"Mom, I don't feel good. I think I'm sick."
Great. Dad's already headed for the airport for a big meeting in Atlanta. Big sister was up and out before sunrise to catch her bus to high school. And Mom's BlackBerry is full of appointments, the first of which is an hour from now. - What do you do? Interrogate your darling daughter to make sure she's not just dodging a test or some nasty pack of middle school mean girls? Administer Tylenol and orange juice, then pack her off to school? Check for a fever and call the pediatrician? Or, given the sweeping threat of swine flu, bundle her up and head straight for the walk-in clinic? - The dilemma is as old as child rearing itself. (Neanderthal Mom, no doubt, got stuck home in the cave with a croupy tween.) But in these pandemic times, the decision is even more difficult than usual. - For some guidance, we talked with doctors who see sick kids every day: Dr. Ajoy Kumar, director of the family medicine residency program at Bayfront Medical Center, and Dr. Juan Dumois, director of the pediatric infectious disease program at All Children's Hospital.
How do you determine just how sick your kid is?
Dr. Kumar: "Basically, what you're looking for is a child that is out of their normal pattern of behavior. If your child is not eating enough, that's okay. But if they're not drinking any fluid whatsoever, they're vomiting or have diarrhea, they could be very, very dehydrated and will need IV fluids. You should call your pediatrician to determine whether to arrange an office visit or go directly to the pediatric ER."
Dr. Dumois: "If they have a fever, that's a good sign to stay home. But you have to be careful. There are some strips that stick to the forehead that under-read temperature. Ear thermometers tend to under-read, too."
(Once you get an accurate reading - see box - Dr. Dumois said anything over 100.4 degrees indicates that the child is truly sick.)
"Also, the Centers for Disease Control has an excellent online resource called 'The Flu, A Guide for Parents,' a two-page Q&A you can get at cdc.gov.''
What kind of symptoms do you consider mild?
Dr. Dumois, a father of two boys ages 10 and 13, takes a common sense approach. A scratchy throat first thing in the morning probably means that the kid slept with his mouth open. Prescription: Drink some juice. Tummy ache? Go to the bathroom and take something to read. Might just be constipation. Nasal congestion without serious sneezing or coughing? Probably allergies.
Dr. Kumar said a mild fever is no reason for alarm. "You can treat that with over-the-counter medications," he said. "Their appetite may decrease, but if they're still eating and drinking, that's okay. That's expected. If they're up and moving around, that's good, too."
What do you consider serious?
Dr. Kumar: "Not drinking or urinating, dry mouth, difficulty breathing - those are the more serious issues. If Tylenol or Motrin is not helping the fever, and they're laying there kind of listless with sunken eyes, then that, along with diarrhea or vomiting, is a very severe kind of thing."
Dr. Dumois: "A poorly responsive child is what worries doctors. A child that's hard to wake up or they wake up and fall back asleep. A high fever - 104 degrees or higher - is serious and may or may not be a sign of something more severe."
Vomiting and diarrhea are "a sign that they're ill. Keep them home from school and call the pediatrician. If they are unable to keep liquids down, that child needs to be seen."
If you keep your children home from school because of illness, how do you know when it's time for them to return?
Dr. Dumois: "That can be a tough call. One thing I look at is, when was the last time they had a fever? I prefer that they be without fever for almost 24 hours, and the CDC is saying right now at least 24 hours with flu. I also assess how they look the next morning. A lot of times it's just a 24-hour illness, and they're raring to go. On the other hand, if the child had a fever at midnight, another day of rest is needed."
What's the best way to prevent getting the flu or other infectious diseases?
Dr. Kumar: "Have good hand, cough and sneezing hygiene. But don't go overboard with the antimicrobial products. Some of those microbes are our friends. Wash your hands, and if you cough, cough into an object (such as your elbow) and not the next person. Most viruses are spread through that kind of contact. Just remember that the flu virus can be sitting on surfaces for up to eight hours."
Dr. Dumois: "At the hospital, we're supposed to clean our hands before and after every patient contact. I could easily be cleaning my hands 40 to 50 times a day, and that's not even overdoing it.
"So I don't get sick from work. I get sick from my own kids because I don't do it at home."
Is there any surefire method to figure out whether a kid is faking it, a la Ferris Bueller?
Dr. Dumois: "I'd have to say no. A Ferris Bueller-type kid could do a really good job of faking a fever. But most kids aren't that clever. If they don't look that sick, just get them out of bed and start them on their normal routine. If they have breakfast, that could be a good indicator there. If they don't want breakfast, they might be really sick. But if it's a teenager, like my 13-year-old, that doesn't help much."
Dr. Kumar: "There is no surefire method whatsoever. If you can't figure out which way it is, I recommend taking them to the pediatrician to have them evaluated. We don't want to put the parents in the role of being clinicians.''
What can parents do to not overthink this whole swine flu thing?
Dr. Kumar: "Just because a child has an influenzalike illness doesn't mean they have swine flu. They could have another virus giving them these symptoms."
For most people, swine flu has been so mild it hasn't required treatment. Most of the more serious cases are connected with underlying medical conditions (see box). It may turn out that swine flu is less deadly than seasonal flu, for which vaccines are now available.
"Regular seasonal influenza annually causes 36,000 deaths in a year and more than 200,000 hospitalizations, and that's just the regular old flu," Dr. Kumar said.
Still, said Dr. Dumois, "People should realize that if they catch the flu, they're not likely to die. They need to be a little more cautious if they have an underlying medical condition."
ADVICE FROM EXPERIENCED MOMS
What's a mom - or a dad, a grandparent or an auntie - to do when faced with a kid who has come down with something?
Here's some timely advice from two local moms who have dealt with this dilemma for years. Paula Lokrantz, an ultrasound technician at Bayfront Medical Center, has three teenagers in high school. Kimberly Thomas-Bowles, a security supervisor with a company that works with the U.S. Department of Homeland Security, has a son in middle school and a daughter in elementary school. Her mother was a pediatric nurse.
How sick do your children have to be for you to keep them home from school?
Paula Lokrantz: "If they are showing any signs of fever or runny nose - they don't have to be very sick at all -I'll keep them home. Being in the health care field, I'd prefer them to not get everybody else sick." Because her children are older, she feels comfortable setting them up with liquids, Tylenol and a remote control before heading off to work.
Kimberly Thomas-Bowles: "Actually, I didn't work today because Katie (her 7-year-old) was home with me sick. She had swollen lymph nodes and a low-grade fever of about 101. Under the CDC guidelines, when you run a fever of 101 or higher, the contagion risk is there."
How does it impact your job or your partner's job when you need to stay home with a sick kid?
Lokrantz: "I'm fortunate because I have Bearly Sick (a hospital-based sick kid care service) at the hospital. In severe cases, my husband takes off because he's salaried, and I'm hourly. I love Bearly Sick. It's one of the biggest advantages of working here."
Thomas-Bowles: "I proceeded to walk into work with her for about 25 minutes, took what items I needed and told them I'd be available to be reached at home. Before I got this position, it would fall on my husband to be the primary caregiver if they were sick."
How can you tell if they're faking it?
Lokrantz: "Usually, my kids' symptoms are pretty obvious. They're flush, or they've been coughing all morning, or they tell me they're not feeling the greatest. Every situation is different, and every child is different, so it all depends on the situation, and times are tough out there. It's hard to take a day off work."
Thomas-Bowles: "I lucked out having a mom who was a nurse. I basically give them a mini physical: Check their throat, check their glands, check if they're cold or clammy, running a fever, etc. They have to run the gauntlet here. If they are sick, they're in bed and that's it. We take away some of the glamor, meaning no Xbox."
- Logan D. Mabe
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a matter of degree
Doctors say the gold standard for accuracy is a rectal temperature. As soon as kids are old enough to hold a thermometer in their mouths for the time it takes to get a reading, that'll do; your next best option is the ear temperature. Try to take the temperature three times and average the result. If you still have an old glass mercury thermometer, get rid of it and go shopping. Mercury is toxic. Here are three options:
- Digital thermometers can be used in the mouth, rectum or armpit. They usually beep and flash a number in the window on the front when a reading is complete.
- Ear thermometers, the method many doctors use, are now available for home use, though many doctors say to add 1 degree to the reading of an inexpensive model, since these can under-read temperature.
- Forehead thermometers test the skin temperature with a soft disc or plastic strip pressed against the forehead. They're considered the least accurate of these three options.
What's an underlying condition?
Some children and adults are more vulnerable to flu - both swine flu and seasonal flu - because they have other conditions that make it harder for them to fight it.
One in 13 of all U.S. deaths from swine flu has been among children. The CDC recently reported that of the first 36 pediatric deaths, most were among children over age 5 who had an illness related to the nervous system, such as epilepsy, muscular dystrophy or cerebral palsy, that makes it harder for them to cough and clear their lungs.
But kids who were otherwise healthy also died -- usually because they caught not only the flu virus but also a bacterial infection, such as pneumonia.
"When you get the flu, your immune system can be a little weakened. You can be more susceptible to other infections,'' said Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention.