Dr. Sarah Gleeson on Coughs, colds and medication safety – How to manage this winter

The extraordinary Dr. Sarah Gleeson has given us permission to share this excellent article on coughs colds and medication from Family HQ. It's one of the most useful articles I've found.

With winter well and truly making its presence felt around Australia, we begrudgingly welcome back seasonal coughs and colds that are common in children. How do you distinguish a run-of-the-mill cough or cold from something more sinister? What medications are safe to use? How do you manage symptoms at home? When do you keep your kids home from school or daycare?

URTIs and LRTIs

Fun to say but, what are they? Upper Respiratory Tract Infections and Lower Respiratory Tract Infections are the names given to the infections that viruses can cause in the throat/nose and lungs. There are lots of types of coughs and the most common is a viral cough. Most are mild and don’t require medical attention and will eventually resolve themselves. 

The average preschooler will develop a whopping six colds each year! If it seems like your toddler is constantly sick during the winter months, you’re not imagining it. Most of these are caused by one of the 200 known viruses that can cause colds. Common symptoms include; runny nose, cough, sore throat and ears, and sometimes, a fever. Young children often get “noisy chests”. This is because they have smaller airways and thinner rib cages than adults.

 What about antibiotics?

Most coughs are due to viral infections, so antibiotics will have no effect. I often say to my patients, it’s like me prescribing blood pressure tablets for a sore knee. It simply won’t help, and the risk outweighs the benefit. Most children who take antibiotics do not get better any faster than children who do not take them.  

“But my son/daughter is coughing up green phlegm”, I hear you say. There is good research to show that the colour of phlegm is not linked to bacterial infections. It’s important to remember that antibiotics are an incredibly precious resource, your GP isn’t being ‘stingy’  if they decline to prescribe them, especially in the early course of an illness. 

Self-isolation when unwell

We all know that the best place for your child to be when they are feeling unwell or miserable is at home. This allows them to rest and recover and stops the community spread of these annoying viruses. It is even more important this winter to stay home and isolate when your child is unwell while we all work against the spread of COVID 19. 

“What about if my child is well and just has a runny nose?” Mild symptoms like a runny nose usually won’t require exclusion from school or daycare and your child’s daycare provider or school will have guidelines for when children are required to be kept home, and when they can return to care. 

As a general rule, I tell parents that if you need to give them paracetamol or ibuprofen, then they need to stay at home. 

Treating coughs and colds and when to use Paracetamol and Ibuprofen

Paracetamol and Ibuprofen are safe to give your child when they are suffering from a cold and are effective in the relief of pain and discomfort associated with fevers, sore throat, sore ears, and body aches. It is crucial to ensure your child receives the correct dose (based on their weight) at the correct time. 

Many parents get confused about which medications they can give. It is safe to give paracetamol and ibuprofen at the same time, or as alternating doses. They are different medicines that work in different ways. It’s important to remember that you can only give 4 doses of paracetamol in 24 hours, and 3 doses of ibuprofen in 24 hours. 

If your kids are feeling a bit miserable, then giving one-off doses of paracetamol or ibuprofen ‘as needed’ is perfectly fine. If your kids are really miserable, I will often tell parents to give regular doses of paracetamol and ibuprofen three times throughout the day (every 6-8 hours), then you have 1 more dose of paracetamol up your sleeve through the night if you need. 

I know first hand that it’s hard to remember what time you gave them their last dose of paracetamol or ibuprofen, especially if more than one of your children is unwell, and it is all too easy to accidentally overdose your child on one of these medications, which can cause liver or kidney damage.        

The Family HQ App takes the hassle out of medication dosage and timing, especially when you’re tired and frazzled. It allows you to enter the time and amount of medicine you’ve given your child and takes the guesswork out of when it’s safe to administer another dose.

 

Should my child receive the flu immunisation?

Absolutely! It is recommended that all children over the age of six months receive the flu vaccination. The flu vaccination is safe and is particularly important for those children who suffer from chronic medical conditions like asthma or are considered high-risk (having chemotherapy). The first time a child receives the flu vaccination, they will require two doses, one month apart. The flu vaccine is free for children under 5, and for children and adults who are considered high risk. For well children over 5 years old, it typically costs around $20. Your family GP is well placed to discuss having your child immunised against influenza.

 

When to seek medical treatment

It’s important to know when to seek help.

You should consult your GP if your child;

• won’t drink fluids
• vomits frequently
• is unusually lethargic
• has a fever that doesn’t improve in 48 hours
• has a cough that lasts more than two weeks
• has noisy breathing or wheezing

Occasionally, children will require urgent medical attention and you should call an ambulance or present to the emergency department of your nearest hospital if your child;

• complains of an intense headache
• is pale and sleepy
• is having difficulty breathing, or is breathing much faster than normal
• has a fever and is less than 3 months old
• develops a rash that doesn’t disappear when you press a glass against it

Common coughs and colds are a normal (albeit, annoying) part of childhood. For the most part, these coughs and colds will resolve on their own with no treatment aside from time and symptom relief with paracetamol or ibuprofen. Ensuring your child is kept hydrated and can rest will assist them to recover and return to normal life.

 

Family HQ’s Top Tips when your kids are unwell. 

• Keep them home
• Don’t worry if they don’t eat too much, fluids are more important
• If your baby is breastfed or bottle-fed, offer smaller, but more frequent feeds
• If your kids are miserable, give paracetamol or ibuprofen.
• If they need more sleep – let them have it. Resting will speed up their recovery.
• If your baby is struggling to breast or bottle-feed, try putting a drop of salty water (called normal saline) up each nostril, give their nose a little squeeze and this will dry some of the mucous before a feed 
• Snot-suckers can be handy to clear mucous in small babies
• Most coughs are viral and don’t need antibiotics (similar for sore throats).
• Be kind to yourself, looking after sick babies and kids is tiring. 
• Don’t panic about a fever, it’s the body’s way of fighting infection. 
• Make sure you weigh your baby to ensure you’re giving the right dose of medicine
• Check out my blog on telehealth and why this can still be a safe way to assess a child with a cough or cold
• Wash your hands and teach your kids to wash their hands. 
• Teach your kids to cough or sneeze into their elbow instead of their hands. 
• Record and communicate when you’ve given your child medication (esp paracetamol)

   

Looking for more trusted information about coughs and colds? Then head to www.familyhq.com.au/resources/ 

Please remember, if your kids are unwell – please keep them at home, and if you’re worried – see your GP. 

Dr. Sarah Gleeson works at the Goondiwindi Medical Centre as a senior GP, at an outreach service for the Aboriginal community of Boggabilla and at the Goondiwindi Hospital in the Emergency and Obstetrics departments. She also teaches medical students at the UQ Rural Clinical School.