In this message we will discuss current staffing challenges and wait times, refill request policies, and home care advice for vomiting/stomach bug and cough/fever illnesses as well as Acetaminophen and Ibuprofen dosing tables.
Dear NAP Families,
Happy New Year! We hope you all had a wonderful holiday season and are ready to get back to a normal routine at home.
As you are aware, sick season is officially upon us! We at NAP are all putting our heads down and working as hard as we can to make sure all our patients are cared for to the best of our abilities. We realize that our same day sick visit appointments are filling quickly, and we apologize that we simply do not have the capacity to see every sick child the same day you call our office. Our nurses are happy to give home care instructions for vomiting, cough, and fever when your child does not seem acutely ill. Please keep in mind the number of calls we are receiving for this advice is very high and there may be a wait to speak with a nurse. These same home care instructions are outlined below.
Currently, we are experiencing a staffing shortage as several of our employees are on temporary leave and new hires have not yet started. Please be kind to our staff as they are doing their best to meet every child’s needs. Remember, you can often book “sick” visits through the MyChart portal to decrease the call volume to the office. As a reminder, we ask that you reserve those slots for relatively acute and straightforward issues that can be addressed by any provider in 10-15 minutes. Also, be aware of the date of the appointment you are choosing, as some slots may be listed for the next day. If you book a visit for the next day and then decide your child no longer needs to be seen, please cancel the visit on the portal or by calling the office. This will allow another patient to be seen in that slot. For more complex or chronic issues, please call our office so our appointment team can schedule you with your PCP within the next few days.
Our nurses would like to remind patients that we require 48 hours to process medication refill requests. Please track your child’s medication supply so you know when they are running low and can call for a refill before they are completely out. Our providers try to respond to refill requests over the noon hour or at the end of the day and do not see refill requests immediately. If you have already requested a refill by calling the office, sending a message through MyChart, or using your pharmacy’s refill request process, please do not send additional requests through another method. For example, if a parent requests a refill on MyChart they should not request a refill for the same medication by calling the office or using the pharmacy’s refill request process. Doing so does not result in the medication refill being sent any more quickly. Instead, it creates more work and confusion for our nursing staff, resulting in possible delay of the refill. If it has been longer than 48 hours since you requested the refill and it has not yet been sent, please follow up with a call to our office.
Home care instructions for vomiting and diarrhea illnesses (the “stomach bug”):
- Hydration is the most important thing during a stomach bug
- If vomiting, start with slow sips of clear fluids (diluted Gatorade or Powerade work well or you may use water, Pedialyte, or broth) every 10 minutes, and then increase as tolerated. Small frequent sips allow the body to stay hydrated without distending the stomach and triggering a vomiting reflex.
- Start bland/BRAT (bananas, rice, applesauce, toast or other simple carbs) diet once tolerating liquids. Okay for simple protein foods and non-gassy vegetables.
- If having diarrhea, may add probiotics such as yogurt or lactobacillus/acidophilus twice daily until diarrhea has stopped.
- Avoid lactose-containing foods (milk, ice cream, soft cheeses) for 1-2 weeks after diarrhea as the body needs to restore the lactase enzyme following this type of illness. Eating lactose may cause increased gas, bloating, and diarrhea.
- Call if worsening or not improving, or for any signs of dehydration.
- Monitor for dehydration by ensuring at least 2-3 urinations per 24 hours.
- Watch for increasing abdominal pain, lethargy, or blood in stools.
Home care instructions for cough/congestion/fever (“upper respiratory infections”):
- Keep well hydrated
- Use humidified air or steamy bathroom
- If older than one year of age, may use 1-2 teaspoons of honey (straight spoonful or mixed with herbal tea or warm lemonade) to relieve cough.
- Keep the head of bed elevated to allow mucous to drain at night and not pool in the back of the throat which causes coughing and nighttime waking.
- Monitor for worsening respiratory symptoms: rapid or labored breathing, shortness of breath, tugging with the muscles in the chest when breathing.
The most effective and safest cold/cough home treatments for children are
- Honey (for children over 1 year)
- Nasal saline irrigation or steam bath followed by suctioning/nose blowing
- Frequent nose blowing
- Topical application of ointment containing camphor, menthol, and eucalyptus oils (such as Vicks)
- Ibuprofen or acetaminophen (dosed by age/weight) for comfort from aches, fever, and/or sore throat as needed. Ibuprofen should not be used for children younger than 6 months.
While we understand there are other “cough and cold” medications available in stores and marketed and labeled for children, the American Academy of Pediatrics recommends avoiding all cough and cold medications in children younger than 6 years. Even in children over 6 years of age there is no evidence to show that these medications are more effective than the treatments above.
We do not recommend decongestants for children. Evidence of the effectiveness of decongestants is limited, and they are associated with serious side effects.
Please note that combination cold medications often contain ingredients that are not specifically safe or helpful for children. Sometimes these combinations contain acetaminophen or ibuprofen that could lead to accidental overdose if the child is also being given these medicines for fever or discomfort.
Resources/sources:
Common Cold
What is a cough?
Use with Caution: Cough and Cold Medicine Safety Tips
Acetaminophen (Tylenol) and Ibuprofen (Motrin/Advil) dosing:
We thank you for your continued understanding and patience so our wonderful staff can continue to provide the best care for all our families.
Have a safe and happy holiday New Year!
Northampton Area Pediatrics