CHEST, ABDOMEN, GENITALS, OR URINARY

Definition Your child is having an asthma attack Use this guide only if a doctor has told you your child has asthma Symptoms of Asthma Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing. Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound. You can hear it best when your child is breathing out. The diagnosis of asthma requires attacks of wheezing that recur. The diagnosis is rarely made before 1 year of age. Causes (Triggers) of Asthma Attacks Infections that affect breathing (like colds or the flu) Pollens (trees, grass and weeds) Animals (like cats or rabbits) Tobacco smoke Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement) Food Allergy (Serious). Asthma attacks caused by food allergy can be life-threatening (anaphylaxis). Examples are nuts or fish. Asthma Attack Scale Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. Wheezes not heard or mild. (Green Zone: Peak Flow Rate 80-100% of normal rate) Moderate: SOB at rest. Speaks in phrases. Wants to sit (can't lay down flat). Wheezing can be heard. Retractions are present (ribs pull in with each breath). (Yellow Zone: Peak Flow Rate 50-80% of normal rate) Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Wheezing may be loud. Rarely, wheezing is absent due to poor air movement. Retractions may be severe. (Red Zone: Peak Flow Rate less than 50% of normal rate) Peak Flow Meter: a peak flow meter measures Peak Flow Rates (PFR). It tells us how well a person can move air out of the lungs. A PFR can be used in children 6 years and older. When To Call Call 911 Now Wheezing and life-threatening allergic reaction to similar substance in the past Start to wheeze suddenly after a bee sting, taking medicine, or eating an allergic food Severe trouble breathing (struggling for each breath, can barely speak or cry) Passed out Lips or face are bluish when not coughing You think your child has a life-threatening emergency Go to ER Now Looks like he did when hospitalized before with asthma Trouble breathing not gone 20 minutes after neb or inhaler Peak flow rate less than 50% of normal rate (Red Zone) Call Doctor or Seek Care Now Pulse oxygen level less than 90% during asthma attack Lips or face have turned bluish during coughing Ribs are pulling in with each breath (retractions) PEFR is 50-80% of normal rate after using nebulizer or inhaler (Yellow Zone) Wheezing not gone 20 minutes after using neb or inhaler Breathing is much faster than normal Nonstop coughing not better after using nebulizer or inhaler Severe chest pain Need to use asthma medicine (neb or inhaler) more often than every 4 hours Fever over 104° F (40° C) Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Mild wheezing lasts more than 24 hours on neb or inhaler treatments Sinus pain (not just congestion) Fever lasts more than 3 days Fever returns after being gone more than 24 hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Don't have written asthma action plan from your doctor Use an inhaler, but don't have a spacer Miss more than 1 day of school per month for asthma Asthma limits exercise or sports Asthma attacks wake child up from sleep Use more than 1 inhaler per month No asthma check-up in more than 1 year You have other questions or concerns Self Care at Home Mild asthma attack Care Advice What You Should Know About Asthma: Over 10% of children have asthma. Your child's asthma can flare up at any time. When you are away from your home, always take your child's medicines with you. The sooner you start treatment, the faster your child will feel better. Here is some care advice that should help. Asthma Quick-Relief Medicine: Your child's quick-relief (rescue) medicine is albuterol or xopenex. Start it at the first sign of any wheezing, shortness of breath or hard coughing. Give by inhaler with a spacer (2 puffs each time) or use a neb machine. Repeat it every 4 hours if your child is having any asthma symptoms. Never give it more often than 4 hours without talking with your child's doctor. Coughing. The best "cough med" for a child with asthma is always the asthma medicine. Caution: Don't use cough suppressants. If over 6 years old, cough drops may help a tickly cough. Caution: If the inhaler hasn't been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new. Use the medicine until your child has not wheezed or coughed for 48 hours. Spacer. Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs. Asthma Controller Medicine: Your child may have been told to use a controller drug. An example is an inhaled steroid. It's for preventing attacks and must be used daily. During asthma attacks, keep giving this medicine to your child as ordered. Allergy Medicine for Hay Fever: For signs of nasal allergies (hay fever), it's okay to give allergy medicine. Reason: Poor control of nasal allergies makes asthma worse. Fluids - Offer More: Try to get your child to drink lots of fluids. Goal: Keep your child well hydrated. Reason: It will loosen up any phlegm in the lungs. Then it's easier to cough up. Humidifier: If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse. Avoid Tobacco Smoke: Tobacco smoke makes asthma much worse. Don't let anyone smoke around your child. Avoid or Remove Triggers: Shower to remove pollens or other allergens from the body and hair. Avoid known causes of asthma attacks (such as smoke or cats). During attacks, reduce exercise or sports if it makes your child's asthma worse. What to Expect: If treatment is started early, most asthma attacks are quickly brought under control. All wheezing should be gone by 5 days. Inhaler With a Spacer: How to Use Step 1. Shake the inhaler well. Then attach it to the spacer (holding chamber). Step 2. Breathe out completely and empty the lungs. Step 3. Close the lips and teeth around the spacer mouthpiece. Step 4. Press down on the inhaler. This will put one puff of the medicine in the spacer. Step 5. Breathe in slowly until the lungs are full. Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs. If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6. Metered Dose Inhaler (MDI): How to Use Without a Spacer (if you don't have one) Step 1. Shake the inhaler well. Step 2. Breathe out completely and empty the lungs. Step 3. Close the lips and teeth around the inhaler mouthpiece. Step 4. Press down on the inhaler to release a puff. Do this just as your child starts to breathe in. Step 5. Breathe in slowly until the lungs are full. Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs. If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6. Ask your doctor for a spacer if you don't have one. It will help send more medicine into the lungs. Older children who don't like a spacer can be prescribed an albuterol dry powder device. Home Nebulizer: How to Use: A nebulizer machine changes a liquid medicine (med) into a fine mist. The fine mist can carry the med deep into the lungs. This is called a nebulizer (neb) treatment. Step 1. Prepare the medicine. First, wash your hands with soap and water. For pre-mixed single dose vials, just add one vial to the neb holding cup. For multi-dose vials, you need to do the mixing. First, add the correct amount of normal saline to the neb cup. Then carefully measure and add the correct amount of medicine to the saline. Step 2. Connect the nebulizer to the air compressor tubing. The air compressor is run by electricity. Portable ones run on a battery. Compressors make the jet of air that turns the medicine into a fine mist. Step 3. Turn on the air compressor. It will start making the fine mist that your child needs. Step 4 for an Older Child. Place the mouthpiece between your child's teeth and seal with the lips. Ask your child to breathe slowly and deeply. Ask your child to hold a deep breath for 10 seconds once a minute. Step 4 for a Younger Child. If your child refuses the mouthpiece, use a face mask. It should cover the nose and mouth. It should fit snugly. Step 5. Continue the treatment until the med is gone. If the med sticks to the side of the cup, shake it a little. An average neb treatment takes 10 minutes. Step 6. After each treatment, take the nebulizer apart. Rinse and clean it as directed. Reason: It can't produce mist if it becomes clogged up. Caution: Closely follow your doctor's instructions. Use the exact amount of med your doctor ordered. Don't give a neb treatment more often than every 4 hours. Call Your Doctor If: Trouble breathing occurs Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours Wheezing lasts over 24 hours You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition A spell that involves holding the breath, then turning blue and passing out Breath-holding spells were diagnosed by your child's doctor Symptoms of a Breath-Holding Spell An upsetting event happens right before the spell. A common trigger is being angry about parents setting limits (temper tantrums). Another is getting scared. Some spells are triggered by a sudden injury, such as falling down. The child gives out 1 or 2 long cries Then holds his breath until the lips and face become bluish Then passes out and falls to the floor Then often becomes stiff. May also have a few muscle jerks. Normal breathing starts again in less than 1 minute. Becomes fully alert in less than 2 minutes. Only happens when child is awake, never when asleep Cause A reflex response to strong feelings. This reflex allows some children to hold their breath long enough to pass out. Spells do not happen on purpose. This happens in 5% of healthy children. Breath-holding spells can run in families. Starts between 6 months and 2 years of age. Goes away by age 6. Many young children hold their breath when upset, turn blue, but don't pass out. This is common and normal. Frequent spells can happen in children who have anemia (low red blood count). This can happen if your child doesn't eat enough foods with iron. If your child is a picky eater, your doctor may order a blood test. When To Call Call 911 Now Breathing stopped for more than 1 minute and hasn't returned You think your child has a life-threatening emergency Go to ER Now Trouble breathing after spell ends Call Doctor or Seek Care Now Passed out more than 2 minutes by the clock and normal breathing now First breath-holding spell Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor During Office Hours Never been checked by a doctor for the spells Spells happen without a reason (no triggers) Muscle jerks during spell Picky eater (especially for meats) Lots of tantrums trigger the spells Spells happen more than once a week You think your child needs to be seen, but the problem is not urgent You have other questions or concerns Self Care at Home Normal breath-holding spell Care Advice What You Should Know About Breath-Holding Spells: While breath-holding spells are scary for parents, they are harmless. Normal breathing always returns on its own. The spells don't lead to seizures (epilepsy). Here is some care advice that should help. Lie Down: During the spell, have your child lie down. This will increase blood flow to the brain. Remove any food from his mouth. Do not hold your child upright. It decreases blood flow to the brain. This could cause some jerking of body muscles. Cold Washcloth to Forehead: Put a cold, wet washcloth on your child's forehead. Keep it on until he or she starts breathing again. That's the only care your child needs. Time the Length of Not Breathing: These spells always seem to last longer than they really do. Time the length of a few spells. Use a watch with a second hand. Breathing almost always returns by 60 seconds. It's hard to guess at the length of a spell and get it right. Stay Calm: Don't start mouth-to-mouth breathing. Don't call 911. Don't put anything in your child's mouth. It could cause choking or vomiting. Never shake your baby. It can cause bleeding in the brain. Don't Give In After the Spell: Some breath-holding spells start with a temper tantrum (Such as your child wanted something and you said "No"). Don't give in to her before or after the attack. After spells, give your child a brief hug and go about your normal routine. What to Expect: Spells happen from 1 or 2 times a day to 1 or 2 times a month. Kids outgrow them by age 6. Call Your Doctor If: Spells become more frequent Spells change You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Your child has been diagnosed with bronchiolitis It's an infection of the smallest airways in the lungs Caused by a virus called RSV Wheezing during the first 2 years of life is often caused by bronchiolitis You wonder if your child needs to be seen again Symptoms of Bronchiolitis Wheezing is the main symptom that helps with diagnosis. Wheezing is a high-pitched purring or whistling sound. You can hear it best when your child is breathing out. Rapid breathing at a rate of over 40 breaths per minute. Tight breathing (having to work hard to push air out). Coughing (may cough up very sticky mucus). Fever and a runny nose often start before the breathing problems. The average age for getting bronchiolitis is 6 months (range: birth to 2 years). Symptoms are like asthma. About 30% of children with bronchiolitis later do develop asthma. This is more likely if they have close family members with asthma. Also likely if they have bronchiolitis more than 2 times. Cause of Bronchiolitis A narrowing of the smallest airways in the lung (bronchioles) causes wheezing. This narrowing results from swelling caused by a virus. The respiratory syncytial virus (RSV) causes most bronchiolitis. RSV occurs in epidemics almost every winter. People do not develop life-long immunity to the RSV virus. This means they can be infected many times. Trouble Breathing: How to Tell Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about: Struggling for each breath or short of breath. Tight breathing so that your child can barely speak or cry. Ribs are pulling in with each breath (called retractions). Breathing has become noisy (such as wheezes). Breathing is much faster than normal. Lips or face turn a blue color. Diagnosis of Bronchiolitis A doctor can diagnose bronchiolitis by listening to the chest with a stethoscope. Prevention of Spread to Others Cover the nose and mouth with a tissue when coughing or sneezing. Wash hands often. After coughing or sneezing are important times. When To Call Call 911 Now Severe trouble breathing (struggling for each breath, can barely speak or cry) Passed out or stopped breathing Lips or face are bluish when not coughing You think your child has a life-threatening emergency Go to ER Now Your child looks like they did when hospitalized before with bronchiolitis Call Doctor or Seek Care Now Trouble breathing. Exception: if it happens only when coughing. Lips or face have turned bluish, but only during coughing Ribs are pulling in with each breath (retractions) New harsh sound with breathing in (called stridor) Wheezing (purring or whistling sound) is worse than when seen Breathing is much faster than when seen Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth, no tears. Not alert when awake ("out of it") High-risk child (such as chronic lung disease) and getting worse Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Age less than 6 months old and worse in any way Fever over 104° F (40° C) Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Nonstop coughing spells Trouble feeding worse than when seen Earache or ear drainage Fever lasts more than 3 days Fever returns after being gone more than 24 hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Coughing causes vomiting 3 or more times Mild wheezing sounds lasts more than 7 days Cough lasts more than 3 weeks You have other questions or concerns Self Care at Home Bronchiolitis same or better than when last seen Care Advice What You Should Know About Bronchiolitis: Bronchiolitis is common during the first 2 years of life. Most children just have coughing and fast breathing. Some develop wheezing. This means the lower airway is getting tight. If you were given a follow-up appointment, be sure to keep it. Here is some care advice that should help. Asthma Medicines: Some children with bronchiolitis are helped by asthma-type medicines. Most children are not helped by these medicines. If one has been prescribed for your child, give it as instructed. Keep giving the medicine until your child's wheezing is gone for 24 hours. Coughing Fits or Spells: Breathe warm mist (such as with shower running in a closed bathroom). Give warm clear fluids to drink. Examples are apple juice and lemonade. Amount. If 3 - 12 months of age, give 1 ounce (30 mL) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed. Reason: Both relax the airway and loosen up any phlegm. Homemade Cough Medicine: Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using the these tips: Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old. Age 1 year and older: Use honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the mucus and loosen the cough. If you don't have any honey, you can use corn syrup. Nasal Saline To Open a Blocked Nose: Your baby can't nurse or drink from a bottle if the nose is blocked. Suction alone can't remove dry or sticky mucus. Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of bottled water or clean tap water. If under 1 year old, use bottled water or boiled tap water. Step 1: Put 3 drops in each nostril. (If age under 1 year old, use 1 drop). Step 2: Suction each nostril out while closing off the other nostril. Then, do the other side. Step 3: Repeat nose drops and suctioning until the discharge is clear. How often: Do nasal saline when your child can't breathe through the nose. Limit: No more than 4 times per day. Saline nose drops or spray can be bought in any drugstore. No prescription is needed. Other option: use a warm shower to loosen mucus. Breathe in the moist air, then suction. Humidifier: If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse. Smaller Feedings: Use small, frequent feedings whenever your child has the energy to drink. Reason: Children with wheezing don't have enough energy for long feedings. Offer enough fluids to prevent dehydration. Avoid Tobacco Smoke: Tobacco smoke makes coughs and wheezing much worse. Don't let anyone smoke around your child. What to Expect: Wheezing and rapid breathing most often improve over 2 or 3 days. Mild wheezing sounds can last up to 1 week. Coughing may last 3 weeks. Some children (2%) with bronchiolitis need to be in the hospital. These children need oxygen or fluids given through a vein. Return to Child Care: Your child can return to child care after the wheezing and fever are gone. Call Your Doctor If: Trouble breathing occurs Wheezing gets worse (becomes tight) Trouble feeding occurs Fever lasts more than 3 days You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Pain or discomfort in the chest (front or back) The chest includes from the top to the bottom of the rib cage Causes of Chest Pain Muscle Overuse. Chest pain can follow hard sports (such as throwing a baseball). Lifting (such as weights) or upper body work (such as digging) can also cause it. This type of muscle soreness often increases with movement of the shoulders. Muscle Cramps. Most brief chest pain lasting seconds to minutes is from muscle cramps. The ribs are separated by muscles. These fleeting pains can also be caused by a pinched nerve. These chest wall pains are harmless. Brief muscle cramps are also the most common cause of recurrent chest pains. The medical name is precordial catch syndrome. Coughing. Chest pain commonly occurs with a hacking cough. Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm. Asthma. Children with asthma often have a tight chest. They may refer to this as chest pain. They also get chest pain when they have lots of coughing. Heartburn. Heartburn is due to reflux of stomach contents. It usually causes a burning pain under the lower sternum (breastbone). Caffeine. A rapid and pounding heart beat may be reported as chest pain. Too much caffeine as found in energy drinks is a common cause. Drugs prescribed for ADHD also can cause a fast heartbeat. Illegal drugs, such as cocaine, can cause a high heart rate as well. Chest Wall Injury. Blunt trauma usually just causes a bruised rib. Sometimes, it causes a rib fracture. Heart Disease (Serious). Heart disease is hardly ever the cause of chest pain in children. Chest pain that only occurs with exercise could have a cardiac cause. Pleurisy (Serious). Pleurisy is another problem of pneumonia. If the infection involves the lung's surface, that area of the chest will hurt. Pain Scale Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed. Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep. Severe: the pain is very bad. It keeps your child from doing all normal activities. When To Call Call 911 Now Severe trouble breathing (struggling for each breath, can barely speak or cry) Passed out (fainted) Bluish lips or face Not moving or too weak to stand You think your child has a life-threatening emergency Go to ER Now Severe constant pain (child not able to move or do anything) Call Doctor or Seek Care Now Your child has heart disease Trouble breathing, but not severe Taking a deep breath makes the pain worse Heart is beating very rapidly After a direct blow to the chest Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Fever is present Cause of chest pain is not clear. Exception: pain due to coughing, sore muscles, heartburn or other clear cause. You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Chest pains only occur with hard exercise (such as running) Sore muscles last more than 7 days Heartburn lasts more than 2 days on treatment Chest pains are a frequent problem You have other questions or concerns Self Care at Home Normal chest pain from sore muscles Normal chest pain from heartburn Care Advice Sore Muscle Pain Treatment What You Should Know About Mild Chest Pain: Chest pains in children lasting for a few minutes are usually harmless. The pain can be caused by muscle cramps. They need no treatment. Chest pains that last longer can be from hard work or sports. The shoulders are usually involved. Sore muscles can start soon after the event. Here is some care advice that should help. Pain Medicine: To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Continue this until 24 hours have passed without pain. Cold Pack for Pain: For the first 2 days, use a cold pack to help with the pain. You can also use ice wrapped in a wet cloth. Put it on the sore muscles for 20 minutes, then as needed. Caution: Avoid frostbite. Use Heat After 48 Hours: If pain lasts over 2 days, put heat on the sore muscle. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed. Reason: Increase blood flow and improve healing. Caution: Avoid burns. A hot shower may also help. Stretching the Muscles: Gentle stretching of the shoulders and chest wall may help. Do sets of 10 twice daily. This may prevent muscle cramps from coming back. Stretching can be continued even during the chest pain. Do not do any exercises that increase the pain. What to Expect: For sore muscles, the pain most often peaks on day 2. It can last up to 6 or 7 days. Call Your Doctor If: Pain becomes severe Pain lasts over 7 days on treatment You think your child needs to be seen Your child becomes worse Heartburn (Reflux) Pain Treatment What You Should Know About Heartburn: Heartburn is common. It's due to stomach acid going up into the esophagus. The esophagus is the tube from the mouth to the stomach. Heartburn causes a burning pain behind the lower part of the breastbone. It also causes a sour (acid) taste in the mouth and belching. Here is some care advice that should help. Antacids: Heartburn is usually easily treated. Give a liquid antacid by mouth (such as Mylanta or the store brand). No prescription is needed. Dose: Give 1 to 2 tablespoons (15 - 30 mL). If you don't have an antacid, use 2 to 3 ounces (60 - 90 mL) of milk. For heartburn that keeps coming back, give an antacid 1 hour before meals. Also, give a dose at bedtime. Do this for a few days. Heartburn Prevention: Do not eat too much at meals. This overfills the stomach. Do not eat foods that make heartburn worse. Examples are chocolate, fatty foods, spicy foods, carbonated soda, and caffeine. Do not bend over during the 3 hours after meals. Do not wear tight clothing or belts around the waist. What to Expect: Most often, heartburn goes away with treatment. But, heartburn also tends to come back. So, preventive measures are important. Call Your Doctor If: Heartburn doesn't go away after 2 days of treatment You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Runny nose and sore throat caused by a virus You think your child has a cold. Reason: Other family members, friends or classmates have same symptoms. Also called an Upper Respiratory Infection (URI) Symptoms of a Cold Runny or stuffy nose The nasal discharge starts clear but changes to grey. It can also be yellow or green. Most children have a fever at the start. A sore throat can be the first sign At times, the child may also have a cough and hoarse voice. Sometimes, watery eyes and swollen lymph nodes in the neck also occur. Cause of Colds Colds are caused by many respiratory viruses. Healthy children get about 6 colds a year. Influenza virus causes a bad cold with more fever and muscle aches. Colds are not serious. With a cold, about 5 and 10% of children develop another health problem. Most often, this is an ear or sinus infection. These are caused by a bacteria. Colds: Normal Viral Symptoms Colds can cause a runny nose, sore throat, hoarse voice, a cough or croup. They can also cause stuffiness of the nose, sinus or ear. Red watery eyes can also occur. Colds are the most common reason for calls to the doctor. This is because of all the symptoms that occur with colds. Cold symptoms are also the number one reason for office and ER visits. Hopefully, this information will save you time and money. It can help you to avoid some needless trips to the doctor. The cold symptoms listed below are normal. These children don't need to be seen: Fever up to 3 days (unless it goes above 104° F or 40° C) Sore throat up to 5 days (with other cold symptoms) Nasal discharge and congestion up to 2 weeks Coughs up to 3 weeks Colds: Symptoms of Secondary Bacterial Infections (other health problems) Using this guide, you can decide if your child has developed another health problem. This happens in about 5 to 10% of children who have a cold. Many will have an ear infection or sinus infection. Look for these symptoms: Earache or ear discharge Sinus pain not relieved by nasal washes Lots of pus in the eyes (Eyelids stuck together after naps) Trouble breathing or rapid breathing (could have pneumonia) Fever lasts over 3 days Fever that goes away for 24 hours and then returns Sore throat lasts over 5 days (may have Strep throat) Nasal discharge lasts over 2 weeks Cough lasts over 3 weeks Trouble Breathing: How to Tell Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about: Struggling for each breath or shortness of breath Tight breathing so that your child can barely speak or cry Ribs are pulling in with each breath (called retractions) Breathing has become noisy (such as wheezes) Breathing is much faster than normal Lips or face turn a blue color When To Call Call 911 Now Severe trouble breathing (struggling for each breath, can barely speak or cry) You think your child has a life-threatening emergency Call Doctor or Seek Care Now Not alert when awake ("out of it") Trouble breathing not gone after cleaning out the nose Wheezing (high-pitched purring or whistling sound when breathing out) Breathing is much faster than normal Trouble swallowing and new onset drooling Ribs are pulling in with each breath (retractions) High-risk child (such as cystic fibrosis or other chronic lung disease) Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids. Fever over 104° F (40° C) Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Age less than 6 months old Earache or ear drainage Yellow or green eye discharge Sinus pain around cheekbone or eyes (not just congestion) Fever lasts more than 3 days Fever returns after being gone more than 24 hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Blocked nose wakes up from sleep Yellow scabs around the nasal openings. (Use an antibiotic ointment) Sore throat lasts more than 5 days Sinus congestion (fullness) lasts more than 14 days Nasal discharge lasts more than 2 weeks You have other questions or concerns Self Care at Home Mild cold with noother problems Care Advice What You Should Know About Colds: It's normal for healthy children to get at least 6 colds a year. This is because there are so many viruses that cause colds. With each new cold, your child's body builds up immunity to that virus. Most parents know when their child has a cold. Sometimes, they have it too or other children in school have it. Most often, you don't need to call or see your child's doctor. You do need to call your child's doctor if your child develops a complication. Examples are an earache or if the symptoms last too long. The normal cold lasts about 2 weeks. There are no drugs to make it go away sooner. But, there are good ways to help many of the symptoms. With most colds, the starting symptom is a runny nose. This is followed in 3 or 4 days by a stuffy nose. The treatment for each symptom is different. Here is some care advice that should help. For a Runny Nose with Lots of Discharge: Blow or Suction the Nose The nasal mucus and discharge is washing germs out of the nose and sinuses. Blowing the nose is all that's needed. Teach your child how to blow the nose at age 2 or 3. For younger children, gently suction the nose with a suction bulb. Put petroleum jelly on the skin under the nose. Wash the skin first with warm water. This will help to protect the nostrils from any redness. Nasal Saline to Open a Blocked Nose: Use saline (salt water) nose spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water. Step 1. Put 3 drops in each nostril. If under 1 year old, use 1 drop. Step 2. Blow (or suction) each nostril out while closing off the other nostril. Then, do the other side. Step 3. Repeat nose drops and blowing (or suctioning) until the discharge is clear. How Often. Do nasal saline rinses when your child can't breathe through the nose. Limit. If under 1 year old, no more than 4 times per day or before every feeding. Saline nose drops or spray can be bought in any drugstore. No prescription is needed. Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops. Reason for nose drops: Suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open. Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril. For young children, can also use a wet cotton swab to remove sticky mucus. Fluids - Offer More: Try to get your child to drink lots of fluids. Goal: Keep your child well hydrated. It also will thin out the mucus discharge from the nose. It also loosens up any phlegm in the lungs. Then it's easier to cough up. Humidifier: If the air in your home is dry, use a humidifier. Reason: Dry air makes nasal mucus thicker. Medicines for Colds: Cold Medicines. Don't give any drugstore cold or cough medicines to young children. They are not approved by the FDA under 6 years. Reasons: not safe and can cause serious side effects. Also, they are not helpful. They can't remove dried mucus from the nose. Nasal saline works best. Allergy Medicines. They are not helpful, unless your child also has nasal allergies. They can also help an allergic cough. No Antibiotics. Antibiotics are not helpful for colds. Antibiotics may be used if your child gets an ear or sinus infection. Other Symptoms of Colds - Treatment: Pain or Fever. Use acetaminophen (such as Tylenol) to treat muscle aches, sore throat or headaches. Another choice is an ibuprofen product (such as Advil). You can also use these medicines for fever above 102° F (39° C). Sore Throat. If over 6 years of age, your child can also suck on hard candy. For children over 1 year old, sip warm chicken broth. Some children prefer cold foods, such as popsicles or ice cream. Cough. For children over 1 year old, give honey ½ to 1 teaspoon (2 to 5 mL). Caution: Do not use honey until 1 year old. If over 6 years of age, you can also use cough drops. Avoid cough drops before 6 years. Reason: risk of choking. Red Eyes. Rinse eyelids often with wet cotton balls. Return to School: Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities. For practical purposes, the spread of colds can't be prevented. What to Expect: Fever can last 2-3 days Nasal drainage can last 7-14 days Cough can last 2-3 weeks Call Your Doctor If: Trouble breathing occurs Earache occurs Fever lasts more than 3 days or goes above 104° F (40° C) Any fever if under 12 weeks old Nasal discharge lasts more than 14 days Cough lasts more than 3 weeks You think your child needs to be seen Your child becomes worse Extra Advice - Air Travel with Colds: It's safe to fly when your child has a cold. He could get some mild ear congestion or even a brief earache while flying. Most often, that can be prevented. (See # 12). Flying will not cause an ear infection. Extra Advice - Prevent Ear Congestion During Air Travel: Most symptoms happen when the airplane is coming down in altitude. This is the descent of the plane during the 15 minutes before landing. Keep your child awake during takeoff and descent. Swallow during descent using fluids or a pacifier. Children over age 4 can chew gum during descent. Yawning during descent also can open the middle ear. Drink lots of fluids throughout the flight. This will prevent the nasal secretions from drying out. And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition The sound made when the cough reflex clears the airway of irritants Most coughs are part of a cold A coughing fit or spell is over 5 minutes of nonstop coughing Coughs can be dry (no mucus) or wet (with white, yellow or green mucus) Causes of Cough Common Cold. Most coughs are part of a cold that includes the lower airway. The medical name is viral bronchitis. The bronchi are the lower part of the airway that go to the lungs. Bronchitis in children is always caused by a virus. This includes cold viruses, influenza and croup. Bacteria do not cause bronchitis in healthy children. Sinus Infection. The exact mechanism of the cough is unknown. It may be that post-nasal drip irritates the lower throat. Or pressure within the sinus may trigger the cough reflex. Allergic Cough. Some children get a cough from breathing in an allergic substance. Examples are pollens or cats. Allergic coughs can be controlled with allergy medicines, such as Benadryl. Asthma. Asthma with wheezing is the most common cause of chronic coughs in children. In adults, it's smoking. Cough Variant Asthma. 25% of children with asthma only cough and never wheeze. The coughing spells have the same triggers as asthma attacks. Air Pollution Cough. Fumes of any kind can irritate the airway and cause a cough. Tobacco smoke is the most common example. Others are auto exhaust, smog and paint fumes. Exercise Induced Cough. Running will make most coughs worse. If the air is cold or polluted, coughing is even more likely. Serious Causes. Pneumonia, bronchiolitis, whooping cough and airway foreign object Trouble Breathing: How to Tell Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about: Struggling for each breath or shortness of breath Tight breathing so that your child can barely speak or cry Ribs are pulling in with each breath (called retractions) Breathing has become noisy (such as wheezes) Breathing is much faster than normal Lips or face turn a blue color Phlegm or Sputum: What's Normal? Yellow or green phlegm is a normal part of the healing of viral bronchitis. This means the lining of the trachea (windpipe) was damaged by the virus. It's part of the phlegm your child coughs up. Bacteria do not cause bronchitis in healthy children. Antibiotics are not helpful for the yellow or green phlegm seen with colds. The main treatment of a cough with phlegm is to drink lots of fluids. Also, if the air is dry, using a humidifier will help. Sipping warm clear fluids will also help coughing fits. When To Call Call 911 Now Severe trouble breathing (struggling for each breath, can barely speak or cry) Passed out or stopped breathing Lips or face are bluish when not coughing You think your child has a life-threatening emergency Go to ER Now Choked on a small object that could be caught in the throat Call Doctor or Seek Care Now Trouble breathing. Exception: present only when coughing. Lips or face have turned bluish during coughing Ribs are pulling in with each breath (retractions) Harsh sound with breathing in (called stridor) Wheezing (high-pitched purring or whistling sound when breathing out) Breathing is much faster than normal Can't take a deep breath because of chest pain Severe chest pain Coughed up blood Not alert when awake ("out of it") Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids. High-risk child (such as cystic fibrosis or other chronic lung disease) Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Fever over 104° F (40° C) Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Nonstop coughing spells Age less than 6 months old Earache or ear drainage Sinus pain (not just congestion) around cheekbone or eyes Fever lasts more than 3 days Fever returns after being gone more than 24 hours Chest pain even when not coughing You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Coughing causes vomiting 3 or more times Coughing has kept home from school for 3 or more days Allergy symptoms (such as runny nose and itchy eyes) also present Runny nose lasts more than 14 days Cough lasts more than 3 weeks You have other questions or concerns Self Care at Home Cough with no other problems Care Advice What You Should Know About Coughs: Most coughs are a normal part of a cold. Coughing up mucus is very important. It helps protect the lungs from pneumonia. A cough can be a good thing. We don't want to fully turn off your child's ability to cough. Here is some care advice that should help. Homemade Cough Medicine: Goal: Decrease the irritation or tickle in the throat that causes a dry cough. Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old. Age 1 year and older: Use Honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup. Age 6 years and older: Use Cough Drops to decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking. Non-Prescription Cough Medicine (DM): Non-prescription cough medicines are not advised. Reason: No proven benefit for children and not approved under 6 years old. (FDA) Honey has been shown to work better for coughs. Caution: Do not use honey until 1 year old. If age 6 years or older, you might decide to use a cough medicine. Choose one with dextromethorphan (DM), such as Robitussin Cough syrup. DM is present in most non-prescription cough syrups. When to Use: Give only for severe coughs that interfere with sleep or school. DM Dose: Give every 6 to 8 hours as needed. Coughing Fits or Spells - Warm Mist and Fluids: Breathe warm mist, such as with shower running in a closed bathroom. Give warm clear fluids to drink. Examples are apple juice and lemonade. Age under 3 months. Don't use warm fluids. Age 3 - 12 months of age. Give 1 ounce (30 mL) each time. Limit to 4 times per day. Age over 1 year of age. Give as much as needed. Reason: Both relax the airway and loosen up any phlegm. Vomiting from Hard Coughing: For vomiting that occurs with hard coughing, give smaller amounts per feeding. Also, feed more often. Reason: Vomiting from coughing is more common with a full stomach. Encourage Fluids: Try to get your child to drink lots of fluids. Goal: Keep your child well hydrated. It also loosens up any phlegm in the lungs. Then it's easier to cough up. It also will thin out the mucus discharge from the nose. Humidifier: If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Avoid Tobacco Smoke: Tobacco smoke makes coughs much worse. Return to School: Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented. Extra Advice- Allergy Medicine for Allergic Cough: Allergy medicine can bring an allergic cough under control within 1 hour. The same is true for nasal allergy symptoms. A short-acting allergy medicine (such as Benadryl) is helpful. No prescription is needed. Give every 6 to 8 hours until the cough is gone. What to Expect: Viral bronchitis causes a cough for 2 to 3 weeks. Sometimes, your child will cough up lots of phlegm (mucus). The mucus can normally be grey, yellow or green. Antibiotics are not helpful. Call Your Doctor If: Trouble breathing occurs Wheezing occurs Cough lasts more than 3 weeks You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Barky cough and hoarse voice caused by a virus Croup is a viral infection of the voicebox (larynx) The croupy cough is tight, low-pitched, and barky (like a barking seal) The voice or cry is hoarse (called laryngitis) Some children with severe croup get a harsh, tight sound while breathing in. This is called stridor. Stridor: A nother Health Problem of Croup Stridor is a harsh, raspy tight sound best heard with breathing in Loud or constant stridor means severe croup. So does stridor at rest (when not crying or coughing). All stridor needs to be treated with warm mist Most children with stridor need treatment with a steroid (such as Decadron) For any stridor, see First Aid for treatment Causes of a Croupy Cough Viral Croup. Viruses are the most common cause of croup symptoms. Many respiratory viruses can infect the vocal cord area and cause narrowing. Even influenza (the flu) can do this. A fever is often present with the barky cough. Allergic Croup. A croupy cough can occur with exposure to pollens or allergens in a barn. A runny nose, itchy eyes and sneezing are also often present. Inhaled Powder. Breathing in any fine substance can trigger 10 minutes of severe coughing. Examples are powdered sugar, flour dust or peanut dust. They can float into the lungs. This is not an allergic reaction. Airway Foreign Object (Serious). Suspect when there is a sudden onset of coughing and choking. Common examples are peanut and seeds. Peak age is 1 to 4 years. Food Allergy (Serious). Croup symptoms can also be caused by a food allergy. This can be life-threatening (anaphylaxis). Examples are nuts or fish. When To Call Call 911 Now Severe trouble breathing (struggling for each breath, constant severe stridor) Passed out or stopped breathing Lips or face are bluish when not coughing Croup started suddenly after bee sting, taking a new medicine or allergic food Drooling, spitting or having great trouble swallowing. Exception: drooling due to teething. You think your child has a life-threatening emergency Go to ER Now Choked on a small object that could be caught in the throat Call Doctor or Seek Care Now Stridor (harsh sound with breathing in) is heard now Trouble breathing. Exception: present only when coughing. Lips or face have turned bluish during coughing Ribs are pulling in with each breath (retractions) Breathing is much faster than normal Can't bend the neck forward Severe chest pain Age less than 1 year old with stridor Had croup before that needed Decadron Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids. High-risk child (such as cystic fibrosis or other chronic lung disease) Fever over 104° F (40° C) Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Stridor (harsh sound with breathing in) occurred but not present now Nonstop coughing Age less than 1 year old with a croupy cough Earache or ear drainage Fever lasts more than 3 days Fever returns after being gone more than 24 hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Coughing causes vomiting 3 or more times Croup is a frequent problem (3 or more times) Barky cough lasts more than 14 days You have other questions or concerns Self Care at Home Mild croup (barky cough) with no stridor Care Advice What You Should Know About Croup: Most children with croup just have a barky cough. Some have tight breathing (called stridor). Stridor is a loud, harsh sound when breathing in. It comes from the area of the voicebox. Coughing up mucus is very important. It helps protect the lungs from pneumonia. We want to help a productive cough, not turn it off. Here is some care advice that should help. First Aid For Stridor (Harsh sound with breathing in): Breathe warm mist in a closed bathroom with the hot shower running. Do this for 20 minutes. You could also use a wet washcloth held near the face. Caution: Do not use very hot water or steam which could cause burns. If warm mist fails, breathe cool air by standing near an open refrigerator. You can also go outside with your child if the weather is cold. Do this for a few minutes. Calm Your Child if He or She has Stridor: Crying or fear can make stridor worse. Try to keep your child calm and happy. Hold and comfort your child. Use a soothing, soft voice. Humidifier: If the air in your home is dry, use a humidifier. Reason: Dry air makes croup worse. Homemade Cough Medicine: Goal: Decrease the irritation or tickle in the throat that causes a dry cough. Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old. Age 1 year and older: Use Honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup. Age 6 years and older: Use Cough Drops to decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking. Non-Prescription Cough Medicine (DM): Non-prescription cough medicines are not advised. Reason: No proven benefit for children and not approved under 6 years old. (FDA) Honey has been shown to work better for coughs. Caution: Do not use honey until 1 year old. If age 6 years or older, you might decide to use a cough medicine. Choose one with dextromethorphan (DM) such as Robitussin Cough syrup. DM is present in most non-prescription cough syrups. When to Use: Give only for severe coughs that interfere with sleep or school. DM Dose: Give every 6 to 8 hours as needed. Coughing Fits or Spells - Warm Mist and Fluids: Breathe warm mist, such as with shower running in a closed bathroom. Give warm clear fluids to drink. Examples are apple juice and lemonade. Age under 3 months. Don't use warm fluids. Age 3 - 12 months of age. Give 1 ounce (30 mL) each time. Limit to 4 times per day. Age over 1 year of age. Give as much warm fluids as needed. Reason: Both relax the airway and loosen up any phlegm. Fluids - Offer More: Try to get your child to drink lots of fluids. Goal: Keep your child well hydrated. It also loosens up any phlegm in the lungs. Then it's easier to cough up. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Sleep Close By to Your Child: Sleep in the same room with your child for a few nights. Reason: Stridor can start all of a sudden at night. Avoid Tobacco Smoke: Tobacco smoke makes croup much worse. Return to School: Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities. For practical purposes, the spread of croup and colds cannot be prevented. What to Expect: Most often, croup lasts 5 to 6 days and becomes worse at night. The croupy cough can last up to 2 weeks. Call Your Doctor If: Trouble breathing occurs Stridor (harsh raspy sound) occurs Croupy cough lasts more than 14 days You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Your child has symptoms of influenza (Flu) and it's in your community Main symptoms: fever AND one or more respiratory symptoms (cough, sore throat, very runny nose) Influenza (Flu) is a viral infection You think your child has influenza because other family members have it You think your child has influenza because close friends have it Symptoms of Influenza Main symptoms are a fever with a runny nose, sore throat, and bad cough. More muscle pain, headache, fever, and chills than with usual colds. If there is no fever, your child probably doesn't have flu. More likely he has a cold. Cause of Influenza Influenza viruses that change yearly Diagnosis: How to Know Your Child Has Influenza Influenza occurs every year in the fall and winter months. During this time, if flu symptoms occur, your child probably has the flu. Your child doesn't need any special tests. Call your doctor if your child is High-Risk for complications of the flu. See the list below. These are the children who may need prescription anti-viral drugs. For Low-Risk children, usually you don't need to see your child's doctor. If your child develops a possible complication of the flu, then call your doctor. See the "What to Do" section. High-Risk Children for Complications From Influenza (AAP) Children are considered High-Risk for complications if they have any of the following: Lung disease (such as asthma) Heart disease (such as a congenital heart disease) Cancer or weak immune system conditions Neuromuscular disease (such as muscular dystrophy) Diabetes, sickle cell disease, kidney disease or liver disease Diseases needing long-term aspirin therapy Pregnancy or severe obesity Healthy children under 2 years old are also considered High-Risk (CDC) Note: All other children are referred to as Low-Risk Prescription Antiviral Drugs for Influenza Antiviral drugs (such as Tamiflu) are sometimes used to treat influenza. They must be started within 48 hours when the flu symptoms start. After 48 hours of fever, starting the drug is not helpful. The AAP recommends they be used for any patient with severe symptoms. The AAP recommends the drugs for most High-Risk children with underlying health problems. See that list. The AAP doesn't recommend antiviral drugs for Low-Risk children with mild flu symptoms. Their benefits are limited. They usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not make them go away. Side effects: Vomiting in 10% of children on Tamiflu. Most healthy children with flu do not need an antiviral drug. When To Call Call 911 Now Severe trouble breathing (struggling for each breath, can barely speak or cry) Lips or face are bluish when not coughing You think your child has a life-threatening emergency Call Doctor or Seek Care Now Trouble breathing. Exception: present only when coughing. Breathing is much faster than normal Lips or face have turned bluish during coughing Wheezing (high-pitched purring or whistling sound when breathing out) Stridor (harsh sound with breathing in) is heard now Ribs are pulling in with each breath (retractions) Chest pain and can't take a deep breath Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears. Not alert when awake ("out of it") Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids. Severe High-Risk child (see that list in Causes). This includes lung disease, heart disease, and bedridden. Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Fever over 104° F (40° C) Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours High-Risk child for complications of flu. Includes children with other chronic diseases. (See that list in Causes). Also, includes healthy children less than 2 years old. Nonstop coughing spells Age less than 3 months old with any cough Earache or ear drainage Sinus pain (not just congestion) Fever lasts more than 3 days Fever returns after being gone more than 24 hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Age more than 6 months and needs a flu shot Coughing causes vomiting 3 or more times Coughing has kept home from school for 3 or more days Nasal discharge lasts more than 2 weeks Cough lasts more than 3 weeks Flu symptoms lasts more than 3 weeks You have other questions or concerns Self Care at Home Influenza with no complications and your child is Low-Risk Care Advice What You Should Know About Influenza: Flu symptoms include cough, sore throat, runny nose, and fever. During influenza season, if your child has these symptoms, he probably has the flu. Most parents know if their child has flu. They have it too or it's in the school. It's also in the news. You don't need any special tests when you think your child has flu. If your child develops a complication of the flu, then call your child's doctor. Examples are an earache or trouble breathing. These problems are included in the "What to Do" section. For healthy people, the symptoms of influenza are like those of a bad cold. With flu, however, the onset is more abrupt. The symptoms are more severe. Feeling very sick for the first 3 days is common. The treatment of influenza depends on your child's main symptoms. It is no different from treatment used for other viral colds and coughs. Bed rest is not needed. Most children with flu don't need to see their doctor. Here is some care advice that should help. Runny Nose with Lots of Discharge: Blow or Suction the Nose The nasal mucus and discharge is washing germs out of the nose and sinuses. Blowing the nose is all that's needed. Teach your child how to blow the nose at age 2 or 3. For younger children, gently suction the nose with a suction bulb. Put petroleum jelly on the skin under the nose. Wash the skin first with warm water. This will help to protect the nostrils from any redness. Nasal Saline To Open a Blocked Nose: Use saline (salt water) nose spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water. Step 1. Put 3 drops in each nostril. If under 1 year old, use 1 drop. Step 2. Blow (or suction) each nostril out while closing off the other nostril. Then, do the other side. Step 3. Repeat nose drops and blowing (or suctioning) until the discharge is clear. How Often. Do nasal saline rinses when your child can't breathe through the nose. Limit. If under 1 year old, no more than 4 times per day or before every feeding. Saline nose drops or spray can be bought in any drugstore. No prescription is needed. Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops. Reason for nose drops: Suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open. Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril. For young children, can also use a wet cotton swab to remove sticky mucus. Medicines for Flu: Cold Medicines. Don't give any drugstore cold or cough medicines to young children. They are not approved by the FDA under 6 years. Reasons: not safe and can cause serious side effects. Also, they are not helpful. They can't remove dried mucus from the nose. Nasal saline works best. Allergy Medicines. They are not helpful, unless your child also has nasal allergies. They can also help an allergic cough. No Antibiotics. Antibiotics are not helpful for flu. Antibiotics may be used if your child gets an ear or sinus infection. Homemade Cough Medicine: Goal: Decrease the irritation or tickle in the throat that causes a dry cough. Age 3 months to 1 year: give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: do not use honey until 1 year old. Age 1 year and older: use Honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup. Age 6 years and older: use Cough Drops to decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking. Sore Throat Pain Relief: Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream. Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help. Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed. Medicated throat sprays or lozenges are generally not helpful. Fluids - Offer More: Try to get your child to drink lots of fluids. Goal: Keep your child well hydrated. It also will thin out the mucus discharge from the nose. It also loosens up any phlegm in the lungs. Then it's easier to cough up. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Avoid Aspirin because of the strong link with Reye syndrome. Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Pain Medicine: For muscle aches or headaches, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Prescription Antiviral Drugs for Influenza: Antiviral drugs (such as Tamiflu) are sometimes used to treat influenza. They must be started within 48 hours of when flu symptoms start. After 48 hours of fever, starting the drug is not helpful. The AAP recommends they be used for any patient with severe symptoms. They also recommend the drugs for most High-Risk children. See that list in Causes. If your child has a chronic disease and gets the flu, call your doctor. The doctor will decide if your child needs a prescription. The AAP doesn't recommend antiviral drugs for Low-Risk children with normal flu symptoms. Their benefits are limited. They reduce the time your child is sick by 1 to 1 ½ days. They reduce the symptoms, but do not make them go away. Side effects: Vomiting in 10% of children on Tamiflu. Most healthy children with flu do not need an antiviral drug. Also, it is not used to prevent flu. Reason: You would need to take the medicine every day for months. Return to School: Spread is rapid, and the virus is easily passed to others. The time it takes to get the flu after contact is about 2 days. Your child can return to school after the fever is gone for 24 hours. Your child should feel well enough to join in normal activities. What to Expect: Influenza causes a cough that lasts 2 to 3 weeks. Sometimes your child will cough up lots of phlegm (mucus). The mucus can be grey, yellow or green. This is normal. Coughing up mucus is very important. It helps protect the lungs from pneumonia. We want to help a productive cough, not turn it off. The fever lasts 2 to 3 days. The runny nose lasts 7 to 14 days. Prevention: How to Protect Yourself from Getting Sick: Wash hands often with soap and water. Alcohol-based hand cleaners also work well. Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way. Try to avoid close contact with sick people. Avoid ERs and urgent care clinics if you don't need to go. These are places where you are more likely to be exposed to flu. Prevention: How to Protect Others - Stay Home When Sick: Cover the nose and mouth with a tissue when coughing or sneezing. Wash hands often with soap and water. After coughing or sneezing are important times. Limit contact with others to keep from infecting them. Stay home from school for at least 24 hours after the fever is gone. (CDC). Flu Shot and Prevention: Getting a flu shot is the best way to protect your family from flu. Influenza vaccines are strongly advised for all children over 6 months of age. (AAP) Adults should also get the shot. The shot most often prevents the disease. Even if your child gets the flu, the shot helps to reduce the symptoms. A new flu shot is needed every year. Reason: Flu viruses keep changing. After the flu shot, it takes 2 weeks to fully protect from flu. But then, the protection lasts for the full flu season. An antiviral medicine only protects from flu while taking it. Call Your Doctor If: Trouble breathing occurs Retractions (pulling in between the ribs) occur Dehydration occurs Earache or sinus pain occurs Fever lasts more than 3 days or goes above 104° F (40° C) Nasal discharge lasts more than 14 days Cough lasts more than 3 weeks You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Your child has symptoms of influenza (Flu) and it's in your community Main symptoms: fever AND one or more respiratory symptoms (cough, sore throat, very runny nose) Influenza (Flu) is a viral infection You think your child has influenza because other family members have it You think your child has influenza because close friends have it Symptoms of Influenza Main symptoms are a fever with a runny nose, sore throat, and bad cough. More muscle pain, headache, fever, and chills than with usual colds. If there is no fever, your child probably doesn't have flu. More likely he has a cold. Cause of Influenza Influenza viruses that change yearly Diagnosis: How to Know Your Child Has Influenza Influenza occurs every year in the fall and winter months. During this time, if flu symptoms occur, your child probably has the flu. Your child doesn't need any special tests. Call your doctor if your child is High-Risk for complications of the flu. See the list below. These are the children who may need prescription anti-viral drugs. For Low-Risk children, usually you don't need to see your child's doctor. If your child develops a possible complication of the flu, then call your doctor. See the "What to Do" section. High-Risk Children for Complications From Influenza (AAP) Children are considered High-Risk for complications if they have any of the following: Lung disease (such as asthma) Heart disease (such as a congenital heart disease) Cancer or weak immune system conditions Neuromuscular disease (such as muscular dystrophy) Diabetes, sickle cell disease, kidney disease or liver disease Diseases needing long-term aspirin therapy Pregnancy or severe obesity Healthy children under 2 years old are also considered High-Risk (CDC) Note: All other children are referred to as Low-Risk Prescription Antiviral Drugs for Influenza Antiviral drugs (such as Tamiflu) are sometimes used to treat influenza. They must be started within 48 hours when the flu symptoms start. After 48 hours of fever, starting the drug is not helpful. The AAP recommends they be used for any patient with severe symptoms. The AAP recommends the drugs for most High-Risk children with underlying health problems. See that list. The AAP doesn't recommend antiviral drugs for Low-Risk children with mild flu symptoms. Their benefits are limited. They usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not make them go away. Side effects: Vomiting in 10% of children on Tamiflu. Most healthy children with flu do not need an antiviral drug. When To Call Call 911 Now Severe trouble breathing (struggling for each breath, can barely speak or cry) Lips or face are bluish when not coughing You think your child has a life-threatening emergency Call Doctor or Seek Care Now Trouble breathing. Exception: present only when coughing. Breathing is much faster than normal Lips or face have turned bluish during coughing Wheezing (high-pitched purring or whistling sound when breathing out) Stridor (harsh sound with breathing in) is heard now Ribs are pulling in with each breath (retractions) Chest pain and can't take a deep breath Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears. Not alert when awake ("out of it") Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids. Severe High-Risk child (see that list in Causes). This includes lung disease, heart disease, and bedridden. Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Fever over 104° F (40° C) Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours High-Risk child for complications of flu. Includes children with other chronic diseases. (See that list in Causes). Also, includes healthy children less than 2 years old. Nonstop coughing spells Age less than 3 months old with any cough Earache or ear drainage Sinus pain (not just congestion) Fever lasts more than 3 days Fever returns after being gone more than 24 hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Age more than 6 months and needs a flu shot Coughing causes vomiting 3 or more times Coughing has kept home from school for 3 or more days Nasal discharge lasts more than 2 weeks Cough lasts more than 3 weeks Flu symptoms lasts more than 3 weeks You have other questions or concerns Self Care at Home Influenza with no complications and your child is Low-Risk Care Advice What You Should Know About Influenza: Flu symptoms include cough, sore throat, runny nose, and fever. During influenza season, if your child has these symptoms, he probably has the flu. Most parents know if their child has flu. They have it too or it's in the school. It's also in the news. You don't need any special tests when you think your child has flu. If your child develops a complication of the flu, then call your child's doctor. Examples are an earache or trouble breathing. These problems are included in the "What to Do" section. For healthy people, the symptoms of influenza are like those of a bad cold. With flu, however, the onset is more abrupt. The symptoms are more severe. Feeling very sick for the first 3 days is common. The treatment of influenza depends on your child's main symptoms. It is no different from treatment used for other viral colds and coughs. Bed rest is not needed. Most children with flu don't need to see their doctor. Here is some care advice that should help. Runny Nose with Lots of Discharge: Blow or Suction the Nose The nasal mucus and discharge is washing germs out of the nose and sinuses. Blowing the nose is all that's needed. Teach your child how to blow the nose at age 2 or 3. For younger children, gently suction the nose with a suction bulb. Put petroleum jelly on the skin under the nose. Wash the skin first with warm water. This will help to protect the nostrils from any redness. Nasal Saline To Open a Blocked Nose: Use saline (salt water) nose spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water. Step 1. Put 3 drops in each nostril. If under 1 year old, use 1 drop. Step 2. Blow (or suction) each nostril out while closing off the other nostril. Then, do the other side. Step 3. Repeat nose drops and blowing (or suctioning) until the discharge is clear. How Often. Do nasal saline rinses when your child can't breathe through the nose. Limit. If under 1 year old, no more than 4 times per day or before every feeding. Saline nose drops or spray can be bought in any drugstore. No prescription is needed. Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops. Reason for nose drops: Suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open. Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril. For young children, can also use a wet cotton swab to remove sticky mucus. Medicines for Flu: Cold Medicines. Don't give any drugstore cold or cough medicines to young children. They are not approved by the FDA under 6 years. Reasons: not safe and can cause serious side effects. Also, they are not helpful. They can't remove dried mucus from the nose. Nasal saline works best. Allergy Medicines. They are not helpful, unless your child also has nasal allergies. They can also help an allergic cough. No Antibiotics. Antibiotics are not helpful for flu. Antibiotics may be used if your child gets an ear or sinus infection. Homemade Cough Medicine: Goal: Decrease the irritation or tickle in the throat that causes a dry cough. Age 3 months to 1 year: give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: do not use honey until 1 year old. Age 1 year and older: use Honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup. Age 6 years and older: use Cough Drops to decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking. Sore Throat Pain Relief: Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream. Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help. Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed. Medicated throat sprays or lozenges are generally not helpful. Fluids - Offer More: Try to get your child to drink lots of fluids. Goal: Keep your child well hydrated. It also will thin out the mucus discharge from the nose. It also loosens up any phlegm in the lungs. Then it's easier to cough up. Fever Medicine: For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Avoid Aspirin because of the strong link with Reye syndrome. Note: Fevers less than 102° F (39° C) are important for fighting infections. For all fevers: Keep your child well hydrated. Give lots of cold fluids. Pain Medicine: For muscle aches or headaches, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed. Prescription Antiviral Drugs for Influenza: Antiviral drugs (such as Tamiflu) are sometimes used to treat influenza. They must be started within 48 hours of when flu symptoms start. After 48 hours of fever, starting the drug is not helpful. The AAP recommends they be used for any patient with severe symptoms. They also recommend the drugs for most High-Risk children. See that list in Causes. If your child has a chronic disease and gets the flu, call your doctor. The doctor will decide if your child needs a prescription. The AAP doesn't recommend antiviral drugs for Low-Risk children with normal flu symptoms. Their benefits are limited. They reduce the time your child is sick by 1 to 1 ½ days. They reduce the symptoms, but do not make them go away. Side effects: Vomiting in 10% of children on Tamiflu. Most healthy children with flu do not need an antiviral drug. Also, it is not used to prevent flu. Reason: You would need to take the medicine every day for months. Return to School: Spread is rapid, and the virus is easily passed to others. The time it takes to get the flu after contact is about 2 days. Your child can return to school after the fever is gone for 24 hours. Your child should feel well enough to join in normal activities. What to Expect: Influenza causes a cough that lasts 2 to 3 weeks. Sometimes your child will cough up lots of phlegm (mucus). The mucus can be grey, yellow or green. This is normal. Coughing up mucus is very important. It helps protect the lungs from pneumonia. We want to help a productive cough, not turn it off. The fever lasts 2 to 3 days. The runny nose lasts 7 to 14 days. Prevention: How to Protect Yourself from Getting Sick: Wash hands often with soap and water. Alcohol-based hand cleaners also work well. Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way. Try to avoid close contact with sick people. Avoid ERs and urgent care clinics if you don't need to go. These are places where you are more likely to be exposed to flu. Prevention: How to Protect Others - Stay Home When Sick: Cover the nose and mouth with a tissue when coughing or sneezing. Wash hands often with soap and water. After coughing or sneezing are important times. Limit contact with others to keep from infecting them. Stay home from school for at least 24 hours after the fever is gone. (CDC). Flu Shot and Prevention: Getting a flu shot is the best way to protect your family from flu. Influenza vaccines are strongly advised for all children over 6 months of age. (AAP) Adults should also get the shot. The shot most often prevents the disease. Even if your child gets the flu, the shot helps to reduce the symptoms. A new flu shot is needed every year. Reason: Flu viruses keep changing. After the flu shot, it takes 2 weeks to fully protect from flu. But then, the protection lasts for the full flu season. An antiviral medicine only protects from flu while taking it. Call Your Doctor If: Trouble breathing occurs Retractions (pulling in between the ribs) occur Dehydration occurs Earache or sinus pain occurs Fever lasts more than 3 days or goes above 104° F (40° C) Nasal discharge lasts more than 14 days Cough lasts more than 3 weeks You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Exposure (Close Contact) to a person with influenza Questions about influenza Your child has no symptoms of influenza (no fever, cough, sore throat, runny nose) For children with symptoms of influenza, see the Influenza care guide. Flu Exposure (Close Contact) Definition Household Close Contact. Lives with a person with flu. Other Close Contact. The CDC defines 6 feet as how far coughing can spread the flu virus. How long the close contact lasts is also important. Close contact includes kissing, hugging or sharing eating and drinking utensils. It also includes close conversations. Direct contact with secretions of a person with flu is also close contact. Includes being in the same child care center room or carpool. In Same Building - Not Close Contact. Walking by a person or sitting in a room briefly is not close contact. Being in the same school, church, workplace or building also is not close contact. In Same Town - Not Close Contact. Living in a town where there are people with the flu is not close contact. Living in the same state or country (such as Mexico) carries no added risk. High-Risk Children for Complications From Influenza (AAP) Children are considered High-Risk for complications if they have any of the following: Lung disease (such as asthma) Heart disease (such as a congenital heart disease) Cancer or weak immune system conditions Neuromuscular disease (such as muscular dystrophy) Diabetes, sickle cell disease, kidney disease or liver disease Diseases requiring long-term aspirin therapy Pregnancy or severe obesity All healthy children under 2 years old are also considered High-Risk (CDC 2009) Note: All other children are referred to as Low-Risk Prescription Antiviral Drugs for Influenza Antiviral drugs (such as Tamiflu) are sometimes used to treat influenza. They must be started within 48 hours of when flu symptoms start. The AAP recommends they be used for any patient with severe symptoms. The AAP also recommends the drugs for most High-Risk children. A list of High-Risk problems is also on the CDC website. The AAP doesn't recommend antiviral drugs for Low-Risk children with mild flu symptoms. Their benefits are limited. They usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not make them go away. Side effects: Vomiting in 10% of children. When To Call Call Doctor Within 24 Hours Influenza Close Contact within last 7 days and your child is High-Risk. See the list of children at High-Risk in Causes for complications of flu. Call Doctor During Office Hours Age more than 6 months and needs a flu shot You have other questions or concerns Self Care at Home Influenza questions and no Close Contact in the last 7 days Influenza prevention questions Tamiflu prescription questions Influenza Close Contact within the last 7 days, but Low-Risk or healthy child Influenza Minor Contact (same school or gathering), but no Close Contact Care Advice Influenza Questions and No Close Contact in the Last 7 days What You Should Know About Flu Exposure: For most healthy people, the symptoms of influenza are like those of a bad cold. But, with flu, the onset is more abrupt. The symptoms are more severe. Feeling very sick for the first 3 days is common. The treatment of influenza depends on your child's main symptoms. It is no different from treatment used for other viral colds and coughs. Most children with flu don't need to see their doctor. Influenza Symptoms: The main symptoms are fever, cough, sore throat and runny nose. Most often, fever is present. (Exception: Sometimes, no fever if the child has a weak immune system.) Other common symptoms are muscle pain, headache and fatigue. Some people also have vomiting and diarrhea, but never as the only symptom. Influenza Diagnosis and Flu Tests: During influenza season, if your child has flu symptoms, he probably has the flu. Your child won't need any special tests. You should call your doctor if your child is High-Risk for complications of flu. These are children with chronic diseases. Examples of such diseases are asthma or a weak immune system. See the High-Risk list in Causes. Also, healthy children under 2 years of age are High-Risk. For Low-Risk children, you don't need to see your child's doctor. If your child develops a complication of the flu, then call your child's doctor. Examples of complications are an earache or trouble breathing. These problems are included in the "What to Do" section. Influenza Treatment: For most children, the treatment of flu is based upon symptom relief. It's no different than the treatment of other viral coughs and colds. Tamiflu is the main antiviral drug used to treat influenza in some children. The AAP recommends it be used for any patient with severe symptoms. The AAP also recommends the drug for most High-Risk children. See that list in Causes. Mainly, it is used for children in the hospital or those with chronic diseases. Treatment is not recommended for Low-Risk children with normal flu symptoms. (AAP) Most patients recover without taking Tamiflu. Antiviral treatment must be started within 48 hours of the onset of flu symptoms. After 48 hours of fever, starting the drug is not helpful. Return to School: Spread is rapid and the virus is easily passed to others. The time it takes to get the flu after contact is about 2 days. The range is 1-4 days. Your child can return to school after the fever is gone for 24 hours. (CDC). The influenza virus is spread in the air from sneezing and coughing. It also can be spread by the hands with flu germs on them. What to Expect: The fever lasts 2 -3 days. The runny nose lasts 1-2 weeks. The cough lasts 2-3 weeks. Call Your Doctor If: You have other questions or concerns Influenza Prevention Questions How to Protect Yourself From Getting Sick: Wash hands often with soap and water. Alcohol-based hand cleaners work very well. Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way. Try to avoid close contact with sick people. Avoid ERs and urgent care clinics if you don't need to go. These are places where you are more likely to be exposed to flu. How To Protect Others - Stay Home When Sick: Cover the nose and mouth with a tissue when coughing or sneezing. Wash hands often with soap and water. After coughing or sneezing are important times. Alcohol-based hand cleaners also work well. Limit contact with others to avoid getting them sick. Stay home from school or work while sick with fever. Your child can return to school after the fever is gone for 24 hours. (CDC). Flu Shot: Getting a flu shot is the best way to protect your family from flu. Influenza vaccines are strongly advised for all children over 6 months of age. (AAP) Adults should also get the shot. The flu shot most often prevents the disease. Even if your child gets the flu, the shot helps to reduce the symptoms. A new flu shot is needed every year. Reason: Flu viruses keep changing. After the flu shot, it takes 2 weeks to fully protect from flu. But then, the protection lasts for the full flu season. An antiviral medicine only protects from flu while taking it. Antiviral Drug (such as Tamiflu): The drug Tamiflu may help prevent flu after close contact. But, it is only advised for some very High-Risk patients (CDC). See the High-Risk list. The CDC recommends early treatment if flu symptoms occur, not preventive treatment. Reasons: Even after close contact, some children don't get flu. Also, Tamiflu is helpful only while your child is taking it. It won't prevent flu once your child stops taking it. To prevent flu, you would need to take the medicine every day for months. Most doctors also wait until flu symptoms start before treating with drugs. If your child is High-Risk, call your doctor within 24 hours of exposure. Your doctor will decide if an antiviral is needed. High-Risk adults with recent close contact should also call their doctor. The High-Risk adult group includes chronic disease, pregnant, or over 65. Call Your Doctor If: You have other questions or concerns Tamiflu Prescription Questions Treating Influenza - Tamiflu: Tamiflu is a prescription anti-viral drug. It can be helpful in treating the flu virus. These drugs should be started within 48 hours of when flu symptoms start. After 48 hours of fever, starting the drug is not helpful. It's taken for a total of 5 days. When to Use: Severe symptoms OR underlying health problems (High-Risk group) For High-Risk children, call your child's doctor at the start of flu symptoms. Most healthy patients have mild to moderate symptoms. Tamiflu treatment is not needed for these patients. The benefits are limited. Tamiflu reduces the time your child is sick by 1 to 1.5 days. It helps reduce the symptoms, but does not make them go away. Tamiflu also has side effects. It causes vomiting in 10% of children. Also, it is not used to prevent flu. Reason: You would need to take the medicine every day for months. Personal Stockpiling of Tamiflu - Not Advised: Some people want a prescription for Tamiflu for all family members. They want it on hand just in case they come down with flu. They currently are well and have not been exposed to flu. Doctors and the CDC are opposed to this practice. The AAP and your State's Public Health Department also do not support this. The supply of Tamiflu is limited. It is used for those with severe symptoms OR who are High-Risk. Call Your Doctor If: You have other questions or concerns Influenza Close Contact Within the Last 7 Days but Low-Risk child What You Should Know: Although your child was exposed to flu, your child does not have any symptoms. Symptoms usually develop within 1-4 days of seasonal flu contact. 7 days is an outer limit. Even if your child gets the flu, your child most likely will do fine. Anti-viral treatment (Tamiflu) is not needed for Low-Risk children. Healthy children get better from flu by treating the symptoms. Call Your Doctor If: You have other questions or concerns Influenza Minor Contact (same school) but No Close Contact What You Should Know: To catch influenza, your child needs to have close contact with an infected person. Close contact includes kissing, hugging, or sharing eating or drinking utensils. It also includes close conversations within 6 feet (2 meters) (CDC 2013). Being in the same child care group or car pool is also close contact. Being in the same school, church or building is not close contact. If there was no close contact, your child probably will not get the flu. Anti-viral medicine (Tamiflu) is not needed for Low-Risk children. Healthy children get better from flu by treating the symptoms. Call Your Doctor If: You have other questions or concerns And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Your child has been diagnosed with bronchiolitis It's an infection of the smallest airways in the lungs Caused by a virus called RSV Wheezing during the first 2 years of life is often caused by bronchiolitis You wonder if your child needs to be seen again Symptoms of Bronchiolitis Wheezing is the main symptom that helps with diagnosis. Wheezing is a high-pitched purring or whistling sound. You can hear it best when your child is breathing out. Rapid breathing at a rate of over 40 breaths per minute. Tight breathing (having to work hard to push air out). Coughing (may cough up very sticky mucus). Fever and a runny nose often start before the breathing problems. The average age for getting bronchiolitis is 6 months (range: birth to 2 years). Symptoms are like asthma. About 30% of children with bronchiolitis later do develop asthma. This is more likely if they have close family members with asthma. Also likely if they have bronchiolitis more than 2 times. Cause of Bronchiolitis A narrowing of the smallest airways in the lung (bronchioles) causes wheezing. This narrowing results from swelling caused by a virus. The respiratory syncytial virus (RSV) causes most bronchiolitis. RSV occurs in epidemics almost every winter. People do not develop life-long immunity to the RSV virus. This means they can be infected many times. Trouble Breathing: How to Tell Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about: Struggling for each breath or short of breath. Tight breathing so that your child can barely speak or cry. Ribs are pulling in with each breath (called retractions). Breathing has become noisy (such as wheezes). Breathing is much faster than normal. Lips or face turn a blue color. Diagnosis of Bronchiolitis A doctor can diagnose bronchiolitis by listening to the chest with a stethoscope. Prevention of Spread to Others Cover the nose and mouth with a tissue when coughing or sneezing. Wash hands often. After coughing or sneezing are important times. When To Call Call 911 Now Severe trouble breathing (struggling for each breath, can barely speak or cry) Passed out or stopped breathing Lips or face are bluish when not coughing You think your child has a life-threatening emergency Go to ER Now Your child looks like they did when hospitalized before with bronchiolitis Call Doctor or Seek Care Now Trouble breathing. Exception: if it happens only when coughing. Lips or face have turned bluish, but only during coughing Ribs are pulling in with each breath (retractions) New harsh sound with breathing in (called stridor) Wheezing (purring or whistling sound) is worse than when seen Breathing is much faster than when seen Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth, no tears. Not alert when awake ("out of it") High-risk child (such as chronic lung disease) and getting worse Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen. Age less than 6 months old and worse in any way Fever over 104° F (40° C) Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Doctor Within 24 Hours Nonstop coughing spells Trouble feeding worse than when seen Earache or ear drainage Fever lasts more than 3 days Fever returns after being gone more than 24 hours You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours Coughing causes vomiting 3 or more times Mild wheezing sounds lasts more than 7 days Cough lasts more than 3 weeks You have other questions or concerns Self Care at Home Bronchiolitis same or better than when last seen Care Advice What You Should Know About Bronchiolitis: Bronchiolitis is common during the first 2 years of life. Most children just have coughing and fast breathing. Some develop wheezing. This means the lower airway is getting tight. If you were given a follow-up appointment, be sure to keep it. Here is some care advice that should help. Asthma Medicines: Some children with bronchiolitis are helped by asthma-type medicines. Most children are not helped by these medicines. If one has been prescribed for your child, give it as instructed. Keep giving the medicine until your child's wheezing is gone for 24 hours. Coughing Fits or Spells: Breathe warm mist (such as with shower running in a closed bathroom). Give warm clear fluids to drink. Examples are apple juice and lemonade. Amount. If 3 - 12 months of age, give 1 ounce (30 mL) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed. Reason: Both relax the airway and loosen up any phlegm. Homemade Cough Medicine: Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using the these tips: Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old. Age 1 year and older: Use honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the mucus and loosen the cough. If you don't have any honey, you can use corn syrup. Nasal Saline To Open a Blocked Nose: Your baby can't nurse or drink from a bottle if the nose is blocked. Suction alone can't remove dry or sticky mucus. Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of bottled water or clean tap water. If under 1 year old, use bottled water or boiled tap water. Step 1: Put 3 drops in each nostril. (If age under 1 year old, use 1 drop). Step 2: Suction each nostril out while closing off the other nostril. Then, do the other side. Step 3: Repeat nose drops and suctioning until the discharge is clear. How often: Do nasal saline when your child can't breathe through the nose. Limit: No more than 4 times per day. Saline nose drops or spray can be bought in any drugstore. No prescription is needed. Other option: use a warm shower to loosen mucus. Breathe in the moist air, then suction. Humidifier: If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse. Smaller Feedings: Use small, frequent feedings whenever your child has the energy to drink. Reason: Children with wheezing don't have enough energy for long feedings. Offer enough fluids to prevent dehydration. Avoid Tobacco Smoke: Tobacco smoke makes coughs and wheezing much worse. Don't let anyone smoke around your child. What to Expect: Wheezing and rapid breathing most often improve over 2 or 3 days. Mild wheezing sounds can last up to 1 week. Coughing may last 3 weeks. Some children (2%) with bronchiolitis need to be in the hospital. These children need oxygen or fluids given through a vein. Return to Child Care: Your child can return to child care after the wheezing and fever are gone. Call Your Doctor If: Trouble breathing occurs Wheezing gets worse (becomes tight) Trouble feeding occurs Fever lasts more than 3 days You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Swallows a non-food solid object Adult suspects an object was swallowed Includes object found in the stool with no history of it being swallowed. Sometimes, a young child swallows an object when no one is around. Finding it in a stool is the first evidence that this has happened. Types of Objects Swallowed by Children Coins. The most common swallowed object. Usually safe except for quarters. Call your child's doctor to be sure. Coin diameters are 18 mm (dime), 19 mm (penny), 21 mm (nickel) and 24 mm (quarter). Source: U.S. Mint. Small blunt (non-sharp) objects. Toy parts, game parts, small buttons, rings, some earrings, paper clips, teeth. Usually safe if not sharp. Button batteries (serious). Needs urgent removal. See below for details. Magnets (serious). Needs urgent removal. See below for details. Sharp or pointed objects (serious). Include needles, pins, pushpins, tacks, nails, screws, toothpicks, some earrings. Pine needles, bones, bottle caps, aluminum pull tabs are also considered sharp. Most need urgent removal. Sharp objects can become stuck and lead to a puncture in the digestive tract. Small pieces of glass generally pass without any symptoms. Food Chunks. Large pieces of meat can get stuck on the way to the stomach. Mainly occurs in adults. Button Batteries Button batteries can cause low-voltage burns within 2 hours if stuck in the esophagus. The esophagus is the tube between the mouth and the stomach. A battery burn can lead to a puncture in this tube. Even "dead" batteries can be harmful if swallowed. All these children need an urgent x-ray to see where the battery is. If the battery is hung up or stuck, it needs urgent removal. Once it makes it to the stomach, it will usually safely pass. This may take a few days. These children need to be followed closely until the battery is passed. If you have it at home, honey may be helpful in preventing this kind of injury. Caution: just for children 1 year and older. Dose: 10 mL (2 teaspoons) every 10 minutes until you can get to the ER. Multiple Magnet Ingestion When multiple magnets are swallowed, problems can occur. Magnets at different spots can become attracted to each other across the bowel wall. The problems include a bowel puncture or blockage. All children who are suspected of swallowing magnets need an urgent X-ray. When to Worry Objects 1 inch (25 mm) or larger often cause problems. Quarters (24 mm) are included. These larger objects can get stuck in the esophagus. The esophagus is the tube between the mouth and the stomach. Symptoms of a blocked esophagus are trouble swallowing and throat or chest pain. Your child may gag, vomit, drool, or spit. Also, your child may not want to eat or drink anything. In addition to large objects, batteries, magnets and sharp objects can also cause problems. Children younger than 2 years are at increased risk of objects getting stuck. What Doctors Recommend for Smooth, Small Harmless Objects If your child has no symptoms, doctors don't always agree on the best approach. They recommend one of the options below: Option 1. Do nothing. No X-ray and no checking the stools. They assume the object is in stomach and will pass unless child develops symptoms. Examples are stomach pain or vomiting. Option 2. Check all stools for the object. If object hasn't passed in the stool by 3 days (72 hours), get an x-ray (author's preference and used in this care guide). Option 3. Get an x-ray on all patients. This can be done to be sure the object is in the stomach. For harmless objects, the x-ray can be delayed for 24 hours. Reason: Object is more likely to reach the stomach after a night's sleep. When To Call Call 911 Now Trouble breathing Stridor (harsh sound with breathing in) is heard now Wheezing (high-pitched purring or whistling sound when breathing out) is heard now You think your child has a life-threatening emergency Go to ER Now Symptoms of blocked esophagus. These include: can't swallow like normal, drooling, spitting, gagging, or vomiting. Your child may not want to eat or swallow fluid or food. Pain or feeling like object is stuck in throat, neck, chest or stomach Sharp or pointed object Button battery (saw or suspect child swallowed). Note: give honey if you have it. See First Aid. Magnet (saw or suspect child swallowed it) High-risk child (narrow esophagus) swallowed any coin or object Child coughed up the object but continues to have coughing or wheezing Your child can’t swallow water or bread Call Doctor or Seek Care Now Object is 1 or more inches (25 mm) across and no symptoms Age less than 2 years old Your child looks or acts very sick You think your child needs to be seen, and the problem is urgent Call Poison Center Now Poisonous object suspected Call Doctor Within 24 Hours All swallowed coins and no symptoms Swallowed object hasn't passed after 3 days You think your child needs to be seen, but the problem is not urgent Call Doctor During Office Hours You have other questions or concerns Self Care at Home Swallowed harmless, small object and no symptoms Object found in stool Care Advice Swallowed Harmless Small Object and No Symptoms What You Should Know About Swallowed Objects: Most small, smooth or blunt objects pass without problems into the stomach. Since your child has no symptoms, the object should be in the stomach. In general, anything that can get to the stomach will pass through the intestines. Just to be sure it isn't stuck, perform a swallow test. Swallow Test - Check Your Child's Ability to Swallow Food: Give some water to drink. If swallowed easily, give bread to eat. Reason: If bread becomes hung up, enzymes found in saliva (spit) can dissolve it. If child swallows bread and water well, a normal diet is safe. When to Check Stools for the Object: For small smooth objects, checking the stools is not needed. Small means less than ½ inch (12 mm). For larger objects or those that are not smooth, check the stools. Also, check the stools if you are concerned for any reason. You can collect stools by having your child wear a diaper. Another way to do this is to have your child poop on a piece of paper. Slice the poop with a knife. Do this until you find the object. What You Should Expect: Swallowed objects almost always make it to the stomach. Once there, they usually travel safely through the intestines. They are passed in a normal stool in 2 or 3 days. There is nothing you can do to hurry this process. Call Your Doctor If: Your child can't swallow water and bread Your child is gagging or doesn't want to eat or drink Stomach pain, vomiting or bloody stools occur Coughing occurs Object hasn't passed within 3 days Your child becomes worse Object Found in Stool What You Should Know About An Object Found in the Stool: Sometimes, a young child swallows an object when no one is around. Finding it in a stool is the first evidence that this has happened. Your child should be safe to watch at home. Check Your Floors and Carpets More Often: Pick up any objects you find on the floor that could be swallowed. Try to teach your child to only put food in the mouth. Call Your Doctor If: You have other questions or concerns And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Definition Breathing sound that is high-pitched and tight A purring or whistling sound You can hear it best when your child is breathing out Use this guide only if your child has not been diagnosed with asthma Causes of Wheezing Bronchiolitis. This is the main cause in the first 2 years of life. Bronchiolitis peaks at 6-12 months. This is a viral infection (usually RSV) of the small airways. These small airways are called bronchioles. Asthma. This is the main cause after age 2. The first attack of asthma can be hard to diagnose. Asthma is defined as attacks of wheezing that recur. Airway Foreign Object (Serious). Suspect this when there is a sudden onset of coughing, choking and wheezing. A clue is wheezing heard only on one side. Common examples of inhaled objects are peanuts and seeds. Peak age is 1 to 4 years. Nasal Sounds. When the nose is congested, it can produce some whistling sounds. This can happen during a cold or with nasal allergies. Unlike wheezing, the breathing is not tight. Also, nasal rinses with saline will make the sound go away. When To Call Call 911 Now Wheezing and life-threatening allergic reaction to similar substance in the past Start to wheeze suddenly after a bee sting, taking medicine, or eating an allergic food Severe trouble breathing (struggling for each breath, very tight wheezing, can barely cry) Passed out or stopped breathing Bluish lips or face Choked on a small object or food recently You think your child has a life-threatening emergency Call Doctor or Seek Care Now Wheezing, but none of the symptoms above. Reason: needs a doctor's exam. Care Advice What You Should Know About Wheezing: Wheezing is a high-pitched purring or whistling sound. Wheezing means the lower airway is tight. This is often part of a cold, but it can become worse. Here is some care advice that should help until you talk with your doctor. Coughing Fits or Spells: Breathe warm mist (such as with shower running in a closed bathroom). Give warm clear fluids to drink. Examples are apple juice and lemonade. Age under 3 months. Don't use. Age 3 - 12 months of age. Give 1 ounce (30 mL) each time. Limit to 4 times per day. Age over 1 year of age. Give as much as needed. Reason: Both relax the airway and loosen up any phlegm. Homemade Cough Medicine: Do not give any over-the-counter cough medicine to children with wheezing. Instead, treat the cough using the these tips: Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 mL). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old. Age 1 year and older: Use Honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup. Nasal Saline To Open a Blocked Nose: Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water. Step 1. Put 3 drops in each nostril. If under 1 year old, use 1 drop. Step 2. Blow (or suction) each nostril out while closing off the other nostril. Then, do the other side. Step 3. Repeat nose drops and blowing (or suctioning) until the discharge is clear. How Often. Do nasal saline when your child can't breathe through the nose. Limit. If under 1 year old, no more than 4 times per day or before every feeding. Saline nose drops or spray can be bought in any drugstore. No prescription is needed. Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops. Reason for nose drops: Suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open. Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril. For young children, can also use a wet cotton swab to remove sticky mucus. Humidifier: If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse. Smaller Feedings: Use small, frequent feedings whenever your child has the energy to drink. Reason: Children with wheezing don't have enough energy for long feedings. Avoid Tobacco Smoke: Tobacco smoke makes coughs and wheezing much worse. Return to School: Your child can return to child care after the wheezing and fever are gone. Call Your Doctor If: Trouble breathing gets worse Wheezing gets worse You think your child needs to be seen Your child becomes worse And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.