Evaluating Winter Flu Symptoms

Every parent of a small child this season involves winter flu symptoms and whether their baby is "too sick" with cough and nasal congestion and/or runny nose. For most caretakers, presence of cough during the night, vomiting after coughing, not eating, and fever are the reasons most parents' fears escalate. As an experienced emergency room physician and private practice pediatrician, I can offer my thoughts concerning when a child is becoming too ill with these symptoms to be taken care of at home. 

The two most important factors determining whether a child needs to be seen are work of breathing and fluid intake. If a child is working too hard to breathe, no matter the cause, the prognosis worsens as it lengthens. I look at the breast bone between the nipples to evaluate chest rising and falling to see if a child is breathing too fast. Ask, "Is this breathing normal for him/her, or is it much faster?" Looking below the ribs will also show retractions, movements the belly makes to help "suck" more air in like a vacuum cleaner. 

These two warnings may have a simple cause. Straightforward measures, like giving fever reducing medicines or saline drops accompanied by quality nasal suctioning, should quickly improve fast breathing and retractions. 

Additionally, a sick child cannot be expected to eat, but must be drinking to avoid dehydration. Signs of dehydration would be dry diapers after 6-8 hours, pale color, dry mouth, crying that doesn't produce tears, or weakened activity level. If signs of respiratory distress or dehydration are apparent after simple supportive measures are attempted at home, the child needs proper medical attention to better manage these symptoms.