Back to school “flues”
This time of year brings mixed emotions for most. The excitement of a new year. The relief with the return of a routine. The uncertainty of new teachers and classmates. The dread of the revolving door of cold symptoms and viruses.
A friend recently reached out about her daughter running a fever and not feeling well. They were concerned because she was snoring loudly (not her normal but common when kids are sick) and sounded congested, but otherwise was not complaining of a sore throat or stomach pain. Her appetite wasn’t great, but she was staying hydrated.
Although her rapid strep test was normal, their pediatrician started antibiotics while a formal throat culture was pending. Flu and Covid-19 tests were negative. This was just toward the end of the second week of school and I had already run into several neighbors who mentioned the same pattern in their kids or kids’ classmates. It is most likely that this is a viral illness, which is what I told my friend on the phone that day. We discussed making sure her daughter stayed hydrated and looking out for worsening or new symptoms.
My friends question was this: “Should we continue the antibiotic or stop it?”
Tricky. You see, I would never have started the antibiotic. Once the antibiotic is on board though, you have to consider the possibility of its presence leading to selection of bacteria resistant to that antibiotic (that maybe weren’t the problem to begin with). These resistant bacteria can cause trouble the next time around and impact how you respond to antibiotics when they are really needed.
I bring this up as an example of something I see all too often. The idea that "start an antibiotic, just in case” is good medicine is false. Antibiotics should be reserved for proven bacterial illnesses, not treated like an extra snack for the school bus. Each antibiotic course can significantly alter the gut microbiome (the collection of microbes that live in your gut and help us digest food, impact how our immune system functions, and helps keep dangerous bacteria in check) and it can takes months to recover.
I encourage parents to question each time their child is being prescribed an antibiotic, especially if symptoms could be viral. Ask your provider why they are prescribing it, what are the risks of taking it and what are the risks of not taking it. In some cases, providers will prescribe the antibiotic with instructions to only take it if certain conditions are met (such as fever not improving with tylenol or a swollen area becoming more red or painful despite anti-inflammatory treatments).
Holistic ways to treat a fever and help your little one through an illness:
First, if the fever is low (<101.4F) and your child is not complaining of discomfort, it is ok to monitor.
Offer water or ice chips often. Ensuring they are hydrating is critical, since the fever is causing water loss on its own and can increase the risk of dehydration.
Encourage rest. Think of it like preparing for a fight-you want your immune system well rested.
Apply a cool compress to the forehead.
Fill a bathtub a few inches with lukewarm (not hot, not cold) water and sponge the water over their shoulders, allowing their skin to air dry. Evaporation will cool their skin, allowing the core body temperature to cool further. Do this for 15-20 minutes. Stop if the child starts to shiver.
If shivering, cover with light blankets. Shivering often comes before a fever and is the body’s way of generating heat to match the “new thermostat” needed to fight the infection.
Have them wear socks to bed, it helps to shunt blood to the feet and allows cooling of the core body temperature.
So what did I tell my friend?
It is ultimately a decision for each parent to make on their own, weighing the risk of taking a possibly unnecessary antibiotic against the risk of not taking it. Each child is unique, with a unique medical history, and that knowledge is necessary to make that decision.
