Some parents are disappointed with the diagnosis “virus” and not getting antibiotics. The only two times in my career a parent has outright yelled in my face were when I didn’t prescribe antibiotics. Today’s guest columnist, Dr. Seth Koster, explains viruses and when antibiotics are needed. Dr. Koster is a resident at the University Hospital and Clinics here in Lafayette.
A lot of parents aren’t sure what to expect with their first child. Did he just cough? He sneezed twice, is that bad? Do I need to go to the doctor? Some things are common, yet seem complicated. Let’s talk about some common conditions that are usually a virus that get better with a little TLC, and some “red flags,” things that need to be checked right away.
I think my kid is wheezing, should I bring her in? Many parents hear baby make funny sounds, and call it wheezing. Sometimes the sound they are trying to describe is the rattling of nose congestion. True wheezing that we worry about is a whistling, gaspy tone in the lungs. Either way you would be safe calling your doctor for a next day appointment if the wheezing doesn’t get better. But if your child seems to be breathing fast or is having to pull in breaths, then he needs to be seen right away.
The vast majority of colds and coughs are viral. Even with true wheezing, this is usually a virus and not pneumonia, and antibiotics won’t help. Hundreds of viruses cause coughs and runny noses and wheezing: adenoviruses, rhinoviruses, enteroviruses, and many more. Antibiotics do not kill viruses. What kids with these need is supportive care, meaning fluids and fever and pain medicine. If they get really sick with wheezing and shortness of breath, they may need IV fluids, breathing treatments, and observation in the hospital.
My child is pulling at his ears. Does she need antibiotics? Most of the time “ear pulling” is not from ear infection. Kids pull on their ears when they are stuffy from congestion, if they have a headache, or some kids just play with their ears. If the child is not fussy and doesn’t have fever, they don’t have to see the doctor.
What if she has fever-rush her to the Emergency Department? No. Ear infections may hurt, but that can be controlled with ibuprofen or acetaminophen (Tylenol) for fever and pain. Over 70% of ear infections are viral and don’t need antibiotics. That being said, if your child is having ear pain and fever, see your doctor. After an exam the doctor can decide if antibiotics or pain drops will help. But ear pain is rarely an emergency that can’t wait until tomorrow.
My child is vomiting, what to do? Whether vomiting needs to be checked out by the doctor depends on how much and how long. Some kids are brought in to the ER when they vomit only once or twice, or only for a few hours. However, that is not enough time for a child to get dehydrated, and most will quit vomiting soon after.
A simple “stomach virus” is usually not serious and will resolve in 1-3 days. If the child vomits, wait an hour for his stomach to settle, then start clear liquids (gatorade, dilute juice, pedialyte), sipping slowly. After the child has stopped vomiting for about 6 hours, you can start bland foods. No fast food. If your child has a fever, ibuprofen or acetaminophen will help with that. For most stomach illnesses antibiotics will not help, and even make vomiting and diarrhea worse.
So when does your child need to be seen? If she is having worsening belly pain, that is worrisome. If your child is vomiting all day or is vomiting blood or dark green, bring them in. If your kid is having diarrhea for more than a week, that is one of the few times an antibiotic may help, since that may be a bacterial illness and not a virus.
Your child will get sick, there’s no avoiding it. You usually don’t need antibiotics to treat them. Most of the time your kid just needs rest, fluids, ibuprofen, and TLC.