ABQJOURNAL HEALTH: Child's illness not necessarily the flu

Monday, October 26, 2009

Child's illness not necessarily the flu

By Lance Chilton
For the Journal
          Q: My daughter has a fever. I know that influenza (the "swine flu") is running rampant in the community. I suppose my child has that, but what else could it be?
        A: You're certainly right about the pandemic H1N1 influenza overwhelming New Mexico at the moment! The media, including the Journal, have done a good job emphasizing how common the disease is and how it's straining doctors' offices and emergency rooms at the same time that it's draining classrooms of their students. Children have been the hardest hit. Several days ago, one of the television stations and the state health department held a call-in question-and-answer session on influenza. We answered hundreds of questions; we couldn't put the phone down between calls.
        Many of our questioners wanted to be sure that what their children had was really "just the flu." We couldn't make definite diagnoses over the phone, but we could make educated guesses, just as parents all over the country are making guesses to help them decide if they need a doctor visit or emergency room stop. Most would rather avoid a visit if they could.
        So what else could it be, and what signs should you use to help you know that something else might be causing your child's fever? Even in the midst of the largest outbreak of an infectious disease in my professional lifetime, other diseases may occur, and we must be ready to spot them. Here are a few relatively common alternative diagnoses, and what to look for.
        Colds in young children often start with a day or two of fever, usually not very high. Cough and runny nose are usually present, and achy arms and legs and heads and tummies are not common. As with influenza, treatment is rarely necessary.
        Ear infections are probably the most common reason for prescribing antibiotics for children, though antibiotics aren't always necessary and we're realizing more and more that ear infections aren't an emergency. Almost always, ear infections are accompanied by pain and irritability; it's as if the pus and bacteria hemmed up in the middle ear were crying to get out. An ear infection might be the cause of your child's fever if she seems to have localized pain; ear infection is not an uncommon fellow traveler of influenza.
        Pneumonia may also be associated with influenza, or it may be seen by itself. Often, cough and difficulty breathing will be present; difficulty breathing can be recognized by an increased breathing rate and retractions. These are movements of the chest wall with each breath, above, between or below the ribs. Chest pain can be seen with both influenza and with pneumonia.
        Blood-borne infection (septicemia) is an uncommon but serious infection, usually seen in young infants, before they develop all of their body defense systems. Because infants are especially prone to septicemia and some other serious bacterial infections, we worry more about infants in their first two to three months. If your child has a fever (a temperature greater than 100.4) and is less than 3 months old, a visit to a doctor should be made. It might be "just the flu," but then again it might not.
        Urinary tract infections, like septicemia, are more common in very young children, in whom it is hardest to be sure without examining the urine. Older children will usually tell their parents that "it hurts when I pee," but infants can't do that, and it is difficult to correlate cries of pain with the appearance of a wet diaper.
        Meningitis, an infection of the covering of the brain and spinal cord, is rare now, far less common than it was 20 years ago thanks to vaccines. Meningitis is a serious infection, though, when it does occur, with significant risk for death and disability afterward. If your child with a fever also has a stiff neck or is hard to arouse, she needs to be examined.
        There are lots of other possibilities — again not everything that we see during a flu epidemic is the flu. As a physician and as a writer of a health care column, I must tread the narrow line between scaring my patients/readers and making them think that influenza is innocuous and other diseases unlikely. You as parents have an even harder job — without an otoscope and stethoscope and with an abundance of concern for your child, you must decide how worried to be. Despite the long lines on our clinic's phone and in the emergency rooms, erring on the side of caution is wise.
        Lance Chilton, M.D., is a pediatrician at the Young Children's Health Center in Albuquerque, associated with the University of New Mexico. He is happy to take questions at 272-9242 or lancekathy@yahoo.com.

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