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  • The San Juan Daily Star

How to spot flu symptoms in children


This year’s influenza season looks to be particularly bad. We asked doctors what parents need to know about the virus — and need to recognize when things turn serious.

By Knvul Sheikh


This year, influenza arrived early in the United States, and it is already proving to be more severe than previous years’ flu. So far, an estimated 8.7 million people have become ill with the virus, according to the latest data from the Centers for Disease Control and Prevention, nearly the same number as those who got sick all season last year. The CDC estimates that 78,000 people have been hospitalized so far because of the flu and 4,500 have died — including 14 children.


“Last year, we saw almost no flu. There were very, very low rates of flu and only one pediatric death that whole year,” said Dr. Katie Lockwood, a primary care pediatrician at Children’s Hospital of Philadelphia.


Experts worry that influenza cases are going to continue increasing until at least January, when the virus typically peaks. And children have generally been particularly vulnerable because of their immature immune systems. That is why it is important for parents to take measures to protect young children and recognize symptoms of illness when they do occur.


“The vaccine this year is a very good match for the circulating strains we have in the United States,” said Dr. James Antoon, an assistant professor of pediatrics and pediatric hospitalist at Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville, Tennessee. Getting vaccinated can reduce the chances of an infection and lessen the severity of illness, including the possibility of complications such as ear infections and bacterial pneumonias that may occur with or after the flu, Antoon said.


Even if you suspect your child has had the flu already, it is not too late to get vaccinated, he added. Influenza type A is the dominant strain making people sick right now, but viral strains sometimes switch later in the season. Here’s what parents need to know about the flu.


What are some symptoms to look out for?


It can be difficult to distinguish the flu from other childhood illnesses such as the common cold or respiratory syncytial virus, which are also circulating right now. The flu often causes a combination of a fever, cough, sore throat, runny nose, chills, muscle aches, headaches and a general feeling of malaise, which may make your child unusually tired and cranky.


“It’s rare that patients come in with just a sore throat,” Lockwood said. “The hallmark of the flu for me is when symptoms are all over.”


Symptoms of the flu also tend to come on abruptly, she said. “Sometimes parents will tell me that their child was fine when they dropped them off at school, and when they picked them up, the child had a fever and all of these other symptoms.”


Some gastrointestinal symptoms, such as diarrhea or vomiting, are also more common with the flu than other viral illnesses.


“Most kids are going to be sick anywhere from three to five days,” Lockwood said. Some symptoms, however, can linger for an average of seven to 10 days, she said. A cough is typically the last thing to clear up.


How should you treat the flu?


In most cases, the best prescription for the flu is to rest and recover at home with plenty of fluids, said Dr. Priya Soni, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s in Los Angeles. Research has shown that keeping your house at a humidity level of 40% to 60% can also ease congestion and reduce virus transmission to others. And using a nasal aspirator to help younger children clear out excess mucus may allow them to sleep better at night, she said.


Doctors generally don’t recommend over-the-counter medicines to help with cough and cold symptoms in children younger than 6, except for fever reducers such as acetaminophen (often sold under the brand name Tylenol) and ibuprofen (found in Children’s Motrin). But a few small studies of children between ages 1 and 5 have found that honey at bedtime may be just as effective in reducing nighttime coughs as over-the-counter cough syrups.


When should you go to a doctor or hospital?


If your child is running a fever higher than 104 or falls in a high-risk group such as those younger than 2, doctors may sometimes prescribe antiviral medication such as Tamiflu to help reduce the severity and duration of the flu. However, high influenza rates are sparking concern among health officials that Tamiflu may become hard to find in some places.


There are three other alternative antiviral medicines that can be used to treat the flu: Relenza, Rapivab and Xofluza. All of these, including Tamiflu, work best when taken early in the course of illness, although their side effects can sometimes exacerbate symptoms such as nausea and vomiting.


Children with chronic medical conditions such as asthma, diabetes, cystic fibrosis, cerebral palsy, heart conditions or seizures are also at a higher risk for influenza-related complications. And because the flu may exacerbate their medical condition, these children may receive antiviral treatment at any point in their illness, regardless of how long they’ve had symptoms, Antoon said.


If your pediatrician’s office is closed and your child shows any signs of fast or troubled breathing, blue lips or a heaving chest, you may want to head straight to an urgent care or emergency room.


Other emergency signs include refusing to eat or drink, having difficulty staying alert, experiencing muscle pain so strong that it becomes hard to walk, and a fever or cough that returns after your child has seemingly been on the mend.


Children who are hospitalized are generally treated with antivirals such as Tamiflu, and some may need additional oxygen supplementation or intravenous fluids, Soni said.


When is it safe to send your child back to school or day care?


In general, the CDC recommends waiting until children are fever-free (below 100 degrees without the use of any fever-reducing medications) for at least 24 hours before sending them back to school or day care. Since this can take a day or two, and because viral infectiousness also drops significantly after about the third day of experiencing symptoms, going back to school around this time also reduces the likelihood of getting others sick.


But parents may also want to consider if appetite and hydration levels are improving. Will the child be able to eat and drink enough without your constant supervision? Will the child have enough energy to do all the activities they need to do in school?


And it may be a good idea to note how actively your child is coughing. “It is a little bit of a subjective decision that parents have to make,” Lockwood said, adding that a child’s cough and other symptoms should at least be improving, even if they have not completely cleared up. “If they’re still coughing a lot, you may want to wait a little longer before they go back to school,” she said.

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