Parenting, particularly with little kids, can feel like a game of whack-a-mole. Your child has a stuffy nose that lasts for days. Then, right after the sniffles finally fade, the child comes home from kindergarten flush with a fever and rumbling cough … or red, runny eyes … or a gurgling, achy tummy. Rinse and repeat.
It’s common for young children to get sick frequently. On average, babies, toddlers and preschoolers can have seven or eight infections a year — or even 12 or more infections if they attend group child care — according to Nipunie S. Rajapakse, M.D., M.P.H., a pediatric infectious disease specialist at Mayo Clinic Children’s Center in Rochester, Minnesota. Dr. Rajapakse explains how to spot symptoms of five of the most common childhood infections, how health care professionals test and treat them, and how you manage these illnesses at home.
Detecting and treating the common cold, flu and COVID-19
Most respiratory viruses, including those that cause the common cold, flu and COVID-19, are spread by droplets created when someone coughs, sneezes, talks or sings, says Dr. Rajapakse. That’s why they are especially likely to infect kids in schools, child care centers and other crowded places. The primary symptoms of the common cold — a runny nose and nasal congestion — are more likely to be mild and affect the upper respiratory tract. The symptoms of flu or COVID-19 — chills, muscle aches and fever — are more likely to be spread across the body.
However, since all these symptoms can overlap, the only way to determine exactly what’s infecting your kid is by giving them a test that can detect different viruses, Dr. Rajapakse says. For children with weakened immune systems and others who are at high risk of developing complications from COVID-19 or flu, testing is helpful. A positive result could qualify them for antiviral medications that can reduce the risk of severe disease. Testing can also be especially helpful if other members of your family are at risk of developing a severe illness from exposure to the flu or COVID-19 viruses. “If your child does test positive for COVID-19, for example, you can take extra steps to reduce the risk of passing on the infection to the high-risk family member,” Dr. Rajapakse explains.
In addition to giving kids plenty of fluids such as soups, broths and popsicles to keep them well hydrated, Dr. Rajapakse says parents can give kids appropriate age- or weight-based doses of acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to soothe feverish aches. Using a nasal saline spray or running a humidifier at night also can help keep kids’ nasal passages clear and moist, she adds. This is especially important for young infants who are breastfeeding or bottle-feeding, since congestion can affect their ability to feed.
To help break the seemingly endless cycle of virus swapping that occurs among school-aged kids, Dr. Rajapakse recommends two key steps:
- Frequent hand-washing.
- Keeping children up to date with all their vaccinations. “Influenza and COVID vaccines are safe and effective. Their primary role is to reduce serious illness and death from these infections, and they do a really good job of that,” Dr. Rajapakse says. The CDC’s vaccination schedule for children and adolescents is available here.
Antibiotics often not needed for ear infections
Kids often vexingly develop ear infections on the heels of a viral illness. “A typical story is that a child has a fever, runny nose and cough for a few days and seems to be getting better. But then, the fever suddenly returns and the child complains of ear pain,” Dr. Rajapakse explains. Tugging on an ear, acting fussy, or eating and drinking less than usual can be nonverbal clues that a baby or toddler is experiencing ear pain. “This can happen either because the child has developed a secondary bacterial ear infection, or because they picked up a new virus just as they were recovering from the first one,” says Dr. Rajapakse.
If you suspect that your child may have a mild ear infection, you can first try giving them children’s doses of acetaminophen or ibuprofen to reduce the pain. “You can also try applying a warm cloth over the ear periodically for a day or two see if that helps reduce their pain while the body fights the infection,” Dr. Rajapakse says.
However, if your child is experiencing severe ear pain or drainage from the ear — or seems to be getting worse — then it’s time to seek medical care. Only a health care professional can definitively diagnose an ear infection by examining your child’s eardrum closely. And if the ear is infected, a health care professional can determine if an antibiotic might be helpful. “In 90% to 95% of children, ear infections usually get better on their own because the immune system fights off the infection. So a prescription for an antibiotic is not always needed even if your child is diagnosed with an ear infection,” says Dr. Rajapakse.
Is it strep throat or just a sore throat?
Unlike sore throats brought on by viruses like the ones that cause colds, flu or COVID-19, strep throat is caused by group A streptococcus bacteria, a bacteria spread by respiratory droplets and direct contact. Symptoms of strep throat typically include an abrupt onset of severe sore throat, fever and enlargement of the lymph nodes at the front of the neck, says Dr. Rajapakse.
Strep throat cannot be diagnosed just by looking at the back of the throat — it can only be confirmed through throat swab testing. But it isn’t necessary to test every sore throat, says Dr. Rajapakse. If a child’s sore throat is accompanied by typical signs of a viral infection, such as a runny nose, cough and congestion, the presence of those symptoms makes it much more likely that the child’s sore throat is caused by a virus rather than strep, she says.
But that’s not the only reason to be judicious about giving kids strep tests. Up to 20% of school-aged children are so-called strep carriers who can have strep bacteria in their throats, often for several months at a time, without experiencing any symptoms or causing any harm to them. Strep carriers are likely to test positive for strep when swabbed, even when a virus is what’s actually causing the sore throat. So to avoid giving strep carriers unnecessary antibiotics, Dr. Rajapakse and her colleagues advise health care professionals not to perform swab tests for strep unless a patient’s symptoms are truly consistent with strep and not suggestive of a viral infection.
However, if your child’s sore throat symptoms are consistent with strep and a swab test confirms that the child is indeed infected with strep bacteria, then treating the sore throat with antibiotics can help. Kids with strep throat usually feel much better within a day or two of starting treatment, she says. And treating strep quickly makes it far less likely that other family members will become infected. “The risk of transmitting the bacteria to others significantly decreases after 24 hours of antibiotic treatment,” she explains. Treating confirmed cases of strep with antibiotics can also reduce the risk of kids developing rare complications, such as throat abscesses or rheumatic fever.
Norovirus: The fast track to vomiting and diarrhea
According to the Centers for Disease Control, norovirus infection is the leading cause of foodborne illness and diarrhea and vomiting in the U.S. This infection typically comes on fast and furious. And while it is very common in adults, it is even more likely to infect kids. “Norovirus is extremely contagious,” says Dr. Rajapakse. “The vomit and stool of someone with norovirus infection contains billions of particles of virus. It only takes exposure to very few virus particles to get infected. That’s why it spreads so easily among children in places like schools and child care, where kids are likely to touch shared objects and surfaces, then put their hands in their mouths.”
It’s also why frequent, scrupulous hand-washing with soap and water is the best way to protect yourself and your kids from norovirus, she adds. See the CDC’s tip sheet on hand-washing and more ways to avoid norovirus here.
Parents don’t have to be too concerned if kids with norovirus don’t feel like eating solid foods for a few days, says Dr. Rajapakse. But parents should help kids stay hydrated by encouraging them to take frequent small sips of liquids, including broth, diluted juice or an oral rehydration solution, such as Pedialyte. A baby or toddler can be offered regular small amounts of breast milk or formula. “If you are concerned about dehydration because your child’s mouth looks dry, their eyes are sunken, they seem lethargic or their urine output is significantly reduced, then you should seek medical care,” she says. It’s also important to see a health care professional if there is blood in the vomit or diarrhea, or your child is not able to keep any fluids down, she adds.
Pink eye doesn’t mean skipping child care
Pink eye (conjunctivitis) is a common eye infection that most commonly presents with reddish or pinkish discoloration of the white part of the eye. Itching, burning and the feeling of something gritty in the eye also are symptoms, as is drainage that can cause the eye to become crusted shut. Symptoms can affect one eye or both eyes, and some kids with pink eye may also experience sensitivity to bright light.
Occasionally, allergens, chemicals or smoke can trigger conjunctivitis. But viruses are the most common cause in kids. Typically, the best thing parents can do is help their kids manage their symptoms while their bodies fight off the virus. Dr. Rajapakse recommends applying a warm or cool compress — whichever children prefer — to relieve itching and mop up the sticky drainage that might otherwise mat their eyelids shut.
Pink eye often clears up within 5 to 7 days, she adds. In most cases antibiotic drops won’t usually help because in most children, pink eye is caused by viruses. However, if your child has eye pain, sensitivity to light, blurry vision — even after you’ve cleared away the discharge — or swelling and redness around the eye, then a health care professional should evaluate the child. If your child has bacterial conjunctivitis, an antibiotic eye drop may be prescribed. Kids who have weakened immune systems, wear contact lenses or have preexisting eye conditions also should be evaluated by a health care professional.
Since pink eye is highly contagious, regular handwashing can help prevent transmission. But while some schools and child care centers still require parents to keep kids with pink eye at home until the infection has cleared up, Dr. Rajapakse and many other medical experts now agree that this is not always necessary: “Current guidelines recommend that children with pink eye do not need to be excluded from school or child care unless they are so ill that they cannot participate in regular activities.”
The effect of antibiotics on common childhood illnesses
Frustrating as it may be to parents whose kids routinely catch colds, flu or other viral illnesses, there aren’t many drugs yet that work against viral infections, says Dr. Rajapakse. And the dangers of overprescribing antibiotics are significant and include antibiotic resistance. “We know that many common infections — such as colds, coughs, runny noses and most sore throats — in children are caused by viruses. Antibiotics do not work against viruses. Taking an antibiotic for a viral infection will not help your child recover faster and can even cause harm,” says Dr. Rajapakse.
Antibiotics work against bacteria, but even some common bacterial infections like ear infections and sinus infections get better without antibiotics, she adds. “Antibiotics commonly cause side effects, such as yeast infections or diarrhea or rashes. They can also cause life-threatening issues like serious allergic reactions or an infection called Clostridium difficile-associated diarrhea (C. diff). So, in general, our approach in medicine is to limit the use of antibiotics to situations in which we know the benefits of antibiotics clearly outweigh the risks,” says Dr. Rajapakse.
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