School has been back in session, along with sniffles, sneezing and coughing. There are many viruses that cause upper respiratory illness (URI) in children and adults, and many of them are present in the environment year-round. When kids are spending hours close together in the classroom, respiratory viruses can spread easily. Children are most contagious several days prior to the symptoms starting. This is the main reason it seems that many kids cannot get well during the URI season.
The progression of a URI is generally predictable. A fever, fatigue, a runny nose and a sore throat are common early symptoms lasting one to two days. Watery eyes, hoarseness, vomiting and diarrhea are symptoms that may occur depending on the virus causing the illness. Coughing usually starts within two to three days of the initial symptoms and may last several weeks in the normal course of a viral URI.
The cough may be dry and hacking or may produce mucus that is generally swallowed by most kids. Nasal discharge may last a few days or the duration of the illness, and the color and consistency of the mucus may change. These changes are normal and do not indicate worsening illness.
An illness may start with a sore throat and fever. If there is no runny nose or cough, the child may have strep throat. In addition, strep throat tends to cause nausea, vomiting, a headache and belly discomfort — symptoms that are not seen with a URI. Some kids will get a fine, bumpy rash on the face, abdomen and groin area. The rash feels like fine sandpaper when you rub your hand over it.
Strep throat with this rash is known as scarlet fever. A pediatric primary care provider should see a child with this combination of symptoms within one to three days for an examination and diagnosis. Many providers use a rapid antigen test to diagnose strep throat, and the results are ready in 10 to 15 minutes. If the test is positive, treatment for strep throat is needed. If the rapid test is negative, a throat culture should be sent to the laboratory. It takes 24 to 48 hours to get the results. If the rapid test and throat culture are negative, no treatment is necessary. Antibiotics will not help a viral sore throat or URI.
When to See a Pediatric Primary Care Provider
Your child needs medical attention with the following symptoms:
* A fever that lasts longer than seven days or that goes away early in the URI, then returns.
* A fever over 105 degrees. Fever is never harmful to the body; however, when it’s over 105 degrees, there is very small increased chance that there is a bacterial infection.
* Nasal congestion that lasts longer than ten days, causes headache or face pain and/or is associated with fever late in the URI when this symptom should be better or gone.
* Nasal congestion associated with fever and forehead swelling.
* Throat pain associated with a virus that lasts longer than five days.
* Sore throat caused by a virus or bacteria that is not getting better or is getting worse.
* Throat pain that is so severe that a child cannot swallow anything, including his own spit.
* Severe one-sided throat pain or one tonsil that is much more swollen than the other.
* Breathing seems labored. Breathing faster, sucking in the skin around the ribs or above the breastbone.
* Nonstop coughing, coughing that keeps the child awake at night, a cough that is still painful after two to three days.
* Wheezing (whistling noise made when he breathes out or in) that does not go away with coughing.
* Your child seems more anxious or tired than seems normal with an illness.
* He seems more sick than he should, given the symptoms he is experiencing.
Most school-age children will experience three or four colds this school year. The best way to stay well is for everyone to do good hand washing, use alcohol based sanitizers and keep surfaces clean at school and at home.
Ann Petersen-Smith, PhD, APRN, CPNP-PC, CPNP-AC, is an Assistant Professor at the University of Colorado Anschutz Medical Campus College of Nursing.