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Should Your Child See a Doctor?

Influenza – Seasonal

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Definition

  • Influenza 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 influenza and it's prevalent in the community

Symptoms 

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

Cause 

  • Influenza viruses that change yearly

Return to School 

  • Spread is rapid because the incubation period is only 24 to 36 hours and the virus is very contagious.
  • Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.
  • For practical purposes, the spread of influenza cannot be prevented.

Prevention with Influenza Vaccine 

  • Yearly "flu shots" prevent 70% to 90% of influenza
  • They are recommended for all children over 6 months.
  • They are recommended for all High-Risk children (see that list) of any age
  • New flu vaccine is usually available by 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 2 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.

See More Appropriate Topic (instead of this one) If 

When to Call Your Doctor for Influenza

Call 911 If…

 
  • Your child has severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing)
  • Your child's 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
  • Lips or face have turned bluish during coughing
  • Wheezing occurs
  • Stridor (harsh sound breathing in) occurs
  • Ribs are pulling in with each breath (retractions)
  • Chest pain and can't take a deep breath
  • Dehydration suspected (no urine in more than 12 hours AND very dry mouth, no tears, ill-appearing, etc.)
  • Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc.)
  • SEVERE HIGH-RISK patient such as chronic lung disease (exception: mild asthma), heart disease, bedridden, 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
  • HIGH-RISK for complications of flu (children with other chronic diseases [see that list] OR healthy under 2 years old)
  • Continuous (nonstop) coughing
  • Age under 3 months old with any cough
  • Earache or ear discharge also present
  • Sinus pain (not just congestion) is also present
  • Fever present for 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 flu shot
  • Coughing has kept home from school for 3 or more days
  • Nasal discharge lasts over 2 weeks
  • Cough has been present over 3 weeks
  • Influenza lasts over 3 weeks
 

Parent Care at Home If

  • Probable influenza with no complications and you don't think your child needs to be seen
 

Home Care Advice for Seasonal Influenza

  1. Reassurance:
    • For healthy people, the symptoms of 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 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, gently suction the nose with a suction bulb.
    • Apply petroleum jelly to the nasal openings to protect them from irritation.
    • Cleanse the skin first.
       
     
  3. Nasal Washes for 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 under 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 without a prescription.
    • Saline nose drops can also be made: add 1/2 teaspoon (2 ml) of table salt to 1 cup (8 ounces or 240 ml) 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:
    • Goal: reduce the irritation or tickle in the throat that triggers a dry cough
    • Age 3 months to 1 year of age: Give 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 until 1 year old.
    • Age 1 year and older: 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.
    • Age 6  and older: 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.
     
  7. Fever Medicine:
    • For fever above 102° F (39° C) or discomfort, use acetaminophen or ibuprofen (See Dosage table)
    • 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).
       
     
  8. Pain Medicine: For pain relief (e.g., muscle aches or sore throat), give acetaminophen every 4 hours OR ibuprofen every 6 hours as needed. (See Dosage Table)
     
  9. Prescription Antiviral Drugs for Influenza:
    • Antiviral drugs must be started within 48 hours of the start of influenza symptoms to have an impact.
    • Their benefits are limited: they only reduce the duration of symptoms by 1 to 1.5 days. They do not cure the disease nor remove all the symptoms.
    • The AAP recommends they be used for HIGH-RISK CHILDREN.
    • Tamiflu is not approved if under 1 year of age.
    • Pediatricians vary in their opinion about the value of prescribing antiviral drugs for HEALTHY CHILDREN with influenza.
       
     
  10. Contagiousness:
    • Spread is rapid because the incubation period is only 24 to 36 hours and the virus is very contagious.
    • Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.
       
     
  11. Expected Course:
    • Influenza causes a cough for 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.
       
     
  12. Call Your Doctor If:
    • Difficulty breathing occurs
    • 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.

References

  1. AAP Committee on Infectious Diseases. Antiviral therapy and prophylaxis for influenza in children. Pediatrics. 2007;119:852-859.
  2. American Academy of Pediatrics, Committee on Infectious Disease: Policy Statement: Reduction of the influenza burden in children. Pediatrics. 2002; 110:1246-1252.
  3. American Academy of Pediatrics: Committee on Infectious Diseases. Influenza. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
  4. Cheung M, Lieberman JM. Influenza: Update on strategies for management. Contemp Pediatr. 2002;19(10):82-94.
  5. Siberry GK. Complications of influenza infection in children. Pediatr Ann. 2000;29:683-690.

Disclaimer

This information is not intended to 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: 8/1/2010

Last Revised: 9/30/2010 5:27:32 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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