We are in the early stages of a worsening combination of an increase in viral infections and lack of resources with which to treat them. There have been huge increases in viral infections from respiratory viruses causing the common cold, respiratory syncytial virus (RSV), influenza and the seemingly always present COVID.
Simultaneously, most of the inpatient hospital beds available for sick children are already full; urgent cares and emergency departments are experiencing very long wait times; there is a shortage of pediatric care providers; and there is a shortage of amoxicillin, a commonly used antibiotic, as well. So, now what?
Now, more than ever, we must utilize available resources as wisely as possible and recognize that viral infections and antibiotics are not a good mix.
Colds, RSV, flu and COVID are all viral infections, have many overlapping symptoms, and are not treated by antibiotics. The common cold is caused by a variety of respiratory viruses that present with similar symptoms. A cold, or upper respiratory tract infection, can be associated with a fever (temp over 100.4), runny nose, congestion, cough, sneezing, fussiness or irritability, and decreased appetite.
RSV causes both an upper and lower respiratory tract infection (called bronchiolitis) and may present differently in kids of different ages. It is associated with the symptoms of a cold as well as rapid breathing, labored breathing (nasal flaring, belly breathing, sucking in of the muscles in between the ribs or above the sternum, grunting and/or head bobbing with breathing), and wheezing.
The flu, caused by the influenza virus, is associated with the symptoms of a cold but with a higher fever that lasts longer, headache, red and/or glassy eyes, sore throat, nausea, diarrhea, and body aches.
And, finally, COVID, can be associated with no symptoms to all the aforementioned symptoms.
Some children with certain medical conditions may be eligible for specialized treatments or antiviral medications for RSV, the flu or COVID, but overwhelmingly, treatment for these viruses is typically supportive care only.
Rest, pushing extra fluids, nasal saline rinses, use of a humidifier and steam, acetaminophen or ibuprofen for comfort, and honey or agave syrup to help settle a cough are all safe and helpful ways to treat symptoms. Honey should not be given to children younger than 12 months of age, and ibuprofen should not be given to babies younger than 6 months of age.
Additionally, fever may help your child fight the infection more effectively so there is no need to treat a fever unless it is causing discomfort, or your child has a history of having seizures associated with his or her fevers.
Most over-the-counter cold medications are not safe or effective for children younger than 4 years old and are not generally effective treatments for kids younger than 6. Making sure your child is up to date on all recommended immunizations, use of regular hand washing, and trying to avoid contact with sick people are important ways to try to avoid getting sick.
Sometimes a child who has been sick with a viral infection ends up needing an antibiotic because he or she may get a secondary bacterial infection, such as an ear or sinus infection. Treating these secondary infections with antibiotics is very reasonable.
Unfortunately, many children are prescribed antibiotics unnecessarily when the provider is uncomfortable not providing any treatment outside of recommendations for supportive care or “just in case,” or when a family demands a prescription.
Over-prescribing antibiotics leads to multidrug-resistant bacteria, can be associated with negative side effects, and leads to drug shortages causing needed medications to be unavailable. Currently, the U.S. is experiencing a shortage of amoxicillin, an antibiotic commonly used to treat ear and sinus infections, and strep throat.
If your child is being prescribed an antibiotic, make sure you understand what specific infection is being treated and if it is necessary. Being prescribed an antibiotic because a child’s ear drum is red may not be appropriate as crying and fever can cause redness and not necessarily signify a bacterial infection. It is also sometimes reasonable to be given a prescription for an antibiotic but wait to fill it after a period of watchful waiting. This means waiting 24-48 hours to see if the child’s symptoms are improving without the need for an antibiotic.
Be prepared to help your child avoid unnecessary consequences of this viral season and don’t hesitate to contact your child’s pediatrician with any questions or concerns.
Melissa Mason is a general pediatrician with Journey Pediatrics in Albuquerque. Send your questions to firstname.lastname@example.org.