March 20, 2019

Your kid is really sick, but the doctor says it’s ‘just a virus’

March 17

Your child has been coughing for days; she hasn’t slept in three nights (which means that you haven’t slept in three nights). She has a fever, has morphed into a living snot factory and has a rash that you think might be leprosy. Or smallpox. Or poison ivy.

So you call the pediatrician, who agrees to squeeze you in. When you arrive, you are ushered immediately into that germ-ridden purgatory pediatricians call the “Sick Child Waiting Room.” You strongly warn your child not to touch anything — because no matter how sick your kid is, the ones who were there earlier might have been sicker. And finally you see the doctor, who does a quick physical exam from as far away as his arms will allow, and scribbles something on your checkout sheet.

“It’s just a virus. He’ll be fine,” he says, and sends you off, leaving you wondering what exactly “just a virus” is supposed to mean and feeling quite confident that your child is far from “fine.”

So what, exactly, is “just a virus”? Well, a virus is a certain type of microorganism, or germ. Viruses have some properties that distinguish them from bacteria and other less common infections, but unless you own a microscope, a lab coat and a petri dish, you probably don’t really care.

Calling something “just a virus” is really misleading, because there are some pretty wicked viruses out there. HIV, polio and Ebola are all viruses. The herpes virus that causes mouth sores in some people can cause brain hemorrhages, seizures and death in infants. Other viruses can lead to cancer, liver failure and heart failure.

Fortunately, most of them don’t. In fact, most of them don’t cause any symptoms at all. And most of the viruses that do produce symptoms will cause some nasal congestion or a sore throat. Really, the vast majority of viral infections are more inconvenient than harmful. But calling something “just a virus” is a bit like saying something is “just an animal.” It could be a cuddly puppy or an angry wolverine; you really need to know more about it before you choose an approach.

Of course, when your pediatrician diagnoses your child with “just a virus,” he’s implying that it’s one of those that doesn’t typically cause much harm. There are thousands of viruses out there that can cause cold symptoms, and we don’t tend to test for them. It would be ridiculously expensive, it wouldn’t change what we do and you probably wouldn’t get the test result until the symptoms had gone away.

“Just a virus” is also implying that it’s a problem he can’t do much about. In contrast to bacterial infections, which are typically treated with antibiotics, most viral infections are stomped out by your immune system in a few days. Antibiotics don’t do a thing to treat viruses.

There are a handful of viruses that we can immunize against — such as measles and chickenpox — often with very good effectiveness. There also are a few that we can give medicine to treat, such as HIV and herpes. But these tend to be the bad ones, not the ones that cause colds. For the rest of them, you just have to give them time.

It’s never really the wrong decision to take your child to the pediatrician. There’s always a chance that there could be something else going on. But for most viral illnesses, your child would probably do just as well waiting it out at home.

If you do take your child to the doctor for a virus of the “just a” variety, she may be diagnosed with a “viral syndrome,” “upper respiratory infection” or “acute viral rhinitis.” These are doctor terms for “a cold.” (When you go to the trouble of bringing your child in, we don’t want to seem like we are downplaying your concerns, so we use a complicated medical term instead of “a cold.”)

After making this diagnosis, the doctor will probably provide reassurance and recommend “symptomatic care.” This means fluids, rest, humidifiers — things you were probably doing already. I promise, it’s not that we don’t understand how miserable “just a” viruses can be. Trust me, we’ve all picked up more than our share from snotty little kids (including our own). It’s also not that we don’t care. It’s just that we have nothing else to offer.

But don’t worry. It’s just a virus. He’ll be fine.

Correction: An earlier version of this article included pertussis in a group of illnesses caused by viruses. Pertussis is caused by a bacteria. This article has been corrected.

Hayes is a resident physician in pediatrics in Greenville, S.C. This article is reprinted from his parenting and pediatrics blog, at www.chadhayesmd.com.


Your kid is really sick, but the doctor says it’s ‘just a virus’

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