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flu

Returning to School After an Illness

Elise Herman , MD · September 18, 2024 ·

Contributor Dr. Elise Herman

As kids head back to school and are together in classrooms again, parents know their child may pick up some illnesses. There are times when it is appropriate to keep sick children home, both for their own recovery as well as protecting fellow students and school staff. Students should be showing signs of improvement before returning to the classroom. Below are helpful guidelines for different illnesses your child may encounter as we move into fall and winter.

Fever: In general, kids should stay home if they have a fever over 100.4 degrees Fahrenheit. They may return to school if it has been about 24 hours without a fever (and no fever-reducing medications like Tylenol or Ibuprofen given).

Colds, RSV (Respiratory Syncytial Virus), COVID, and Influenza: if cough and congestion are mild and there is no fever, kids may stay in school. If they have a fever, follow the above guidelines. If your child has a more persistent cough or is very fatigued, keep them home until they are improving. When they return to school, kids should wear a mask for up to 5 days after becoming sick to protect others.

Gastroenteritis (Vomiting and Diarrhea): Kids should stay home if stools are very watery and hard to control (this may depend on the age of your child). If it has been hours since the last vomiting episode and the child is now keeping down liquids and solids, they may return to school.

Strep Throat: Children diagnosed with strep throat may return to school if it has been 12-24 hours since starting antibiotics and they are feeling better. Make sure they are drinking and eating adequately, too.

Pinkeye (conjunctivitis): If eye discharge is thin and watery with pink eyes, this infection is most likely due to a virus and no treatment is needed. This should resolve on its own within 5-7 days and your child may stay in school (be sure to review good hygiene to prevent spread). If eye discharge is thick, green/ yellow and eyes are very red, call your child’s provider since antibiotic drops or ointment may be appropriate if the cause is bacterial. Kids can return to school about 24 hours after starting this treatment.

Chickenpox (varicella): Chickenpox is less common now with effective vaccination, but if it occurs, all sores should be dry and crusted before returning to school.

Impetigo: This common skin infection may be treated with topical antibiotic cream or oral antibiotics. Kids can be in school once treatment has been started.

Hand, Foot, and Mouth Disease: This viral illness causes painful sores in the mouth and small blisters on the palms and soles. There often is fever and a body rash, too. Children should stay home till they are drinking and eating well and fever-free x 24 hours; the rash does not need to have resolved since that can take 1-2 weeks.

Lice, scabies, and ringworm (tinea): These infections are very common in school-age kids, and children may return to class after treatment is begun. Kids do not need to be ‘nit-free’ to be in school.

Make sure your child is up to date on vaccines to prevent common and potentially dangerous illnesses, including COVID-19 and influenza. Remind your child about handwashing and good hygiene– and be a good role model with this! Call your child’s healthcare provider if you have concerns about your child’s illness and return to school. Policies about returning to class may differ between school districts; many school districts post their policy online. Your child’s school nurse is an excellent source of information if you still have questions.

Resource

https://www.cdc.gov/orr/school-preparedness/infection-prevention/when-sick.html

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Respiratory Virus Season and Children

Elise Herman , MD · October 22, 2022 ·

Contributor Dr. Elise Herman

As cooler weather approaches, the “sick” season does, too. For kids, this usually means respiratory illnesses, ranging from cold to croup or pneumonia. While these sicknesses are usually mild, more severe cases are rapidly increasing, with more kids going to the ER and being hospitalized. The viruses responsible include Respiratory Syncytial Virus (RSV), rhinovirus, adenovirus, and enterovirus. To complicate things, influenza season typically starts in October, and with COVID-19 currently spiking in Europe, a surge is predicted to hit the US soon.

Children are walking in nature, fall leaves.

This earlier and more severe start to the respiratory season for kids is felt to be related to gathering again (without masks) in schools and social settings. Kids do not have much immunity from last year when the respiratory season was milder due to social distancing and other anti-COVID measures. Wildfire smoke exposure may also be a contributing factor.

Most kids who contract these viruses will get a simple cold (“upper respiratory infection”), nasal congestion, mild cough, and mild fatigue. A low-grade fever is common for the first three days of illness. Kids may be sick for 1-2 weeks but remain fairly active with good fluid intake though overall eating is often decreased.

Younger or premature infants and children with lung problems like asthma are at increased risk of more severe illnesses like pneumonia. General warning signs include the pale or dusky color of the lips or skin, and increased work of breathing—rapid breathing with the ribs showing on inspiration (“retractions”). Unusually noisy breathing, such as wheezing (high-pitched musical noise with breathing out) or stridor (crowing noise with breathing in), is concerning. An infant who cannot feed well from a breast or bottle is worrisome. Extreme lethargy or limb weakness at any age is very concerning.

For mild respiratory illnesses, the diagnosis is usually based on symptoms and examination alone. Checking respiratory rate, heart rate, and oxygen level are routine when the child is seen by a medical provider. Testing for viruses with a ‘respiratory panel’ can be done but is expensive and usually reserved for those more severely ill since there are few specific anti-viral treatments available. Specific testing for COVID-19 and RSV may be done, given that the implications of having these viruses are more significant regarding attending school, childcare, etc.

If your child has typical cold symptoms, it is essential to ensure they stay well-hydrated; solid food intake is less important. Offer infants extra breast milk or formula. Saltwater nose drops and nasal suction for infants can be helpful in terms of clearing mucous which interferes with breathing through the nose. Fever control with Tylenol (over age two months, though talk to a provider first) or Advil (over age six months) is primarily for comfort since fever, as part of the immune response, may help fight the virus.

No cold medications are recommended under the age of four years and should be used with caution for those 4-6 years old. These meds are usually not helpful and may have harmful side effects in younger kids. Honey (1/2 to 1 tsp by mouth) may help to cough but is safe only for those over one year of age.

To help prevent respiratory illnesses, keep up the frequent handwashing we have all gotten good at during the pandemic. In addition, kids should be reminded not to touch their faces and not to share food or drinks. Although not easy, masking (especially if your child will be in a large group) does help prevent illness. Lastly, it is vital to get your child vaccinated against those respiratory viruses for which we have safe, effective vaccines—COVID-19 and influenza.

Resource / HealthyChildren.org

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

David Martin (H1N1)

HealthNews · October 29, 2019 ·

Prior to coming to the US, the flu season began this year in Australia. US drug companies learned the vaccine they had prepared for the 2019/20 season was not very effective against the strains of flu they were seeing in other areas of the world.  The drug companies responded by quickly recalling the original vaccine and reformulating a new vaccine that is more effective against the emerging flu.  This recall is what has caused the shortage in vaccines. As you can see through the story below, it is critical that you get your flu shot. While the vaccine supply is trickling in to KVH, we have not yet received our complete supply and we do not currently have enough to serve all of our clinic patients.  Everyone  is experiencing the same shortage but the most important thing is that you get your flu shot.  Give your clinic a call and we can help direct you to a KVH clinic, pharmacy or drug store in the area who currently has the most recent vaccine.

David Martin (H1N1)

It started with a nagging cough.

David Martin hadn’t felt well for several days. “You don’t go running to the doctor for the first little sniffle,” admits his wife, Jennifer. Still, she suggested he get checked out, just in case.

David went to Reno, instead.

An associate professor in Construction Management at CWU, David was part of a group traveling to Nevada for an annual student competition. The next Monday, David was back in the classroom. He felt run down, and so did several of his colleagues, who had contracted the flu. Unlike his colleagues, David hadn’t gotten a flu shot that year.

“Honestly? I just didn’t get around to it,” he says.

David called in sick on Tuesday. By Wednesday, Jennifer was worried. “He wasn’t pulling out of it quickly enough,” she recalls. After three restless nights, David went to the doctor. “I was just so tired,” he says. “I needed to sleep.”

David was given two flu tests. Both came up negative. He was diagnosed with walking pneumonia and sent home with antibiotics. Saturday, he returned to the clinic, still unwell.

“He was really not looking good,” says Jennifer, “kind of grayish in color.” Dr. Arar measured his oxygen level at 87. “You’re going to the hospital,” she said, and sent him straight to the emergency room.

“But first, we went through the drive through at Taco Bell,” laughs Jennifer. “Neither of us had had anything to eat, and he wanted some sweet tea.”

In the ER, David was put on oxygen. “They couldn’t get his levels to budge.” Jennifer, who works at KVH as a respiratory therapist (RT), called in her boss, Jim Allen, “because you don’t work on your own family.” When David was put on BiPAP, a noninvasive ventilator, Jennifer wasn’t overly concerned. “I thought, okay, he just needs to get some rest.” It had been a long week, and she went home to rest, herself.

Sunday morning, David was in the critical care unit. Jim had spent the night there. Dr. Survana, the hospitalist on duty, told Jennifer David was too sick to stay – he needed to be transferred to Yakima, and Jim would go with him. At Memorial, David was intubated, placed on a vent, and put into a medicated coma.

That night, tied to the phone, Jennifer checked in repeatedly with the RT in Yakima, who assured Jennifer that David was okay. “I went to bed feeling like he’d be on the vent four or five days down there, and we’d be all right.”

Monday was President’s Day. Jennifer was getting ready to head to Yakima, when pulmonary internist Dr. Ramachandran called to tell her David would have to be transferred, again: he needed to be put on extracorporeal membrane oxygenation (ECMO) to give him his best chance to live.

“I was like, ‘What?!’” says Jennifer.

The doctor explained there was an 80% chance that her husband wouldn’t survive if he stayed on a conventional ventilator. He would be transferred to Portland for care.

“I was freaking out,” she recalls. A friend drove Jennifer and her two sons down to Portland. They arrived not long after David, who was taken by fixed wing to Legacy Emmanuel. “I was able to go in and see him,” says Jennifer.

Normally, ECMO is used in open heart cases, bypassing the entire circulatory system. David’s ECMO removed blood from the inferior vena cava (at the thigh), oxygenating it and passing it back through the superior vena cava, which carries blood from the head and upper body, to the lungs. It’s a drastic procedure, but effective. In addition to the ECMO, David was on an oscillating ventilator.

By the time Jennifer arrived, David’s oxygen levels were improved. Doctors then performed additional tests to determine what was going on. If there was a MRSA infection present, things could be dire.

The seriousness of the situation was hitting home with Jennifer. “I was begging God for ten more years, for my kids to grow up with a father.”

Fortunately, David’s tests were negative for MRSA, but positive for influenza. David had swine flu, the H1N1 virus. “The attending physician said one flu shot would have stopped this,” recalls Jennifer. “He might have still gotten sick, but not this badly.”

“They gave him an 85% chance of survival,” she says. David remained on ECMO for nine days. Then, weaned onto a tracheostomy tube, he was put on a regular ventilator.

When David awoke, he was delirious. “I thought it was just the next day,” says David, but he’d been there three weeks. He figured he was in Seattle. He knew he was sick: he’d been having dreams about it. Vivid dreams, largely brought on by the drugs keeping him comatose while his body regained strength.

Jennifer gave it to him straight. “I told him he’d been there a month. I said, ‘You need to know, you almost died.’”

David was moved to ‘track U,’ a step-down unit where, among other things, he was able to use a speaking valve on his tracheostomy tube to finally, clearly communicate. Within days, he seemed well enough to begin inpatient physical therapy. “My legs were like spaghetti,” says David, but his Christian faith gave him encouragement and direction. “God gave me a small role to play: do what the doctors tell you, work hard, get better and get back home as soon as possible.”

Four days later, David insisted he was ready to go home. Jennifer was hesitant. “He’s about 100 pounds heavier than me,” she says. “What if he fell after we got home?”

But David was ready. “I was telling the staff, ‘I couldn’t walk on Monday. It’s Thursday, and I’ve walked around the entire hospital on my own.’” He calls his rapid recovery “miraculous” and “not supposed to happen.”

Back home, family, friends, colleagues, and even strangers were thinking about David and his struggle to live. “While I was in the hospital, I can’t say that I actually knew when somebody was praying for me, but boy, did I ever feel the effects,” he says. “For every day I was there, I experienced about three days’ worth of recovery. I recovered three times faster than anyone said I would.”

Some five weeks after arriving in Portland, it was finally time to head home, where David took it easy – doctor’s orders. After three months of rest, “I was climbing a ladder, painting the house,” he admits, thanks in part to time spent in physical therapy. By fall, he was back in the classroom.

Now that they’re on the other side of David’s health scare, the Martins want to emphasize their gratitude to those who supported their family while David was in the hospital. “People from work, the community, friends, friends of friends, people I didn’t know, people from all walks of life – everyone was reaching out to help us,” says Jennifer. “The outpouring of support was incredible.”

Among their supporters, fellow RT Heather Zech was a standout. “She took it on herself to organize meals for us. With all that was going on, it was such a relief to know there’d be something I could just take from the freezer and put in the oven – and Heather made that happen.”

There’s another message the Martins want to make loud and clear – flu shots can save lives.

“What are you getting from now on?” Jennifer prompts her husband.

He grins, “A flu shot.”

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