For many parents, the return to school means the end of freedom from stuffy noses, fevers, and 9 p.m. calls to the pediatrician: Your children are likely to bring home more than just homework once they’re back in close quarters with other kids. What can you do? Schedule an end-of-summer visit to the doctor to make sure your kids (even tweens and teens) have all the vaccinations they need. And follow the advice of Pamela Murray, MD, vice-chair of the department of pediatrics and adolescent medicine at the West Virginia University School of Medicine: “Put hand sanitizer on your back-to-school shopping list.” A refresher course in frequent (after the bathroom and before all meals) and thorough (warm water, lots of lather, scrub long enough to silently sing “Happy Birthday” through twice) hand washing is also a good idea. Still, your kids are bound to come down with something, so here’s our guide to spotting, treating, and preventing the most common childhood illnesses.
The Common Cold
What is it? A fact of life caused by a group of different “rhinoviruses.” Generally, the question is not “Will my kid catch a cold this year?” but “How many colds will my kid catch this year?” According to the Centers for Disease Control and Prevention (CDC), the number is eight, on average. Good grief.
How do you catch it? By being near a sneezing, coughing cold sufferer or touching surfaces he or she has touched.
What are the symptoms? Runny nose, nasal congestion, sneezing, and, sometimes, a sore throat, cough, headache, or low fever.
How is it treated? With rest and plenty of fluids. While over-the-counter cold medications can help ease symptoms, they should not be given to children under the age of 6.
How is it prevented? Hand washing, hand washing, hand washing, and/or the liberal use of hand sanitizer.
When should a doctor be consulted? “Most colds will go away in about a week,” says Barbara Frankowski, professor of pediatrics at the University of Vermont College of Medicine and immediate past chair of the American Academy of Pediatrics Council on School Health. “People often feel better after five days.” If, by then, your child is not on the mend, has had a fever for more than two days, or starts to develop ear or sinus pain, call the doc. She may have developed a bacterial infection in the ear canal or sinuses and could need antibiotics.
What is it? An upper respiratory infection caused by influenza viruses.
How do you catch it? Same way as a cold.
What are the symptoms? Fever, chills, sore throat, cough, runny or stuffy nose, headache or other body aches, fatigue, and—in children—vomiting or diarrhea.
How is it treated? A viral illness, the flu should be treated with plenty of rest and fluids until it just runs its course. Kids who are more susceptible to complications from the flu (such as those under 5 or with asthma or diabetes) may need to be treated with antiviral medications. The CDC says children can return to school 24 hours after their fever has resolved.
How is it prevented? The annual flu vaccine—a shot with inactivated flu virus that prompts the body to mount a defense to the illness—is recommended for children over the age of 6 months. It’s typically released in September. There is also a nasal flu vaccine with live virus, but it cannot be administered to children younger than 2. Even with vaccination, always practice good hand washing.
When should a doctor be consulted? Anytime your child appears to be sicker than a run-of-the-mill cold, it’s a good idea to call. In addition, phone immediately if your child exhibits rapid breathing or has trouble breathing, or has a blue tinge to his skin. Other signs of trouble: Your child is not eating or drinking enough fluids; isn’t interacting normally; develops a rash along with a fever; has a fever or cough that wanes, then returns; or generally does not seem to be improving.
What is it? An infection of the throat caused by group A streptococcus bacteria.
How do you catch it? Respiratory secretions (from a cough or sneeze, say) passed directly on the hands or by way of shared cups or eating utensils.
What are the symptoms? Strep is most common among kids ages 5 to 15. The big giveaway is an extremely painful throat, often accompanied by a fever that can be quite high. “Strep is usually marked by the absence of upper respiratory symptoms, such as a runny or stuffed nose,” says Murray. “You may feel like you can’t swallow, but you’re not going to be sneezing or having the water-faucet nose.”
How is it treated? Antibiotics are recommended, says Murray, not just to treat the infection but to prevent the rare, but more serious, consequences of strep such as rheumatic fever or kidney damage. Scarlet fever, a complication of strep that involves a red, sandpapery rash all over the body, is actually less of a concern than it was in the past, probably because of the changing strains of bacteria over the years, says Murray. Now scarlet fever is seen as another manifestation of the infection, rather than a dangerous complication. After 24 hours on antibiotics kids will no longer be contagious; the second day after starting treatment, kids will usually feel well enough to return to school. Before antibiotics kick in, Tylenol or ibuprofen can help lower the fever and make children more comfortable. Gargling with warm salt water several times a day can also ease throat pain.
How is it prevented? Advise your children not to share drinks and eating utensils.
When should a doctor be consulted? If you suspect strep, get your child to the doctor as soon as possible to be tested and treated.
What is it? A viral infection caused by the parvovirus.
How do you catch it? Fifth disease is passed through contact with respiratory secretions (i.e. when someone coughs or sneezes) and is usually contagious in the days—or even weeks—before its telltale rash appears.
What are the symptoms? Children exhibit a characteristic red “slapped cheek” look. Some develop a lacy or marbleized rash over their trunk and arms that fades from the center out. Lasting one to two weeks, it may or may not be accompanied by fever. Once the rash appears, children are usually no longer contagious.
What is the treatment? Fifth disease is a viral illness that will run its own course and resolve on its own.
How is it prevented? Hand washing.
When should a doctor be consulted? If your child develops a fever that is either very high (over 102 degrees) or prolonged (more than two days) or is unable to eat or drink. But, says Frankowski, “fifth disease is benign for children. Sometimes kids don’t even get much of a fever.” The bigger concern is exposure to pregnant women who have never had the condition; in rare cases, it can lead to anemia in the fetus or a miscarriage. If you are pregnant and believe you have been exposed to fifth disease, talk with your obstetrician. (Also, women who work with children and plan to become pregnant should ask their health care provider about having their immunity to the virus checked.
What is it? Known by its more formal name, conjunctivitis, this infection of the eye can be caused by a virus, bacteria, or allergies.
How do you catch it? Viral conjunctivitis usually comes from a cold-stricken child accidentally wiping mucus into his eyes, says Frankowski. A child can easily contract bacterial conjunctivitis by, say, playing with a toy that an infected child touched after rubbing his eye. It can also be spread by sharing washcloths or towels with someone who has conjunctivitis.
What are the symptoms? Itching; discharge from the eye; a pink or bloodshot look to the eye; crusts that form along the eyelid overnight; increased tear production.
How is it treated? Warm compresses on the eye can help relieve any itchiness. Viral conjunctivitis “will go away when the cold goes away,” says Frankowski, but the bacterial variety will need prescription antibiotic eye drops. Since there’s no real way to distinguish between the two types without a culture, a parent will likely have to consult a doctor. Similarly, pink eye that is caused by allergies generally improves on its own, but it can be treated with prescription eyedrops if it persists.
How is it prevented? Hand washing.
When should a doctor be consulted? Though pink eye is often harmless and will generally improve on its own, there is one form of bacterial conjunctivitis that can cause blindness. Deciding when to consult a doctor “is a little bit of a guessing game,” says Frankowski. “If [the issue is] just discharge and the rest of the eye does not look pink or bloodshot, it is less likely to be bacterial.” But there’s no way to be sure without a doctor weighing in.
What is it? Pertussis, aka whooping cough, is a bacterial infection of the upper respiratory tract that causes violent coughing fits.
How do you catch it? Children may breathe in respiratory secretions traveling through the air or come in contact with them on shared surfaces.
What are the symptoms? Pertussis begins as a typical cold might and can come with a low-grade fever, but it eventually progresses to an uncontrollable cough that often leaves a child breathless. When he finally sucks in air, he’ll make the characteristic “whooping” sound. However, kids under 6 months (and adults) often do not make the whooping sound. The cough can last for three months and keep kids out of school for an extended period.
How is it treated? Kids who are exposed to pertussis and treated early with an antibiotic can decrease their chances of coming down with the cough or spreading it to others. The CDC recommends that children under 18 months who have pertussis be closely monitored to make sure their breathing is not impaired. Infants with pertussis sometimes require hospitalization: While whooping cough is usually just an “annoying cough” in older kids, it can be fatal in babies.
How is it prevented? With a vaccination (DTaP vaccine) administered at 2 months, 4 months, 6 months, 15 to 18 months, 4 to 6 years, 11 to 12 years, and then every 10 years after that until a person is no longer likely to be around small children. “The biggest reservoir for the infection now is middle and high school kids who didn’t get the booster,” says Frankowski. “It’s the babysitting population, and they spread it to other kids.” And, she advises, given the severity of whooping cough in infants, “if you have a new baby in your life, make sure that any parent, grandparent, or aunt who takes of the baby is vaccinated.” The same goes for siblings.
When should a doctor be consulted? As soon as you think a child is exhibiting symptoms.
What is it? A viral infection that once got a bad rap as “the kissing disease.”
How do you catch it? Unlike the common cold, which can easily be passed on through surface contact, mono requires prolonged exposure. So it’s usually transmitted between people who spend a lot of time with one another—one reason it’s often blamed on teenage necking. “Don’t freak out that your 13-year-old has been kissing someone,” advises Murray. “It’s not a sexually transmitted disease. It can be passed through all sorts of respiratory secretions.” Though adolescents and teenagers are no more likely than younger kids to catch mono, they have a greater chance of getting really sick. In the pre-tween set, mono may resemble a milder viral illness that passes quickly.
What are the symptoms? Mono is very common and has a range of symptoms, some so mild that people can recover from mono without knowing that they ever had it. Most kids will feel very tired and may have a low-grade fever and swollen lymph nodes or tonsils. “People with mono often have the ugliest tonsils I have ever seen,” says Murray. In severe cases, mono can lead to infections such as hepatitis, pneumonia, and meningitis.
How is it treated? As with most viruses, there is no treatment. The best medicine, says Murray, is rest, making sure that the child stays hydrated and is fully recovered before resuming normal activities. “When your child is ready to go back to school, do it in a way that you are not re-fatiguing them or they could end up back where they started,” says Murray. She recommends starting the day late, attending for only a few hours a day, or alternating days to help students slowly regain their full strength. (A mono infection, says Murray, “is one of the few times I will have parents negotiate with a school.”) Kids are also advised to stay away from contact sports for two to three months, because inflammation in the lymph nodes can lead to swelling in the spleen, putting it at risk for rupture.
The recovery rate from mono varies widely, with some children better in 10 days while others need as long as four months to recover.
How is it prevented? Good old hand washing or religious use of hand sanitizer.
When should a doctor be consulted? If you suspect your child has mono, or if following a diagnosis of mono he or she has difficulty swallowing fluids or develops upper abdominal pain, which could mean the spleen is in trouble.
What is it? Though your old elementary-school nemesis—a virus called varicella zoster—has been subdued by a vaccine, it can still cause trouble on occasion, especially in communities where many parents have decided not to vaccinate against it.
How do you catch it? The virus travels through the air (through respiratory secretions, for instance), so there is no way to avoid it, except to be vaccinated.
What are the symptoms? Chicken pox is a tricky illness that changes its presentation over time, says Frankowski. Beginning as what looks like mosquito bites, the pox will blossom into more blistery “dewdrop-like” lesions that eventually burst and scab over. And, yes, it itches quite a bit.
How is it treated? There’s no treatment for chicken pox, just measures that can reduce its symptoms—remember those itchy days on the couch, all stiff from calamine lotion? Cool oatmeal baths can also help, as can oral antihistamines (if kids are old enough to take them), and fingernails should be trimmed so that scratching doesn’t lead to a secondary infection. Children will need to stay out of school for the duration of the infection (usually 7 to 10 days).
How is it prevented? Get your child vaccinated. “The dangerous part about chicken pox is that it can lead to skin infection, and the virus can get into the lungs or the brain. It’s relatively rare, but every year before they developed the vaccine, there were children who died of the disease,” says Frankowski. In most cases, vaccination is enough to keep a child who comes in contact with the virus from contracting it. And though the immunization doesn’t provide 100 percent protection, an immunized child who does come down with the virus will suffer from far fewer spots (say 12, instead of 100). Plus, a vaccinated child who gets chicken pox is much less likely later in life to develop shingles, a dangerous and painful manifestation of the disease that can strike adults who have had the pox as kids.
When should a doctor be consulted? If you suspect your child has chicken pox, call your doctor immediately. In most states, chicken pox needs to be reported to the health department.
What is it? An inflammation of the membranes surrounding the spinal cord and brain, meningitis can be caused by a virus or bacteria. Viral meningitis, the more common and milder form, is prominent in the late summer and early fall. Bacterial meningitis is more serious, but there are many vaccines to prevent it.
How do you catch it? Just as you do a cold or flu: through infected respiratory secretions in the air or on surfaces. The good news is that meningitis is far less contagious than those more common conditions.
What are the symptoms? Headache, stiff neck, and fever, sometimes accompanied by nausea and vomiting, light sensitivity, or seizures. If your child does not want to move his neck, that’s a possible tip-off. Infants with meningitis, however, do not typically display those symptoms and may instead be slow, inactive, or irritable and may suffer vomiting and a decreased appetite.
How is it treated? Bacterial meningitis is treated with antibiotics. Viral meningitis will usually resolve on its own. In serious cases of either, hospitalization may be required.
How is it prevented? There are two early-childhood vaccines—HiB vaccine and pneumococcal conjugate vaccine—that are part of the normal vaccine schedule and protect children from several kinds of meningitis. For meningococcal meningitis, which is rare but can be fatal, a vaccine is administered at age 11 or 12 and again before college.
When should a doctor be consulted? Immediately anytime your child is showing symptoms consistent with meningitis.
What is it? The scourge of kindergartens, lice are tiny parasites that live off of the blood in scalps. Though the ick factor with lice is about a 10, the danger factor is less than 1. In fact, the American Academy of Pediatrics released a report last year saying that because lice do not spread disease (and because children have already been contagious by the time the maddening itching starts), there’s no reason for infected kids to stay home from school once the lice have been discovered.
How can you catch it? Lice crawl (they can’t jump) from head to head, which is why they plague preschoolers and kindergarteners (all those little heads huddled close together over tables and during story time).
What are the symptoms? A very itchy scalp (an allergic reaction to the saliva of the lice); pinhead-sized nits (unhatched eggs) in the hair (if alive, they are tan and if dead, black; you may also find the white casings of hatched eggs); sesame seed–sized brown bugs that hang out in the hair behind the ears or at the nape of the neck and run from light.
How is it treated? There are two approaches to treating lice: one that involves medication, one that doesn’t. Over-the-counter pesticide shampoos and conditioners kill lice and their eggs and are usually used two times—once when the lice are discovered and again 7 to 10 days later to get any remaining nits. If OTC products do not work, your doctor can prescribe a medication. Always remember that all of these treatments are pesticides, not regular shampoos, so following package directions exactly is important to keep your child safe. And never use them until you have a confirmed diagnosis.
Given the involvement of pesticides, some parents opt for alternative approaches like the “comb-out,” a method Frankowski says can be effective if done correctly. Make sure to buy a comb specifically for head lice, such as the Licemeister ($10, cvs.com), and follow the directions of the National Pediculosis Association (an organization that advocates for nonchemical lice treatments). In conjunction with any treatment—nonchemical or not—make sure to wash exposed bedding and recently worn clothing in hot water and dry on high heat. Vacuum beds, sofas, stuffed animals, and car seats, and soak combs and brushes in very hot water for 10 minutes.
How is it prevented? You can’t. “It is a risk of childhood, just like colds and sore throats,” says Frankowski. So consider it a parenting rite of passage when that note comes home from school, and take action.
When should a doctor be consulted? Because the condition is easily confused with dandruff, if you suspect your child has lice, he or she should be checked by a doctor or school nurse.
What is it? There’s no way to sugarcoat this: Scabies are tiny mites that burrow under the skin, lay their eggs, and cause a very itchy rash.
How do you catch it? Skin-to-skin contact in close quarters (which is why the mites often besiege homeless shelters, but also favor preschools and child-care centers) and, to a lesser extent, through shared bedding or clothing.
What are the symptoms? An itchy rash characterized by pencil-like red lines or pimple-like nodules. Sometimes hidden between fingers, the rash is most bothersome at night.
How is it treated? With a chemical pesticide that is a stronger concentration of the most common over-the-counter treatment for lice, permethrin. “It is usually left on overnight and then showered off the next day,” says Frankowski, who advises having a doctor check out any child who has had close contact with a scabies sufferer. Though scabies does not represent a significant health risk to your child, it will continue to spread and cause discomfort until it is properly treated. The CDC recommends machine-washing in hot water any bedding and clothing used in the three days prior to treatment; dry it on the highest heat setting (or have it dry-cleaned). Items that cannot be washed should be stored in a sealed plastic bag for several days to a week.
How is it prevented? There’s not much you can do, should your child come down with scabies, except to treat the rest of your family preventatively (including thoroughly washing clothes and bedding).
When should a doctor be consulted? Immediately, if a child is exhibiting the symptoms of scabies—before you’re all awake half the night scratching yourselves.
What is it? A lovely gift of the playground, pinworms are tiny worms whose eggs can be found in animal feces. If a child plays in dirt (or a sandbox) that has them, he or she can become infected through hand-to-mouth contact. The eggs hatch in the digestive tract and the worms make their way through the body (causing no harm) before they emerge in an itchy heap to lay more eggs in the skin around the anus.
What are the symptoms? Intense itching in the anal area that worsens at night. If you notice your child scratching the area, become your own diagnostician. Sneak into his room at night and, using a flashlight, look for tiny, threadlike worms making their exit.
How is it treated? With a chewable pill taken once, and then again in two weeks. Until the treatment is complete, parents will need to be extra-vigilant about making sure infected children wash their hands thoroughly (and their bedding and clothes should be frequently cleaned in hot water). Because the worms emerge at night to lay their eggs, good bathing in the morning is recommended to prevent spreading the eggs. Exposed family members should consider treatment.
How is it prevented? Good, frequent hand washing, especially after a trip to the sandbox, a dig in the dirt, and before eating.
When should I call the doctor? “You should make an effort to see the pinworms,” says Frankowski. It’s no fun, but Frankowski recommends using Scotch tape, when you tiptoe into your child’s room at night, to pick up a few to show your doctor. You can also look for them in stool or on toilet paper after wiping. Then call the doc with your evidence to get the prescription treatment.
Ringworm, Jock Itch, and Athlete’s Foot
What are they? They sound like a troublesome bunch, don’t they? All three are caused by a group of funguses that like to make their home in the skin.
How do you catch them? All of these fungi can pass from skin-to-skin contact or through infected towels, clothes, or surfaces. They all thrive in humid environments such as indoor pool decks and locker rooms.
What are their symptoms? Ringworm (also known as tinea corporis) is an itchy rash on the skin that tends to clear in the center and spread outward, creating a ring. (Despite its name, no worms are involved.) Jock itch (or tinea cruris) shows up in the skin folds of the groin as itching red, scaly patches that may blister and ooze, while athlete’s foot (tinea pedis) is characterized by itchy, cracked, red skin around the toes.
What is the treatment? Over-the-counter antifungal medications are the first line of attack, but if they fail, stronger prescription medications may be used. Because a fungus infection can be stubborn, Murray recommends treating it “for two weeks after everything looks fine or a minimum of four weeks, whichever is longer.” In extreme cases, oral antifungals may be necessary.
How are they prevented? Sending your kid to gym class with a pair of shower shoes should help, and Murray recommends routine (at least weekly) washing of all gym clothes and jock straps. Note: Nothing should be left in the locker room over the weekend. For kids who are susceptible to athlete’s foot or jock itch, using drying powders or lotions after bathing is a good idea.
When should a doctor be consulted? If over-the-counter medication is not doing the job.