What to Try & When to Call

by Pediatric Associates of Richmond

What a fall this has been so far. Influenza seems to have enveloped the Richmond metro area right now. Simultaneously, RSV and many other respiratory illnesses have increased in number. We have seen a proportional increase in the number of calls with questions and concerns, and the demand for sick visit appointments has once again exceeded availability. As we continue to adapt and rework schedules to create more sick visit appointments for your children, we want to make sure we are giving you as many practical tips and resources as possible to use in the meantime.

Within our Medical Resource Library are a host of topics including specific infections or viral syndromes such as influenza, croup, and RSV, as well as more general symptoms such as fever, cough and cold symptoms, sore throat, and ear pain. We invite you to use and reuse these pages as a reference, and share with your friends and family. If you haven’t explored/read them before, please do. They cover most of the anticipatory guidance we give parents at sick visits for these complaints or illnesses. There are also helpful tips for managing symptoms and advice regarding when to call.

Below is a summary of What to Try and When to Call with respect to Fever, Cough and Sore Throat – the most common complaints for which children are being seen in our offices right now.

Fever (100.4 degrees F or higher, regardless of age)

What to Try

  • Hydration, hydration, hydration
  • Acetaminophen (Tylenol) dosing chart can be found here
    • is safe for children down to 2 months old
    • can be given as often as every 4 hours, but not more than 5 doses per 24 hours
  • Ibuprofen (Motrin/Advil) dosing chart can be found here
    • is approved for children down to 6 months old
    • can be given every 6 hours as needed, preferably after food, breastmilk or formula
    • can cause upset stomach/vomiting, so should be avoided if your child is not eating and/or has been vomiting
  • Some people will alternate acetaminophen and ibuprofen doses every 3 hours. This is often unnecessary, but if you do so, keep a written log or note on your phone as to what you give and when so you know what to give next
  • Lukewarm baths and cool washcloths on forehead or neck are ok, but we don’t recommend cold baths or ice packs
  • Never give aspirin to a child for fever due to the risk of Reye syndrome, unless aspirin is specifically prescribed by a medical provider

When to Call

  • Fever rule of 5’s: if the temperature reaches 105 or your child has a temp of 100.4 degrees F for 5 consecutive days
  • If your child is 2 months old or younger and has a rectal temperature of 100.4 or higher
  • If your child has been on antibiotics for 48 hours or more and still has fever
  • If your child’s fever goes away for > 24 hours then returns
  • If none of the above fever-reducing tools are effective and you’re worried about how your child is looking, acting, breathing or hydrated

Cough

What to Try

  • Honey – clinically proven to outperform cough and cold syrups in head-to-head medical studies
  • Due to risk of botulism, never give honey to a child under 1 year old
  • Honey may be given every 1-2 hours as needed for cough
    • 0.5 teaspoon for 1-5 year olds
    • 1 teaspoon for 5-12 year olds
    • 2 teaspoons for 12 and up
  • Nasal saline (either drops or spray) to help flush nasal mucous, then suction infants/toddler or have older children blow their noses. Less post-nasal drip, less cough
  • Steamy bathroom
  • For barking cough, have your child breathe in cold air from the freezer, or outside if cold enough to need a coat
  • Antihistamines such as Claritin, Zyrtec, Allegra and Xyzal may help if the cough is due to seasonl allergies, but are unlikely to do much if symptoms are due to a virus. Same with Benadryl and allergy nose sprays. That said, any can be tried if age-appropriate

When to Call

  • If the cough looks or sounds like it’s associated with breathing difficulty
    • Look for fast breathing, nostril flaring with every breath, or retractions (belly sucking under rib cage, neck muscles/skin sucking under collar bones/breastbone, or muscles/skin sucking in between each rib)
    • Listen for wheezing (typically squeaky, breathing-out sound) or stridor (gasping, breathing-in sound sometimes associated with barky cough)
  • If the cough is associated with fever
  • If the cough is not relieved by the above remedies
  • If the cough seems to be associated with a cold but doesn’t resolve in 2 weeks
  • If the cough seems to be associated with allergies but doesn’t improve with antihistamines and allergy nose spray

Sore Throat

What to Try

  • Acetaminophen or ibuprofen
    • Ibuprofen will be a better pain reliever and act longer for most people, but should not be given on an empty stomach or if the patient has been vomiting or is struggling to stay hydrated
  • Honey
  • Warm tea
  • Throat lozenges for children 5 years and older (not for younger ages due to choking risk)
  • Popsicles
  • Ice Cream
  • Gargling warm salt water
  • Steamy bathroom
  • Antihistamines and/or nasal steroid sprays if associated with seasonal allergies

When to Call

  • Sore throat with fever
  • Poor hydration due to pain/difficulty swallowing
    • Dryness to inside of mouth
    • Less than 4 wet diapers/24 hrs for children less than 1 year old, or fewer than 3 voids/24 hrs for children over 1 year.
  • Refusal to swallow
  • Inability to swallow
  • Pain worsening despite trial of the aforementioned recommendations
  • Sore throat for 2 weeks or more