Timing is Key

Having knowledge about common childhood infections does not mean that I always know when to bring my children in to the pediatrician when they have signs and symptoms of colds. In fact, there have been a few times when I knew the cause was viral and there would be nothing for the pediatrician to offer, but I made an appointment anyway. I needed to prove to myself that that was the case and nothing more, especially before the weekend. Or perhaps I wanted to be able to tell the school that she's fine and can be in school. On the other hand, there was a time when I thought it was just a cold when in fact it was a "strep" infection that was rather contagious. After that episode, I err on the cautious side, but I still don't rush her in with every sniffle or cough -- unless she has a companion rash (turned out to be a contact dermatitis).

My daughter has had a cold for 3 weeks. It started out with a sore throat, sneezes, runny nose, and cough, but has not had a fever or changes in energy level or activity interest. Gradually her coughing started to get better, and her thick, yellow mucus stopped being a messy problem. And then at 5 am yesterday, I heard loud whimpering and complaints that her left ear was hurting and "I don't like it I don't like it I don't like it!" She felt warm to the touch, but too bad my thermometer chose not to work anymore. She had also kicked her covers off of her, claiming that they were making her hot. I tried a warm water bottle for her ear, which consoled her for 3 minutes. She then complained about her face hurting (probably from leaning on the mouth of the bottle). Nevertheless, I gave her 2 chewable ibuprofen tablets (2 acetaminophen would have been fine, too) in hopes of relieving her acute ear pain and treating her discomfort from the fever. She immediately fell back to sleep (without her lullabies cd) for 4 solid hours. She woke up yelling that she didn't feel pain anymore. By then I had already scheduled an appointment for her. Thankfully(?), she did have a slight headache. I wasn't going to take her complaints about ear pain lightly because it was sudden and she has had the lingering cold. But, yes, I did consider not calling and just letting her sleep it off. Despite her quick turnaround, I brought her in. The verdict? She was diagnosed with bilateral acute otitis media. Most of the cases are viral and don't require antibiotics, but this was likely a secondary infection. Ten days of antibiotics. I must say that despite her refusal to rest properly, my daughter is a good patient. She drank a lot of fluids, including chicken soup that my friend made and brought over. Moreover, she took her first dose of the antibiotic immediately in the car. The pharmacist made it easy for us with the free dosing spoon.

Ear infections are not contagious, but the resurgence of her cold may be, so she won't be going to school until she has taken 24 hours of antibiotics. However, she does not want to miss her clay class after school. Her first dose of the antibiotic was in the car. I just gave her her second dose. I had to wake her, but I wouldn't want to delay her dose to give the bacteria a chance to adapt to the antibiotic. Giving this class of antibiotics (cephalosporin) on time ensures killing of the bacteria. Timing is key; for the visit with the pediatrician and for giving the medication.

"She has Scarlet Fever"

It started with a low-grade temperature, sneezes, and general fatigue on Thursday. She did mention a sore throat (which made me think Strep throat right away). I kept my daughter home from preschool. Each time I measured her axillary (under armpit) temperature it was normal, but her tactile temperature felt much warmer. She even looked flushed. In the afternoon, it actually was 98.9 degrees F (at or above 99 is considered a fever). I didn't quite trust the digital thermometer because she still felt warm and she kept saying she was cold. By the way, KidsHealth offers a terrific summary of fever in children. My daughter was actually very whiny and looked ill. I offered her chewable acetaminophen (generic Tylenol) tablets to help her rest better (note, I expected her to refuse). She took all 3 tablets and actually liked it. After a while, she took a nap. I kept asking her if her throat still hurt, and she kept denying it. So much for my strep theory. She also slept through the night.

The next morning, she asked for more acetaminophen, but she clearly did not need it. She claimed that her throat hurt a little. After she drank some water, she said it was better. Maybe because I kept offering to take her to the pediatrician if her throat still hurt. In any case, she looked 100% better and was jumping, singing, and dancing. I wondered if I should let her go to school, but it was suggested that she go because she's turned around. "Does your throat hurt?" "Just a little." Later, "no." She was fine the rest of the day; just one or two sneezes. There was a case of strep reported in the 3's class. Since she didn't ever have a fever, I kept it on the back burner. What my daughter has is probably just viral; the common cold.

Saturday morning, my husband noticed a rash on her cheeks. He relayed that to me, but I must not have heard him. Her throat hurt in the morning, but then it didn't. We went to a ballet performance and then a late lunch/early dinner. No sneezing. She ate like a champ. In the evening, though, when I gave her a bath, I noticed a rash on her back, her trunk, and her pelvic area. There were a few blotches of red, but the rest were small and skin colored. They felt like sandpaper. They reminded me of goose pimples. We thought she might have fifth disease, which is caused by parvovirus. She did develop the rash 2 days after the "fever" and she was flushed (slap cheek). Since she didn't have a fever, I decided to wait until Monday to bring her to the pediatrician to take a look. In 5th disease, once the rash breaks out, the child is no longer contagious. Here is a good collection of skin rash photos.

On Sunday, she developed a few little red lesions around her mouth, but otherwise fine. We ran errands and all was well. The red lesions on her body were fading in color, but the sandpaper rash was still there.

On Monday, the lesions around her mouth were still there. She woke up a little later than usual, but was chipper. I brought her to school and then was able to schedule an appointment with the pediatrician. When I brought her in, he took one look at the rash and said, "She has scarlet fever." He then looked at her throat and took a sample for a throat culture. She was started on cefdinir (Omnicef) twice a day for 5 days. Sure enough, the culture was positive for strep in less than 24 hours. I should have trusted my initial instinct.

Cefdinir liquid is white and tastes bitter (not like the acetaminophen chewable tablets), but I explained to my daughter the rationale for taking this. I let her eat a piece of gummy candy and then drink from the medicinal spoon. We repeated this a few times. I even diluted the remaining volume (1 mL with water), but she quickly asked if she had to drink it all. Next time I will not dilute it with so much water. This morning, she refused to take it, but I gave her a freeze pop to numb her tongue and to cleanse her palette after each swallow. It worked like a charm.

We're home for a couple of days because scarlet fever is highly contagious. She will be allowed to return to school after being fever-free for 24 hours and after taking a full day of her antibiotic. The nurse also told me to change her toothbrush after 48 hours of starting her antibiotic. We're expecting some peeling later on in the week, but she' recover. Scarlet fever is not as life-threatening as it seems if treated in a timely manner with appropriate therapy. I'm glad I brought her in.