Influenza - Seasonal  

This Care Guide Covers:

  • Influenza (Flu) is a viral infection
  • The nose, throat, and upper parts of the lungs are involved
  • You think your child has influenza because other family members
  • You think your child has influenza because close friends have it
  • You think your child has influenza and it's all around in the community

If not, see these topics

 

 

When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Lips or face are bluish when not coughing
  • You think your child has a life-threatening emergency
Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Trouble breathing (Exception: present only when coughing)
  • Breathing is much faster than normal
  • 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 (called retractions)
  • Chest pain and can't take a deep breath
  • Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
  • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
  • SEVERE HIGH-RISK child such as lung disease, heart disease, bedridden
  • Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen.)
  • Fever over 104° F (40° C)
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • HIGH-RISK child for complications of flu. Includes children with other chronic diseases. (See that list). Also, includes healthy children less than 2 years old.
  • Nonstop coughing spells
  • Age under 3 months old with any cough
  • Earache or ear discharge
  • Sinus pain (not just congestion)
  • Fever lasts more than 3 days
  • Fever returns after gone 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 a flu shot
  • Coughing causes vomiting 3 or more times
  • Coughing has kept home from school for 3 or more days
  • Nasal discharge lasts more than 2 weeks
  • Cough lasts more than 3 weeks
  • Flu symptoms lasts more than 3 weeks
Parent Care at Home If
  • Influenza with no complications and your child is LOW-RISK
Causes & Health Information

Symptoms

  • Main symptoms are a runny nose, sore throat, bad cough and fever.
  • More muscle pain, headache, fever, and chills than with usual colds.
  • If there is NO fever, the child probably doesn't have flu. More likely he has a cold.

Cause

  • Influenza viruses that change yearly

Diagnosis: How to Know Your Child Has Influenza

  • Influenza occurs every year in the fall and winter months. During this time, if flu symptoms occur, your child probably has the flu.
  • Your child doesn't need any special tests.
  • Call your doctor if your child is HIGH-RISK for complications of the flu. See the list below. These are the children who may need prescription anti-viral drugs.
  • For LOW-RISK children, usually you don't need to see your child's doctor. If your child develops a possible complication of the flu, then call your doctor. 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:

  • 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 needing long-term aspirin therapy
  • Pregnancy
  • Healthy children under 2 years old are also considered HIGH-RISK (CDC 2009)
  • Note: All other children are referred to as LOW-RISK

Prescription Antiviral Drugs for Influenza

  • Antiviral drugs (such as Tamiflu) are sometimes used to treat influenza. They must be started within 48 hours when the flu symptoms start.
  • The AAP recommends they be used for any patient with severe symptoms. They also recommend the drugs for most HIGH-RISK children. See that list.
  • The AAP 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 make them go away.
  • Side effects: Vomiting in 10% of children.

Return to School

  • Your child can return to school after the fever is gone for 24 hours. Your child should feel well enough to join in normal activities.
  • Spread is rapid. The time it takes to get the flu after contact is about 2 days. The range is 1 to 4 days. The virus is easily passed to others.
CARE ADVICE FOR SEASONAL INFLUENZA

  1. What You Should Know:
    • Flu symptoms include cough, sore throat, runny nose, and fever. During influenza season, if your child has these symptoms, he probably has the flu.
    • Special tests are not needed. Usually, you don't need to call or see your child's doctor.
    • If your child develops a complication of the flu, then call your child's doctor. Examples are an earache or trouble breathing. These problems are included in the "When to Call Your Doctor" section.
    • For healthy people, the symptoms of influenza are like those of a common cold.
    • With flu, however, the onset is more abrupt. 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. It is no different from treatment used for other viral colds and coughs.
    • Bed rest is not needed.
    • Here is some care advice that should help.
  2. Runny Nose with Lots of Discharge: Blow or Suction the Nose
    • The nasal mucus and discharge is washing germs out of the nose and sinuses.
    • Blowing the nose is all that's needed.
    • For younger children, gently suction the nose with a suction bulb.
    • Put petroleum jelly on the skin under the nose. Wash the skin first with warm water. This will help to protect the nostrils from any redness.
  3. Nasal Washes To Open a Blocked Nose:
    • Use saline nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use warm tap water.
    • STEP 1: Put 3 drops in each nostril. (If age under 1 year old, use 1 drop. Also, do 1 side at a time.)
    • STEP 2: Blow (or suction) each nostril out while closing off the other nostril. Then, do the other side.
    • STEP 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
    • How often: Do nasal washes when your child can't breathe through the nose. Limit: No more than 4 times per day.
    • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
    • Saline nose drops can also be made at home. Use 1/2 teaspoon (2 ml) of table salt. Stir the salt into 1 cup (8 ounces or 240 ml) of warm water.
    • Reason for nose drops: Suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open.
    • Other 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.
  4. Medicines for Colds:
    • Age Limit. Before 4 years, never use any cough or cold medicines. Reason: Unsafe and not approved by the FDA. Also, do not use products that contain more than one medicine.
    • Cold Medicines. They are not advised. Reason: They can't remove dried mucus from the nose. Nasal washes are the answer.
    • Decongestants. Decongestants by mouth (such as Sudafed) are not advised. They may help nasal congestion in older children. Decongestant nasal spray is preferred after age 12.
    • Allergy Medicines. They are not helpful, unless your child also has nasal allergies. They can also help an allergic cough.
    • No Antibiotics. Antibiotics are not helpful for colds. Antibiotics may be used if your child gets an ear or sinus infection.
  5. Homemade Cough Medicine:
    • Goal: Decrease the irritation or tickle in the throat that causes a dry cough.
    • AGE 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 ml). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
    • AGE 1 year and older: Use HONEY ½ to 1 teaspoon (2-5 ml) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.
    • AGE 6 years and older: Use COUGH DROPS to coat the sore throat. If you don't have any, you can use hard candy.
  6. Sore Throat Pain Relief:
    • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice.
    • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
    • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
    • Medicated throat sprays or lozenges are generally not helpful.
  7. Fluids:
    • Try to get your child to drink lots of fluids.
    • Goal: Keep your child well hydrated.
    • It also will thin out the mucus discharge from the nose.
    • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
  8. Fever:
    • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: lower fevers are important for fighting infections.
    • AVOID ASPIRIN because of the strong link with Reye syndrome.
    • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
    • For babies, dress lightly. Don't wrap in too many blankets. Reason: can make the fever higher.
  9. Pain Medicine:
    • For muscle aches or headaches, give acetaminophen (Tylenol) OR ibuprofen. Use as needed. See Dose Table.
  10. Prescription Antiviral Drugs for Influenza:
    • Antiviral drugs (such as Tamiflu) are sometimes used to treat influenza. They must be started within 48 hours of when flu symptoms start.
    • The AAP recommends they be used for any patient with severe symptoms. they also recommend the drugs for most HIGH-RISK CHILDREN. See that list.
    • The AAP doesn't recommend antiviral drugs for LOW-RISK children with normal flu symptoms.
    • Their benefits are limited. They reduce the time your child is sick by 1 to 1 1/2 days. They reduce the symptoms, but do not make them go away.
    • Side effects: Vomiting in 10% of children.
  11. Return to School:
    • Spread is rapid, and the virus is easily passed to others.
    • The time it takes to get the flu after contact is about 2 days.
    • Your child can return to school after the fever is gone for 24 hours.
    • Your child should feel well enough to join in normal activities.
  12. What to Expect:
    • Influenza causes a cough that lasts 2 to 3 weeks.
    • Sometimes your child will cough up lots of phlegm (mucus). The mucus can be gray, yellow or green. This is normal.
    • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
    • We want to help a productive cough, not turn it off.
    • The fever lasts 2 to 3 days.
    • 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 also work well.
    • Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way.
    • Try to avoid close contact with sick people.
    • Avoid ERs and urgent care clinics if you don't need to go. These are places where you are more likely to be exposed to flu.
  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. After coughing or sneezing are important times.
    • Limit contact with others to keep from infecting them.
    • Stay home from school for at least 24 hours after the fever is gone. (CDC 2009).
  15. Flu Shot and Prevention:
    • Getting a flu shot is the best way to protect your family from flu.
    • Yearly influenza vaccines are strongly advised for all children over 6 months of age. (AAP)
    • Adults should also get the shot.
    • The shot most often prevents the disease.
    • Even if your child gets the flu, the shot helps to reduce the symptoms.
  16. Call Your Doctor If:
    • Breathing becomes hard or rapid
    • Retractions (pulling in between the ribs) occur
    • Dehydration occurs
    • Earache or sinus pain occurs
    • Fever lasts more than 3 days
    • Nasal discharge lasts more than 14 days
    • Cough lasts more than 3 weeks
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2012

Last Revised: 1/14/2013

Content Set: Child Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.