The Importance of Supportive Care

Mar 28, 2022 | Featured, General

This time of year, it seems someone in the household is always sick. Children in their first year of daycare are especially prone to developing cold symptoms, as their immune systems are exposed to a variety of new viruses. During the COVID-19 pandemic, public health guidelines and general anxiety have significantly increased the frequency with which parents seek medical care for their child’s stuffy nose or cough. 

While antibiotics are sometimes needed to treat throat, lung, or ear infections caused by bacteria, the majority of cold symptoms in children are due to viruses. If your child is diagnosed with a viral illness, your pediatrician will likely recommend “supportive care” while your child’s immune system fights the virus. 


6 Components of Supportive Care


  1. Monitoring

At home, monitor symptoms closely. If there is a change in breathing, skin color, or level of alertness, call the pediatrician or seek medical care right away. Other reasons to be concerned include high fevers ( > 102 °F) that do not respond to Tylenol or Motrin, severe pain, poor fluid intake, persistent vomiting, or a decrease in urine output.  


  1. Rest

 Children should rest while they are sick. Sleep plays a critical role in restoring energy and promoting healing. For infants and toddlers, this means more naps. For older children, it means relaxation, refraining from intensive physical activity, and going to bed early. Reading is a great daytime resting activity. As a child begins to feel better, reintroduction of physical activity is an important part of recovery.  


  1. Treatment of fevers

A fever is any temperature of 100.4 or higher. Motrin and Tylenol work differently, and may both be used to treat fevers. Check with your pediatrician if you are unsure if your child can have Motrin or Tylenol. One good way to use these medications is to stagger them every 3 hours. Give Tylenol at 3 PM, Motrin at 6 PM, Tylenol at 9 PM, etc., as needed for fever. Appropriate treatment of fever has a domino effect on recovery: your child will feel better, sleep better, breathe more easily, and tolerate more fluid intake. 


  1. Treatment of pain

Similar to fevers, viral symptoms such as belly pain, headache or sore throat can limit your child’s ability to recover. When we have pain, we are less likely to drink enough fluids, eat nourishing foods, or get restorative sleep. Just like fever, pain should be treated with Tylenol or Motrin. Warm fluids such as tea or soup broth may be used to soothe a sore throat. A heated blanket may be used to relieve belly pain and muscle aches.  


  1. Hydration

Adequate fluid intake is a crucial part of supportive care. It allows the circulatory system (heart, blood, arteries, and veins) to function optimally, and therefore allows all of the organs to function optimally. 

For infants, hydration is best achieved with breast milk or formula. If these are not tolerated, you may use Pedialyte instead. In fact, you can “dilute” breast milk or formula with Pedialyte so that it is easier to drink and digest. You should not try to keep an infant hydrated with water, since the infant kidney is not able to handle much water. For older kids, hydration is best achieved with Pedialyte. Juice, soda, and sports drinks do not work as well. If a child is having diarrhea and/or vomiting, it is especially important to “put back” the fluid, sugar and electrolytes they are losing. 

Signs that a child is well hydrated include: tears while crying, wet tongue/lips/gums, urine looks light yellow, and peeing every 4 hours or more frequently. 


  1.  Removal of mucus

When it comes to colds, mucus is the enemy. It is often the source of cough, congestion, poor sleep, and difficulty breathing. Infants will not cooperate with nose blowing, so you must suck the mucus out yourself. The best way to do this is (1) keep the air warm and moist with a humidifier (2) instill a few salt water drops into the left nostril while holding the right nostril closed (3) use a bulb suction or other infant suctioning device to suck the salt water and mucus out (4) repeat for the right nostril. This is especially important before bed. For older children, encourage nose blowing. Over the counter salt water sinus rinses may also be used for older children.


Important Medicines and Supplies 

To provide basic supportive care, you should keep the following items stocked in your home. All of these are available without a prescription. Be sure to store medications out of reach of small children, and in their appropriately labeled, child-proof containers. Educate older children and adolescents about the importance of asking a parent or caregiver prior to accessing medications. For medication dosing, follow the manufacturer’s label or discuss with your pediatrician.  


✔ Children’s Tylenol (Acetaminophen; liquid; 160 mg/5 mL)

    • For older children, may use tablets.
    • Note that all Tylenol products (Infant’s and Children’s) contain the same strength of the active ingredient acetaminophen.

✔ Children’s or Infant’s Motrin (Ibuprofen; liquid; 100 mg/5 mL or 50 mg/1.25 mL)

    • For older children, may use tablets. 
    • Do not use in infants < 6 months.
    • Note that Infant’s Motrin is 2x the strength of Children’s Motrin. 

✔ Children’s Benadryl (Diphenhydramine; liquid; 12.5 mg/5 mL)

    • For older children, may use tablets. 
    • Do not use in children < 2 years old unless directed by your pediatrician. 

✔ Saline nasal spray or drops (salt water)

    • For older children, sprays work best. For infants, use drops.

✔ Room humidifier 

    • Use the warm steam setting to keep the room around 60% humidity, or until condensation just begins to appear on the windows. 

✔ Bulb suction or other suctioning device

    • Useful for infants, toddlers, or any child not able to cooperate with nose blowing. 

✔ Pedialyte (or equivalent generic hydration liquid)

    • Available in a variety of flavors.
    • Keep the clear kind stocked for infants.

✔ Thermometer 

    • Rectal temperatures are best for infants. For older children, tympanic (ear), oral (mouth),  axillary (armpit), or temporal (forehead) readings may be used. 
    • Use the method specified on your thermometer.

✔ Notable exceptions

    • Vapor rubs: may be used for children ages 2 years and older, but are generally not as effective as a humidifier, and are not considered a mainstay of supportive care.
    • Herbal remedies: lack of evidence and FDA regulation make it difficult for pediatricians to recommend these.
    • Combination flu and cold medicines: generally, components of these medications are either not suitable for children, or it is better to give the components separately. Adult-sized children may use them. They usually contain Tylenol, so do not use in combination with other sources of Tylenol.
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