Kids’ After Hours Clinics see record numbers of patients during RSV, flu spikes

November 8, 2022

As Shana Bondo, M.D., drives to work as medical director of the MUSC Children’s Health After Hours Clinics, she knows what she’s likely to see when she arrives: a lot of sick kids and their parents.

“September was our busiest month on record for our After Hours Clinics, which are our pediatric urgent cares, followed by October, which was our busiest month on record. And so far, November is on track to be just as busy, if not break the record again.”

MUSC Children’s Health’s three After Hours Clinics, in Mt. Pleasant, North Charleston and Summerville, are open from 3 pm to 10 pm Monday through Friday and noon to 7pm on weekends and holidays. The first real flu season since the start of the pandemic, coming on the heels of a wave of the respiratory virus RSV, has them all packed.

In fact, respiratory illnesses are so widespread right now that Allison Eckard, M.D., division chief for Pediatric Infectious Diseases at MUSC Children’s Health, recently put it this way: “The number of hospitalized and critically ill patients we’ve seen in such a short period of time is unprecedented.”

But most of the patients coming to the After Hours Clinics don’t need to go to the hospital, Bondo said. In fact, some might not even need to go to a clinic.

“Everyone is unaccustomed to having all these fevers, misery, body aches, and they’re coming to the clinics to have that assessed. But children don’t necessarily need to be tested and they don’t necessarily need to see a doctor. They really just need to stay home to prevent spreading of their germs.”

Sometimes, of course, children do need to see doctors. Figuring out that threshold can be tricky for worried parents. Bondo had some advice.

“So I would say there are three main buckets for that. The first is hydration. Are they drinking enough to fuel their body when they’re sick? Try to keep track how many times they have used the restroom, how many times they’ve urinated. And if we find that they have urinated at least three or four times in 24 hours, then they’re probably okay,” she said.

“The next bucket is breathing status. Certainly respiratory viruses cause a cough. Sometimes they cause a bad cough. That’s okay as long as your child is breathing comfortably, not having chest pain. If your older child is complaining of chest pain or if your younger child is breathing fast persistently or making noise when they breathe, then they need to be seen.”

When it comes to fevers, Bondo said she knows they can be scary for families. “In the last 10 days we’ve seen tons and tons of influenza. Flu causes high fever. It causes high fever, sometimes for four or five, even six days. That is worrisome to a parent. But once your child spikes the first fever and you identify, hey, they’re sick, go ahead and put them on a round-the-clock scheduled fever medicine for at least 48 hours,” she advised.

“They’re likely to get more fever and you don’t want them to have peaks and valleys where they’re feeling good and then feeling bad. So just keep them on doses of medicine. We treat the fever not because it’s bad for them. I mean, fever is a healthy immune response. We treat fever because it makes you feel stinking awful. And the better our kids feel, the more comfortable we can make them, the better they’re going to be at drinking and doing the other things they need to do to get better.”

Like Bondo, the Centers for Disease Control and Prevention says most people with the flu get mildly ill and don’t need to go to an urgent care clinic or an emergency room. However, it does list some factors that signal the need for a child with the flu to get immediate medical care, including:

  • Fast breathing or trouble breathing and/or chest pain, as Bondo mentioned.
  • Bluish lips or face.
  • Ribs pulling in with each breath.
  • Severe muscle pain (child refuses to walk).
  • Dehydration, as Bondo mentioned (no urine for 8 hours, dry mouth, no tears when crying).
  • Not alert or interacting when awake.
  • Seizures
  • Fever above 104°F.
  • In children less than 12 weeks, any fever.
  • Fever or cough that improve but then return or worsen.
  • Worsening of chronic medical conditions.

Bondo said her team is working hard during this busy period to ensure every child who comes into an After Hours Clinic gets the best care possible — despite the record-setting numbers.

“Our main goal in the After Hours Clinics is access, and we are providing access. We are the only walk-in pediatric facility in town outside of the emergency department. So while we’re providing access to each individual patient, there are many individual patients. So it takes a lot of time for us to see each person. So please be patient.”