COVID-19 (coronavirus) Featured

Navigating the ‘tridemic’ of flu, RSV and COVID-19

Written by Marie Sanderson

Your kid sneezes, then starts coughing. Suddenly they’re feeling a bit warm. Your heart drops. Welcome to the “tridemic,” where parents are facing the triple threat of flu, RSV and COVID-19.

“It’s a full-time job caring for your kids and juggling everything else,” says Dr. Ali Appelton, a family physician with Sunnybrook’s Department of Family and Community Medicine who has three young sons. “Many parents are scared.”

Dr. Appelton says it’s more important than ever to have reliable medical information to help guide you. Together with Dr. Claire Murphy, also a family physician at Sunnybrook, and Jo Arbus, a pharmacist in the hospital’s neonatal intensive care unit, they provide their tips and recommendations for parents. To view a webinar on the same topic, please visit our YouTube channel.

Three things to do as soon as you can

Review your child’s immunization records: Many children are behind in school-based vaccines and it’s important to get kids caught up. You can see the listing here. And don’t forget the flu vaccine and COVID-19 vaccine, both are safe and approved for kids aged six months and older.

Embrace prevention: You and your entire family should wash your hands frequently, wear proper masks in crowded indoor settings, cough into your sleeve, get vaccinated and stay home from school or work if sick.

Invest in a good thermometer: Digital is best. If your child is under two years of age, the armpit or rectum provide the most accurate measurement. When they’re older, taking their temperature by mouth or ear is the best way.

Assemble a list of both virtual and in-person after-hours clinics: You don’t want to scramble if and when your child does become sick. Good virtual resources include Toronto Virtual Emergency Department and Sick Kids Virtual Urgent Care, and there are many in-person after-hours clinics throughout the province.

If your child gets sick

When your child has a fever:

  • If your child’s temperature is raised (38 degrees Celcius or higher) but their energy is okay and they’re drinking: It can be scary seeing a higher temperature, but treat your child, not the temperature. If they’re relatively energetic and drinking water, juice/diluted juice or Pedialyte or eating popsicles, you don’t necessarily need to treat the fever with medication. The same goes for those infants who are breastfed or on formula – if they’re drinking that’s great as keeping hydrated is the most important thing.
  • If your child has a high fever AND they’re lethargic: Your child should be treated to bring the fever down. Dose the medication given based on weight not age.

For COVID-19:

  • Know how to test with a rapid antigen test (RAT): swab in between the lower teeth and gums and turn the swab three times. Then swab the back of the throat, followed by each nostril. Do this every couple of days. If the test continues to be negative, it’s likely not COVID.
  • If the test is positive, check out a resource created by the Department of Family and Community Medicine, University of Toronto and the Ontario College of Family Physicians.

Medication do’s and don’ts

Medication for fever:

  • Under six months of age: no medication at all unless prescribed by a doctor
  • Over six months of age: only ibuprofen or acetaminophen, and dose the medication based on weight, not age

Cough and decongestant medication: There is no evidence these over-the-counter medications work so they are not recommended. Coughing can be very helpful as it helps the body get rid of mucous. Medications that stop this normal response to cough can also actually be harmful as they may contain codeine (this cannot be taken by children 12 and under). Decongestants can act as stimulants and lead to insomnia in children. For a very stuffy nose, saline drops or sprays can soften the nasal mucous and offer relief, and nasal aspirators can remove the mucous.

Natural health products: These are not always safe for children. Please speak with your health care provider before taking any labeled as ‘natural’ or ‘homeopathic.’

When do I take my child to the doctor?

When your child has had a fever for more than three days, so day four of a fever, you should call your doctor. Many viruses circulating now are causing prolonged fevers, so it’s good to check in with your family doctor, pediatrician or nurse practitioner. A fever that goes away and comes back may be a sign of a bacterial infection.

If your child has shortness of breath that has them flaring their nostrils, with the skin around their ribs sucking in like an accordion, also call your doctor to rule out a chest infection.

Take your child to the closest Emergency Department if they are:

  • Younger than three months of age and have a fever
  • Dehydrated, which means no urine in 8 to 12 hours and no tears. You can monitor urine output in their diapers – put some toilet paper in their diaper so it will be easier to check
  • Severely short of breath to the point they are unable to feed to sleep
  • Extremely lethargic, and cannot even muster a cry, or only moan and groan

About the author

Marie Sanderson

Marie Sanderson is a Senior Communications Advisor at Sunnybrook.

Have a question about this post? Get in touch.