Blog

Sickness and the Holidays

December 18, 2023

Respiratory illneses, including RSV, Influenza and COVID19 continue to spread rapidly in our area. With the holidays fast approaching, it is important to understand how to limit your family’s exposure to these illnesses as well as protect vulnerable friends, schoolmates and family members from your potentially sick child.

Prevention:

• Your best first line against infection is via immunization.  We have influenza and COVID19 vaccines readily available in the office (influenza for all ages 6 months+, COVID19 for ages 6 mo- 18 years.)
• RSV vaccines are unfortunately in very short supply for infants under 6 months of age.  However, expectant mothers can get a different vaccine that stimulates their body to create antibodies which cross the placenta and provide protection for your soon-to-be born infant.
• Masks work, especially if well-fit and filtered (an N95.) Try to mask in public for at least 4-5 days prior to events to avoid getting sick. 
• Washing hands frequently with soap and water, and wiping down frequently touched areas in the house such as doorknobs and counters helps minimize in house spread of illness.
• Ventilation and filtration- planes are pretty good at this, but remember to mask up in the airport and boarding areas at minimum. If your child is too young to mask, try a stroller with a rain shield when possible until you get settled in your seat.

Testing:

• COVID19 home tests can be negative early on- remember to test several times over 2-3 days if you have symptoms to increase the chances of detecting the virus (2 tests 48 hrs apart will catch 39% of asymptomatic infections and 92% of symptomatic infections. ANY line should be considered a positive (though the fainter, the less contagious you are.)
• If your child has fever, aches, chills, sore throat and cold symptoms they may have the flu- contact our office for evaluation and testing.
• RSV presents as any other common cold (congestion, sore throat, cough.) Testing is indicated only in small infants who may become unusually ill. If your older child has these symptoms, assume they have one of many respiratory viruses including RSV, and consider whether they should be around vulnerable people.

Contagiousness:

The most common questions we get are about WHEN your sick child can safely go to school/a birthday party/your family gathering.  Many illnesses are contagious for a day or two PRIOR to symptom onset- hard to do anything about that (but do alert anyone who may have been exposed to your sick child unknowingly.)

Here are some general guidelines for when your child can go back in public-

• COVID19- most contagious just prior to symptom onset and in first 5 days. Day 0 is the first day of symptoms- you child needs to be home/isolated from other family members if possible for days 1-5, and can return to school MASKED on days 6-10 if they are fever free for 24 hours and feeling better.  Two negative rapid covid tests 24 hrs apart indicate they are likely no longer contagious, but this is not required for return to school/activities or after 10 days (and they still should mask for days 5-10 in public.)

• Strep throat- when on antibiotics for at least 12 hours, AND fever free, feeling better and able to stay hydrated.

• RSV– typically lasts 1-2 weeks, with a peak around day 3-5 but congestion and cough can last for WEEKS. It is most contagious in the first week. If your child seems better, then has a new fever/earache/worsening cough we would want to reevaluate them. Your child can return to school when fever free for 24 hrs, able to hydrate, and generally feeling better (no hacking cough or streaming nose.) Avoid more vulnerable people for at least a week, ideally 2 weeks.

• Impetigo (scabbed/oozy/blistering skin rash from staph or strep)- can return  to school/daycare when on antibiotics for 12 hours and the rash is drying up/not spreading. Cover infected areas when possible. 

• Pink eye (conjunctivitis)- this is almost always viral, but many schools/daycares require (unnecessary) antibiotic eye drops to return. We generally only prescribe such drops if your child has persistent thick eye discharge. Conjunctivitis  is most contagious prior to symptom onset, and is generally highly contagious (bacterial or viral). Schools usually require that any thick discharge has cleared up prior to return.

• Influenza A&B- incubation period is about 1-4 days post exposure and is typically spreads via respiratory droplets (coughs, sneezes…) Symptoms (fever, body aches, cough, congestion and sore throat) are worst in the first week, and are usually milder if your child has been immunized.  Cough and fatigue can last up to 2 weeks, but your child can return to school once fever free for 24 hrs, able to stay hydrated, and their symptoms are minimal. Avoid vulnerable people for at least a week.

• The ”Stomach Flu” (not a real flu, but usually from another virus such as Norovirus)- spreads rapidly via exposure via direct contact with bodily fluids OR contact with infected surfaces (this is the time to pull out the bleach wipes!) Norovirus often begins suddenly with bad abdominal pain, vomiting and diarrhea. While the vomiting phase is usually over within 1-3 days, the diarrhea can last for up to 2 weeks.  Children can return to school/daycare when fever free for 24 hrs, they are able to stay hydrated, and can control their bowel movements (or in infants, diarrhea has slowed and is contained within a diaper.)

• Croup– caused by any number of upper respiratory viruses (usually parainfluenza) that cause throat inflammation and cough. The incubation period is generally 2-7 days post exposure, and it spreads via contact with respiratory secretions. Can return to school/daycare when fever free for 24 hrs, able to stay hydrated, and the cough/congestion is minimal (sense a trend here?)

• Hand Foot Mouth (HFM)- caused by Coxsackie virus, with an incubation period of 2-7 days. Spread by respiratory secretions and saliva/stools (wash hands well after diaper changes.) Children can return to school/daycare when fever free for 24 hrs, able to stay hydrated, and the rash is no longer spreading and lesions have scabbed.

• Poison Ivy– NOT CONTAGIOUS!!! It is spread by contact with urushiol oil from Poison Ivy leaves, and the rash doesn’t emerge for several days, long after the oil has been washed off or absorbed by the skin. Various areas of involvement emerge over several days, depending on the amount of oil absorbed by the skin. Itching won’t spread the rash, but can worsen it. Washes such as Zanfel help draw the oil out of the skin and minimize the reaction.

For more information on the treatment of coughs and colds, please visit our website.