Flu and Kids

What is the flu?

The flu (influenza) is an all-too-familiar illness for most parents, especially during flu season (November to April). This highly contagious respiratory tract infection can send a child to bed for three to five days with a high fever, headache, congestion, chills, coughing, diarrhea, and vomiting, as well as muscle aches and fatigue. It's caused primarily by two flu viruses, influenza A and influenza B, which spread quickly in schools and other places where people gather in large groups. Occasionally the flu virus mutates, causing enormous outbreaks. The flu may have more serious consequences for children with chronic health problems like asthma and diabetes.

What are the signs that my child has the flu?

The early symptoms aren't always easy to detect. The first sign may be a change in her behavior, such as acting unusually grumpy or tired. If your child has a high fever (101 to 103 degrees F), a dry cough, chills, fatigue, sore muscles, and a headache, she probably has the flu. The group of symptoms, of course, differs slightly from child to child. Children typically recover from the symptoms in about three to four days (although they may continue to feel achy for up to two weeks), and the body's immune system will build natural defenses against the virus.

How did my child get the flu?

Children usually become infected through contact with someone who has the flu or by touching infected items such as plastic toys and utensils. People can pass on the flu virus by touching, kissing, and coughing, and the hardy virus can live for up to two hours on the surface of objects like toys or bedposts. Because it's so easily transmitted in densely populated areas such as schools, the flu has the highest incidence among children ages 5 to 14. During flu season, anywhere from 5 to 20 percent of the entire US population may be infected with a flu virus of one type or another.

What's the best way to treat my child?

Bed rest, plenty of water and juice, and nutritious foods are the best remedies when your child has the flu. Frozen fruit bars are a good way to give her extra liquid, and hot soup or broth may ease the sense of congestion. For muscle aches, give your child a pain reliever such as acetaminophen. (Never give aspirin to children or teenagers, particularly if they may have a viral infection; this can cause Reye's syndrome, a rare but potentially life-threatening condition.) Because the flu is so contagious, practice good hygiene around your child during her illness: Use disposable paper cups, throw away used tissues promptly, and wash your hands after caring for her.

Does my child need a flu shot?

Experts recommend inoculating all children against the flu, since the illness is responsible for so much lost time from work and school. Because a bout of the flu can send even healthy children to the hospital, the Centers for Disease Control recommends the flu shot for everyone over 6 months of age.

While everyone should receive the flu vaccine, the CDC stresses the importance of vaccination for kids at greater risk, including those with chronic heart or lung illnesses (such as asthma), children who are regularly hospitalized because of a suppressed immune system, children who have chronic metabolic diseases (including diabetes mellitus and certain kidney diseases), and children on chronic aspirin therapy.

Likewise, vaccination is of particular urgency for caretakers and family members of children at high risk, especially those taking care of children younger than 6-months-old.

If your child has never been vaccinated for influenza, she'll need two shots, one month apart, to build immunity. Because the flu vaccine is developed from eggs, children who are allergic to eggs or chicken should not be vaccinated.

How can I prevent my child from getting the flu?

Because the flu virus is so easily spread -- through human touch, on objects, and in the air -- it's tough to guard your child against it. Here are some tips that can help:

Teach her to cough or sneeze into a tissue, then throw it out immediately afterwards. If she doesn't have a tissue handy, tell her to cough or sneeze into her elbow or sleeve.

Teach her to wash her hands with soap and water for at least 20 seconds, especially after she coughs, sneezes, or touches her eyes. Alcohol-based hand sanitizers are great for killing germs. When someone in your house is sick, antibacterial wipes are good to use on surfaces in high-traffic areas, such as kitchens and bathrooms.

• Tell her not to touch her eyes, nose, or mouth. (You can spread germs from the mucus in your eyes and mouth this way.)
• Killing germs is one thing; staying healthy is another. Make sure your child gets enough sleep, stays hydrated, and eats lots of fruits and vegetables -- it will help keep her body's immune system working at its peak.
• Finally, if your child feels sick or has a fever, keep her home until the fever is gone for 24 hours (without having to take medicine to reduce it), and limit her contact with others

The flu can turn into ear, sinus, or dangerous lung infections such as pneumonia. But most normally healthy children make a full recovery from the flu in three to five days.

When should I call my child's pediatrician?

If your child is HIV-positive or has a chronic illness (such as cancer, sickle cell anemia, diabetes, or lung, heart, or kidney disease), call your pediatrician at the first sign of flu. Call, too, if your child is on chronic aspirin therapy and shows symptoms of flu.

In these circumstances, call for an immediate appointment:

• If your child has an earache, ear drainage, or severe pain in her face or forehead; this could signal sinusitis or an ear infection.
• If she has persistent chest pain and fever, or if she's wheezing and coughing up discolored mucus; these might be signs of pneumonia or bronchitis.

Pediatricians also stress that each child's case depends on the combination of symptoms. A child with a fairly high fever who is resting quietly, for example, probably has "normal" flu symptoms. On the other hand, a child who is running a slight fever but straining to breathe while lying in bed or watching television should be seen by her doctor. If your child becomes sick again soon after quickly bouncing back from the flu, or if she has a high fever for more than three to four days, call your pediatrician for advice.

Further Resources

Robert H. Pantell M.D., James F. Fries M.D., Donald M. Vickery M.D., Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care. Da Capo Lifelong Press.

References

Mi Young Hwang, Do You Have the Flu? JAMA 281(10):310. http://jama.ama-assn.org/cgi/reprint/281/10/962.pdf

National Institute of Allergy and Infectious Diseases, National Institutes of Health. Is It a Cold or the Flu? http://www.niaid.nih.gov/topics/Flu/Pages/coldOrFlu.aspx

Centers for Disease Control. Key Facts About Seasonal Influenza (Flu). http://www.cdc.gov/flu/keyfacts.htm

Centers for Disease Control and Prevention. Key Facts About Seasonal Flu Vaccine. http://www.cdc.gov/FLU/protect/keyfacts.htm

Centers for Disease Control and Prevention. Key Facts About Flu: Who should get vaccinated? http://www.cdc.gov/flu/keyfacts.htm#whoshould1

Centers for Disease Control and Prevention. Children, the Flu, and the Flu Vaccine. http://www.cdc.gov/flu/protect/children.htm