Sniffles & Sneezes
Getthing through the winter without your child getting sick.
by Dr. Mary Ann LoFrumento M.D., FAAP
PARENTGUIDE NEWS JANUARY 2006

Once the arrival of the flu in a neighborhood makes the headlines, parents begin to worry about every
sniffle. So how do you know if your child has the flu or just a cold?

The common cold lasts about nine to ten days and is sometimes described as three days coming, three days here and three days going. The first three days your child may have a fever. In infants and toddlers, their temperature might reach 103-104, but if you give them some acetaminophen or ibuprofen, their temperature will lower and they will seem better. In older children, there might be a low-grade fever or none at all. But then comes the runny nose. A cold always causes a runny nose, but the flu usually does not.

During the middle phase of a cold, a child may develop a cough due to congestion from the nose, however, it will not be a deep or hacking cough, and usually there is no chest pain as they would have with the flu. During this time the fever is usually gone, and your child might be back to his activities, despite the runny nose and mild cough.

The final three days is when the mucous starts to thicken and become crusty. At this point, wipe your child’s nose and use humidifiers to help your child breathe easier at night.

Flu symptoms are very specific and include high fever (usually lasting four to six days), sore aching muscles, generalized weakness, headache, pain behind the eyeballs, a sore throat and a hacking cough.

The uncomplicated flu lasts seven to ten days and does not respond to antibiotics. Treatment includes plenty of fluids, bed rest and acetaminophen or ibuprofen for fever, headache and body aches. For coughs, try a mixture of honey and lemon (if older than 1 year), non-caffeine teas or an over the counter (OTC) cough suppressants containing DM (Dextromethorpan). Remember, to prevent Reye’s syndrome, a potentially fatal illness, never give aspirin to your child or adolescent with the flu.

How do I know if my child has developed bronchitis or pneumonia?
Bronchitis is an infection of the “bronchi.” These are the tubes that go from our airways into the lungs. Most cases of bronchitis in small children are caused by viruses, but a small number of cases can be bacterial. Uncomplicated viral bronchitis can start like a cold, but the main symptom is cough and not a runny nose. The child may or may not have a fever. The illness can last for about ten days, although the worst of the cough will occur in the first week. If the bronchitis is caused by a bacteria, then the fever will be higher and last longer and the child may have a chest pain when they cough as well. Children with bacterial bronchitis usually look sicker.

Pneumonia is an infection of the lungs themselves. As with bronchitis, the cause of pneumonia may be viral or bacterial. Children with bacterial pneumonia look sick. They usually have a high fever and a cough, although some cases actually cause stomach pain. This is when the infection is in one of the lower lobes of the lung.

Both bronchitis and pneumonia may be complications of the flu which can be very serious, especially in small infants.

When should I call the doctor?
Call your doctor if the cough is worsening or your child is having difficulty breathing. Also call if a cough is accompanied by a very high fever or chest pain.

Be sure to call your pediatrician immediately if you suspect your infant (under 1 year old) has the flu, especially if he/she has a high fever and cough which persists for more than three days. NOTE: Any infant under 2 months with a fever (rectal temperature of 100.8 degrees or greater) must be seen.

If your older child has a high fever for more than five days, a worsening cough (with or without chest pain), a headache for more than five days or a headache which is getting worse or accompanied by a stiff neck, see a doctor.

How to avoid respiratory infections during the winter months:
• Avoid close contact.
Keep your children away from people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
• Keep your child home.
Keep your child home if he becomes sick or if there is a known outbreak in his daycare or school.
• Cover your mouth and nose.
Teach your child to cover his mouth and nose with a tissue when coughing or sneezing.
• Clean your hands.
Washing your hands and your children’s hands often will help protect you from germs.
• Teach your child to avoid touching his eyes, nose or mouth.
This is a hard one for parents. Germs are often spread when a child touches something that is contaminated with germs and then touches his eyes, nose or mouth.

Formerly in private practice for 18 years and a clinical assistant professor of Pediatrics at Columbia University’s College of Physicians and Surgeons, “Dr. Mary Ann” currently teaches at the Goryeb Children’s Hospital in New Jersey and is the author of the Simply Parenting Childcare series of books and DVDs including: Understanding Your Newborn and Infant and Understanding Your Toddler. Dr. Mary Ann LoFrumento M.D., FAAP is dedicated to bringing childcare back to basics for parents. She is the editor of the “Your Child” column in Yourlifemagazine.com and has written numerous articles on parenting that can be found on her Web site, www.simplyparenting.com, including “What’s Going Around.”