Navigating the Sick Season with Kids: Flu, RSV and More

Navigating the Sick Season with Kids: Flu, RSV and More

Lisa Biggs, MD: Hello, I'm Dr. Lisa Biggs. Some of you may know me as a pediatrician at our Karabots office, or you may know me as the Vice President and Associate Chief Medical Officer of our CHOP Primary Care Network. I wanna welcome you and thank you for joining us and viewing the videos of a great team of experts that we've gathered together to help answer your questions as we partner together during a very challenging time for children and for all of those who care for children.

As you likely know, as you've heard in the media, there is a surge of early viral respiratory illnesses that is creating a nationwide capacity problem. It's leading to very high volumes in our pediatric hospitals, our emergency rooms, urgent cares and offices. There's an extremely high demand for sick visits leading to long waits for return phone calls and long waits in all of those settings.

And although hearing this is really very scary to parents, there is good news, and the good news is is that most children still will not require hospitalization, and most children still will not require an emergency room visit. Today and through these videos, we hope to answer your questions. We want to inform you so that you are aware of what's going on and what's happening around us.

We want you to learn about what efforts we're attempting to make sure that we can care for the kids who need us the most during this time. We wanna help build your confidence that you know when to worry, what to do about the most common problems that present in childhood, when should you seek care and what type of care should you seek?

All of those things are necessary for us to get through this together. We know how frustrating this is for you. It's frustrating for us. As we manage through this crisis to ensure that you and your child get the care that you, we ask for your patience and tolerance, as your healthcare team is working as hard as they can to deliver the high quality care that you are used to and that you deserve.

Katie Lockwood, MD, MED: It depends how old your child is in terms of how long they can vomit before they might become dehydrated. So it's important to consider whether or not it's an infant or an older child. But either way, the vomiting from a stomach virus typically lasts about 24 hours and then may change to other symptoms, like diarrhea. During that 24 hour period with vomiting, they can vomit multiple times and that's okay. The most important thing is that you keep them well hydrated while they're vomiting, and if you keep up with their hydration, you can keep them out of the hospital. So you wanna offer fluids in small sips or small portions, very frequently.

You don't wanna overfill their stomach too much or they'll throw up again, and so small sips frequently to keep them hydrated and they can vomit for at least 24 hours before you need to worry and bring them to a doctor, as long as they're staying hydrated during that time period.

It can be really hard to keep little ones safe from daycare germs when you have older kids at home who are coming home from the daycare setting where there might be a lot of coughing, sneezing, sniffling children. There are a few things that you can do though. The first is to teach your older child really good hand hygiene. So teach them how to wash their hands well and make sure that they wash their hands either before they leave daycare or as soon as they get home. I like to keep hand sanitizer in my car, so as soon as the kids get in, they can put some hand sanitizer on to hold us over until we get home and can wash well. You also wanna teach them to cough or sneeze into their elbow. So by doing that, they're keeping their hands free of those germs and avoiding touching other surfaces to spread it.

Some viruses can live on surfaces for a few hours, and so it's also a good idea to wipe down high-touch areas with a cleaner of your choosing. And so that includes things like doorknobs, light switches, and even your cell phones. And so for kids, this might be their favorite toy that they bring back and forth to daycare or other things like their lunchbox that they might be touching a lot throughout the day.

And so you can wipe those things down and wash them as soon as you get home to avoid spreading those germs around your household. I also like to have families take their shoes off at the door because anything that their child stepped in at daycare is then tracked all over your house where your little one might be crawling or laying.

And if your child does get sick, try to keep them separate as much as possible and wash your hands after you've done care for your older child before you touch your young infant.

Jeffrey Seiden, MD: The large number of pediatric patients that are presenting to urgent care and emergency departments across the region is likely due to a variety of factors. Certainly, we know that the lifting of COVID precautions, meaning we are no longer social distancing routinely, we are no longer wearing masks routinely, that is contributing. In addition, many young children have not been sick for a few years, and therefore their immune systems are not used to all of these viral infections. As a result, children who typically would get a simple sniffle or cough may now be getting some more severe symptoms with these same viral infections.

In an average year, most children will actually get a febrile illness about eight to 10 times, and many of those illnesses are clustered in the winter months and the late fall. So it's not surprising that children will often get sequential consecutive viral infections, which may make it seem like they are sick nearly all the time during the winter months.

This is not necessarily a reason to be alarmed. As long as the child is able to maintain their hydration and remain comfortable, you don't necessarily need to be seen in an urgent care or an emergency department simply because the child has been sick multiple times within a short period of time.

Katie Lockwood, MD, MED: Probiotics can help replace the good bacteria that live in our gut that sometimes get lost when kids are having a lot of vomiting or diarrhea. You can buy probiotics over the counter to help supplement, and this may reduce the number of diarrheal stools that children have. But there are also ways to do this through the diet.

And so you can offer your child foods like yogurt or any food that's been fermented, like pickles or sauerkraut or kimchi, and these foods can help replace some of that good bacteria naturally. It might be hard to get them to eat these foods though while they have a stomach bug. So if they're not eating the foods, you can choose a supplement, like a probiotic from your pharmacy.

Kathleen Filograna, MD, FAAP: So the symptoms of COVID-19, influenza and the common cold are all respiratory symptoms. They can look very similar, with coughing, congestion and fever. Influenza tends to have a sudden onset of symptoms. So your child will show high fever, sore throat, runny noses, coughing, body aches, and even GI symptoms.

The common cold tends to be a little milder. So they may have a runny nose, some congestion, coughing, and even fever. COVID-19 virus -- we've seen children with some mild cold symptoms, rashes, GI upset. We've also seen children who have severe respiratory illness, requiring hospitalization. So again, the most important thing for your child is to get vaccinated against the flu and COVID-19, if you haven't done so already.

So cold symptoms can easily last 10 to 14, days with coughing and congestion. So you're okay to monitor your child at home if they haven't shown any signs of labored breathing and are drinking well throughout the illness.

So to relieve some of the cold symptoms, we recommend using nasal saline drops and suctioning to remove the congestion. A cool mist vaporizer can also be helpful at night to alleviate the cough. Over-the-counter cough and cold medicines are not recommended for toddlers because they can have dangerous side effects.

Cough, remember, is protective. So it allows your child to clear the mucus out of the airway and prevent a pneumonia. You can give some warm fluids like apple juice, milk, and even tea with honey for children over a year of age, to help the soothe the sore throat and alleviate the cough.

Jeffrey Seiden, MD: RSV or respiratory syncytial virus is one of any number of viruses that cause respiratory infections in young children. Simply knowing that it's RSV, generally makes no difference in the treatment course for your child. As a result, you don't need to be tested for RSV in order to manage your respiratory infection.

The same rules apply for RSV infections as they do with any upper respiratory infection, and that is making sure that the infection stays in the upper respiratory tract and is not causing that increased work of breathing that we've discussed. RSV is also very commonly associated with bronchiolitis, which is a lower respiratory infection that typically affects children under the age of one or maybe between one and two years of age.

Bronchiolitis causes wheezing and increased work of breathing. And the most common concern with RSV bronchiolitis, is that it can affect the way in which a child can maintain their hydration. Young infants have a difficult time latching onto the nipple and drinking enough fluids to maintain their hydration, and so that's really what we wanna focus on.

If a child with an RSV bronchiolitis infection is able to drink vigorously and has several wet diapers over the course of the day, then there really is no other treatment for RSV infections other than continuing the supportive care. And these infections can often last for up to a week and sometimes even two weeks to get fully resolved.

Kathleen Filograna, MD, FAAP: Unfortunately, there's really no way to predict, when RSV season will wrap up this year. We're certainly hoping that it's soon. The most important thing, again, is to vaccinate your child for influenza and COVID-19 to prevent other respiratory illnesses.

Jeffrey Seiden, MD: There are many differences between a pediatric emergency department and an adult emergency department, and I would say that for most younger children, certainly under the age of one, you may get better service, specifically related to pediatric illnesses, in a pediatric specific urgent care or emergency department.

Adult emergency departments are certainly capable of managing most of childhood illnesses, specifically in adolescents. But if your child is younger, I would recommend seeing a pediatric-specific emergency department.

Katie Lockwood, MD, MED: The CHOP website has lots of information online that you can trust, but besides us, I like the American Academy of Pediatrics and they have a website called healthychildren.org. There's lots of information there that you can trust as a parent, and it's very easy to navigate.

Jeffrey Seiden, MD: If your child is vomiting, there are several things to consider when they're trying to figure out if you need to come to urgent care or to the emergency department. The first is, what does the vomit look like? If you notice any blood or any dark army green coloration to the vomiting, your child should be seen that day probably in emergency department, but in an urgent care if that's closest to you.

When trying to manage vomiting that is not bloody and doesn't have that dark army green color, the most important thing is hydration. When trying to get your child to drink enough fluids over the course of the day, it often works better to follow an oral rehydration schedule. What that generally entails is taking smaller amounts of fluid at a time and offering it to them more frequently.

So rather than expecting them to drink an entire cup full of juice, instead offer them small teaspoons or tablespoons of juice and do that every several minutes. Using an oral syringe may be helpful, and you can find these at any of your local pharmacies.

Katie Lockwood, MD, MED: There are many things that we can handle in primary care and we should be your first stop. If you're not sure though if you need to come to primary care, urgent care, or the emergency department, you can give us a call. There are also some great resources on our chop.edu website about navigating the sick season, including where to go and when.

So when your primary care pediatrician's office is not open, urgent care can be a good alternative. This is to be used for things that can't wait overnight until your pediatrician opens again in the morning. This could include something like a burn or a wound that needs emergent care, like stitches. It also could include things like trauma -- if your child twisted their ankle or you're afraid that they have a broken bone. Those things can be handled well in our urgent care division and do not need to go to an emergency room necessarily. However, if you are worried that your child has dehydration or has had a major trauma and might need orthopedic care, you should go to the emergency room instead.

So I think of the emergency room is for emergencies. Urgent care is for minor emergencies that can't wait overnight, but don't need a hospital-level of care and primary care where your general pediatrician is for everything else. And when you aren't sure, use our primary care after-hours program to call and we will help you find the right place.

Fevers are a natural part of getting an infection. That tells us that our body is cranking up the thermostat to fight those germs and help us get better. So I expect to see a fever when kids have many common childhood illnesses. When do I get worried about a fever? Well, I always worry about a fever in an infant under the age of two months.

So anything a 100.4 or higher in that age group needs to go to the hospital. Above the age of two months though fever can be watched at home, and if your child has a fever for more than three days, that's when I would want you to give me a call so we can check out why that fever is lasting longer than expected.

I don't worry so much though about the actual fever number. So whether it's 102, 103 or 104 degrees doesn't matter to me as much as how the child looks. So if your child has any fever and is lethargic, is not eating and at risk for dehydration, or is having a change in their mental status, then you should seek care immediately.

But if your child's fever is high and they're feeling and looking well otherwise, you don't have to do anything about it. If you're worried that the fever is keeping them from being able to eat and drink and they might get dehydrated, that's when I use antipyretics, like acetaminophen or ibuprofen, to bring that temperature down so they feel better and they can hydrate and get better faster.

So don't worry so much about the number, but think about how your child looks and if it's longer than three days, seek care, or if they're a newborn under the age of two months. Remember, fever is our friend and it helps us fight germs.

We recommend that you get your flu shot during the flu season. After you get your flu shot, can take about two weeks to build up antibodies, but it's better than nothing. So it's definitely not too late to get your flu shot because we're starting to see flu cases and those will grow over the next few months.

Typically the peak flu season is the end of January, early February. We are seeing a lot of cases already, so we expect this to be a bad season. So it's really important that you get your flu shot and that way you can be protected when we reach that peak. So it's time to get your flu shot now, and it'll help protect you the whole season.

Most kids who get the flu can be treated at home. They might feel miserable because the flu has a lot of symptoms associated with it. So it can be headache, fever, cough, congestion, sore throat, muscles aches and pains, fatigue, vomiting, diarrhea and more. And while they feel miserable, the most important thing is that you keep them well hydrated.

So let them rest. You can use antipyretics, like ibuprofen or acetaminophen, if they have fever and feel miserable from it. But really it's about keeping them hydrated and letting them rest till they get better. There are certain kids who I worry about though, who I wanna hear about and maybe see in my office, and that includes kids who are immunocompromised, have severe asthma, chronic heart or lung conditions, or morbid obesity.

These kids may benefit from antiviral medications or they might just need to be watched a little bit more closely. But that's a rare exception. Most children will do fine with the flu and they can stay home. It's important that you get your flu shot because even though you might still get the flu, it will make your symptoms milder and shorter and it's more likely to keep you out of the hospital.

So while there are some kids who we worry about with the flu, most will do okay. They don't need any medication other than what you give them at home, and they don't need any special testing to find out whether or not it's the flu or not. You probably know from the symptoms they have and how they're feeling.

Give us a call if you're concerned. Otherwise, stay home, rest, and hydrate.

Jeffrey Seiden, MD: If you suspect that your child may have a COVID-19 infection, rest assured that we are in a different phase of the pandemic now than we were earlier. As such, it's not essential to come to an urgent care or an emergency department just to get tested. In fact, you can take an at-home test or not test at all, and simply follow the CDC's guidelines for isolation in order to prevent the spread of infection -- really just as you would for any respiratory infection.

COVID-19 in children at this point is really behaving just like any of the other respiratory viruses, and you're left to monitor for signs of lower respiratory infection, as opposed to the much more common upper respiratory infections we see with COVID-19 and other respiratory viruses.

Kathleen Filograna, MD, FAAP: So we're certainly here to help answer any questions that you have about your child's illness.

Call the primary care office, but also remember to check our website. We have Symptom Checker available where you can enter the symptoms your child's experiencing and get some on-the-spot care advice.

Jeffrey Seiden, MD: As a parent myself, I understand how frustrating it can be when you're concerned about your child and you're faced with very long waits, either to make contact with your primary care provider or to be seen in an urgent care or emergency department. Please know that the healthcare community is doing all we can to see every child that requires our care.

Children are seen in the order in which they present, as well as based on the acuity of their condition. And so we ask for your patience as we all try to do our best to make sure that every child in our community is healthy.

Lisa Biggs, MD: Thank you for taking the time to view our Family Town Hall. Thank you for submitting your questions.

This surge will end and we will get through this together.