What’s Going Around: Flu, deep coughs, stomach virus

This week at UPMC Pinnacle’s Heritage Pediatrics there have been more coughs with wheezing. In many cases these are due to viruses that cause wheezing and a deep cough, and can result in difficulty breathing. In younger children and babies this illness is called “bronchiolitis.”

Bronchiolitis starts as a typical cold the first few days with a lot of nasal congestion and nasal discharge and sometimes a fever.  Then after a few days to a week, the cough becomes deeper and wheezing begins.

Wheezing can present as fast shallow breathing, a whistling sound with breathing, and coughing spells. If your child is showing any of these signs, call your medical provider.

Treatment for bronchiolitis is supportive; there is not a medicine that will make it resolve faster. However, younger children and babies can worsen before they improve, sometimes to the point of respiratory distress. If you think your child is wheezing, be sure to call immediately.

According to WellSpan Pediatric Medicine, cases of bronchiolitis have been reported in Lancaster and York Counties. Bronchiolitis is a lower respiratory infection caused by a virus that infects younger children, usually under the age of two. It can cause cough, fever, runny nose, and most concerning, a lot of trouble with breathing.

Penn Medicine Lancaster General Health Physicians Roseville Pediatrics saw a lot of viral illnesses, many with high fevers that are lasting four to six days.

They also saw a lot of ear infections.  Pneumonia has continued to rise, as has bronchiolitis. Strep throat remains at around 40 percent of the sore throats seen, which is high.

Influenza A was also seen in high numbers, which is typically for the start of flu season.

Dr. Joan Thode offered the following advice when it comes to fevers:

“When concerned about a fever, remember to LOOK, LISTEN, ASK and HYDRATE.
LOOK: The first thing to do when your child has a fever is to see if your child is having trouble breathing. All kids will breathe a little bit faster than their typical baseline when they have a high fever, but you want to see how much effort they are putting into breathing. Comfortable, slightly faster breathing is OK to observe at home, though very rapid (over 50 breaths per minute that persists) breathing or persistent expanding of their chest or their belly in an exaggerated way for more than a minute or two is concerning. It’s about how stressed your child looks while breathing.

LISTEN: Is your child making any consistent noises or gasping sounds when they inhale or exhale? Is their cry nice and strong, or weaker and more hoarse? Noisy breathing or change in their cry is concerning in the context of increased breathing effort. Persisting respiratory distress is a reason to call your physician.

ASK: In older kids, ask them a question. If they can answer it appropriately, they are alert. In younger, pre-verbal kids, try to have them engage in a toy or book that they like. If they respond appropriately, they are alert. They may appear fatigued and have low energy, but they are not at a concerning level of true lethargy until they struggle to wake up and cannot maintain any coherent conversation or response due to their immediately falling back asleep. True lethargy is a reason to call your physician right away.

HYDRATE: The most important thing that you can do to help your child through an illness with a fever is to give them water*. The higher temperature causes evaporation of water from the skin surface, and with the typically low appetite and faster breathing, can cause some dehydration. Your child will feel better overall if well-hydrated. *Babies younger than 6 months should be hydrated only with formula or breastmilk, never with pure water. Inability to maintain hydration and a decrease in urine output is a reason to contact your doctor for evaluation.

You’ll notice that medicating a fever is not on the list. A fever does not need to be treated. We often treat them not to protect the body from the heat but to make the child feel a bit better and thereby be more willing to drink water and stay hydrated. The body will not “cook” itself to a deadly level; rather it is using the higher temperature to make it harder for a virus or bacteria to survive (thus helping the immune system win the battle). The aim during a fever is hydration and comfort for your child.
All fevers lasting five consecutive days should be evaluated by a physician in the office and likely additional testing.”

The CVS MinuteClinic in Lancaster reported the following this week:
Submitted by: Jessica Myers, Nurse Practitioner, MinuteClinic in Lancaster

Influenza – We have started to see sporadic flu cases in Lancaster. Patients complain of a sudden onset of fever, chills, tiredness, body aches and cough. It is important to seek prompt evaluation for consideration of prescription anti-viral medications to reduce length and severity of symptoms. Anti-virals reduce hospitalizations and other complications of the flu. Symptoms can last seven to14 days. Children, elderly, persons with asthma or other chronic conditions or more at risk for complications.

Ear Inflection – We have seen many pediatric patients with ear infection over the holiday period. Many report having an upper respiratory infection or cold prior to the onset of ear pain and fever. Antibiotics and pain/fever reducers are treatments.

Stomach Virus – We have seen across all ages a stomach virus with rapid onset vomiting and/or diarrhea. Symptoms can last 24-72 hours. We recommend not taking anti diarrheal medications. Eat a bland diet, drink sips of fluids to stay hydrated. Tylenol for any body aches or fever. Prescription nausea medication can be prescribed in more severe cases. Follow up care is needed for dehydration; no wet diapers for babies or not able to make urine.

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