Considering the twists and turns of the pandemic, the best ways to get caught out are the beliefs that one size fits all, there is a perfect plan that will see us through, or that we are nearly through it all.
The desire behind these thoughts is strong, and written deeply into human psychology. It’s strongest when caring for children, up to and including young adulthood. In general practice, this is very evident in the high volume of conversations we’re now having with parents.
If we were to casually believe the pandemic was almost over because of a major loosening of lockdown, that would be incorrect. There is no sign of this letting up any time before the winter ends.
Looking back over six-eight weeks, we have seen huge increases in viral upper respiratory tract infections (v-URTIs). In babies and pre-school children we’re seeing much bronchiolitis and croup, together with much coughing, fever, runny noses, sore throats and tummy upsets. Added to all of this ‘minor illness’ is the additional complexity of ‘Could this be Covid?’, to which the answer has to always be ‘yes’.
It’s been exceptionally busy in practice and on GP Co Ops. People have been brilliant. Large numbers of parents are very correctly ‘sticking it out’, treating sick children with fluids, fresh air, regular paracetamol, working doggedly and hard to square the very tight circle of work, homecare of sick children and the constantly changing requirements of creche, childcare and schools.
Not infrequently there is an elderly relative or medically complex family member in the background, adding more complexity. In my view, parents are the heroes in all of this.
In discussions with parents, the following points repeatedly come up. Most now truly understand antibiotics and cough bottles make no difference (and antibiotic use causes problems) in treating v-URTIs. Some parents are frequently getting blindsided, expecting a v-URTI to resolve after five to seven days, when in actual fact they normally go on for up to 12-14 days.
This means digging in for the longer haul, and continuing consistently with fluids, paracetamol/ibuprofen. Some parents are acutely concerned regarding temperatures, but it’s more useful to understand fever is part of the normal immune response to a v-URTI. There will be less fever and the child will be more comfortable if paracetamol/ibuprofen is used regularly. The big question for many parents as days go by is ‘does my child have a serious illness?’
One of the best ways to answer this relates to how the child is, their response to paracetamol and their fluid intake in the preceding 24 hours. In many instances, the response to these three questions will be ‘not too sick, responds well to paracetamol and is drinking fairly well’.
If this is so, it’s fine to march on for the 12-14 days. In all pre-school children, it’s far more useful to keep a measure of fluid intake than to obsessively check temperature. In children with asthma, ensure immediate, regular and consistent use of asthma medication (usually inhalers) for the full duration. If fluid intake is less than half the usual over a 24-hour period, and/or if you are convinced the child is seriously sick (as opposed to worrying about it), or if they are not responding to paracetamol/ibuprofen at all, do be in touch with your practice, or if necessary your GP Co Op. There is excellent and detailed guidance on www.hse.ie – get familiar with this website. Ensure everyone in your household eligible for it is Covid immunised now.
When are antibiotics necessary? Persistent severe earache may require antibiotics; transient earache does not. A bacterial sore throat, where drinking becomes very difficult, there is breath odour and pus on the throat or tonsil will also require antibiotics. A bacterial lung infection, characterised by progressive lethargy, poor fluid intake and worsening respiratory distress will also require antibiotics.
We do not have enough GPs and GP nurses to maintain all services. Most parents are being brilliant in managing v-URTIs, and their efforts are crucial in the broader effort to ensure vital medical care can continue to be delivered. Just now, they are the heroes !
Dr Brendan O’Shea MD, FRCGP, MICGP.