written by Dr Kate Miller
Viruses and other illnesses are running rampant this fall. Things are even harder because there seems to be a shortage of almost all the things you might use to treat your child at home. Here are some tips for getting through the winter and fall
Prevention is worth a pound of cure
The best way to avoid needing medications is to do your best to avoid getting sick in the first place. All the things we've been doing for years to prevent covid, prevents all the other things too.
Wear masks (and have your child wear a mask) when in high risk situations.
Wash hands often and well or use sanitizer
Cough into your elbow instead of your hands
Stay home or keep your child home when they are sick - especially in the first couple of days when things are most infectious.
Everyone should get a flu shot and keep their covid shots up-to-date
Taking a temperature and managing a fever
The Canadian Pediatric Society has good outline on taking a temperature and what to do including all the different types of thermometers
This great video from the NHS goes over managing fever in a child
Medications to treat a fever & viral illnesses
Most viruses should be managed at home with simple supportive things. Very few of them need any prescription medications.
Fever - do simple things like not overwrapping your child but avoid cold cloths and baths (they don't help but often make the child feel worse). Treat the crummy feeling that comes with the fever rather than the number. I know a high fever seems scary but the height of the temperature isn't a good marker of how sick your child is - looking at them will tell you more than the thermometer does. Fevers may help the immune system work better so if your child feels fine, there is no need to treat it. Acetaminophen (Tylenol) and Ibuprofen (Advil, Motrin) are your best choices to treat a fever if you need medications
Red eyes and discharge - this is almost always viral, esp if your child also has cold symptoms. Despite what the daycare and the internet tells you "pink eye" does not generally need treatment - 90% of the time it will go away on its own. Over the counter antibiotic drops like Polysporin are not needed. Use warm compresses and artificial tears to reduce the discomfort.
Stuffy and runny nose - Sadly most decongestant medications don't work well in kids but can have risks. That's why they are never available for children under 6. Try things like saline rinsing sprays, a humidifier or the "snot sucker". For older children, you can consider trying OTC medications but don't be surprised if they don't help much.
Earache - most ear infections are also viral so antibiotics don't help them. The good news is they will go away on their own in 2-3 days. About 30% of ear infection are caused by bacteria and will need antibiotics. Have your child assessed if their earache lasts more than 48-27 hours, if there is discharge from the ear or if your child has had more than 2-3 ear infections in the last year.
Covid - lots of the viral infections we are seeing are caused by covid. Managing covid in your child is very much the same as if the same symptoms are caused by a cold or other virus. Confused about covid is a great source of information for all things covid including what to do for your child.
How much can I give? What about the shortage?
These handy charts outline how much acetaminophen and how much ibuprofen to give a child - including using adult forms. Almost all acetaminophen and ibuprofen tablets can be crushed and added to something like jam, applesauce or yogurt. Look for forms without special coatings.
If your child is too small for a full acetaminophen or ibuprofen tablet, you may be able to cut them in half. This requires doing some math to make sure you are getting the right dose. Be very careful with your calculations - it is easy to overdose a child. Do not try to cut tablets into smaller amounts - it is too hard to do this accurately. It is always better to use a child specific formulation if it is available. If you are not sure how much to give your child - ask your pharmacist to help make sure you're doing it right.
The recommended dose of ibuprofen (Advil/Motrin) is 10 mg/kg. That means a 10 kg (22lb) child would need 100 mg. An adult regular strength ibuprofen is 200 mg which means a 22lb child could have 1/2 an adult regular strength tablet. A child who is at least 44 lbs can have a full regular strength tablet.
The recommended dose of acetaminophen (Tylenol) is 10-15 mg/kg. That means a 15 kg (33lb) child would need 130-225 mg. An adult regular strength acetaminophen is 325 mg. Half of that tablet is 162.5mg which is right in that range. So a 33 lb child could have 1/2 of an adult regular, and a 66 lb child could have a full regular strength tablet.
Does all that calculating confuse you? Not sure if it is safe to cut the adult pills you have? Talk to your nurse practitioner, doctor or pharmacist for advice. Pharmacists are great at this! Just make sure you have a fairly recent and fairly accurate weight for your child.
When should my child see a doctor?
Most of the time you can manage this at home and your doctor or nurse practitioner won't be able to do anything more to help. You should have your child assessed if:
Any child with a fever under 6 weeks of age
If your child has a fever lasting 72 hours or more
If your child has an earache lasting more than 48-72 hours
If your child is struggling to breath or is really out of breath
If your child is not eating or drinking. It's very normal to eat and drink less. Liquids are more important than food
If you're not sure what to do, check out health Connect Ontario which has a symptom checker, live chat with a nurse or you can call 811 to be connected with a nurse 24 hours a day.
