Katherine Rivera-Spoljaric, M.D.: Hi, I am Katherine Rivera-Spoljaric, and I am a Pediatric Pulmonologist at St. Louis Children's Hospital, and I'm a Mom Doc.  

Melanie Cole (Host): Viruses like COVID-19, flu, and RSV are more common during the winter. We know this, but how do you know which one that your child has? And is there this crossing of these types of illnesses at this time of the year? And it can be very confusing and actually quite scary. Welcome to Mom Docs, the podcast from St. Louis Children's Hospital. I'm Melanie Cole. Doctor, thank you so much for joining us today. And I'd like to ask you, have you seen an uptick in RSV and other respiratory illnesses as we're starting to get into the fall and the winter and people aren't necessarily wearing masks? And I mean, there's a lot of confusion about these three things and they kind of work around each other. Tell us a little bit about that.

Katherine Rivera-Spoljaric, M.D.: Yes. So, the fall and spring seasons, and of course the cold, the winter as well is hard because you have uptick of respiratory symptoms in general in all children that are propense for chronic respiratory illnesses and any child that has returned to school or is back to preschool or daycare.

It's sometimes it's hard to tell when it's symptoms of allergy versus symptoms of virus. And a lot of these viruses are very similar and are very difficult to tell apart. Some of the symptoms are the same. For example, you can have sneezing, runny nose and cough for both an allergy and a respiratory illness, and a lot of these viruses have similar symptoms. Children can have fever, runny nose, congestion, cough, shortness of breath, and it's hard to tell which virus is which. But definitely we've been seeing everything starting to rise up since schools started back up.

Host: Well, thank you for that. And so, doctor, tell us a little bit about the differences. We've got COVID and the flu and RSV and allergies, as you said, and rhinoviruses and bronchitis. I mean, there's a lot of things right now kind of floating around in the air. Tell us how, as a doctor, but also for us parents, how we can tell the difference since those symptoms do overlap. Are there differences?

Katherine Rivera-Spoljaric, M.D.: You can't tell the difference. That is one of the biggest frustrations when talking to parents about, you know, how do I know this is just allergies? Or is it a virus? It's hard to tell. And it's hard to tell which virus it is. There are some characteristics of some of the viruses like fever and body aches that are very similar that can happen with any virus. And other non respiratory symptoms as well. Typically if you have other non respiratory symptoms associated and fever, it's not an allergy. If there's fever it's most likely a viral infection or a bacterial infection. Depends on what's going on with your child. But you really can't tell, except for that one component of fever and maybe the body aches and if there are other systemic symptoms like vomiting or nausea, diarrhea, things that are accompanying the respiratory symptoms that

Host: are

Katherine Rivera-Spoljaric, M.D.: typically associated with infection rather than allergy. Sometimes it's hard to tell if it's just mere respiratory symptoms.

So I, I could see how it could be frustrating for parents, especially for parents of children that have allergies and or asthma that have an allergic component to tell when, is it what but I usually just say instead of focusing on trying to figure out which one it is, it's more about supportive care and the treatment that we're going to start for the children.

And of course, if they come to be evaluated to a clinic or to an urgent care, then we can always evaluate the child and, or if it's appropriate, do respiratory testing for respiratory viruses.

Host: Well doctor, so I understand these symptoms overlap, but there's also a contagion factor and with allergies they're not contagious, but if we want to know whether it's one of these viruses or whether it's just an allergy, we want to know whether we're sending them to school. So how do we know when to take them to our pediatrician or urgent care so that you can tell us what this is and we know whether or not they can go to school?

Katherine Rivera-Spoljaric, M.D.: Yeah. So, of course, if there's fever I wouldn't send them to school. That's, an easy one. And when it's other symptoms like accompanying like body aches and nausea and diarrhea and things like that that accompany the symptoms. If the symptoms are severe like the child doesn't stop coughing, they're coughing a lot at night. They're having a lot of congestion, it's more likely something else. And, or if the symptoms don't go away quickly. So, if their symptoms are mild and you can treat them with over the counter allergy medications as instructed by your doctor and they resolve really quickly, then I think those kids can go to school.

But if you have more symptoms of fever and body aches and it looks like more, that there's more systemic so when I say systemic, I mean the whole body is affected, then that's more likely a viral infection. And in terms of your other question in terms of when do you take him to school, I think when the symptoms are severe, when they are impairing their daily activities, they're impairing sleep and they just don't resolve with your over the counter medications that you have at hand.

Host: Well okay, so I know that you get asked this all the time, Doctor, about antibiotics. Please explain to the listeners about these respiratory viruses that we're discussing. And, you probably get asked, can I get an antibiotic for this child? They're coughing or this, but if it's bronchitis, that's a different deal or strep or something like that. But if it's RSV or COVID or flu, you don't give antibiotics. Yes?

Katherine Rivera-Spoljaric, M.D.: Correct. Sometimes we think about medications for infections as antimicrobials, right? Because there are some medications that we do use for flu that are antivirals and sometimes to decrease the symptom burden. But in general, viruses are not treated with antibiotics. I always joke that the day I find an antiviral that will treat viruses, I'll be retired in an island somewhere.

No, unfortunately we don't have antibiotics that treat viruses. Antibiotics are for bacterial infections, and you are correct. Sometimes there are providers that will treat a child for a sinusitis or a rhinosinusitis. When the symptoms become a little bit more burdensome. They have been present for a longer time. There's like a lot of nasal drainage of kind of like, purulent secretions the same way as like coughing up purulent stuff. If the chest x ray looks like there's pneumonia then we might prescribe antibiotics, but in general, unfortunately there are no antibiotics that will help COVID or RSV or anything like that.

Now there are some antiviral medications that do help flu, and there are some antiviral medications that help COVID, but in children, we typically don't use those unless the child is sick enough to require admission. There are some antibiotics and people may have heard of that out there that could have some anti-inflammatory properties but in general, we don't use them in viral infections.

Host: Well, then let's talk about supportive home care that we should be doing for our little kiddos. What helps? What's good? What's bad? I mean, when I think of congestion with our kids, you know, steam showers, Vaporub. I used to love to put that on my kid, and I didn't love it, but you know what I mean? I loved, it was a sweet time to put that on, to put it under their nose, and it seemed to help. As did the steam room. Turning on the shower or taking them out in the cold if it was whooping cough or something like that. But tell us about some of the things that we see on the shelves. Robitussin, Chest Congestion, Afrin. I mean, there's so many things.

Katherine Rivera-Spoljaric, M.D.: I know. Yeah, so majority of the studies that have been done with children and on some of these over the counter cough suppressants or medications for cold and flu show they're not that helpful. Quite frankly, there was one study a long time ago that was done that showed that just, honey and lemon were fine as long as you don't have an infant that cannot have honey, of course.

But that was just fine or a little warm tea to soothe the throat was helpful. Yes, I typically do not recommend over the counter medications because they're just not have shown to be helpful and some of them can be dangerous and cause some heart side effects. So we, typically don't recommend those for children.

Now, there are some homeopathic remedies out there. I'm not necessarily against them. I hear you when you say that, parents do use some home remedies that seem to be helpful. I remember growing up and my mom used to put Vicks up my nose and on my feet and everywhere in my body.

And I hated it because it made my eyes really watery. But she thought it was helpful. So yeah, so there are some homeopathic remedies out there. As long as, you read the ingredients, discuss them with your doctors, make sure that they are safe for your child, that they don't interfere with perhaps other medications that your child can be on, then I think that those are fine.

In children that have history of other respiratory conditions like asthma, for example, or cystic fibrosis or any other chronic pulmonary disease, I would just make sure that we are not replacing the medications to treat that with some of the homeopathic stuff. So I, tell the parents, you can give them elderberry syrup is a very common one, right? So I say, you can do that, but also give them the albuterol, the medication for cough and other stuff that they need.

Host: One of the things you mentioned as a symptom is fever. And certainly some of these respiratory viruses come with a fever and the kids feel not great. Do we want to bring that fever down, doctor?

Katherine Rivera-Spoljaric, M.D.: Absolutely. Yes. Yes. That absolutely. Tylenol, ibuprofen. Those medications are safe when dosed appropriately. However, if your child has fever for more than one or two days, I would definitely call the pediatrician's office and discuss because depending on the age, there may be other things that need to be checked out, for example, ear infections or as you mentioned before, strep throat or something else that can be going around in the community.

Host: I would love your last best advice as we wrap up this informative podcast for parents. You know, there's so many of these viruses going around right now and not as many people are masking, but is there a way to protect our children from these respiratory viruses in the fall, winter, and spring? Is there anything we can do to help them?

Katherine Rivera-Spoljaric, M.D.: Well, I think that the most important thing is hand washing. So keep appropriate hygiene, hand washing, instructing your children to be careful about sharing drinks with others at school. I think we all have to do our part, right? So when our children are sick or have fever or have significant respiratory symptoms, maybe we don't want to take them to school. Maybe we don't want to take them to a daycare to share whatever viruses they may be carrying. I know that especially now that we go into the holiday season, we don't want to miss activities. We don't want to miss fun stuff, but by also attending those with children that are sick, we promote this contagion factor that we talked about earlier. We continue to promote the virus continuing to spread in our community. So, I think the most important thing is really hand washing, making sure that you have explored the vaccines that are out there to prevent some of the viral illnesses, such as the COVID vaccine and the influenza vaccine.

And talk to your doctor about that if you have concerns or if you have no concerns, then just seek out opportunities to receive those. So yeah, I think that's the simplest thing I can say is hand washing and staying away from people that are sick.

Host: Well, that's an excellent point that you made, Dr. Rivera-Spoljaric, because vaccines are one of the best ways that we can help our kids to fight off some of these things in this coming triple demic season that we've got coming up. Thank you so much for joining us today. For more advice and articles, check out the MomDocs website at childrensmd.org. That concludes another episode of MomDocs with St. Louis Children's Hospital. I'm Melanie Cole. Thanks so much for joining us today.