With the school year now in full-swing, and subtle signs of autumn beginning to surface despite uneven temperatures, seasonal illnesses have begun making their presence known.
For months now, every pharmacy, big box store, and urgent care clinic has been advertising the availability of flu shots, and news headlines have been announcing that particular illness’ dreaded return.
But another, equally infamous sickness is making the rounds in Maryland. KinderMender has experienced an unusually high rise of children arriving with fever, sore throat, cough, vomiting, and diarrhea – all symptoms consistent with enterovirus.
Patients have ranged in age from infants to older adolescents. Because of their immune history, older children typically are not affected by such viruses, with the exception of influenza, which changes each year.
In just two weeks, this enterovirus outbreak has spread rapidly throughout our communities. Although we typically see waves of the illness each season, this noticeable uptick in cases is somewhat unusual and unnerving.
Because of this, it is important for parents and guardians to be able to identify the symptoms and stages of enterovirus, which has a tendency to manifest with fever, vomiting, and/or respiratory distress.
In many cases, when discussing the illness’ history with patients, we often discover that early signs of the enterovirus actually occurred several days before, but were not considered significant or were misconstrued as allergy symptoms. The viral illness poster that hangs in our examination rooms deftly illustrates the path a virus takes after entering the body.
Enteroviruses, in particular, follow a distinct pattern, and not every stage is as severe or as distressing as another, which can be misleading. After causing local symptoms such as minor congestion, the enterovirus will work its way through the following phases:
- Headache and sore throat – This level of discomfort demands a little more attention from the sufferer. Older children may say they feel like they have strep, while younger children will lose their appetite because of discomfort swallowing.
Infants, too, tend to launch into a pattern of “start and stop” – or what I refer to as “Groundhog’s Day” style – feeding. They start to eat because they are hungry, hit the brakes when the milk or formula stings their throat, but then start feeding again shortly after because they almost immediately forget the irritation. Many infants will also drool excessively at this stage, because their throats hurt too much to swallow. Moms and dads may attribute the drool to teething, but it should be noted that an enterovirus will cause drooling to intensify significantly. Babies also frequently bang or pull on their ears because of referred pain to the ear from the throat, or smack their heads due to a headache they can’t express.
- Fever – As the enterovirus segues from local to systemic stages, many children feel sicker and achier. Some even develop rashes, which prompts families to seek unnecessary testing for illnesses such as strep.
- Gastrointestinal distress – Ultimately, unfortunately, the enterovirus settles in the stomach causing vomiting in some, nausea in others, and intermittent gas pain in most children. The latter will make babies more fussy and unsettled at nighttime, causing interruptions in sleep and ear-piercing, middle-of-the-night screams when they wake up in pain. It is important to note: Although children with ear pain can also have fussiest at night, the pain associated with gas pain has a very characteristic, sharp, on-and-off pattern. Many parents have told us that they jump out of bed very concerned only to find baby calmed down dramatically. Just as they settle back in bed after checking on baby, the screams begin again.
Many babies may also exhibit “false alarms,” in which diaper odor indicates that a surprise may be waiting, only to yield fruitless searches. An initial decrease in bowel movements, in fact, can be a deceptive lull before the storm that creates concerns about constipation. Not to worry – the next phase is usually diarrhea that is uniquely powerful in odor and typically “blamed on the other side of the family!”
Of particular concern with enterovirus are children with a history of sensitive airways. Even if not formally diagnosed with asthma, children who cough more severely at night will usually exhibit more chest congestion and mucus production.
While most illnesses caused by enterovirus are self-limited and are managed symptomatically, some children are more vulnerable than others. Younger infants, for example, are at risk for dehydration due to vomiting or diarrhea. Children with respiratory problems, too, can have worsening symptoms that may need to be relieved with albuterol or in some cases even steroids to reduce chest congestion or inflammation. Although rare, we have also treated an infant with enteroviral meningitis, which required hospitalization.
If your child is exhibiting symptoms consistent with enterovirus, contact your pediatric provider. Again, it is important to remember that many illnesses have multiple overlapping symptoms, and what may appear as strep throat or an ear infection, may actually have causes that are non-bacterial in nature and cannot – in any way – be remedied with antibiotics.
To rule out unnecessary testing and/or overtreatment with antibiotics that can lead to side-effects and resistant superbugs, it is crucial to receive a measured, clinical evaluation and diagnosis from a trained provider.
KinderMender always looks at the big picture, first. Ultimately, that big picture is the continued health of our children. Our offices are open 7 days a week, 365 days a year.