Knowing what to look for can help parents tell ordinary illness from problems needing hospital care
Your 7-year-old woke up with a fever of 102 degrees and a dry cough. She's eating and drinking, but she's been complaining about headaches and muscle pains for two days. Should you call your pediatrician or take her to a hospital emergency department?
Anxiety about the H1N1 influenza virus has prompted many Rogue Valley parents to seek medical attention for children rather than care for them at home. But hospital emergency physicians say nearly everyone who has flu symptoms — including children — will eventually recover just fine without medical attention.
"None of the kids I've been seeing are profoundly ill," says Dr. Victoria Harris, an emergency department physician at Rogue Valley Medical Center. "Parents just need that assurance (that their kids are going to be OK)."
Concerned parents have been bringing sick kids to hospitals in droves. RVMC has been seeing about 150 emergency patients a day this week, about 50 percent more than average.
"They were lined up 10 deep at 3 a.m.," said Terri Carson, an emergency nurse at RVMC. "Some were waiting three hours (to see a doctor)."
Harris has been seeing sick kids since the flu outbreak started. Of the hundreds she has treated, she says none has been ill enough to be admitted to the hospital.
It's a similar story at Providence Medford Medical Center, where the volume of emergency patients is up about 30 percent.
"The vast majority of patients (with flu symptoms) don't need to seek care unless they develop significant symptoms," says Dr. Cory Bergey, medical director of the emergency department at Providence.
Before seeking a doctor's care, Bergey says, parents should look for symptoms such as dehydration caused by diarrhea or vomiting, obviously labored breathing, or extreme fatigue, lethargy or decreased mental alertness.
"Just to (come to the hospital) to check to see if you have swine flu is not a reason," she says.
State rules prevent testing for the H1N1 virus unless someone has been admitted to the hospital. Emergency patients are not considered admissions.
Harris says parents need to know they can trust their own judgment when it comes to taking care of their kids. Fever alone isn't reason enough to see a doctor, she says.
"Fever happens all the time," she says. "Don't be afraid of the fever. Use Tylenol (acetaminophen) and Motrin (ibuprofen) together."
"Trust your instincts," Harris says. "Treat the fever aggressively."
The two different drugs work together to lower fever. Acetaminophen is metabolized by the liver; ibuprofen, by the kidneys.
Even a high fever isn't necessarily a reason for concern, Bergey says.
"I'd be much more concerned about a kid with a fever of 101 who is lethargic than one who has a fever of 105 sitting in bed and drinking Gatorade."
A full-blown case of influenza can last seven to 14 days, so parents can expect their children to feel ill for some time. Drugs such as Tamiflu don't cure the illness — they only shorten the duration of symptoms, and they must be administered within 48 hours of the onset of symptoms to be effective.
Bringing a child who has a moderate illness to the hospital could expose him or her to more serious illness, Harris says.
"If you bring your child to the ER, they're going to be around people who probably have H1N1, and your child is going to get H1N1," she says.
Bergey says the virus is highly contagious, which encourages its spread among children.
"Every child coming in sick had a sick kid at school the day before," Bergey says.
Harris says the severity of illness from H1N1 isn't much different from ordinary seasonal influenza, which usually arrives later in the fall and peaks in mid-winter, but more people, especially children, are getting sick in this outbreak.
Harris recalls she saw 30 patients during an all-night shift this week.
"Did they all need to be seen? No, but these are parents worried about their child. Who can blame them?
"The disease is fear," she says. "The sheer numbers we're seeing are a result of fear."
Reach reporter Bill Kettler at 776-4492 or e-mail firstname.lastname@example.org