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  • Writer's pictureChristine Poulos, MD

Fever, Pharyngitis, and Phlegm

As we approach the Flu season, I thought I would write a brief instruction manual for parents to deal with the three "F"s of Flu season: Fever, Pharyngitis (sore throat), and Phlegm (congestion and cough). I hope this will help guide you on when your child needs to be seen for an appointment with me.


Fever is defined as a temperature of 100.4. If you are taking it under the arm, do NOT add a degree.

When to come in:

  1. Any baby under 2 months of age is a MEDICAL EMERGENCY and needs to be seen in the ER

  2. 2 months to 6 months of age, bring your baby into the office to be examined within 24 hours

  3. 6months-2 years, may wait 3 days if having other symptoms of congestion, cough, but may want to call the office to discuss first. If fever is 102.5 or higher, please bring them in within 24 hours. If your child is not eating well, not sleeping well, and seems to be in pain, please bring them in at the first available time.

  4. 2 years and older, after 3 days of fever, your child needs to be seen in the office. If lethargic, having pain, or any other concerns, please bring them in sooner.


Basically sore throats are either viral or from the bacteria strep pyogenes (Group A strep), otherwise known as "strep throat". If your child is tested for strep throat with a rapid test and it is negative, most likely the infection is viral and does NOT need an antibiotic. There may be exceptions to this rule, but in general, for a simple sore throat, antibiotics are NOT needed unless the strep test is positive. Children under 2 years old do NOT get strep throat.

When to come in:

  1. If your child has a sore throat for over 24 hours WITHOUT cold symptoms (nasal congestion and cough), they need to be checked for strep.

  2. If your child is very uncomfortable swallowing, drooling, or having difficulty talking, they need to be seen same day

  3. If your child has a sore throat and rash, they need to be seen same day - even if there is no fever.

  4. If your child has hold cold symptoms for a few days and NOW they have a sore throat and fever, they should be seen within 24 hours.

  5. If there is strep going through the classroom or in your family, bring your child in if they develop sore throat symptoms, even without a fever.

Phlegm (cough)

Coughs can be tricky, especially if your child has asthma. For asthmatic patients, please follow your asthma action plans or make sure you have an updated plan before the flu season hits! Also make sure your inhalers are full and not expired.

When to come in:

  1. If you have a baby under 2 months, they need to be seen same day. This is because they are not vaccinated (so we worry about whooping cough), and they are more severely effected by RSV and Influenza.

  2. If you have a baby 2 months to 6 months, they should be seen within 24 hours. If you have concerns about their breathing, bring them in sooner.

  3. For children 6 months to 2 years, any fever with cough should be seen within 24 hours or sooner if having any difficulty breathing. If you hear any wheezing, your child is having poor feeding, or they are vomiting, please bring them in same day for an appointment.

  4. For older children, any cough lasting over 2 weeks, needs to be seen within 2-3 days.

  5. Any cough that your child is having to the point of vomiting, he/she needs to be seen within 24 hours.

  6. Any cough that you hear wheezing or feel that your child is struggling to breath, call our office for further instruction since your child may need emergent care!

Remember the best prevention for illness is handwashing, vaccination, eating healthy, and getting plenty of rest!

With Love,

Dr. Christine

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