We asked Julia Sann, MD, FAAP, a board-certified pediatrician with Summit Health; Eberechi Nwaobasi-Iwuh, MD, FAAP, pediatric infectious diseases consultant, and director of the division of pediatric hospital medicine for Hersh Children’s Center at Atlantic Health System’s Overlook Medical Center and Goryeb Children’s Hospital in Morristown; Gary Kohn, MD, a pediatric pulmonologist at Summit Health, and Brittany Dee Mueller, MD, an internal medicine physician at Atlantic Medical Group Primary Care at Westfield, for answers to your most pressing questions.

Q: What is RSV and how is it treated?
KOHN: RSV (respiratory syncytial virus) is a common respiratory illness that is the leading cause of hospitalization among infants. Before the pandemic nearly all children were infected with RSV by their second birthday. For many, it’s a simple cold that comes and goes. But some kids are more susceptible to severe disease than others. Since young children have smaller airways, mucus and debris are more likely to develop and obstruct the normal flow of air. You can help small children by clearing secretions from the nose with saline irrigation at home as often as needed. Secretions can cause nasal obstruction and are a major cause of respiratory distress in infants. There is no specific medicine to treat RSV. Antibiotics will not treat the virus. If your child is admitted to the hospital, there is excellent technology and supportive care available. Infants may need IV fluids or oxygen. Most children have a full recovery within a few weeks.

Q: How can I tell the difference between COVID and the flu?
MUELLER: COVID and flu are both viral illnesses so many symptoms can overlap. Flu comes around every year and we see slight variations from year to year. With COVID we see a lot
more sore throats. If someone has a sore throat, we consider testing for COVID and strep. Achiness or feeling run down could be flu or COVID. Treatment for both can include over-the-
counter medication, lots of fluids and plenty of rest.

Q: My child gets a lot of headaches. What could be the cause?
SANN: Most commonly children get secondary headaches associated with viral illnesses, such as colds and flu. Another common type of headache is a tension headache. Important first steps in managing tension headaches include ensuring adequate hydration and a regular sleep routine, limiting screen time, limiting stress and not skipping meals. It can be helpful to get an eye exam to rule out any eye strain causing headaches. I encourage parents and children to keep track of their headaches in a diary which can be helpful to provide to their pediatrician to identify the cause. It is always a good idea to make a visit to your pediatrician if your child is getting headaches often to rule out any other underlying issues. Other causes of headache include migraine and post-traumatic headaches. Very serious causes of headache, like brain tumors, are extremely rare.

Q: Should I give my baby/child all different foods to avoid food allergies?
SANN: Yes! Studies have shown the early introduction of allergens reduces the risk of food allergies. Aside from honey (which is off limits until age 1) most foods can be given after 6 months if made into safe textures. For example, I advise parents to water down peanut butter so it is not so thick. Common allergens to introduce include peanuts, tree nuts, milk, egg, soy, wheat and shellfish.

Q: Is the COVID booster a good idea for my child? When is the best time to get it? What if my child already had COVID?
SANN: Yes. The protection from a COVID-19 vaccine wanes over time and the Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics recommend booster shots for most children ages five and older. The new boosters are called “bivalent” because they
provide wider protection against the original virus that causes COVID-19 as well as Omicron variants. Currently the bivalent vaccines are only approved for ages 12 and up. The bivalent boosters are recommended by the CDC as long as it has been at least two months from your child’s last dose. We are hopeful for a bivalent vaccine coming soon for our younger patients. After having COVID-19 your child can safely receive the vaccine as soon as they are out of isolation
and symptoms have resolved. It’s also not unreasonable to delay the vaccine until 2-3 months after infection as their body may have some natural immunity.

Q: My child is anxious and needs help but therapists and psychologists/psychiatrists are booked and many don’t accept insurance. How can I best support my child?
SANN: Your pediatrician will often have a list of local behavioral health resources and may have a sense of which providers can get your child in sooner. The pediatric patients I see at Summit Health can seek behavioral health and cognitive therapy for child and adolescent mental health conditions at the group. While there is high demand for behavioral health treatment,
providers’ offices can inform you of the first available appointment. Resources such as PerformCare can help connect children with behavioral health services in New Jersey and can help if your child is experiencing a behavioral health crisis.

Q: My child complains of growing pains. How can I help?
SANN: While we don’t know the exact cause of growing pains, they may be related to overwork during intense activity. It can be helpful to encourage periodic rest during daily activities and alternate physical activities (so as not to overuse one muscle group). Additionally, you can give your child a warm bath before bedtime or massage their legs when they are having pain. If the
pain is preventing your child from sleeping, a dose of acetaminophen or ibuprofen may help. If the pain is localized to one location, worsening, or associated with other symptoms (i.e. fever, sweating, swelling) you should bring your child to their pediatrician.

Q: I worry my picky eater is not getting his nutritional needs met. When should I use supplements or vitamins?
SANN: In general, most children with relatively well-balanced diets don’t need any additional vitamin supplements. Occasionally if your child is an extremely picky eater your doctor will recommend a supplement. Important nutrients to take note of include calcium, vitamin
D and iron. The American Academy of Pediatrics (AAP) has an excellent resource for parents (healthychildren.org) with specific requirements for all age groups. Milk is an excellent source of vitamin D, calcium and fat. The AAP recommends 16-20 oz. per day for children ages 1-5. If your child is allergic or does not like milk, it’s not the end of the world! I encourage yogurt, cheese
and other calcium-fortified foods (i.e. cereal, tofu). Milk alternatives, such as plant-based milk, will provide very similar nutrients.

Q: What’s the best way to keep a cold from spreading to other family members?
NWAOBASI-IWUH: I always tell parents you can take certain measures to prevent the spread of germs, but don’t drive yourself crazy. Short of quarantining in the house you can’t prevent transmission but what you can do is make sure everyone is well-rested and hydrated. If you’re run
down, you’re more susceptible to getting sick. If you have smaller children, you can disinfect surfaces but it’s really hard since toddlers touch everything.