Influenza

Symptoms

DEFINITION

• Influenza (Flu) is a viral infection of the nose, throat, trachea, and bronchi
• You think your child has influenza because other family members have it
• You think your child has regular (seasonal) influenza and it's prevalent in the community

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Symptoms

• Main symptoms are a runny nose, sore throat, and bad cough
• More muscle pain, headache, fever, and chills than with usual colds

Cause

• Influenza viruses that change yearly

Prevention with Influenza Vaccine (Flu Shots)

• Yearly "flu shots" prevent 70 to 90% of influenza
• They are recommended for all children over 6 months of age
• New flu vaccine is usually available every year in October

Diagnosis: How to Know Your Child Has Influenza

If influenza is widespread in your community and your child has flu symptoms with fever, then he or she probably has flu. You don't need to get any special tests. You should call your doctor if your child is HIGH-RISK for complications of the flu (see the following list). For LOW-RISK children, you don't need to call or see your child's doctor, unless your child develops a possible complication of the flu. (see the "When to Call Your Doctor" section).

HIGH-RISK Children for Complications From Influenza

Children are considered HIGH-RISK for complications if they have any of the following conditions:

• Lung disease (such as asthma)
• Heart disease (such as a congenital heart disease)
• Cancer or weak immune system conditions
• Neuromuscular disease (such as muscular dystrophy) 
• Diabetes, sickle cell disease, kidney disease OR liver disease
• Diseases requiring long-term aspirin therapy
• Pregnancy
• Healthy children under 5 years old are also considered HIGH-RISK (CDC: September 2009)
• Note: All other children are referred to as LOW-RISK

Prescription Antiviral Drugs for Influenza

• Antiviral drugs (such as Tamiflu) must be started within 48 hours of the start of flu symptoms to have an impact.
• The CDC recommends they be used for any patient with severe symptoms AND for all HIGH-RISK children (see that list).
• The CDC doesn't recommend antiviral drugs for LOW-RISK children with mild flu symptoms.
• Their benefits are limited: they usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not cure the disease.
• Side effects: Vomiting in 10% of children.

Return to School

• Your child can return to child care or school after the fever is gone for 24 hours and your child feels well enough to participate in normal activities.
• Spread is rapid because the incubation period is only 2 days (range: 1 to 4 days) and the virus is very contagious.

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See More Appropriate Topic (instead of this one) If

• Swine Flu (H1N1 Flu) suspected, see SWINE FLU (H1N1 FLU)
• Swine Flu (H1N1 Flu) exposure, but no symptoms, see SWINE FLU (H1N1 FLU) EXPOSURE
• Influenza vaccine reaction suspected, see IMMUNIZATION REACTIONS

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

• Severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing)
• Lips or face are bluish when not coughing

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick
• Difficulty breathing (under 1 year old) not relieved by cleaning the nose
• Difficulty breathing (over 1 year old) present when not coughing
• Breathing becomes very rapid
• Lips or face have turned bluish during coughing
• Wheezing (tight, purring sound with breathing out)
• Stridor (harsh sound with breathing in)
• Ribs are pulling in with each breath (retractions)   
• Chest pain and can't take a deep breath
• Dehydration suspected (no urine for over 8 hours AND very dry mouth, no tears, ill-appearing, etc.)
• Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen)
• Fever over 104° F (40° C) and not improved 2 hours after fever medicine

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think your child needs to be seen
• Your child is HIGH-RISK for complications of flu (such as age under 2 years OR underlying heart disease or lung disease, OR weak immune system, etc)
• Continuous (nonstop) coughing
• Age under 1 month old with any cough
• Age 1 to 3 months with a cough for more than 3 days
• Earache or ear discharge also present
• Sinus pain (not just congestion) is also present
• Fever present for more than 3 days
• Fever returns after going away for more than 24 hours

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Age over 6 months and needs flu shot
• Coughing has kept home from school for 3 or more days
• Nasal discharge lasts over 2 weeks
• Cough lasts more than 3 weeks
• Flu symptoms last over 3 weeks

Parent Care at Home If

• Probable seasonal influenza with no complications, your child is LOW-RISK, and you don't think your child needs to be seen

Care at Home

HOME CARE ADVICE FOR INFLUENZA

1. Reassurance:
   • Since influenza is widespread in your community and your child has flu symptoms (cough, sore throat, runny nose, and fever), your child probably has the flu.
   • Special tests are not needed.
   • You don't need to call or see your child's doctor unless your child develops a possible complication of the flu (such as an earache or difficulty breathing).
   • For healthy people, the symptoms of seasonal influenza are similar to those of the common cold.
   • With flu, however, the onset is more abrupt and the symptoms are more severe. Feeling very sick for the first 3 days is common.
   • The treatment of influenza depends on your child's main symptoms and is usually no different from that used for other viral respiratory infections.
   • Bed rest is unnecessary.
2. Runny Nose with Profuse Discharge: Blow or Suction the Nose
   • Nasal mucus is washing viruses and bacteria out of nose and sinuses. Blowing the nose is all that's needed. For younger children, use nasal suction.
   • Apply petroleum jelly to the nasal openings to protect them from irritation.
   • Cleanse the skin first.
3. Nasal Washes To Open a Blocked Nose:
   • Use saline nose drops or spray to loosen up the dried mucus. If not available, can use warm tap water.
   • STEP 1: Instill 3 drops per nostril. (Age < 1 year, use 1 drop and do one side at a time)
   • STEP 2: Blow (or suction) each nostril separately, while closing off the other nostril. Then do other side.
   • STEP 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
   • Frequency: Do nasal washes whenever your child can't breathe through the nose.
   • Saline nasal sprays can be purchased OTC
   • Saline nose drops can also be made: add 1/2 tsp of table salt to 1 cup (8 oz) of warm water
   • Reason for nose drops: suction or nose blowing alone can't remove dried or sticky mucus.
   • Another option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
   • For young children, can also use a wet cotton swab to remove sticky mucus.
   • Importance for a young infant: can't nurse or drink from a bottle unless the nose is open.
4. Medicines for Colds:
   • Cold medicines are not recommended at any age. (Reason: they are not helpful. They can't remove dried mucus from the nose. Nasal washes can.)
   • Antihistamines are not helpful, unless your child also has nasal allergies.
   • Decongestants: OTC oral decongestants (Pseudoephedrine or Phenylephrine) are not recommended. Although they may reduce nasal congestion in some children, they also can have side effects.
   • Age Limit: Before 4 years, never use any cough or cold medicines. (Reason: unsafe and not approved by FDA) (Avoid multi-ingredient products at any age.)
   • No Antibiotics: Antibiotics are not helpful, unless your child develops an ear or sinus infection.
5. Homemade Cough Medicine:
   • Before 1 year of age, only use warm clear fluids (e.g., water or apple juice) to treat the cough. Dosage: 1-3 teaspoons (5-15 ml) four times per day when coughing. Avoid honey.
   • After 1 year of age, use Honey 1/2 to 1 tsp (2 to 5 ml) as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. (If not available, can use corn syrup.) Drugstore cough medicines are not as helpful as honey.
   • After 6 years of age, use Cough Drops to coat the irritated throat. (If not available, can use hard candy.)
6. Sore Throat Relief: For mild sore throat, use warm chicken broth over 1 year old and hard candy over 6 years old. For throat pain more than mild, Ibuprofen is very effective (see Dosage table).
7. Fluids: Encourage adequate fluid to prevent dehydration.
8. Fever Medicine:
   • For fever above 102° F (39° C) or discomfort, use acetaminophen or ibuprofen (See Dosage table for Acetaminophen or Ibuprofen)
   • AVOID ASPIRIN because of the strong link with Reye's syndrome.
   • FOR ALL FEVERS: Give cold fluids in unlimited amounts. Avoid excessive clothing or blankets (bundling).
9. Pain Medicine: For pain relief (e.g., muscle aches or headaches), give acetaminophen every 4 hours OR ibuprofen every 6 hours as needed. (See Dosage Table)
10. Prescription Antiviral Drugs for Influenza:
    • Antiviral drugs (such as Tamiflu) must be started within 48 hours of the start of flu symptoms to have an impact.
    • The CDC recommends they be used for any patient with severe symptoms AND for all HIGH-RISK CHILDREN (see that list).
    • The CDC doesn't recommend antiviral drugs for LOW-RISK children with mild flu symptoms.
    • Their benefits are limited: they usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not eliminate them.
    • Side effects: Vomiting in 10% of children.
11. Contagiousness:
    • Spread is rapid because the incubation period is only 2 days and the virus is very contagious.
    • Your child can return to child care or school after the fever is gone for 24 hours and your child feels well enough to participate in normal activities.
12. Expected Course:
    • Influenza causes a cough that lasts 2 to 3 weeks.
    • Sometimes your child will cough up lots of phlegm (mucus). The mucus can normally be gray, yellow or green.
    • Coughing up mucus is very important for protecting the lungs from pneumonia.
    • We want to encourage a productive cough, not turn it off.
    • The fever lasts 2 to 3 days and the runny nose lasts 7 to 14 days.
13. Prevention: How to Protect Yourself From Getting Sick:
    • Wash hands often with soap and water.
    • Alcohol-based hand cleaners are also effective.
    • Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way.
    • Try to avoid close contact with sick people.
    • Try to avoid unnecessary visits to the ER and urgent care centers because those are the places where you are more likely to be exposed to flu, if you don't have it.
14. Prevention: How to Protect Others - Stay Home When Sick:
    • Cover the nose and mouth with a tissue when coughing or sneezing.
    • Wash hands often with soap and water, especially after coughing or sneezing.
    • Limit contact with others to keep from infecting them.
    • Stay home from school or work for at least 24 hours after the fever is gone (CDC, August 2009).
15. Call Your Doctor If:
    • Breathing becomes difficult or rapid
    • Retractions (pulling in between the ribs) occur
    • Dehydration occurs
    • Earache or sinus pain occurs
    • Fever lasts over 3 days
    • Nasal discharge lasts over 14 days
    • Cough lasts over 3 weeks
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.