Sniffles, sneezes and sore throats: When to come to the doctor

It’s back to school time in Cordova, which means that soon kids will be sharing more than their lunches with their friends.

It’s common in the fall to see a spike in runny noses and cough, even before flu season begins.  So when should you bring your kids (or yourself) to the doctor and when should you wait it out?  Here are a few basic guidelines.

Most upper respiratory infections are viral in origin and do not require antibiotics to resolve.  If you and your child are otherwise healthy, and have no secondary conditions like asthma or a history of pneumonia, it is okay to wait for 7-10 days before coming to the doctor.  Most colds and even rhinosinusitis will resolve on their own during that time.

Frequently you can run a temperature with a virus, and a fever in itself with classic runny nose and cough does not necessarily mean you need to come to the doctor.  Also, the color of your nasal drainage during the first seven days is not a good predictor of a bacterial infection.

In other words, you can have green or yellow (or even blood streaked) nasal drainage during that first week, which is part of your body’s response to the viral infection, and you still do not need antibiotics. If you are a smoker, it does make it more likely for both you and your children to develop a secondary bacterial infection, even if you don’t smoke in the house.  So that is another caveat where you may want to come to the doctor sooner rather than later.  Or even better, come in before you get sick and make a plan to stop smoking, as tobacco is the number one preventable lifestyle choice that causes early death and disability in our country.

But when SHOULD you  come to the doctor for an upper respiratory infection if you are otherwise healthy?

  1. A fever in your child over 101.5 that lasts longer than 3 days.
  2. Severe ear pain in your child with fever (indicating an ear infection).
  3. Upper respiratory symptoms or sinus symptoms that were getting better and then suddenly get worse after 7 days. This is one of the best predictors (along with other physical findings on exam) of a true sinus infection.
  4. Cough and malaise that persist after 10-14 days.
  5. Wheezing or increased shortness of breath at any time during the illness.
  6. Purulent nasal drainage persisting after 10 days

Another time to come to the doctor sooner rather than later is if your child has a sore throat without classic respiratory symptoms such as snotty nose and cough.  This could be strep throat and should be treated within the first 3 days of symptoms.

Symptoms of strep throat can be similar to a common cold, but do not have the copious colored nasal drainage, but can have a thin, clear drip.  Strep throat almost always has large anterior lymph nodes (which unfortunately can also be enlarged with a cold) and frequently has fever, headache, nausea and either beefy red tonsils or pus on the tonsils.   Your doctor can determine strep very quickly with a rapid strep test and/or a culture sent off to the lab.

The last reason to come to the doctor within the first two days of your illness is if you have severe, rapid onset of flu-like symptoms that might indicate the true flu.   There are over 200 different viruses that can cause a common cold, but only a few strains of virus that cause influenza.  You can actually see when the flu hits our state by looking at the CDC web site and clicking on the state of Alaska.  (https://www.cdc.gov/flu/weekly/usmap.htm).

If you have not gotten the flu shot and develop rapid onset of fever over 102, severe body aches, headache with pronounced congestion and cough you can actually get treated with an antiviral medication that will shorten the course and severity of the illness.  But you must come in during the first 48 hours of the onset of symptoms.  Family members can also be treated prophylactically over 3 months of age.  Babies over 2 weeks of age also can be treated, as they are at highest risk before 2 years old of having complications from the flu.

However, as with so many things relating to your health, an ounce of prevention is worth a pound of cure.  It is recommended that everyone age six months and older receive a flu shot in October or November.  This is particularly important for children younger than 5, anyone with chronic medical conditions, and or pregnant.  The CDC also sites that if you are Native American or Alaskan, you have a higher risk of complications and hospitalization for the flu independent of other risk factors.  The flu shot is safe, effective, and will protect not only you, but those at higher risk from complications in your circle of family and friends.  The flu vaccine will be available in town within the next month and I encourage everyone schedule yours as soon as possible.  Happy fall and we hope to see you soon.

 

Dr. Kristel Rush is the medical director at  Ilanka Community Health Center in Cordova. Rush is a family medicine doctor who is a Tennesseean by birth, but Alaskan by heart. She first came to Alaska in 1996, and has been captivated ever since. She trained in rural medicine at Quillen College of Medicine in Tennessee and community medicine at Wake Forest, in Winston-Salem, NC.

 

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Dr. Kristel Rush is the medical director at Ilanka Community Health Center in Cordova. Rush is a family medicine doctor who is a Tennesseean by birth, but Alaskan by heart. She first came to Alaska in 1996, and has been captivated ever since. She trained in rural medicine at Quillen College of Medicine in Tennessee and community medicine at Wake Forest, in Winston-Salem, NC.