A little while ago, Jaybird expressed an interest in the stuff I find boring and commonplace. As we are on the cusp of my busy season, wherein I see patient after patient after patient with the same litany of cold symptoms, I thought I would oblige him.
There are a few caveats that should be dispensed with immediately. First and most importantly, nothing in this post should be in any way construed as medical advice. I am sharing the following thoughts as a helpful FYI, but any actual questions about real, live patients should be directed to the appropriate medical providers. Also, I don’t know how interesting or useful this will be to anyone, since I have no idea how many parents read this blog with any regularity. (I’m guessing somewhere in the low thousands, but that’s just a rough estimate.) I apologize if this post is boring as hell.
That being said, here are a few Handy Tips About Colds:
1) Green nasal discharge does not mean it’s a sinus infection. The color of the snot yields no helpful information in determining if the symptoms are related to a bacterial infection (for which antibiotics are useful) and a viral infection (for which they are worthless). The color is the result of enzymatic activity on the part of certain white blood cells, so it does indicate that the immune system is active. But it doesn’t indicate the need for an antibiotic all by itself.
2) The degree of fever is not a reliable indicator of the kind of infection, either. Some viruses can cause high fevers. Some bacterial infections don’t present with fevers at all. In general, I’m more interested in how the fevers are trending than the absolute number. And I’m much more interested in how the kid looks in general. I’m far less worried about a kid with a temperature of 103.4 who’s destroying my exam room than I am about the kid with a temp of 101 who looks like death warmed over.
3) Cough suppressants don’t work. If they did, they’d be dangerous. I understand that the cough can be the most frustrating symptom of a viral upper respiratory infection, particularly if it’s bad at night and interfering with everyone’s sleep. I am sincerely sympathetic. But there are multiple reasons not to give cough medications. The first and most basic is that they simply aren’t effective. One study showed that even codeine is no more effective than honey at suppressing cough (though the flipside is that honey is just as good as codeine). But as annoying as the cough is, it serves an important physiological purpose. Infections in the lungs lead to an accumulation of a lot of excess material, which is what produces that congested, rattly sensation when affected children breathe. The cough is the body’s mechanism for clearing those excess secretions, and suppressing it would only allow the material to accumulate. Accumulated material both impairs lung function and serves as a great medium for bacteria to proliferate, both of which are really undesirable outcomes. We don’t have anything to recommend to take the cough away, and we really wouldn’t want to, even if we could.
4) It’s not usual for the cough to last for 10-14 days. I know, it’s awful. But even if it’s been a week, that doesn’t necessarily mean it’s anything other than a straightforward upper respiratory infection. As with fever, I’m interested in how things are trending. It’s not unusual for the cough to sound worse midway through the illness, and to go from a dry sound to a more loose or wet sound. As the infection clears, the accumulated material mentioned above begins to loosen, making the cough sound worse. Like I said, this is the body doing what it’s meant to do.
5) I’m not withholding antibiotics because I’m a dick. I’m sure I’ve harped on this before, but it’s a point that always seems to need repeating. Antibiotics won’t do a blessed thing to clear a viral infection. If your child’s symptoms are consistent with a viral infection, of which it is normal for children to get about one per month during the peak season, chances are that’s what it is, and what I’m going to diagnose. I’m not going to prescribe a medication that is unlikely to help, and will only cause side effects and raise the possibility of antibiotic resistance down the line. I know that’s not what a lot of people want to hear, but it’s the right answer much of the time. It’s far easier to scribble out a prescription and make people happy (show me a script for a Z-pak and I’ll likely be able to show you a lazy doctor), but if I don’t do it please believe it’s because I’m trying to do right by both your child and the community at large.
I have no idea if any of this is information that’s interesting or informative to anyone. However, since I know I will see lots of patients in the coming months whose parents are bringing their kids in for one of the reasons above, it seemed like a useful thing to do to put this out there. I’ll get back to commenting about Project Runway soon.