Friday, February 24, 2017

Colds/coughs/congestion 2017 (symptomatic treatment/when do you need to be seen?)

Colds/coughs/congestion

We are in the midst of full blown cough and cold season.  It is important to have some guidelines to help you figure out when a trip to the doctor's office is indicated. Many times, there is nothing to do but wait it out, so I am including  some tips to help you and your child get through the illness as comfortably as possible.

Colds and coughs are a common issue for all of us with or without kids. Studies say that most children will have an average of EIGHT colds within the first 18 months of life. Most of the time the congestion is caused by a viral syndrome. Allergies and teething* can also be culprits causing you to be congested.

*Most medical literature disputes whether or not teething is connected to any symptoms, but I have been at my job for many years, and I see what I see

All that mucous is the perfect breeding ground for bacteria, which is why something that starts as a virus can turn into an ear infection, sinus infection, or lower respiratory infection fairly quickly. Be warned,  we can see a patient one day with clear lungs and no ear issues, and the very next day they can seem a lot worse and have a raging infection.
Right now we have lots of families suffering with some nasty colds and coughs. The coughs have been lasting for several weeks.

When to come in  
If you are dealing with a congested family member, here are the questions to consider:

*Do they seem to be having any labored breathing?  Babies with labored breathing will look like their little tummies are going in and out more than usual. Respiration will be more rapid (I am more concerned with the lungs than a stuffy nose.) Noisy breathing alone is not a very good indicator as it may be caused by upper airway issues that we aren't too worried about.

*How is their mood?

*Do they have a fever?

*How is the appetite? If your baby is nursing well, that is very reassuring

*Are they sleeping well at night?

* What color is the mucous?

*How long has this been going on?

If you have any labored breathing, wheezing, a child who is much grumpier or fussier than usual, and/or a fever that is hard to control or has lasted more than 3 days, an office visit is needed.  I am also interested in mucous that is getting thicker and greener. Green mucous does not automatically signal a problem. It is just one more clue. 

It is okay to play the wait and see game if we have a reasonably consolable child with clear mucous who is eating and sleeping  well, whose breathing isn't alarming and who has no significant fever,  
Of course if the symptoms show no signs of improvement, please check in with your doctor's office. Many colds and coughs can last between 1 and 2 weeks. Some coughs can really hang on.

If you find that you are having a hard time assessing the respirations, try sticking your ear up to their lungs and see if you can hear anything. If you can hear nice clear air noises, that is great. If you hear whistles or squeaky noises, that may mean the congestion has spread down to the lungs. Using your ear as a stethoscope doesn’t always work; more than half the time you won't be able to hear anything, but once in awhile parents are able to get some important clues from the "ear to chest" evaluation.
If your child is old enough to cooperate, have them take a great big deep breath, in and out.
If they are wheezy or have any inflammation in their lungs, that deep breath will often trigger a bit of a coughing fit. If that happens, it is probably worth an office visit.
It is not a bad idea to get an idea of what “normal” looks like. If you are lucky enough to be reading this when your child is healthy, lift up their shirt and watch them breathe for a minute or two. How fast are their  normal breaths?

Any baby less than 2 months old is probably worth a visit to the office with their first cold, unless they are eating really well and seem completely happy. It is certainly at least worth a call to the nurse.

Sometimes a big mucous plug may be momentarily blocking an airway, causing a minute of distress that clears with a big cough. If coughing and steam are able to clear things up, it is more likely that it is upper airway congestion.

Management tips
The best way to manage congestion at home is to make sure your little patient is getting plenty of fluids (this will help to keep the mucous thinner.) Breast milk is perfect if you are lucky enough to have it.

With some older kids, cow's milk may not be the best choice because it can increase the amount of mucous (it doesn't impact everyone the same way.) I have plenty of patients who love their milk and taking it away for a couple of days is not a reasonable option. Sometimes thinning it will a bit of extra water is a good compromise.

Steam is great. Hang out in the bathroom when anyone takes a shower. Running a humidifier or vaporizer at night is a good idea. Turn it off during the day and give the room a chance to dry out so that you don't grow mold. Make sure you change the water daily. As long as you follow those rules, I don't have a preference between warm or cool mist.

Humidifier blog post

Keeping the head elevated makes a huge difference. Some of the younger babies will do best napping in their car seats, bouncy seat or swing. Make certain that they are in a safe place. For night time, try a crib wedge or place a towel underneath the mattress to raise it up a bit. Some parents place a book underneath two of the crib legs to get it on a mild slant

You can put saline drops or breast milk into the nose (and then suck it out with a Nose Frida or snot sucker). This is the most natural way to clear the nose. Your baby will no doubt hate this, but if you can manage to do it about ten minutes before a feeding, it may clear the nose up enough to make eating much easier. Do not torture your baby with the nasal irrigation if they are managing just fine.

Some of my parents really like  the Oogiebear nose and ear cleaners. These are safe, soft little plastic scoops that allow you to remove stubborn little boogies.

For patients over 6 months of age, ask your doctor about Windbreaker or Pipecleaner. These are Chinese herbs that we use to dry up congestion. Many of our families swear by these. They are sold at the Chinese medicine works on 25th and Noe. For convenience our office tries to also keep it them stock.
Consider acupuncture!
One of our neighborhood acupuncturists gets some good results from her treatments for your basic coughs and colds. Her treatment of children often does not use any needles.
http://theacupunctureden.com/

Still in the realm of Chinese medicine, there is a new product on the market.
Dr. Loo, a local physician, has created a patch to treat the symptoms of congestion.
These are safe for any age!
Her website is a work in progress but you can learn all about the products by clicking below.
It is possible that we will have some of the patches available for purchase. 
http://www.drloosnaturalremedies.com/

For older kids and adults, don't minimize the value of chicken soup! There was a fun study done a few years ago that found that soup drunk out of a mug was actually statistically better than soup out of a bowl.

So, what about the over the counter cough medications?
I have been an advice nurse here at Noe Valley pediatrics for a shockingly long time (1988.) For many many years the nurses and docs were pretty quick to prescribe over the counter cough and cold remedies to our patients over 6 months.
The rules and recommendations kept changing. First they moved the age to 2 and over, the next thing I knew the age was 6 and over.
In my experience, those meds were useful and harmless. It was nice to have an option for the younger patients to help them get over the hump of a nasty cold, but the powers that be are pretty firm that the labels remain for older kids only.

There are some homeopathic remedies out there that are considered completely safe. Chestal and Zarbees are are two of the brands I have had parents give good reports about.
Make sure that you don’t give anything honey based to a child under one year of age. The Zarbees does have an infant formula.

Here in our office our docs may recommend a dose of Zyrtec or Benadryl at night to help dry the kids up and get them a good night's sleep. Before I would do that, I would want them checked out to make sure the lungs and ears are clear.

For night coughs, without taking anything orally, you might try a bit of  Vicks Vaporub on the feet!  Trust me, I scoffed at that as much as anyone, until I asked my patients to test it out and was shocked at how much it seems to help.

Prevention
For parents and big kids I really like Sambucol and zinc lozenges. They mayy be placebos, but in my case I say " bring it on" because they seem to work. Remember that I work in the germ factory and (knock wood) I manage to avoid many of the things I tend to be exposed to. The second I feel that little tickle in my throat or any tell tale signs of an illness I take a zinc cold therapy lozenge (Walgreen's generic taste better and are cheaper) and a Sambucol lozenge twice a day.

Another very good thing to do for folks who are old enough is to use a Neti Pot or sinus irrigation. Make sure to use distilled water.
NeilMed has quite a few excellent products to help clear out the nose. For nursing moms, this is my absolute favorite remedy. If you have a deviated septum, this may not work well for you.


Good hand washing is of course essential.

Related posts
When is your child Contagious?
Croup
RSV

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