Kids learn more than reading and writing in Shelly Gudmunsen’s third-grade classroom — they learn the importance of proper hygiene, too. It’s an effort to stave off at least some of the thousands of germs circulating in schools, grocery stores, day cares, playgrounds and everywhere this time of year.

If you have kids, you know November-March is a fifth season Up North: Sick season.

“We’ve had lots of sniffles since the first day of school,” said Gudmunsen, a teacher at Petoskey’s Central Elementary School. “… The bottom line is that kids, by virtue of being kids, will spread germs and get sick.”

In her classroom, children are encouraged to donate boxes of tissues because so many are used; Gudmunsen also teaches students proper handwashing skills and all are asked to use soap and water after using the restroom. A hand-sanitizer dispenser is available, too.

Some of Gudmunsen’s classroom requirements would be good ones for kids and parents to follow back at home, including table-washing daily with nontoxic Shaklee Basic H and cotton towels.
During the school year, sniffles and sneezes aren’t cause for too much alarm among those in the trenches every day.

“As long as a child doesn’t have a fever and hasn’t vomited in the last 24 hours, I expect them to be at school. Sniffles and coughing are a part of life here in third-grade throughout the winter,” Gudmunsen said. “We all go through it — even the teacher.”  

Parent primer: Cold or flu?

The word cold is not a medical term, according to Dr. Roderic E. Tinney, MD, a Charlevoix pediatrician with Pine River Medical Associates.

“We speak of an upper respiratory illness or URI. URIs, or colds, are caused by a number of different viruses, the most common probably is the rhinovirus,” said Tinney.

In medicine, the term flu means infection with influenza virus and “when we talk about ‘flu-like illness,’ we are generally referring to a URI (cold) associated with fever body aches and cough. Some people when they say ‘the flu’ are talking about gastroenteritis — vomiting and diarrhea — but while people may have some stomach upset with influenza it is a respiratory virus and not generally considered a cause of gastroenteritis,” Tinney said.

With those differences noted, the doctor said the most common identifiable cause of gastroenteritis in children is rotavirus, for which there is now a vaccination. “Current guidelines are to vaccinate all children over 6 months of age with flu vaccine,” Tinney said. “It is also important for family members of young infants to be vaccinated, especially if the infant is less than 6 months old.”
 

What’s contagious, what’s not

Figuring out when a child is contagious is tough. Many children are the most contagious in the very early stages of illness even before they appear to be sick.

“Therefore, keeping them home when they appear ill may be somewhat like closing the barn door after the horse gets out,” Tinney said. “If a child has a fever it is probably best they stay home, mostly because they are too miserable to have fun or learn anything if they are sick with fever.

“As a general guide I would suggest deciding when to keep a child home is intuitive, and just depends on a parent’s judgment.”

If a child has a runny nose and slight cough, but is not feverish and is running about and playful, he or she is likely fine to go to school or day care.

“It should be pointed out the greatest risk for contagious illness is for the young child, under age 2, in day care, especially those who are not breastfed. This is not only related to immunity and young age, but also because young children are not only in diapers but often share other body fluids through close play contact and less-than-adequate hand washing,” Tinney said.  

Have you heard ear infections aren’t contagious?

That is sort-of true.

“We generally think of ear infections as a complication of an upper respiratory infection,” said Tinney. “The URI is contagious, but we would not consider the ear infection to be contagious.

“Ear infections usually are a complication of a cold. I am always suspect when a child presents to an ER with fever and no cold symptoms and an ear infection is diagnosed that the diagnosis is incorrect.”

Ear infections, also known as otitis media, are very common. Because they are usually associated with a cold, any situation where a child is getting more colds will potentially make ear infections more common.

This includes the season of the year; fall and winter, day care exposure and being a young child in a large family are factors. Ear infections are common under 3 years of age and at least 80 percent of children will have at least one.

“Some families seem genetically more prone to ear infections,” Tinney noted. “Environmental irritants such as second-hand smoke increase the likelihood of ear infections — another reason never to expose children to second-hand smoke”

Ear tube surgery is probably the most commonly performed surgery on children. The inserted tube serves as an artificial Eustachian tube and is supposed to equalize pressure in the middle ear to avoid the development of fluid and allow drainage of any fluid that might develop.

“There are no hard and fast guidelines for surgery, but tubes are often considered for a child who has persistent fluid after 3 months or recurrent acute infections, especially if they get quite sick with them,” the doctor said. “We always try and eliminate things such as second-hand smoke before recommending surgery.”

Tubes stay in for varied lengths of time, months to occasionally years, and they usually will come out on their own.

For most ear infections, Tinney said it is acceptable to treat an older child’s ear pain with Tylenol or Motrin, as many ear infections probably resolve on their own.  

Fever pitch

Fevers are common and one of the most typical reasons parents will seek medical care. The majority of fevers in children are because of minor illnesses such as URI or gastroenteritis, Tinney said.
These illnesses are generally self-limited so the majority of fevers run their course without antibiotic treatment.

“Fevers from infection do not harm children,” Tinney said. “A fever is part of the body’s way of fighting the infection. There is no urgency to lower a fever. The reason we may offer fever reducers, such as acetaminophen or ibuprofen, is to make children more comfortable.”

Some children are prone to have a seizure with a fever; these tend to run in families and while seizures from infection are very frightening to witness they are rarely ever dangerous and most of the time stops on their own within minutes.

If a child has a fever, especially if they seem otherwise well and have symptoms of a likely viral illness, such as a runny nose, they generally can be observed at home.

Often the most useful test with fever is taking some time to see if it resolves, or whether a treatable illness is apparent, Tinney noted.

“There are some cases, however, when medical care should be sought,” the doctor said. “Young infants, especially those under 2 months, should be evaluated for fever as they could have more serious infection and are often more difficult to evaluate. A child of any age with fever of any degree who seems very ill should be promptly seen.”

Parents of young girls should also be aware of important information: Tinney said girls under 2 years old with fever and no symptoms to suggest a viral illness (runny nose for example) and especially if the fever persists for more than two to three days should be seen to evaluate for a urinary tract or “kidney infection.” Left untreated, the infection could be potentially damaging to the kidney.

“Studies have shown that maternal instinct can be very useful and if a parent — especially a mother — feels something is seriously wrong it is always best to get the child examined,” Tinney said.

Can young children take OTC meds?

The guidelines for the use of cough and cold medications in young children have been steadily becoming more strict in recent years. “It is true, we should avoid cold medicines in the young child,” said Tinney. “Treatment of a cold is symptom-based. Keep your child well-hydrated and appropriately dressed so as to not add further stress to the body. Honey for children over the age of 1 has actually been shown scientifically to help with coughs, that and lots of cold drinks, or if older, hot drinks such as tea or hot lemonade.”

Aches and pains and fever may be treated with acetaminophen or ibuprofens; however, Tinney cautioned caregivers to not use aspirin to treat a febrile illness in children because of a reported increase in a rare condition called Reye’s syndrome.

For the older child who is coughing a lot at night, he often suggests a dose of Benadryl, which suppresses the cough, dries the nose and can offer some relief to help sleep.

“I will occasionally prescribe a cough suppressant to the older child, but again just for bedtime use and not for infants and young children,” Tinney said. “None of these things make the cold go away, but just try and make us feel better.”

The basics can come in handy for keeping illness at bay in the first place, he added.

“Teach your children and model coughing into your arm when sick,” he said. “If you have young infants, avoid crowded situations during the respiratory virus season. Breast feed infants and avoid large day cares if possible.”

Anatomy of an ear infection

An ear infection, sometimes called otitis media, means that the middle ear is infected. The middle ear is the eardrum and the small space behind the eardrum.

The small space behind the eardrum in the middle ear is normally filled with air. It is connected to the back of the throat by a tiny channel called the Eustachian tube.

The middle ear space sometimes becomes filled with mucus (fluid), often during a cold. The mucus may then become infected by bacteria or viruses.

Symptoms include:
Earache is common, but does not always occur.
Dulled hearing may develop for a few days.
Fever (high temperature) is common.
Children may feel sick or vomit, and can be generally unwell.
Young babies cannot point to their pain. One of the causes of a hot, irritable, crying baby is an ear infection.

Sometimes the eardrum perforates (bursts). This lets out infected mucus and the ear becomes runny for a few days. As the pain of earache is because of a tense eardrum, a burst eardrum often relieves the pain. A perforated eardrum usually heals within a few weeks after the infection clears.

Most bouts of ear infection will clear on their own without treatment within 2-3 days. The immune system can usually clear bacteria or viruses that cause ear infections.

A few drops of a local anaesthetic drug placed into the ear may help to ease pain. Antibiotics are not advised in most cases, because in most cases the infection clears within 2-3 days on its own.
Source: University of Michigan