Monday, November 27, 2006

"Sick for a Month"

Dear Lisa,

I have a 15 month old son, who has been sick now with a cold, sore throat, a little diarrhea, and he isn’t eating much, and hasn't eaten much in the past 2 days, and he can't sleep b/c of his coughing and congestion. He also has had a fever of 103 degrees and fluctuates to 100 degrees, and I have been rotating Tylenol and Motrin, and yes it helps with the fever, but he seems to have a little discomfort when he coughs, and dry heaves b/c of the congestion running from his nose and throat, the Doctors won’t give him anything and say he'll get over it. But he's been sick on and off for a month.

“Sick on and off for a Month”,

Dear “Sick on and off for a Month”,

It makes me feel so sad when I hear about a little one who is so sick, especially for such a long time. Most parents agree that there is nothing worse then to have a sick child. The stress and exhaustion can affect the whole family. An illness that lasts so long can be particularly stressful, especially if there doesn’t seem to be any improvement in your child’s condition.

It seems that you are not satisfied with the answer that your Doctor gave you, that “he’ll get over it”. As in most professions, each professional in the field practices a little differently or has a different approach to care. Some doctors stop their recommendations at the point it is decided that a child has a virus and an Antibiotic is not needed. Other practitioners give additional recommendations about how to alleviate a child’s symptoms and give suggestions about how to care for a child during an illness.

It is true that if a child has a virus, that Antibiotics will not treat the infection. Instead the child’s own body fights the infection. Just because a child has a virus does not mean that there are no measures that you can take to help your child feel better. Information about how to keep hydrated, comfortable, sleeping well and breathing easily is needed. There are also natural remedies and practices that can be followed that can help a child get through their illness.

The measures that you can take to keep your child from becoming dehydrated include giving him cold liquids. Cold liquids are recommended because the cold will numb the child’s painful sore throat and as a result there is a better chance that he will drink. Ice pops, sherbet, Jell-O, cold applesauce and cold drinks are all good choices that should make a child’s throat feel better. It is also a good idea to give a dose of Tylenol or Motrin 30 minutes before a meal. These medications do not only treat the fever, but also treat pain. There is a better chance that a child will eat or drink if their pain is controlled.

In order to help clear a child’s nasal secretions you can try bringing him into the shower or using a cool mist vaporizer. Directly exposing a child to hot steam is not recommended because this can result in burns.(1) Elevating your child’s head during sleep by putting a pillow under the mattress can also help your child sleep at night. Using saline nose drops and giving a child extra fluids to drink can help loosen your child’s nasal secretions. By loosening nasal secretions it makes them easier to remove.

Prescription medications such as Rynatan and Viravan can help decongest the nose and dry up a post nasal drip. These medications can temporarily help a child breathe better through the nose. If a child has so much mucus that they can not eat, sleep or breath well he may be a candidate to receive these medications. You can ask your doctor if your child’s condition would be helped with the use of these medications.

Measures to help soothe a child’s cough include menthol rubs on the chest, and sugar and lemon drinks which help soothe the throat.(1) Your son is too young for a cough drop, but he could have a lollipop which serves a similar purpose.

A product found in most households can also be given to help a child with a cough. This product is caffeine. In the 1800's, coffee was the treatment of choice for Asthma.(2) The caffeine found in coffee and tea is a natural bronchodilator. The purpose of bronchodilators is to open the bronchial tubes and help a person breathe easier. Today, bronchodilators are the first line treatment for people with Asthma. In a large Italian study, it was found that adults that drank two to three cups of coffee daily had about 25% less Asthma than adults who abstained. (2)

Theophylline is one of the modern day prescription medications used to treat Asthma. It is chemically related to the caffeine found in tea and coffee. (2) Therefore it can not hurt a child to have a cup of warm tea (not too hot, because you don’t want him to get burned!) or iced tea when he is coughing a lot.

It is also important to know that a cough that lasts 4 weeks needs to be evaluated by a Physician in order to determine and treat its cause. It is important that the cause of a persistent cough is determined, especially when there is a fever involved. (1) A sore throat accompanied by fever should also be evaluated. Strep throat is a common childhood illness that presents as a sore throat and fever.(3) A child with a sore throat and fever should have a throat culture performed in order to rule out Strep. (3)

Any fever in a young child that lasts more than 5 days should be re-evaluated in order to rule out a secondary bacterial infection. It is common for a child to begin their illness with a virus and because their immune system is taxed, become secondarily infected with Bacteria. A Bacterial infection requires treatment with an antibiotic. Because of this, it is important to know which specific symptoms and what timeframe requires a visit back to the Doctor’s office. If a child takes a turn for the worse; becomes lethargic, stops eating, has difficulty breathing or develops a worsening temperature, he should be re-evaluated.

Young children with poor oral intake and diarrhea can develop dehydration. Signs of dehydration include decreased urine output, non-elastic skin, dry mucus membranes (a dry mouth), decreased amount of tears, a fast heart rate, irritability, weight loss, lethargy, sunken eyeballs and a sunken fontanelle (soft spot). A young child who is not eating and having diarrhea should be evaluated by a health care professional for dehydration.

The most important thing that I can tell you is to trust your own instincts. If you think that your child is sick and that there is something wrong then you are probably right. Parents who spend 24 hours with a child and know there child’s personality can much better assess how sick their child is. It is not possible for a Doctor who spends about 10 minutes in the office with the child to understand the breath and depth of a child’s symptoms and illness unless a parent gives them specific details about what is going on at home.

Sometimes it is necessary to write down all of your child’s complaints and problems before you get to the Doctor’s office so that you can communicate all of your concerns. In other words if a child visits the office and the parent says, "my child’s not feeling well", it can be interpreted many ways. If a parent explains to the doctor that my child is so sick that he can’t sleep at night, he can’t breathe because of all of the mucus coming out of his nose and mouth, he can’t eat because his throat hurts so much, he is coughing so much that he can’t catch his breath and he is so lethargic and tired that he won’t get up and put his clothes on, then the doctor should take your concerns more seriously.

If you have given every effort to explain how ill your child is and your doctor does not seem to take your concerns seriously, then it would be important to let your doctor know how you feel. The optimal relationship with your child’s doctor should involve open communication, trust, feelings that your concerns are taken seriously, honesty and compassion. If you do not feel that your relationship fulfills these basic requirements, it may be time to search for a Doctor that practices in a manner that you are comfortable with. After all, something as precious as your child’s health should be managed by a Doctor who you can trust.

I hope your son recovers soon.

References:
(1)Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics. ACCP evidence-based clinical practice guidelines. Chest. 2006;129:260S-283S.
(2)Kemper K, Lester M. Alternative asthma therapies: An evidence–based review. Contemporary Pediatrics. 1999.16
(3):162-195.(3)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990: 496.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents with Sick Children

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