A Pediatrician's Perspective: How to be prepared for life's little cold and fu misadventures! Kathleen Leach, MD October 12, 2010 Swarthmore College

Transcription

1 A Pediatrician's Perspective: How to be prepared for life's little cold and fu misadventures! Kathleen Leach, MD October 12, 2010 Swarthmore College

2 About the speaker Dr. Leach is a primary care pediatrician practicing in Newark, Delaware since 2006 This is my first talk at Swarthmore College

3 Overview The fall through spring is the fifth season - it is known as flu season! However... there are a lot of illnesses out there other than the flu!

4 Overview And... pharmacies are brimming with all kinds of remedies oh, what to choose? And... how can you manage some symptoms at home, when do you HAVE to call your child's doctor? I am here to try to shed some light!

5 Goals of this talk To review common presentations of several pediatric illnesses and help you to recognize the signs of more serious ailments To discuss some AAP recommendations for prevention of disease, and highlight several key guidelines for flu vaccination To review the safety profiles of several OTC medications and discuss their avoidance for young children To answer any questions you may have

6 Everywhere you look...

7 A little about the flu... and why to vaccinate Influenza is a very contagious virus that is transmitted via respiratory droplets and can cause significant disease and even death The highest risk groups are young children, pregnant women and the elderly, especially special health needs groups Symptoms of the flu vary from mild to severe, and serious complications are unpredictable

8 More about the flu! SYMPTOMS: Fever Chills Malaise Headaches Aches and pains Sore Throat Cough Vomiting and Diarrhea

9 Flu vs Common Cold Influenza-Like-Illness aka ILI The flu is contagious longer than a cold Symptoms can be similar a bad cold can be a mild flu In general, the flu is more severe and intense The flu is more dangerous and can be deadly if the patient becomes super-infected with Staph or develops pneumonia.

10 Who should get the flu vaccine All Americans 6 months and over are now recommended to get the flu vaccine by the CDC The flu vaccine comes in an injectable form (with a lower dose for 6 months through 2 years old) and a live inactivated nasal mist for healthy people aged 2 years through 49 years You should not get the flu vaccine if you are allergic to eggs

11 So, what if I suspect my child has the flu? Call your pediatrician, especially if your child is under 5 years old, has heart disease or asthma, or appears ill. Keep them home from school Antiviral medications may be prescribed by your doctor if your child has ILI and certain risk factors, or has been exposed to a confirmed case of the flu the earlier in the course of illness these meds are started, the better they work and after the third day the probably do not help much at all...

12 ...suspect the flu... Infants under 24 months (especially younger infants) and children with underlying medical conditions are a special circumstance and your doctor should be notified immediately if influenza is suspected in these kids Try to keep your child comfortable with fever reducers, lukewarm baths, wet washcloths on the forehead, plenty of fluids and plenty of rest

13 ...suspect the flu... If any signs of severe illness are present (change in mental status, worsening breathing, rapid decline in health, increasing severity of symptoms) notify your healthcare provider right away Of course, vaccinated children are much less likely to get the flu!

14 So what is out there other than flu? Croup Respiratory Syncytial Virus / Bronchiolitis The common cold viruses Ear infections Pharyngitis viral and strep Serious bacterial infections (pneumonia, sepsis, meningitis, abscesses, MRSA infections) Pertussis ( Whooping Cough ) The lists can go on and on...

15 A little bit about Croup Croup is a typically very acute illness that hits suddenly, usually waking the child from sleep Characterized by a very unique cough dry and barky like a dog or seal Children can have trouble breathing even between coughs with a squeaky sound when they inspire and prominent rib and neck skin retractions The most common cause is Human Parainfluenza Virus

16 How to recognize croup The sudden onset of a different sounding cough, usually in the middle of the night The sound of stridor between breaths Often a pretty high fever Child can be perfectly well with no symptoms before bedtime then wake up with croup Croup typically lasts 3-4 days followed by up to a week of more typical cold symptoms

17 What else can it be? Since children are now vaccinated for HIB and pneumococcus during infancy, the likelihood of contracting life-threatening bacterial infections of the windpipe ( tracheitis or epiglottitis ) are much less common Signs this is something worse, or even bad viral croup, include true respiratory distress or drooling, holding the chin out in front of the body, or an ill appearing child

18 Stridor

19 Barky cough

20 Croup home care Cool night air (or stand in front of the open freezer) Humidity sitting in the bathroom with the shower on for a while Running a humidifier bedside Fever reducers for the fever ER! any color change, stridor that does not resolved within 15 minutes, or respiratory distress Medications prescribed at your doctor's office

21 Pertussis

22 How pertussis is different Bacterial not viral Typical cold symptom prodrome Paroxysmal cough Whoop at the end of the coughing fits Cough is exhausting Cough lasts weeks, not days Can be more acutely dangerous to young infants than croup typically is, due to Apnea spells

23 How to prevent Pertussis This is Extremely Contagious The ap in the DtaP vaccine is the pertussis component Make sure all children are vaccinated in infancy as per the CDC schedule, and all parents have the Tdap booster to ensure they remain immune

24 Wheezing

25 What makes children wheeze Wheezing is caused by narrowing of the tiny lower airways in the lungs called bronchioles, due to swelling, mucous, or spasm of tiny muscles Viruses infecting the lower part of the respiratory tree can make children wheeze RSV can cause a wheeze Lungs with asthma and reactive airway disease can react to upper respiratory viruses, cold air, environmental irritants (smoke, bad air quality, perfume), and allergens

26 What to do? For the first time wheezing infant or child, there is no specific home care just keep them relaxed and get in touch with your doctor If the child is struggling or wheezing badly, take to the ER If your child has bronchodilator medication at home (Albuterol or Xopenex) it should be administered if you suspect or hear wheezing, or for the typical asthma cough

27 More to do... Remove the child from the suspected trigger and call your physician for acute wheezing Steam and moisture typically are not helpful wheezing children usually need medical treatment If they have a fever you can treat that to keep the child comfortable

28 RSV RSV stands for the Respiratory Syncytial Virus It is a virus that can range from a mild common cold to full blown infant viral bronchiolitis causing wheezing and trouble breathing Infants with RSV can develop apnea and stop breathing Typically there are copious nasal secretions, coarse breathing sounds, and fever with cough

29 RSV Treatment aimed at opening the airways unfortunately is typically not as effective as we want it to be Babies and children who are very ill often need to be in the hospital for observation, suctioning, and oxygen If RSV is suspected due to a wheeze, bad cough and fever, or an ill appearing child you should be in touch with your physician right away

30 Treatment...

31 How to prevent RSV No vaccine... There is a prophylactic injection called palivizumab (Synagis) given monthly to certain high risk groups (preemies and babies with lung disease) for 3-6 months over the winter season Good hygeine, avoidance of known infected children, and lots of handwashing remain the best prevention measures

32 Pneumonia Pneumonia can be either viral or bacterial the flu can cause pneumonia itself Pneumonia by definition is an inflammation or infection of the lung tissue itself, usually causing fever cough and sometimes chest pain Pneumonia usually does not come out of nowhere; most kids get it after having the common cold

33 Pneumonia There are 2 types of bacterial pneumonia - walking or atypical pneumonia, or typical community acquired pneumonia Both require antibiotics Only a doctor can tell if the child has pneumonia a chest exam is required Chest Xrays are often needed to assess a child who seems to have pneumonia Hospitalization and oxygen support +/- IV antibiotics are occasionally needed for bad cases

34 So I think it is just a cold... Most children with runny noses and fevers in the winter likely have one of the hundreds of viruses that cause a cold Home care should be aimed at comfort and support; keep them home from school or daycare if they have a fever or are coughing a lot Colds can cause green nasal drainage not all green is an infection but if unsure it should be checked out by the pediatrician sometimes it means it is almost over!

35 ...Just a cold... Fever management and avoidance of environmental irritants can be helpful Home hygiene to try to keep other household members healthy is important Hand washing! Any cold lasting more than 10 days should be checked by a doctor to make sure there is no underlying infection present

36 A little about OTC medications... The AAP and FDA finally have cracked down on cold and cough medication marketing for young children Medicines to dry the nose, expectorate phlegm and decrease cough are in this category Children under 24 months should NEVER be given an OTC cold medication due to safety concerns they are banned now OTC Studies indicate that cough and cold medications given to children under 6 years are likely only as effective as placebos

37 What IS ok OTC? SALINE!!!! Nasal aspirators Fever reducers (not the recalled ones of course...) Antihistamines under the guidance of your physician Cough and cold medications for kids over 6 are occasionally helpful Cough drops and honey are great for older kids.

38 Does menthol help? Kids who like Vicks and do not have asthma are usually made no worse by it Kids who are wheezing may be exacerbated by these therapies and you should avoid them Menthol is a comfort measure and has not need shown to open the nasal passageways it is just a sensation...

39 A little on fevers... Fevers themselves are usually neither harmful or helpful to children fighting an illness Reducing a fever for comfort does not prolong an illness Alternating acetaminophen (Tylenol) and ibuprofen (Motrin) every 3 hours has NOT been shown to reduce febrile seizures A fever less than 105 is usually considered safe to attempt to manage at home, depending at the other symptoms

40 Fevers in little ones... Babies under 2 (or even 3) months with any fever (rectal temp of or higher) are considered potentially septic and need to be seen in the ER call your child's physician for advice in these circumstances Any child under 12 months with a fever usually should have a doctor's visit or phone advice even if a common cold is suspected

41 Ear infections... Getting through the night So until yesterday it was just a cold and now she has a terrible ear ache... Most ear pain can wait to be seen by the doctor the next day Give pain/fever reducers Sometimes a very low heating pad (be VERY careful to avoid a burn) can be helpful for a throbbing ear

42 A little about sinus infections In children sinus infections or nasal infections typically happen after a period of the common cold Older kids with seasonal allergies may experience sinus symptoms more acutely Facial pressure, headache, fever, bad taste or breath can all be signs If sinus infection is suspected the child should be seen by their pediatrician

43 Food? When kids are sick they usually lose their appetites this is OK Children must remain hydrated to fight their illnesses Focus on fluids, like electrolyte replacement solution for infants, breast milk and/or formula, clears and soup for older kids Skipping a few meals is usually OK offer crackers and cereal if the child is up to it

44 Daycare or school? Children with any illness with a fever can not return to school for at least 24 hours after the fever breaks Children with pinkeye or strep throat should stay home until treated for 24 hours Presumed or suspected flu should stay home for generally a 5-7 day period after they start feeling better and have no fever (!) they are still contagious!! Use good judgement would you want your child exposed to what your child has? If not stay home.

45 Conclusions Never hesitate to call your child's physician if you think your child is really sick they are the best resource Look for the signs of more serious infections and be aware of danger signs Home care measures can really help (as for croup), or be harmful (as for OTC medications for children under 4-6 years) be cautious! Up to date vaccinations and annual flu vaccines are the best way to prevent many serious ailments

46 Thank you! Questions?