Handling the Back-to-School Epidemics – Common Childhood Illnesses
Getting Ready for Back-to-School Epidemics
This post is not about COVID – there is plenty of information out there about that and I’m happy to talk with people individually about those concerns. But every year as we start up the school season kids are around kids and kids love to share germs. So, we usually see an uptick in strep throat, sinus infections, and stomach infections in the first few weeks after school starts up again. This post is about the common childhood illnesses that seem to pop up when kids get back into their school routines.
Strep throat is usually characterized by a fever (including low-grade – 99.5 and above), swollen lymph nodes in the neck (they feel like little marbles or grapes next to the throat), absence or minimal cough (if the child is coughing a lot, that is usually a viral infection), and most important, white exudate on the back of the throat (this looks like milk or cottage cheese stuck on the tonsils or the back of the mouth). If there is any exudate, or if all three of the other signs are present, do give us a call and come on in – we can treat this quickly and avoid complications related to strep throat.
On the other hand, if the child has a lot of congestion (either a runny nose or a post nasal-drip) and is coughing, this is usually a virus. Kids pick up viruses quickly, get sick quickly, and usually get better quickly. Watch at home if the child has a low grade fever and is otherwise acting pretty normally. A little bit fussy or complaining is normal. Lots of fluids is helpful, a humidifier by the bedside at night, and honey for children over the age of 2 helps to sooth the throat and reduce cough. If the symptoms are lasting more than 3 days or if you are concerned that these aren’t normal symptoms, then let the doctor know. If you are concerned about these symptoms in relation to COVID, then definitely let the doctor know, so we can arrange for testing. Otherwise, watch and wait, and if they turn around in a few days then no doctor appointment is needed. A child that is gradually improving usually does not need to be seen. If he plateaus or takes a turn for the worse, then we are concerned about a bacterial infection setting up on top of the viral infection, and that is worth a visit.
We are concerned if the fever is above 101 degrees, or if there are muscle aches or generalized body aches. We are very concerned if the child is lethargic – that is, she just wants to curl up in a ball and not move at all. Other red flags include not taking in fluids, and not urinating (or if the urine is very dark). These are signs of a more advanced illness that may require antibiotics. The best indicator overall of a child’s health is their behaviour. A child that is acting normally but has a 102 fever is far less concerning than a child with a 100.4 fever but is too tired to move or complain. If the child is complaining of sharp pain in the ears, or a persisting ear ache, that is also reason to be seen by a physician to check for ear infections.
As for stomach infections – we also are usually not too concerned about nausea, vomiting, and diarrhea that is mild and lasts for less than 48 hours. Hydrate well, drink Gatorade or Pedialyte to replace the electrolytes that are lost, and usually it will calm down within a couple of days. Stomach infections in children are almost always caused by viruses and replacing fluids is the most important thing. I tell frequently tell my patients “I don’t care if you’re eating or not, as long as you’re drinking.” If the symptoms are severe, painful, or lasting more than 48 hours, then you should come in to be seen.
This is general advice that will hopefully help you decide when it’s safe to watch and wait versus when you should take your child in to be seen. If there is a concern about COVID then definitely call – children recover very well generally but we are always concerned about contacts with people who may be at greater risk for complications from the illness.
And if you’re not sure about whether or not to call – you think this is a common childhood illness but you’re not sure, please call. I’d much rather give reassurance early than miss something important. If you are getting the naggy feeling that this is something more concerning than the common colds and stomach issues kids get, let us know!