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Once influenza season is underway, it’s natural that if you hear your child start coughing, you wonder: could this be the flu or another virus? And if you think it is the flu, what should you do?

Is it the flu, RSV, COVID –– or just a cold?

It’s not always easy to tell these illnesses apart, especially at the beginning.

• Flu: The flu usually comes on suddenly, and its symptoms can include fever, runny nose, cough, sore throat, headache, muscle aches, feeling tired, and generally just feeling rotten. Some people have vomiting and/or diarrhea, too. Not everyone has all these symptoms, and the illness can range from mild to severe.
• RSV: Along with fever and sore throat (and feeling tired and rotten), RSV often causes a lot of nasal congestion and a mucusy cough. In some babies, it causes wheezing.
• COVID causes similar symptoms to flu and RSV, but the cough generally isn’t as mucusy, the fatigue can be worse, and some people will lose their sense of taste and/or smell.
• The common cold generally causes similar symptoms to flu, RSV, and COVID, but milder and often without a fever. However, some people have bad colds — and some people have mild cases of the flu, RSV, or COVID.

Call your doctor for advice

Because these illnesses are so similar, it’s a good idea to call your doctor’s office if your child has cold symptoms. You don’t necessarily need an appointment, but you should call for advice. Describe your child’s symptoms. Based on the symptoms, and your child’s particular situation (such as any medical problems they might have, or vulnerable people like infants or elderly living with you), your doctor

• may suggest testing for COVID, flu, or RSV
• may want you to bring your child in
• may want to prescribe antiviral medication.

Because every child and every situation is different, you should call and get advice that is tailored to your child and family.

What helps when your child has the flu?

Once you’ve called your doctor for advice or have a diagnosis of flu, the steps below will help your child feel more comfortable and speed recovery.

Stock up on supplies

There are a few things that make getting through the flu easier, including:

• acetaminophen and ibuprofen for fever and aches
• a reliable thermometer, if you don’t have one
• hand sanitizer (buy a few to keep all over the house)
• tissues
• fluids to keep your child hydrated, such as clear juices, broth, oral rehydration solution (for infants), and popsicles (which are great for sore throats, and eating them is the same as drinking). If you don’t have a refillable water bottle (one with a straw is great if kids are lying down), get one of those too.
• honey (if your child is older than a year) and cough drops (if your child is at least preschool age)
• saline nose drops
• a humidifier, if you don’t have one
• simple foods like noodle soups, rice, crackers, bread for toast.

Make sure your child rests

Turn off or at least limit the screens, as they can keep children awake when their body needs them to sleep. Keep rooms darkened, and limit activity. If they aren’t sleeping, quiet things like reading (or reading to them), drawing, card games, etc. are best.

Push fluids, don’t worry about food

When children are fighting the flu, the most important thing is that they stay hydrated. They need a bit of sugar and salt too, which is why juices and broths are good choices. If they only want water, give them some crackers to get the sugar and salt — but don’t worry too much if they don’t want to eat more than that. They will eat more when they feel better.

Watch for warning signs

Most children weather the flu fine, but some children get very sick, and there can be complications. Call your doctor or go to an emergency room if your child has

• a high fever (102° F or higher) that won’t come down with acetaminophen or ibuprofen, or a new fever after your child seemed to be getting better
• any trouble breathing
• severe pain of any kind
• severe sleepiness, so that it’s hard to wake them or keep them awake
• trouble drinking or keeping fluids down
• anything that seems strange or worries you (I always respect a parent’s “Spidey sense”).

Keep your child home until they are well

That doesn’t necessarily mean they can’t go to school or daycare until they are cough- or runny nose-free, but it does mean that they have to be fever-free for at least 24 hours, not coughing constantly, able to eat and drink, and have enough energy to do whatever school or daycare entails. Not only is this important for your child’s recovery, but it’s important for preventing the spread of influenza. Which leads me to the last point…

Do your best to keep others from getting sick

Besides keeping your child home (and staying home yourself if you catch it), there are other things you can do, such as:

• Make sure everyone in the house washes their hands frequently (that’s where the hand sanitizer all over the house comes in handy).
• Teach everyone to cover coughs and sneezes (they should do it into their elbow, not their hands).
• Don’t share cups, utensils, towels, or throw blankets.
• Wipe down surfaces and toys regularly.
• Discourage visitors (use technology for virtual visits instead).
• Be thoughtful about physical contact. Some degree of contact and snuggling is part of parenthood, but siblings may want to keep a bit of distance, and you can always blow kisses and do pretend hugs instead of the real thing.

Remember, too, that it’s never too late to get a flu shot if you haven’t already.

To learn more about the flu and what to do, visit flu.gov.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Ever see ads for products that promise to supercharge immunity? Activate your body’s natural defenses? Support a healthy immune system while delivering a potent boost derived from nature’s hottest immune-enhancing ingredients?

While the words may change to reflect the latest trends, the claims certainly sound amazing. But do the multitude of products promoted as immune boosters actually work? What steps can we take to support the immune system? Both are important questions, especially in the wake of a deadly pandemic and as flu and cold season arrives.

IV drips, supplements, cleanses, and superfoods

The lineup of immune-boosting products and advice includes:

• Home intravenous (IV) drips. Want a health professional to come to your home with IV fluids containing various vitamins and supplements? That’s available in many US cities, and some companies claim their formula is designed to supercharge immunity. These on-demand IV treatments aren’t risk-free and can be quite expensive.
• Vitamins and supplements. Popular options include turmeric, milk thistle, and echinacea, often in combination with various vitamins. Hundreds of formulations are available.
• Superfoods and foods to avoid. If you search online for “foods to boost the immune system” you’ll see thousands of articles touting blueberries, broccoli, spinach, dark chocolate, and other foods to keep infections away. There’s also a list of foods to avoid, such as sugary drinks or highly processed meats, because they’re supposed to be bad for your immune system.
• Cleanses and detox treatments. No doubt you’ve seen pitches for cleanses and detox products intended to remove toxins from the body. Their marketing warns that the environment is full of harmful substances that get into the body through the air, water, and food, which we need to remove. Advocates suggest that, among other harmful effects, these often unnamed toxins make your immune system sluggish.

Are the heavily marketed IV drips, supplements, or detox products endorsed by the FDA?

No. In fact, the standard disclaimer on supplements’ claims of immune-boosting properties says: “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Yet sellers are allowed to use phrases like “boosts immune function” and “supports immune health.” These terms have always seemed vague to me. More importantly, they’re confusing:

• Boosting immunity is what vaccinations do. They prime your immune system to help fight off a specific infectious organism (like the flu shot before each flu season).

• Immune support typically describes vitamins such as vitamin C, or other nutrients necessary for a healthy immune system. It’s true that a deficiency of vital nutrients can cause poor immune function. But that doesn’t mean a person with normal levels of nutrients can expect supplements to improve their immune system.

Can products marketed as immune boosters actually boost immunity?

Unless you have a deficiency in a key nutrient, such as vitamin C or zinc, the short answer is no.

That is, there’s no convincing evidence that any particular product meaningfully improves immune function in healthy people. For example, results of studies looking at various supplements for colds and other similar infections have been mixed at best. Even when taking a particular supplement was linked to reduced severity or duration of an infection like a cold, there’s no proof that the supplement boosted overall immune function.

This goes for individual foods as well. None has ever been shown to improve immune function on its own. It’s the overall quality of your diet, not individual foods, that matters most. A similar approach applies to advice on foods you should avoid, such as sugary drinks or highly processed meats: the best foods to avoid in support of your immune system are the same ones you should be limiting anyway.

How to get the most out of your immune system

It’s not a secret and it’s not a product. What’s good for your overall health is good for immune function. The best ways to keep your immune system at peak performance are:

• Eat well and follow a heart-healthy diet, such as the Mediterranean diet.
• Exercise regularly and maintain a healthy weight.
• Don’t smoke or vape.
• If you drink alcoholic beverages, drink only in moderation.
• Get plenty of sleep.
• Minimize stress.
• Get regular medical care, including routine vaccinations.
• Take measures to prevent infection such as frequent hand washing, avoiding people who might have a contagious illness, and wearing a mask when it’s recommended.

This list probably looks familiar. These measures have long been recommended for overall health, and can do a lot to help many of us.

Certain illnesses — HIV, some cancers, and autoimmune disorders — or their treatments can affect how well the immune system works. So some people may need additional help from medications and therapies, which could truly count as immune boosting.

The bottom line

Perhaps there will come a time when we’ll know how to boost immune function beyond following routine health measures. That’s simply not the case now. Until we know more, I wouldn’t rely on individual foods, detox programs, oral supplements, or on-demand IV drips to keep your immune system healthy, especially when there are far more reliable options.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Let’s file this under unsurprising news: the COVID pandemic prompted the biggest spike in alcohol consumption seen in 50 years. Illnesses, hospitalizations, and deaths linked to alcohol misuse rose as well.    

Yet even before the pandemic sparked disruptions, losses, stress, and isolation, alcohol use among older adults had been trending upward. And a quarter of people 18 and older reported heavy drinking (five or more drinks for men, four or more for women).

If you’re feeling sober curious or simply ready to cut back, consider joining millions of others who abstain from alcohol during Dry January. Your heart, liver, memory, and relationships could be all the better for it.

Why try Dry January?

If you’d like to cut down your alcohol consumption or start the new year with a clean slate, join in the Dry January challenge by choosing not to drink beer, wine, or spirits for one month. Dry January began in 2012 as a public health initiative from Alcohol Change UK, a British charity. Now millions take part in this health challenge every year.

While past observational studies suggested a link between drinking a moderate amount of alcohol and health benefits for some people, more recent research has questioned whether any amount of alcohol improves health outcomes. And heavier drinking or long-term drinking can increase physical and mental problems, especially among older adults. Heart and liver damage, a higher cancer risk, a weakened immune system, memory issues, and mood disorders are common issues.

Yet, cutting out alcohol for even a month can make a noticeable difference in your health. Regular drinkers who abstained from alcohol for 30 days slept better, had more energy, and lost weight, according to a study in BMJ Open. They also lowered their blood pressure and cholesterol levels and reduced cancer-related proteins in their blood.

Tips for a successful Dry January

A month may seem like a long time, but most people can be successful. Still, you may need assistance to stay dry in January. Here are some tips:

• Find a substitute non-alcoholic drink. For social situations, or when you crave a cocktail after a long day, reach for alcohol-free beverages like sparkling water, soda, or mocktails (non-alcoholic cocktails.)
  Non-alcoholic beer or wine also is an option, but some brands still contain up to 0.5% alcohol by volume, so check the label. “Sugar is often added to these beverages to improve the taste, so try to choose ones that are low in sugar,” says Dawn Sugarman, a research psychologist at Harvard-affiliated McLean Hospital in the division of alcohol, drugs, and addiction.
• Avoid temptations. Keep alcohol out of your house. When you are invited to someone’s home, bring your non-alcoholic drinks with you.
• Create a support group. Let friends and family know about your intentions and encourage them to keep you accountable. Better yet, enlist someone to do the challenge with you.
• Use the Try Dry app. This free app from the UK helps you track your drinking, set personal goals, and offers motivational information like calories and money saved from not drinking. It’s aimed at cutting back on or cutting out alcohol, depending on your choices.
• Don’t give up. If you slip up, don’t feel guilty. Just begin again the next day.

Check your feelings

Sugarman recommends people also use Dry January to reflect on their drinking habits. It’s common for people to lose their alcohol cravings and realize drinking need not occupy such an ample space in their lives. If this is you, consider continuing for another 30 days, or just embrace your new attitude toward drinking where it’s an occasional indulgence.

If you struggle during the month, or give up after a week or so, you may need extra help cutting back. Talk to your doctor about getting the help you need.

The Rethinking Drinking site created by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is also an excellent resource. For the record, NIAAA recommends limiting alcohol to two daily drinks or less for men and no more than one drink a day for women.

Be aware of problems that might crop up

Dry January can reveal signs of potential alcohol problems, including symptoms of alcohol withdrawal ranging from mild to serious, depending on how much you usually drink.

• Mild symptoms include anxiety, shaky hands, headache, nausea, vomiting, sweating, and insomnia.
• Severe symptoms often kick in within two or three days after you stop drinking. They can include hallucinations, delirium, racing heart rate, and fever.

“If you suffer alcohol withdrawal symptoms at any time, you should seek immediate medical help,” says Sugarman.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

It isn’t often that a study leads to fundamental changes in how cancer patients are treated. But new research is doing just that for some men with prostate cancer that recurs after initial treatment.

Post-treatment recurrence

The first sign of recurrence is typically a rise in blood levels of prostate-specific antigen (PSA). PSA should drop to zero after surgical removal of the prostate, and to near zero after radiation therapy. Prostate cancer cells release PSA, so if the levels rise again after this initial treatment, then new tumors are likely forming in the body. This is called a biochemical recurrence, because the newly developing tumors are still too small to see on traditional imaging scans.

Doctors ordinarily treat biochemical recurrence with hormonal therapies, drugs that prevent the body from making testosterone (a hormone that fuels prostate cancer growth). But results from a large clinical trial show there’s a better approach.

Study methodology and results

During the study, called the EMBARK phase 3 clinical trial, investigators enrolled 1,068 men whose PSA levels had doubled within nine months of initial treatment. When PSA rises that quickly, men are at high risk of rapid cancer progression.

The men were randomly divided into three groups: One was treated with a hormonal therapy called leuprolide, given by injection every 12 weeks. A second group was treated with leuprolide as well as a daily oral dose of enzalutamide, a drug that deflects testosterone from its cell receptor. The third group was treated with daily enzalutamide by itself.

The investigators already knew from earlier studies that enzalutamide delays further progression and lengthens survival for men with metastatic prostate cancer. With this new study, they hypothesized that earlier uses of that drug might have similar benefits for men with biochemical recurrence.

That hypothesis proved correct. The men were followed for just over five years after their treatments were completed. And according to the results, more of the enzalutamide-treated men remained free of worsening cancer. Specifically, 87.5% of men who got the combined treatment — and 80% of men treated with enzalutamide by itself — avoided metastatic cancer, compared to 71.4% of the men who only got leuprolide.

Enzalutamide treatment was also more effective at preventing further PSA increases. In all, 97.4% of men who got the combined therapy and 88.9% of men who got enzalutamide alone avoided PSA progression, compared to 70% of the leuprolide-treated men. If the PSA was less than 0.2 ng per milliliter at 36 weeks, then the men could go off treatment altogether. Far more of the enzalutamide-treated men (up to 90%) went off treatment for durations ranging up to 20 months.

Enzalutamide treatment was well tolerated. The most common side effect was mild to moderate nipple pain and breast enlargement. Most of the men in all three groups are still alive, and EMBARK investigators are following them see if treatment-related differences in survival show up over time.

Observations and comments

Based on EMBARK’s results, Dr. Neal Shore, director of the Carolina Urologic Research Center in Myrtle Beach, South Carolina, and the study’s co-lead author, concluded that enzalutamide treatment “should now be the standard of care for high-risk biochemical recurrence.” Whether enzalutamide treatment should also be combined with leuprolide is a decision that men can make in consultation with a doctor.

An important point is that doctors now have a better way to detect metastatic prostate cancer that wasn’t available when EMBARK was launched. The cancer cells contain high levels of a protein called prostate-membrane specific antigen (PSMA) that shows up on specialized imaging scans. PSMA-based imaging methods can reveal tiny metastatic tumors in the body that weren’t previously visible. In such cases, patients who might once have been diagnosed with biochemical recurrence are now known to have metastatic cancer. And since doctors can now see those tumors, they can treat them directly with surgery or radiation — and potentially achieve a cure.

Still, Dr. Stephen Freedland, an EMBARK lead investigator and urologist at Cedars-Sinai Medical Center in Los Angeles and the Durham VA Medical Center in Durham, North Carolina, says the study’s findings still apply. If PSMA findings are negative even as PSA continues to rise, “then EMBARK shows that systemic treatment [using enzalutamide with or without hormonal therapy] is still the best option,” he says.

If PSMA findings show just a few metastatic tumors (this is called oligometastatic prostate cancer), then those tumors can be treated surgically or with radiation, and possibly with hormonal therapy. And if PSMA reveals widespread metastatic cancer throughout the body, then “metastasis-directed therapy is no longer an option, and hormonal therapy with enzalutamide is the best option to delay progression as shown in EMBARK,” Dr. Freedland says.

This study addresses a very large segment of the treated prostate cancer population — those in whom residual cancer following surgery or radiation therapy persists — and the results are “welcome and surprising,” says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. “Also welcome is the ability of men to go off of therapy if their PSA values were low at the end of 36 weeks of therapy. As pointed out by both Drs. Shore and Freedland, their study adds a significant contribution to this large patient population. The authors should be congratulated on this important contribution.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

If you’ve been stuck mostly at home with one or more family members over the past year, chances are you’ve gotten on one another’s nerves occasionally. When you’re under a lot of stress, it’s not uncommon say something unkind, or even to lash out in anger to someone you care about. And we all make thoughtless mistakes from time to time, like forgetting a promise or breaking something.

Not sure if you should apologize?

Even if you don’t think what you said or did was so bad, or believe that the other person is actually in the wrong, it’s still important to apologize when you’ve hurt or angered someone. “To preserve or re-establish connections with other people, you have to let go of concerns about right and wrong and try instead to understand the other person’s experience,” says Dr. Ronald Siegel, assistant professor of psychology at Harvard Medical School. That ability is one of the cornerstones of emotional intelligence, which underlies healthy, productive relationships of all types.

How to apologize genuinely

For an apology to be effective, it has to be genuine. A successful apology validates that the other person felt offended, and acknowledges responsibility (you accept that your actions caused the other person pain). You want to convey that you truly feel sorry and care about the person who was hurt, and promise to make amends, including by taking steps to avoid similar mishaps going forward as in the examples below.

According to the late psychiatrist Dr. Aaron Lazare, an apology expert and former chancellor and dean of the University of Massachusetts Medical School, a good apology has four elements:

• Acknowledge the offense. Take responsibility for the offense, whether it was a physical or psychological harm, and confirm that your behavior was not acceptable. Avoid using vague or evasive language, or wording an apology in a way that minimizes the offense or questions whether the victim was really hurt.
• Explain what happened. The challenge here is to explain how the offense occurred without excusing it. In fact, sometimes the best strategy is to say there is no excuse.
• Express remorse. If you regret the error or feel ashamed or humiliated, say so: this is all part of expressing sincere remorse.
• Offer to make amends. For example, if you have damaged someone’s property, have it repaired or replace it. When the offense has hurt someone’s feelings, acknowledge the pain and promise to try to be more sensitive in the future.

Making a heartfelt apology

The words you choose for your apology count. Here are some examples of good and bad apologies.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD