Winter is upon us, bringing with it illnesses that usually present fever, upper airway congestion, and cough or wheezing. Respiratory syncytial virus, also referred to as RSV, is one of the many causes of adult colds, but it frequently triggers prolonged illnesses in infants who haven't yet developed effective immune responses. This year, emergency rooms and pediatricians' offices are busier than usual with the early arrival of RSV, suggesting that "the flu" is not likely far behind.
Most parents become anxious when their children don't feel well or develop fevers, coughs, and congestion, which are commonly accompanied by a loss of appetite. While it is normal to be nervous when our children are ill, some moms and dads panic unnecessarily.
Infections of this type are common among preschoolers, who frequently average a cold a month. During the first year of life, infants are protected from the infections that their moms are immune to due to the transfusion of maternal antibodies during pregnancy. Once that protection wanes, however, toddlers must develop their own protective antibodies each time they encounter a new bacteria or virus. While it is almost impossible for little ones to avoid exposure to these illnesses, their affects can often be minimized.
Avoid fever phobia
Fevers signal illness, nothing more, and they are inconsistent indicators of the severity of an illness. While parents frequently worry about the effects of high fevers, it is a medical fact that an elevated temperature, by itself, does not cause brain damage or life-threatening problems. Using the following guidelines may help parents and caregivers avoid needless worry and prevent unnecessary intervention:
A child does not have a fever until his temperature rises above 100.4 degrees.
A temperature of 104 is, by itself, no more dangerous than a fever of 102. A visit to the doctor or emergency room, based solely on a child's temperature, puts you at risk of exposing your child to other infectious illnesses.
Medical evaluation should be considered if the fever is accompanied by pain, difficulty breathing, irritability out of proportion to the fever, or has lasted more than three days.
Children under 3 months of age should always be seen by their pediatrician whenever their temperatures rise above 100.4 degrees.
Use medications wisely
It is not necessary to give acetaminophen or ibuprofen for every fever. In fact many pediatricians believe that fevers are one of the body's normal protective mechanisms and that a fever should be allowed to run its course.
It is not necessary to awaken a sleeping child or engage in a power struggle with an active 2-year-old to administer "fever medication."
When giving medication, carefully monitor the correct dosage. Use a standardized dispenser; never measure with a kitchen spoon, as their sizes frequently vary, resulting in severe over or under dosing. Do not give more frequent or higher doses than your pediatrician recommends, because, when taken incorrectly, these medications can be toxic.
Over-the-counter cold remedies are now considered unsafe for children. The Academy of Pediatrics says that children under 6 years of age should not be given cough or cold medications. The US Federal Drug Administration has declared these medications unsafe for children under 2 years of age, but is considering revising that recommendation. It is believed that some of these medications may have been associated with a number of childhood deaths. Since these drugs provide little, if any, therapeutic benefits, why put a child at risk?
An ounce of prevention...
Even though we can't prevent all infections, we can minimize their effects and avoid many of their potential complications.
Take advantage of vaccination programs. They are safe and effective. Influenza vaccine is now available and, as of this year, is recommended for everyone above 6 months of age.
Keep your hands clean. Washing your hands throughout the day, with soap and water or an alcohol based hand sanitizer, helps to eliminate germs and reduce the spread of infection.
Avoid touching mucous membranes with your hands (mouth, eyes, and nose). If you do, wash your hands.
Avoid crowds, particularly with infants, during cold and flu season.
Colds, fever, and cough are generally signs of common, self-limited viral infections. Don't panic, overreact, over treat or over medicate. Use common sense and parental instincts as guidelines for treatment. However, if worry gets the best of you, do not hesitate to call your pediatrician for support and guidance.
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Dr. Edward Bailey is chief of pediatrics at NSMC North Shore Children's Hospital, on staff at MassGeneral Hospital for Children and a father of three. You can contact him at ebailey@aap.org.
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