Disclaimer: The information in this blog is not medical advice, but rather just general information. Your use of this blog does not establish a doctor-patient relationship. Also, if you buy products through links on this page, I may get a teeny tiny commission at no additional cost to you.

This fall, there has been a huge surge of sick kids. Pediatrician offices, urgent cares, and emergency rooms are full. There are no regular and intensive care unit beds in some hospitals. How does a momma know their kid is sick enough to risk a 7-hour wait at the hospital? As a pediatrician with kids in daycare, I have a lot of experience with runny noses and coughs. Here are the 3 things I check in my kids to know if they are sick sick, and if I need to intervene and with what. Fever, hydration, and breathing. See below for a chart that summarize these general (not medical advice) thoughts.

Fever

How do you know your child has a fever? Well, there’s using your parent’s touch. Just feeling the burning forehead, and looking at your child’s rosy cheeks might offer hints that your child has a fever. However, sometimes it’s just nicer to know. And, because after the 3rd or 4th day of fever, the silly doctors (hi, that’s me) and nurses always want to know exactly how many days of fever and how high the temperature was. My choice thermometer to check is the Exergen forehead scanning device because it is quick, accurate, and very durable (I had the last model for 8 years). Of course a baby under 3 months old should only have their temperature checked rectally with a thermometer like this one.

Now that we have accurately determined your child has a fever, what next? Treat the child, not the temperature. Is the child playing like mine is here, swatting the ceiling with a pool noodle? If a child has a high temperature, like 103F or more, then you probably want to give the, fever reducing medication, but it’s not necessary. A fever won’t damage a child’s brain. However, a kid might feel pretty miserable with a fever, and that will prevent them from drinking fluids. Giving a kid ibuprofen or acetaminophen might help them feel more comfortable and therefore more willing and interested to drink fluids such as water or pedialyte and to stay hydrated.

If a baby under 2 months has a fever of 100.4F or more taken rectally, then take the baby to the emergency room. If the baby is 2-3 months old, then call the pediatrician’s office for advice. After 4-5 months, a fever is likely viral with less concern of a bacterial infection…. UNLESS the baby is screaming a lot more or tugging on their ears, the fever lasts more than 3 days, the fever initially improves and then gets high again or the fever is associated with a severe sore throat in a kid 3 years old or older. If any of those scenarios are true for my patients, I advise their parents to call the pediatrician’s office for more advice.

Hydration

While kids might feel achy and lose their appetite when they are sick, what we have to monitor closely is how much they are drinking and peeing. Remember back in high school biology, we need salt and sugar to absorb water. If a kid is eating something – crackers, goldfish – and drinking water, then they are probably fine. However, if a kid refuses to eat anything, then they will need an electrolyte drink to stay hydrated. Pedialyte powder packs are a nice way to stock those drinks. I prefer the powder because it is probably lasts longer and takes up less space than the ready to drink bottles, and I can put a couple into our travel bag. Enough hydration means that the kid is peeing at least 3 times per 24 hour period. Not meeting that threshold means that the kid might need to go to the emergency room for IV fluids to stay hydrated.

Breathing

I have a rule. If it bothers the me more than the kid, then I let it go. Congestion and cough is a normal part of my kids’ toddler experiences as a daycare attendee. Congestion can be many different colors. It can make the kids sounds louder and snore when they breathe. But what if it does interfere with sleep and drinking fluids? A humidifier like this Vicks Humidifier can help loosen up the congestion so that the mucus is not as thick and can drain out. We want to stick with cool mist so that it doesn’t accidentally burn the kids if they touch it. A Nose frieda suction device can also help remove and declog a kids’ nose, but I only recommend that if the congestion severe interferes with the kids’ eating and drinking function. Kids don’t like it, so using it on a resisting child can result in more harm than good, not to mention more congestion from crying.

So when does breathing get scary? Look at the ribs and nostrils. If the ribs are sucking in with each breath and/or the breathing is faster than 60 times per minute and/or the nostrils are flaring out with each breath, then we usually refer these patients to the emergency department. Persistent coughing that interferes with playing, eating, drinking, or sleeping would also be an excellent reason to check in with the doctor’s office. Of course, a parent should also call for any other question or concern they have.

In conclusion, if my kids are generally happy (with or without medication), drinking, peeing several times a day, and not having trouble breathing (defined as fast, ribs flaring, non-stop coughing), then I just let them be their snotty selves. Reminder that this blog is not medical advice. Please call your child’s doctor to formulate a plan specific to your child’s individual needs.