School Bugs and Germs

In the winter, schools are transformed into hothouses for nasty germs. For the kids cooped up inside, that can mean an onslaught of viruses -- colds, flu, and stomach bugs.

"There's a lot of germ swapping in schools," says Laura A. Jana, MD, a pediatrician and owner of Primrose School of Legacy, a child care center and kindergarten in Omaha, Neb. "You can limit the spread of viruses with good hand washing, but your children are going to get sick sometimes. It's inevitable."

When your child comes home from school feverish and pale, what should you do? Here's some advice on how to help children feel better as they endure a winter's worth of school germs.

Children and Viruses: Stomach Bugs

Of all the nasty things your kids might bring home, stomach bugs are among the worst. While often called "stomach flu," they're unrelated to true influenza and are caused by other viruses.

Try these tips when your child is brought low by a stomach virus.

1. Drink Plenty of Fluids

If children have vomiting and diarrhea, they're losing fluids. Make sure they're drinking to prevent dehydration, says Joel Rosh, MD,director of pediatric gastroenterology and nutrition at Goryeb Children’s Hospital in Morristown, N.J. Wait 30 to 60 minutes after they vomit and give them a small amount of fluid. If they can keep that down, give a little more.

It's important to drink slowly, since a large volume of liquid will trigger vomiting. "I recommend frozen Popsicles," says Jana, who is also co-author of Heading Home with Your Newborn  and Food Fights . "You can't eat them too fast, and that's especially important with young kids who might want to guzzle." Drinking liquids with a spoon is another way to slow down the intake.

What should your sick child be drinking? Start with clear liquids or oral rehydration solutions for children sold in drug stores. Acidic drinks -- like orange juice -- are not a good idea if your kids are still vomiting. But in general, most liquids -- even milk -- are fine, as long as your children tolerate them.

"Milk gets a bad rap," says Jana. "Parents think that it's hard to digest when their kids are sick to their stomachs, but that's not the case. It's also a good source of protein, fat and calories."

2. Reintroduce Foods Slowly Into Their Diet

Once your children have gone six hours without vomiting, offer them some food. If they're not interested, don't force it. Just try again later.

Start with bland foods, but experts recommend returning to a normal diet within 24 hours if possible.Just keep the portions small -- it's often the volume of the food that upsets the stomach.

Fat in food can also help with diarrhea. Fat takes longer to digest, so it can slow down your child's system. However, continuing to eat a bland, fat-free diet for days on end could prolong diarrhea.

"I sometimes see kids with ongoing diarrhea after a virus," says Rosh. "They think I'm a genius when I tell them to go eat some ice cream and drink some milk and they get better."

3. Use Over-the-Counter Medicine With Care

Some medicines designed to settle stomachs and stop diarrhea are FDA-approved for children. OTC medicines such as Imodium and Kaopectate 1-D, containing the drug loperamide, are approved for children age 6 and over. Regular Pepto-Bismol and Kaopectate, containing bismuth subsalicylate, are approved for kids 12 and older. Pepto-Bismol and Kaopectate contain aspirin-like ingredients and should not be used in children with chicken pox or flu-like symptoms because of the risk of Reye's syndrome, a rare but serious illness. Children’s Pepto-Bismol does not have aspirin-like ingredients and can help settle stomachs but does not contain medicine to stop diarrhea.

It's a good idea to check with a doctor before using these medicines in a child of any age. Drugs that stop diarrhea could be dangerous if your child has a bacterial infection in the intestines. These medicines could prevent the body from flushing out the bacteria. If your child has signs of infection, like a fever or bloody stools, do not use these medicines and call a doctor.

Also, medicines that contain bismuth subsalicylate, like aspirin, pose a small risk of Reye's syndrome in kids. If your child or teenager has recently had a flu or chickenpox, avoid those drugs.

Children and Viruses: Cold and Flu

Telling the difference between colds and flu isn't always easy, but in general, flu is more severe. While a cold might be annoying, flu will leave your children flattened on the couch. Here are five things to consider.

1. Fluids. With cold and flu, dehydration is less of an issue than it is with a stomach virus. Liquids are still important, since they help loosen mucus and prevent it from getting sticky. Warm fluids, like soup, might be especially helpful.
   Some parents run for electrolyte solutions whenever their kids have any kind of illness. It's not necessary with cold and flu, Jana says. Just about anything your child wants to drink is fine. Again, the protein and fat in milk make it a good choice -- despite the common misconception that milk causes congestion.
2. Food. "Parents really need to take food off the worry list when their kids have a cold or flu," says Jana. Yes, your child might not eat much for a few days and lose some weight. But that weight comes back very quickly after they recover. Anything your child wants to eat is acceptable, Jana says
3. Pain and fever relief. Children's acetaminophen or ibuprofen can help ease discomfort and bring down a fever. However, Jana says that parents should pay more attention to how their children feel than the number on the thermometer.
   "Parents tend to overtreat fever," says Jana. "If your children have a fever but are out playing in the yard happily, you probably don't need to give them medicine."
4. Cold and flu medicines. Don't use any OTC cough, cold, or flu medicine in a child under 4. Even in older children, it might be best to check with a pediatrician first. These medicines do have risks and there's not much evidence that they will help. And never give aspirin to a child, especially those with flu-like illnesses, unless you discuss this with your pediatrician first.
5. Moisture. Dry air can aggravate cold and flu symptoms. Keep a humidifier running in your children’s room to help make them more comfortable. If they'll tolerate it, a nasal saline spray could help too.

Children and Viruses: When to Get Help

In the majority of cases, colds, flu, and stomach bugs will pass on their own. However, some symptoms definitely do need to be checked out by a pediatrician. They include:

• Fever of 100.4 degrees or higher for a child 2 months old or younger, 101 degrees or higher for a child 3 to 6 months old, and 103 degrees or higher in a child older than 6 months
• Fever that lasts more than 24 hours
• Difficulty breathing
• Behavior changes or lethargy
• Not urinating for eight hours or more
• No tears when crying
• Vomiting that goes on for more than eight hours
• Blood in vomit or stool
• Green vomit

"I believe strongly in parental radar," says Rosh. "If your children just don't seem right to you, bring them to the pediatrician."

Children and Viruses: What Else Can You Do?

At this point, you might be thinking: There must be something else I can do for my poor kid.

"Nothing tugs on a parent's heartstrings more than a sick child," says Rosh. "Parents become desperate to do something to make them better." Unfortunately, there probably isn't anything. You just have to wait for their body to fight off the virus.

While you might not be able to make the illness go away faster, you can take this time to be close with your children, Rosh says. Read a book or watch a movie together. Be with them. They're going to have a lot of viruses in their lives. You're helping them learn how to cope with them.

Beyond that, be patient. "Comfort your child," says Rosh, "and wait for the human body to do its thing."