If you are feeling like just about everyone is sick, we hear you!  Monday of this week brought record call volumes to our office.  Despite providers coming in to work extra and squeeze in additional patients, for every child that we saw there were 20 other calls from families with concerns.  We appreciate everyone’s patience waiting to speak to the triage nurses, as we understand how frustrating this is for families.  As much as we try to go above and beyond, the burden of illness is more than we can accommodate in the office.  We always hate the idea of sending children to the emergency room, but there are some things that there is no question about.  Emergencies that should be directed immediately to the UVA ED include fevers of 100.4 or greater in infants under 2 months, respiratory distress especially with labored breathing and color changes, and dehydration with decreased urine output when children will not tolerate sips of clear fluids especially when they have failed to respond to a medication to treat nausea.  Other times it may not feel as clear to families if a child warrants a trip to the emergency department.  Some reassuring features in older children include mild symptoms of cough and congestion when they are tolerating fluids and breathing comfortably.  Older children can have fevers for up to 5 days with viral illnesses.  Some viruses including influenza can result in high fevers.  Although it can feel alarming to see those high numbers, fevers themselves are not inherently dangerous.  Older children can be treated with tylenol and ibuprofen, which can go a long way in helping children to feel more comfortable and allow for improved fluid intake and hydration.  We will continue to try to prioritize younger children in the office for visits and offer guidance for older children with mild symptoms as we get through these busy days.