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Returning to School After an Illness

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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
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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.

Preventing Respiratory Syncytial Virus Infections

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Contributor Dr. Elise Herman

As the winter weather approaches, so does the ‘sick season’, including illness due to RSV (Respiratory Syncytial Virus). RSV typically starts in fall, peaks in winter, and causes cold symptoms including runny nose, cough, and fever in children and adults. Most kids have had RSV by age 2. Although usually mild, RSV can cause more serious problems like wheezing, pneumonia, and trouble breathing. These problems are more likely in premature babies or in kids with heart disease, lung issues like asthma, and immune system problems. Between 58,000 and 80,000 kids under age 5 are hospitalized due to RSV each year. Adults aged 60 and above are also at higher risk of more severe RSV illness. Reinfections with RSV are common.

Like other colds viruses, RSV spreads by the droplets released by coughing or sneezing. You can also get it by direct contact (for example kissing) or touching a contaminated surface like a counter or cup and then touching your eyes, nose, or mouth.

There is no effective treatment for RSV and since it is a virus, antibiotics do not help. There are, however, two new good ways to prevent RSV—vaccines for adults and antibody treatment for young children. Vaccines stimulate the formation of antibodies to help fight infection (active immunity). Antibody treatments give antibodies directly to the body (passive immunity).

RSV vaccines are available for those 32-36 weeks pregnant during RSV season and if given at least 2 weeks before delivery, will help protect the baby from severe RSV. RSV vaccine is also recommended for those 60 years and older.

Antibody therapy (Nirsevimab) is approved for babies less than 8 months during RSV season (if mom did not get vaccine at least 2 weeks before delivery). Nirsevimab is also appropriate for some infants aged 8-19 months with severe health issues including extreme prematurity, immune system problems, cystic fibrosis, and heart disease. Nirsevimab is an injection and lasts 5 months, so helps protect for the entire RSV season. There is another antibody treatment called Palivizumab that has been used for years, but this is only approved for very high-risk children under age 2 and requires a monthly injection.

Side effects of Nirsevimab are uncommon and include temporary discomfort, redness or mild swelling at the injection site, and a rash. Nirsevimab can be given with routine childhood vaccines and may be given if a child has mild cold symptoms. Children who have had RSV should still receive the antibody therapy due to the risk of getting infected again later in the sick season.

There may be some difficulty having enough Nirsevimab for all kids who are eligible this year; contact your child’s provider about this. Supplies of RSV vaccine for those who are pregnant or 60 and over seem adequate; check with your provider or local pharmacy.

Remember the routine ways we can all help prevent the spread of RSV and other viruses, such as frequent hand-washing, avoiding touching one’s face, staying home if sick, and wearing a mask when appropriate. Also, cover sneezes and coughs, do not share cups or utensils, and keep countertops and other frequently touched surfaces clean. Don’t forget your child’s other important vaccines including Influenza and COVID vaccines as these are also important to help keep your child healthy this winter season.

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.

RSV in Kids

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Contributor Dr. Elise Herman

We are definitely in the sick season and Respiratory Syncytial Virus (RSV), a common fall/wintertime virus, is very prevalent right now. Most kids have had RSV at least once by age 2 years and usually it just causes a mild cold. In some children, especially preemies, young infants, and those with heart, lung, or immune system problems, RSV can be more serious. It can cause pneumonia (lung infection) and bronchiolitis (inflammation of the small airways). Adults also get RSV, though as with most kids, they usually just have mild cold symptoms. Elderly adults or those with compromised immune systems or underlying health problems can develop more severe RSV.

RSV spreads by direct contact with the virus by kissing, sharing drinks, or touching a contaminated surface). Airborne droplets from a cough or sneeze are also infectious. People are contagious for a day or two before signs of illness and then for 3-8 days after becoming sick.

RSV symptoms include runny nose, cough, sneezing, fever, and decreased appetite. There may be mild wheezing, which is a high-pitched musical sound heard with breathing out. RSV typically lasts 1-2 weeks.

If RSV is more severe, there may be signs of difficulty breathing such as rapid breathing and sucking or pulling in between the ribs or just below the neck (“retractions”). Other warning signs include grunting respirations, and the lips or tongue appearing pale or bluish. Trouble breast or bottle feeding and pauses in breathing are worrisome signs sometimes seen in young infants.

Testing for RSV (done with a nasal swab) is not needed if your child is mildly affected. If the illness seems more severe, RSV testing may be ordered.  Kids can test positive for RSV for days to weeks, even once they appear recovered. There is no need to do testing to see if a child is “over” their infection.

There is no cure for RSV and most kids just need basic at-home care. Ensuring your child gets enough fluids is important. Small frequent feedings may be better tolerated and using saltwater nasal drops and suctioning prior to infant feedings can help. Breast milk can be expressed and put in a cup or bottle if feeding at the breast is too difficult.

Tylenol (over 2 months) or Advil (over 6 months) for discomfort is fine, but do not worry about “getting a fever down”, as the fever may be helping your child fight the infection. Severely ill kids may need oxygen and IV fluids in the hospital to treat dehydration, but this is uncommon and usually is just for a few days. Only 1-2% of infants under 6 months of age need to be hospitalized with RSV.

To decrease the risk of kids and adults getting and spreading RSV, practice good handwashing with soap for 20 seconds. Teach your child to cover coughs and sneezes with tissue or their elbow. Avoid sharing drinks and utensils.  If your child is at high risk of severe RSV, you may want to avoid childcare and crowded settings if RSV activity is high. Masks in kids over age 2 years are effective at decreasing spread of the virus. Avoid smoke exposure which is harmful to lungs in general.

There is no vaccine for RSV yet, though some are in the works. If your child is 6 months or older, it is vital to vaccinate them against influenza and COVID-19 since these can make RSV more serious. There is an injected monoclonal antibody medication to prevent severe RSV only in very high-risk kids.

Remember that most kids with RSV will have a mild illness. You should call your child’s provider, however, if there are signs of dehydration (not drinking well, poor urination, or looking pale or weak), extreme fatigue, or difficulty breathing.

Find more information on our RSV resource page: kvhealthcare.org/rsv

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.

RSV and Other Respiratory Viruses

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From the Washington State Department of Health

Pediatric hospitals and clinics across Washington are in crisis as rising case rates of Respiratory Syncytial Virus (RSV), flu and COVID-19 cause overcrowding in the midst of staffing shortages. Flu hospitalizations are at the highest rates seen in 10 years for this time period and pediatric emergency departments are seeing a record number of RSV patients. To slow the spread of respiratory viruses, Washington State Department of Health (DOH) recommends that everyone 6 months and older be vaccinated for influenza and get a COVID-19 booster to lower the risk of respiratory virus transmission and serious illness. Find resources here

What is RSV?

Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States. (Centers for Disease Control and Prevention)

Pediatrician Discusses RSV Cases American Academy of Pediatrics

RSV is spreading rapidly and much earlier than normal this year. That combined with flu season and the continued spread of COVID makes for a scary time for many parents of young children. Pediatrician and parent of young kids Dr. Parga-Belinkie offers reassurance and practical guidance for parents in this new video, including signs it’s time to #CallYourPediatrician to be seen.

Posts by Pediatrician Dr. Elise Herman

Returning to School After an Illness

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.

Continue Reading

Preventing Respiratory Syncytial Virus Infections

RSV typically starts in fall, peaks in winter, and causes cold symptoms including runny nose, cough, and fever in children and adults. Most kids have had RSV by age 2. Although usually mild, RSV can cause more serious problems like wheezing, pneumonia, and trouble breathing.

Continue Reading

Information / Flyers, Handouts and Printable

Seattle Children’s Hospital

American Academy of Pediatrics

Center for Disease Control

Local Resources

If you or someone you are taking care of are exhibiting symptoms that you feel require immediate medical attention, please call 9-1-1. If you or someone you are taking care of are experiencing symptoms but do not require emergent care, please contact your primary care provider.

Most health insurance companies offer a 24-HR Nurse Line to assess symptoms, provide support and guidance for non-emergency situations. Check the back of your insurance card for the phone number.

What does RSV sound like?

All about RSV

Respiratory Virus Season and Children

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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.