometer. With high fevers we expect kids to be fussy, clingy and want to sleep more. They should be able to talk or interact (even if not in a pleasant way!), drink fluids to stay hydrated, and have moments where they perk up and seem happy, even if short lived. A child who is lethargic - so sleepy they cannot lift their head off the bed, difficult to arouse - should always be evaluated regardless of temperature.
*this only applies to children who are over 2 months and up to date on vaccines - if your child is unvaccinated or undervaccinated please call us with a fever over 101, they may need much sooner medical attention. Under 2 months, 100.4 or higher is an emergency and should be evaluated in the ER.
Should I alternate acetaminophen and ibuprofen?
The goal with fever is to keep your child comfortable. If the temperature is 101 and they are happy and playing, you don't need to give medicine at all. Alternating medicine can be helpful for high fevers since one medication may only bring the temperature down by 2-3 degrees. Acetaminophen can be given as often as every 4 hours and ibuprofen (in children over 6 months only) can be given as often as every 6 hours. There is no specific interval you need to wait between ibuprofen and acetaminophen.
Does my child need Tamiflu?
Tamiflu is an antiviral medication for influenza. While it is helpful in shortening duration of symptoms by about a day, it does not make kids better in 24 hours like many antibiotics. Tamiflu is definitely recommended for children under 2 years old or children with other medical problems like asthma or diabetes. For a healthy child over 2 years old Tamiflu is optional. Some kids get upset stomach and prefer to skip the medication. Unfortunately, we cannot prescribe Tamiflu over the phone. If you child is sick we want to examine them be sure that there isn't an ear infection or pneumonia in addition to influenza that needs to be treated. Tamiflu must be started within 48 hours of onset of symptoms.
What other symptoms should I look out for?
The cough with flu can be severe. If your child is having any trouble breathing (breathing fast, retractions under the ribs, nostrils flaring out with every breath) they should be evaluated right away - you can come to walk ins 8:30-11:30 Monday through Saturday, call us for a sick appointment in the afternoon, go to urgent care, or go to the ER.
Kids eat and drink much less than normal when sick. Encourage fluids to avoid dehydration. Kids should pee at least 3 times per day, the inside of their mouth should look wet, and they should have tears when they cry. For babies, the fontanelle (soft spot) on the top of the head should not be sunken in. We always want to evaluate a child who looks dehydrated.
Is it too late to get a flu shot?
Definitely not! Last year we saw influenza well into May. Even if you child has already had the flu, there are multiple strains and the flu shot may protect against getting sick again. Call the office to schedule a vaccine visit.
Does the flu shot work this year?
The short answer is we don't know. Often early reports don't look promising, then after the season ends studies find it was actually pretty effective. The flu vaccine last season was much more effective in children than adults. Even if the vaccine doesn't prevent flu, up to 80% of kids who die of the flu were unvaccinated, so it definitely helps prevent more severe complications.