It’s that time of year again. It seems someone in the household is always sick. Our community experienced a high spike in flu, RSV, and other respiratory viruses during the late fall and early winter of 2022-2023. More recently, we experienced an increase in COVID-19 cases. Respiratory virus season (“cold season”, October to March) is currently in full swing, and many of our patients at Pediatric Associates of Cheshire (PAC) are suffering from recurrent viral illnesses. Read on for a pediatrician’s perspective on cold season, and what it means for your family.
What is a cold?
The medical term for a cold is viral upper respiratory illness. Cold viruses infect the upper airway, which includes the nose, sinuses, throat, and voicebox. Symptoms tend to appear 2 days after exposure. Symptoms include congestion, runny nose, cough, sore throat, hoarse voice, fever and fatigue. Infants and younger children may develop difficulty breathing due to upper airway obstruction (croup) or severe mucus congestion. Symptoms tend to be worse during the first 5 days of illness, improve by day 7, and persist until day 14. The treatment for most colds is supportive care (treating the symptoms to promote comfort, rest, and recovery). See our post about supportive care for more information.
Kids are sick often during cold season
Many parents are frustrated by how frequently their child gets colds. This is especially true for children in daycare. We often hear “you don’t understand; she is always sick!” or “he was better over the weekend, but now he’s coughing again; there must be something wrong.” Some parents even wonder if their child has an immune deficiency. While recurrent viral illnesses are common, immune deficiencies are quite rare. It may surprise you to learn that it is normal for children to have up to 8 colds per cold season, or 12 colds per year. This comes out to, on average, around 1 cold per month. Since cold symptoms can last for around 2 weeks, some children will have cold symptoms for half of the entire cold season!
You are not alone
We care for sick children day in and day out. As a result, despite our best efforts, we sometimes catch these viruses ourselves, and may even bring them home to our families. Needless to say, we understand what you’re going through, and so do many other families in your community. We hope you will take our word for it: you are not alone!
Our phones are busy
We receive many phone calls about sick children every day during cold season. We are always happy to hear from you. It is our privilege to care for your children when they are sick, and we take great pride in the trust you have placed in us. We appreciate your patience when there is a delay in getting back to you. Just know that the reason for this delay is often that there is a virtual line of families waiting for a call back, the majority of whom will tell us about– you guessed it– cold symptoms.
Antibiotics do not treat viral illnesses
With children sick so frequently, it is easy to understand why parents are seeking a solution. Wouldn’t it be nice to take medication and make the cough disappear? While bacterial illnesses usually respond to antibiotics, viruses do not. If you are concerned that your child has a bacterial illness, call for an appointment. The pediatrician can determine if (s)he needs an antibiotic.
Diagnosing bacterial illnesses in children requires medical training
At PAC, we will never dismiss your concerns. We encourage you to trust your instincts as a parent or caregiver, and call us for an appointment if you believe your child’s symptoms are no longer “just a cold”. There are, however, a few common misconceptions about bacterial illnesses that parents should be aware of.
- Not every red, painful ear is an ear infection. An ear infection is diagnosed when pus accumulates behind the eardrum, causing it to bulge. And even then, this may be due to a virus. The rest of the medical history and physical exam must be taken into account in order to diagnose an ear infection.
- Not every red, sore throat is strep throat. Many different viruses can cause a sore throat. And yes, viruses can even cause the tonsils to exude pus. The presence of pus merely indicates the presence of white blood cells, which are needed to fight both viral and bacterial illnesses. A physical exam and throat swab are needed to diagnose strep throat.
- Bronchitis is a very rare diagnosis in children. While a parent may be diagnosed with bronchitis by their doctor and prescribed an antibiotic or inhaler, this does not mean that the child will require these medications. Children’s bodies do not respond to illnesses the same way as adults.
Making a diagnosis of a bacterial illness is a job for a doctor or other qualified provider (PA, APRN) who has completed pediatric-specific clinical training.
Antibiotics can cause harm
It is important to accurately diagnose a bacterial infection before giving antibiotics. Most parents are fortunate never to have witnessed the immense (sometimes life-threatening) harm that antibiotics can cause. Below are some examples of complications that can occur when antibiotics are used incorrectly (some can even occur despite the correct use of antibiotics):
- Clostridiodes difficile (“C. diff”) is an opportunist bug (a bacterium that thrives when the immune system’s guard is down). All antibiotics have the potential to kill healthy bacteria in the gut. When this happens, C. diff has a chance to take over. C. diff causes fever, abdominal pain, severe diarrhea, and can be life-threatening, especially in vulnerable patients.
- Antibiotic resistance is a big problem. When antibiotics are given for a non-bacterial illness, or when the wrong antibiotic is given, the body’s existing bacteria adapt to become immune to that antibiotic. Over time, bacteria adapt to evade multiple different types of antibiotics, and become more and more difficult to treat. These are what the news media refer to as “superbugs”.
- Inflammatory bowel disease is a group of conditions that includes Ulcerative Colitis and Crohn’s Disease. These diseases are chronic, difficult to treat, often progressive, and sometimes fatal. They have been linked to frequent antibiotic use in childhood.
- Medication reactions are always a concern when prescribing antibiotics. These range from mild to life-threatening. Examples include drug rashes, anaphylaxis (a severe, life-threatening drug allergy), serum sickness, DRESS, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis (a life-threatening condition that involves skin blistering and peeling).
Clearly, antibiotics come with risks. Your doctor’s job is to decide when the benefits of antibiotics outweigh those risks. This decision should not be made lightly, and should not be made by a person without pediatric-specific medical training.
Antibiotics should not be prescribed over the phone (with rare exceptions)
This is a sore subject for many parents and pediatricians. Refusal to prescribe antibiotics is a common reason parents express dissatisfaction after speaking with the on-call doctor. Now that you know the risks that come with antibiotics, we hope you can understand why antibiotics are generally not prescribed over the phone.
In Cheshire and the surrounding communities, pediatric health care resources are abundant. We have convenient access to two of the largest and best pediatric centers in the northeast: Yale and Connecticut Children’s Medical Center (CCMC). Not to mention, our office almost always has same-day sick visit openings. See our post about after-hours care resources. There is no reason to risk prescribing antibiotics over the phone when pediatric care is so readily available in our area. We believe your child’s health is worth waiting until the office is open in the morning. And if the problem is urgent, it is worth traveling a short distance to the local pediatric urgent care center or pediatric emergency department.
We’re here to help
We hope that a pediatrician’s perspective will help you and your family stay healthy and informed during this cold season. If you have any questions, please do not hesitate to call the office. We invite you to follow us on Facebook, and check out our other blog posts which cover frequently-discussed topics in pediatrics.
Pediatric Associates of Cheshire