It's cold and flu season, which means plenty of moms are facing that age-old parenting dilemma: Do I send my coughing, sniffly child to school? And if I make the wrong choice, will the school nurse call a few hours later asking me to take him back home?

Figuring out when to keep your child home from school and when he's well enough to go back isn't always easy, says Dr. Loraine Stern, associate clinical professor of pediatrics at UCLA School of Medicine in California.

“The truth is, you can't always tell how sick a child really is," says Stern. For instance, some kids may seem totally fine at breakfast but take a quick turn for the worse and end up very sick two hours later.

What to Do With a Flu
Of course, when it comes to such flu symptoms as high fever, vomiting and body aches, the answer is a no-brainer."If your child is running a fever, you should keep her home because she's not going to be able to sit at her desk and pay attention," says Stern. This applies to seasonal flu as well as H1N1 virus (swine flu), she adds.

What to Do With a Cold
When your child has run-of-the-mill cold symptoms like a runny nose and cough, deciding whether to send or keep him home isn't always cut and dry, says Stern."Let's face it, if you wait for children to have noses that are completely clear, they're never going to go to school," she says.

So, as long as your child doesn't have a fever and is acting normal, it's fine to send him to school with a minor cold. Even nasal discharge, as unpleasant as it may be, isn't reason enough to keep a child home.

“Young children often have this at the end of a cold, and it's perfectly normal and not contagious," says Stern."If the discharge goes on for seven to 10 days, it may be a sign of a sinus infection, but that's not something that's contagious either."

On the other hand, a cough that's bad enough to disturb other kids in the classroom is a good reason to keep a child home.

More Signs to Stay Home 
Some signs to stay home are more clear-cut. For example, keep your child home if she has a highly contagious infection such as strep throat or conjunctivitis, says Stern. With strep throat, kids need to be on antibiotics for 24 hours before they can return to school. But with conjunctivitis (pinkeye), kids need only be under treatment, and they can go back to class."That means the condition is getting better with medication but not necessarily cleared up yet," says Stern.

Since ear infections are not contagious, there's no reason to keep your child home when she has one, even if she's taking antibiotics."Yet the current thinking is that the majority of ear infections get better by themselves without antibiotics," notes Stern.

Quick Reference Guide
Here's Stern's cheat sheet on the do's and don'ts of keeping a sick child home.

Keep your children home if they:

• Have a fever.
• Are unable to concentrate on schoolwork due to symptoms.
• Have symptoms (such as diarrhea) that disrupt activities  or distract classmates (such as a hacking cough).

Send your children to school if they:

• Had a fever that has been gone for 24 hours.
• Are alert and able to pay attention in class.
• Don't require a teacher to provide extra care.

And if you do have a sick child at home, try to see the silver lining."Enjoy the time at home with him," says Stern."It's a chance to do the kinds of things you don't have a chance to do when everyone's so busy -- like curling up on the couch with your child in your lap and reading books together."

Photo by Kyle Nieber on Unsplash

No mom enjoys hearing her child cough, even though pediatricians often remind parents that coughing is actually a good thing: It's the body's way of keeping the lungs clear and preventing pneumonia. But that doesn't make the problem any easier for you or your child, especially when your little one can't get a good night's sleep because of a nagging cough.

Figuring out the cause of your child's cough can be tricky, says Dr. Roy Benaroch, assistant clinical professor of pediatrics at Emory University in Atlanta.

"The description of the cough is really just a starting point because different people hear slightly different things," says Benaroch."You really need to look at the cough in context of the other symptoms.”

The first question you need to ask yourself is, "How sick is my child?" says Benaroch. For instance, if your child is sucking in her ribs with every breath, breathing fast or having trouble speaking in complete sentences, these are all signs of breathing difficulties that require prompt medical attention either in the physician's office or in the emergency room, he says.

Below is a guide to deciphering and treating the most common types of cough symptoms in young children.

Cough symptom: Wet and productive, or dry and hacking

What it probably means: It's likely a cold or another upper respiratory infection, which are the most common causes of coughs in children, according to Benaroch. He adds that while the child's cough may sound productive, it usually isn't; young children generally don't cough up phlegm.

How to treat it: Plenty of fluids and a vaporizer, which adds moisture to dry air, effectively ease coughs due to colds. Parents can also administer appropriate over-the-counter cough and cold medicine based on the age of their children. If the cough is accompanied by a high fever (more than 103 F), take your child to a pediatrician to rule out pneumonia. "If the fever comes on in the middle of the night, you don't need to rush to the ER right then," says Benaroch."In this case, it's usually OK to wait until the next morning.”

Cough symptom: Wheezy

What it probably means: This is the classic chronic cough that often accompanies asthma symptoms. Oftentimes, the cough is triggered by cold air or exercise.

How to treat it: If you notice that your child is wheezing, call your doctor right away, as it might be a sign of a first asthma attack. If the wheezing is severe and your child has difficulty breathing (struggles for each breath, makes grunting noises with each breath, or cannot speak or cry due to difficulty breathing), call 911 immediately. Depending on the severity and frequency of asthma symptoms, your child may need to take asthma drugs to control the disease, treat the symptoms or do both. 

Cough symptom: Dry and tickling

What it probably means: A cough that's caused by environmental allergies, such as mold or ragweed, often originates in the upper airways, says Benaroch. "By the time kids are about 6 or so, I'll often ask them to show me where the cough is coming from. With allergy-related coughs, they'll usually point to the upper chest," he says. Other symptoms that accompany the cough include an itchy nose and frequent sneezing.

How to treat it: The best solution for managing allergies is to try to minimize exposure to known allergens. However, over-the-counter allergy medicines, such as those that contain the antihistamine loratadine, can also be helpful.

Cough symptom: Bark-like

What it probably means: If your child wakes up in the middle of the night and her cough sounds like a seal or a small dog barking, the likely culprit is croup. This common childhood infection causes swelling of the larynx and trachea, which is why children also often have a hoarse voice and make a high-pitched, squeaky sound as they inhale. The cough usually lasts three or four days; it often improves during the day and then gets worse again at night.

How to treat it: "I tell parents it's important to remain calm so that the child remains calm. As children become more anxious, they tighten their throats and that just makes the cough worse," says Benaroch. The best remedy for croup is to take your child outside if it's cold or into a steamy bathroom if the weather's warm. The cold or steamy air will help reduce swelling and ease the cough. Severe cases may require oral steroid medications. Children under the age of 2 are at a higher risk of developing breathing problems with croup, so be on the lookout for the signs of breathing difficulty listed above.

Cough symptom: Severe, violent and rapid

What it probably means: It could be whooping cough, a persistent bacterial infection of the lungs that has been increasingly prevalent across the U.S. "In school-age children, the infection can cause very severe bouts of coughing," says Benaroch. "A child may not be coughing constantly throughout the day, but he'll periodically have violent spells where he coughs so rapidly that he really doesn't get a chance to catch his breath."

The name comes from the "whoop" sound that kids make at the end of the cough as they take a big breath to try to get air into the lungs. Although babies generally don't cough, they're at the greatest risk of dying if infected with the bacteria. Until the pertussis vaccine became available in the 1950s, whooping cough was a common cause of mortality in newborns, says Benaroch, "and unfortunately it seems to be making a bit of a comeback."

A big cause for the resurgence in cases, he says, is that the pertussis vaccine given to babies doesn't offer lifelong immunity, and many preteens aren't getting the recommended pertussis booster recommended at age 11 or 12. A booster is also suggested for adults.

How to treat it: Antibiotics are essential to stop the spread of the bacteria. However, antibiotics generally don't ease symptoms or shorten the duration of the illness. If you or a family member has a persistent or severe cough, it's a good idea to avoid close contact with infants until a doctor has ruled out whooping cough.   

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You've been stuck at home with the flu for what seems like an eternity. The worst is over, but you still have some lingering sniffles, coughs and aches. Are you still contagious? Consult our guide.

The Common Cold
You’re still contagious: From one day before your first symptom to about three days after it.
You can catch the common cold from over 200 different viruses that lurk in the air and on common surfaces. You can be contagious before such telltale symptoms as sneezing, stuffy or runny nose, sore throat and coughing even begin. That means stellar hygiene is key 24/7, not just when you feel under the weather. And remember that a cold must run its course -- there is no cure for this common respiratory infection.

Seasonal Flu
You're still contagious: From one day before your first symptom to up to seven days after it.
The flu hitches rides on sneeze and cough droplets. "You're most infectious during the first three days that you're sick with the flu, because that's when you experience the most nasal secretions," says Dr. Linda Meloy, a pediatrician and professor in the division of general pediatrics at Virginia Commonwealth University Children's Medical Center in Richmond, Va. This period also usually corresponds to when your fever is highest. An antiviral medication may shorten the stretch that you're contagious, so see your doctor at the first sign of symptoms: fever, headache, muscle pain, fatigue, runny nose or sore throat.

Strep Throat
You're still contagious: From the first day of symptoms to 24 hours after you start taking antibiotics.
The streptococcal bacteria is the culprit behind the classic symptoms: sudden sore throat, pain when you swallow, fever over 101 F, swollen tonsils, swollen lymph nodes, and white or yellow spots on the back of the throat. Unlike when you have a cold or the flu, you need an antibiotic to get well, so it's crucial to visit your doctor for a strep test and a treatment plan that includes prescription antibiotics. Although you're typically not contagious after a full day on the medication, it's important to complete the entire course of treatment to eradicate the infection completely.

Bronchitis
You're still contagious: From the first day of your first symptom to up to 7 days after it.
A virus is usually to blame for this inflammation of the bronchial tubes, and the infection takes about a week to leave your system. Key symptoms include a cough that produces mucus, wheezing, low fever and chest tightness. Once in a while, bronchitis is caused by bacteria (your doctor can check), and you'll need an antibiotic to kick it.

Pneumonia
You're still contagious: From the first day of your first symptom to 24 hours after you start taking antibiotics.
This infection of the lungs is most often caused by bacteria called pneumococcus, so you won't recover until you treat it with antibiotics. The most common symptoms are cough, fever, chills, wheezing and shortness of breath. That said, in rare cases, pneumonia is caused by a virus, so medications won't wipe out the infection (and it will take about a week to stop being contagious).

Allergies
You're still contagious: Never.
Many hay fever symptoms -- sneezing, stuffy nose, headache, wheezing -- copycat the symptoms of the common cold. However, you can't spread or catch allergies, because they're not infectious illnesses, says Dr. Charles Ericsson, head of clinical infectious disease at the University of Texas Medical School in Houston. So why do you and your spouse get hay fever at the same time? Probably because you've been exposed to the same environmental triggers, such as pollen, mold and dust.

Photo by engin akyurt on Unsplash

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When adults get hit with the flu, there's no mistaking it. You're feverish, your head feels stuffed up, and you ache everywhere. But with kids, the signs aren't always as easy to detect. Young children with the flu can run the whole gamut of symptoms," says Dr. Martha Snyder, a pediatrician and assistant professor of pediatrics at Duke University School of Medicine."Some children have the mildest of mild symptoms, while for others, symptoms are very severe.”

Below is your guide to spotting flu symptoms no matter what your child's age, and ways to bring relief.

Infants Under Six Months
Babies in the first six months of life are at the greatest risk of complications from the flu, says Snyder, because their immune system is not fully mature yet and their very small airway makes it easy for them to experience respiratory distress.

If your infant has a fever, call your doctor and watch for other signs of illness, such as dehydration. "When babies this age don't feel good, they usually don't want to drink," she adds. Provide plenty of water to keep an infant hydrated.

 

Children Six Months to 2 Years
Kids under the age of 2 who come down with the flu often have respiratory symptoms (cough, runny nose, sneezing), high fevers (sometimes as high as 104 F), diarrhea and vomiting."But while many kids have all of these symptoms, others may only have one," says Snyder.

Recognizing the early signs in toddlers is especially important, she says, because they can also get dangerously dehydrated very quickly. In addition, because of their smaller airways, babies can quickly progress to having wheezing and labored breath, which requires medication. Signs that a child's breathing is compromised include wheezing, fast breathing or shortness of breath, and nose flaring.

Children 2 to 4 Years
A child who can't talk yet (or can't talk well) obviously can't tell you that his body aches all over, so you need to be alert for behavioral changes, says Snyder. For instance, in many cases, children with the flu will have shaking chills and refuse to walk, because their legs are very achy.

With kids under the age of 4, you really have to watch them to see how they're acting. Respond to anything that seems out of the ordinary," adds Snyder. "Young kids often have a limp look to them. Or they're so uncomfortable they just want to be held."

Children 4 to 6
Once kids can tell you how they feel, listen for complaints similar to an adult's. But be aware that if your child is under the age of 6, oral over-the-counter cold and flu medications are not recommended. "You should never give children this age decongestants, cough suppressants and other OTC cold remedies, because of the side effects," says Snyder.

But there are other things you can do. "It's OK to give your child acetaminophen or ibuprofen for fever or pain reduction," adds Snyder. It's also safe to apply topical soothers to help relieve symptoms. And some children don't mind saline nasal sprays for stuffy noses but be careful not to use them too often (more than six times a day), since overuse can cause swelling of a child's nasal passages.

Other beneficial non-drug treatments for colds and flu include chamomile tea with honey, and a cool mist humidifier. Just be sure to use one that has a humidity gauge and to keep the level at no higher than around 50 percent to avoid a mold problem.

Children Over 6
For children over the age of 6, symptoms are essentially the same as adults'. And at this point, OTC decongestants and cough suppressants are generally safe, although they're not recommended for children with certain health conditions. For instance, if your child is taking medication for ADHD, ask your doctor before giving your kid a decongestant, since the combination of the two drugs has been shown to cause heart problems.

In addition, kids with asthma or any kind of respiratory problem should stay away from cough suppressants, says Snyder, because these products may make it harder for them to clear secretions from their lungs, which can lead to pneumonia.

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This year, when you're hosting parties and relatives during the holidays, there's an extra challenge to add to the mix: the risk of spreading cold and flu germs. While we all love to celebrate with friends, family and co-workers, it's easy for germs to crash the party.

Luckily, you can be a gracious host and keep everyone healthy, says etiquette expert Anna Post, great-great-granddaughter of Emily Post, the American author on etiquette. "It's always important to have good manners, but it's especially important during cold and flu season," she says

Post has some valuable advice for how to handle six of the season's most common germ-spreading scenarios. Follow her lead, and no one will leave your home with hurt feelings -- or the flu.

Scenario No. 1: Your friends arrive for a long weekend, and their child regularly sneezes without covering her mouth.

It's not your place to correct someone else's child, says Post. It's better to speak to the parent -- be clear and calm, as you're more likely to offend if you sound upset. Make it easy on your guests by saying, "I know we're all extra-worried about the flu this season. I'd be happy to leave a stool in the kitchen so the kids can wash their hands." Their daughter might even be excited to wash her hands like a grown-up. Finally, you could offer to teach her a clean-hands trick, but once again, make your tone gracious:"My kids love this trick of sneezing into their sleeve. May I teach it to Sara?”

Scenario No. 2: At this year's holiday potluck, people will want to shake hands when they arrive, but you don't want to encourage the spread of germs.

It's OK not to shake hands as long as you convey a warm welcome with your words and body language," says Post. She recommends tailoring the greeting to the person:

Close friends and loves ones: Give a hug.

• Acquaintances: Give a welcoming smile but keep your hands to yourself as you say, "It's so great to see you!”
• Co-workers: It's best to shake hands with colleagues. Just slip away to wash your hands once greetings are over.

Scenario No. 3: During a weeklong visit to your home, a relative comes down with a cold.

The most important thing is not to make her feel like a pariah, says Post. "She's not suddenly persona non grata just because she got sick." Tell her how sorry you are that she is feeling under the weather. She may decide to leave early, but if not, help her feel as comfortable as possible in your home. Set her up in a cozy bedroom that is quiet and away from others so she can get plenty of rest. (This also helps keep germs from spreading.) Set up a TV in the room and bring her some books to keep her occupied. Finally, go beyond asking what she needs, because she may be embarrassed to make requests, says Post. Offer to bring her some tea, draw her a hot bath, or run to the drugstore for medicine.

Scenario No. 4: You're playing games after a holiday dinner, and a friend coughs on the Wii remote and then hands it to you.

There are two appropriate responses, says Post. If the cougher isn't overly sensitive, go the direct route. Jokingly say (with a smile in your voice),"John, that's gross -- go clean that thing up!" If you're not comfortable being so blunt, try a more diplomatic approach. Simply take the remote as you say, "With the flu going around, let me just wipe this thing down.”

Scenario No. 5: You host a holiday happy hour at your home for your co-workers. One of them starts helping prepare appetizers but doesn't wash her hands before touching the food.

As hostess, it's your responsibility to speak up for the well-being of all your guests. That said, no one likes to be corrected, so it's important to speak gently. "When we're worried or stressed, we often forget that tone of voice makes all the difference. You need to be direct but also kind," says Post. Smile at your friend and nonchalantly say, "Oh, Kate, since it's cold and flu season, do you mind washing up? We just want to be extra-careful. There's some soap at the sink."

Scenario No. 6: It's two hours before your annual holiday cookie swap, and you notice the first signs of the flu. You don't want to let everyone down by canceling, but you don't want to get anyone sick either.

Call a close friend who's coming to your party and ask her to step in as hostess. You could say, "Jen, I think I'm coming down with something. I know this is a lot to ask, but everything is all ready, and I was hoping you could play hostess. I'll stay upstairs, but I want everyone to enjoy themselves.”

If you're too sick to have people in your home, ask a neighbor who is invited if she could hold the party at her house. Say, "Pam, I know this is last minute, and I'm so sorry. But I've got the flu and don't want to get anyone sick. Could we redirect to your place?" If she agrees, ask her to help you call the other guests to spread the word, and have your husband answer the door for any you can't reach. All he has to say is, "We're so sorry -- we tried to reach you. But my wife is sick, and we don't want to pass it along, so the party's next door."

If you don't have a friend who can host, then you must call your guests and cancel, says Post. "It's unfortunate to cancel last-minute, but it's better than causing your friends to get sick.”

Photo by Zohre Nemati on Unsplash

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