Winter illnesses

Thank you for joining our chat. We will start taking questions at noon. Stay tuned.

Hi everyone, let’s get started. I’m Julie Deardorff, your moderator, and today we’ll be talking with Dr. Ari Brown, a full-time pediatrician in private practice, co-author of the best-selling books Expecting 411, Baby 411 and Toddler 411, a spokesperson for the American Academy of Pediatrics, a parenting and health blogger and a mom. I have no idea how she gets it all done. It’s her busy season, so we’re lucky she is able to take the time to join us. So, Dr. Brown, are you seeing lots of cases of the flu these days?

Yes! Flu season is definitely here in my home state as well as across the country. We are seeing flu virus, cold viruses, and Strep throat as the top bugs right now.

I think many parents want to know how they can tell whether it’s strep throat or just a cold. Are there telltale signs?

Strep throat, caused by a bacteria, usually has isolated symptoms of sore throat with a fever. Some children will also complain of headache or stomachache. Occasionally there will be a red, raised, pinpoint, rough (like sandpaper) rash too. But the key difference between Strep and just a cold virus is that there usually is NO runny nose or cough with it.

And since strep is caused by a bacteria, antibiotics might be in order, right? Can you use antibiotics with a cold?

Good question. Strep does need to be treated with antibiotics. While the throat infection may clear on its own, Strep bacteria (officially called Group A Strep) that isn’t treated can damage other body parts–like the kidneys or heart…which is why it is so important to treat it with the entire course of antibiotics. Colds are caused by viruses, so antibiotics won’t help at all to change the course of the illness.

Is it OK to alternate Tylenol and Motrin for fever?

Many parents worry about fevers. Fever is the body’s way of fighting infection, so the fever itself is not dangerous. (What’s important is to figure out what is causing the fever). That said, there is no need to alternate fever reducing medications unless your child is prone to having febrile seizures. Using the medication as directed (Ibuprofen dosed every 6 hrs or Acetaminophen dosed every 4 hrs) should be enough to keep your child comfortable and bring the fever down by a couple of degrees.

Is it better, then to let a fever run its course, as long as the fever isn’t too high?

Actually, the body will fight the infection even if you help reduce the fever by a degree or two (which is at best, what the fever reducers will do…they aren’t fever eliminators). So, it is fine to give either type of medication if your child has a temp of 100.4 or greater.

Hi Lauren,
For children at least six months of age and up, I prefer ibuprofen because it is effective and lasts for 6 hours–acetaminophen only lasts for 4 hrs. And in the middle of the night, those 2 extra hours are a good thing! What is NOT recommended is ibuprofen for kids under 6 months of age or if a child is really dehydrated.

Especially since it’s impossible to keep their hands out of their mouths!

Using really good hygiene is best for kids and adults. Yes, that means washing hands–everytime before your hands go up to touch your face or put things into your mouth. You’d be amazed how many times you touch your face during the day without thinking about it. And, germs are everywhere. Computer keyboards, phones, doorknobs, pens, etc. And, having everyone cover their coughs goes a long way too. Don’t share food or drinks with family…that leftover chicken nugget may be a real mistake when your child wakes up vomiting later that night!

For kids under a year of age, I always recommend taking a temperature rectally. Babies really don’t care about having it taken that way. After a year, it is less critical to get an exact temperature. You just want a ballpark idea of fever vs no fever. Under arm temps are not very reliable, but if you want to take it that way, just report it to the doctor as what you read on the thermometer. Do not add a degree. Newer temporal artery scanners are kind of cool, and fairly accurate. Just still kind of pricey.

Several people on this chat have voted for homepathic medicines as the remedy they’d most likely try for a cold. These are much different than herbal medicines. Can you talk a little about whether there is any evidence of efficacy?

Despite their popularity, the scientific evidence is lacking to show that these products actually reduce the severity of a person’s symptoms. I always encourage people to check out the National Center for Complementary and Alternative Medicine at nccam.nih.gov to read about the products before purchasing them.

Great question Gail. Pregnancy puts a woman in an immune-compromised state, which means that her body’s immune system may not fight infection off as effectively. So, having the flu as a pregnant woman can be much more serious. So, yes, I would suggest that people attending the family gathering get flu vaccine to protect her.

Hi Tiffany,
It’s true that teething gets blamed on a variety of symptoms. But, rarely is it the cause of any of them. So, if your baby has a runny nose, it is more likely to be a cold than just teething. If the runny nose persists more than a couple of weeks or if it is associated with a fever, disrupted sleep, really grumpy mood, or labored breathing…see your baby’s healthcare provider.

Hi Mary,
Yes, it sounds like a viral illness. Assuming this is you, an adult, who is sick, I personally would recommend a cough lozenge and lots of fluids. Using a humidifier also helps keep the airway most and mucus/secretions loose. That helps reduce the need to cough. When I am sick, rarely do I use cough and cold meds. They really don’t help much. Occasionally, I will use a decongestant nose spray for a couple of days…just know that those have potential for the nose getting addicted to them so it’s important to stop using after a few days.

Hi Darlene,
Here are some red flags for vomiting:
1. Persistent vomiting with no obvious cause (e.g. no diarrhea to go with it)
2.Vomiting with a head injury.
3. Vomiting bile (bright yellow or green)
4. Vomiting over 12 hours straight.
5. For babies: projectile vomiting more than 3 times in a row.
6. Vomiting only in the mornings.
7. Vomiting blood or something that looks like coffee grounds.
8. Abdominal pain THEN vomiting.

Hi Carrie,
I recommend cool mist humidifiers for really practical reasons. A warm mist humidifier makes the room really toasty and uncomfortable to sleep in. And, if you have a baby or toddler roaming around on the nursery floor, he might be able to grab the humidifier and sustain a burn (they get pretty hot).
Either product is effective in helping loosen up mucus.

Hi Tiffany,
Children over one year of age can try a teaspoon of honey before bedtime. There is some actual research that shows it can be effective. (Note: Honey is not recommended for infants as there is a risk of botulism). You can also try using some Vapo-rub. As you probably know, all the cough and cold remedies for children under 4 years of age were taken off the market for safety concerns. As an aside, they weren’t very effective anyway. If your child is truly up night after night with a cough, it is time to check in with the doc anyway. There are some prescription cough medications available if really necessary (I am not a huge fan of those either to be honest)

Hi Mary,
When people are hospitalized with pneumonia or people have cystic fibrosis, respiratory therapists will perform “chest physical therapy”. In essence, it helps to mobilize the thick secretions in the lungs. I am not sure a certified massage therapist would perform the same maneuvers while doing a back massage, but it wouldn’t hurt to ask.

I keep hearing Vapo-rub works if you put it on your feet. (But then I’ve also heard that sleeping with wet socks helps with insomnia. ) Really??

Funny! Yes, many, many of my patients parents swear by putting the Vapo Rub on the feet. The only thing I can figure is that placing the Vapo Rub right near the nose can be a bit overwhelming and perhaps more bothersome than useful for a person with a sensitive sniffer! I cannot comment on the wet socks and insomnia. I think I would have insomnia with wet feet, but that is just me!

Sleep position can be a real issue, particularly for people who have sleep disordered breathing or sleep apnea. These people are constantly repositioning their airway while trying to sleep so they can breathe effectively. As a result, they wake up hundreds of times a night and never get quality sleep.

Other than that, I really cannot comment!

Also, if a child is on antibiotics, is it OK to have a playdate?

Great question Mary.
In general, people are contagious with a viral illness while they have a fever or for the first 48-72 hours of the illness. A person may be coughing from a common cold for 10-14 days. So, no, the lingering cough is not always spewing virus germs with it. However, doing good cough management (coughing into the crease of your elbow) is always a kind thing to do.

Hey Julie–
As for antibiotics…once a child is on antibiotics for 24 hours (for instance for Strep throat), he can resume regularly scheduled activities for school and play.

That’s going to wrap it up for today. I’m sorry we couldn’t get to all the questions, but I want to thank everyone for joining and Dr. Brown for spending so much time with us. Our next chat will be at noon CT (1 p.m. ET/10 a.m. PT) on Tuesday, Feb. 22 and it will look at the results of alternative medicine.

Thanks for tuning in everyone. Stay healthy this winter!