Influenza (The Flu) in Children

Influenza (the flu) is an upper respiratory virus that causes cold symptoms such as runny nose, cough, and sore throat; however, the symptoms are usually a little worse and there is a greater chance of complications than with the common cold. There is also a vaccine to prevent it.

• Runny nose and nasal congestion lasting 7-10 days.
• Cough lasting up to 2-3 weeks.
• Fever up to 102-103 or higher for the first 2-4 days (fever itself will not harm your child).
• Body aches.
• Decreased appetite, tiredness, fatigue, crankiness.
• Sometimes sore throat, headache, hoarseness, body aches, red watery eyes, vomiting, and/or loose stools.
• Ears may feel full or stopped-up.

• The influenza virus is a respiratory virus that spreads every year around the world.  Antibiotics will not kill or treat viral infections. There are some anti-viral medications that can slow the virus down, though the virus is becoming resistant and there are side effects to the medicines.
• The flu infects millions every year and kills about 36,000 Americans each flu season.
• The influenza virus exists as several types and strains every year, including the new H1N1 strain (also known as “swine flu”.)
• A vaccine is available to prevent the flu; however, because the virus changes every year, a new vaccine has to be produced each year. And when a totally new strain appears, a new vaccine must be developed.

• The worst day is usually around the 4^th day. Fever should be resolved by the 5^th day and the child starts to feel better. 
• Many children will not eat as well but will usually drink enough to stay hydrated, and this is what matters most. 
• The nose is usually clear and very runny at first, though it sometimes starts as congestion. 
• After 3-4 days, the mucous usually gets thicker and child is more congested. In younger children, it will turn green/yellow before it has a chance to come out. This is normal and a sign the infection is getting better.
• Congestion usually lasts 7-10 days but can last up to 14 days; cough typically starts after the first few days and can last 14-21 days as well, occasionally even longer.

• There is no cure for the flu; antibiotics will not treat it at all and can make things worse. 
• Antiviral medications can make the flu less severe and last a few days less. They have to be started within 2 days of the start of symptoms.
• Because of resistance and side effects, the antiviral medications are only recommended in children at high-risk of complications from the flu, such as children with asthma and diabetes.
• Cough and cold medicines can be used in children 6 years and older. They may provide temporary relief of the symptoms for several hours but they will not treat the infection itself nor will they change how long it lasts.
• Treatment for a runny nose: wiping and blowing the nose. Sniffing and swallowing is fine and may be better than blowing.
• If the skin around the nose becomes raw and irritated, Vaseline can be put on the skin.
• Treatment for a congested, stuffed up nose:
  • Use nose drops of warm tap water, homemade saline (1/2 tsp table salt in 8 oz warm water) or saline nose drops from the drug store. Place 3-4 drops in each nostril or spray the solution in the nose; wait one minute, then blow to remove the loosened mucous.
  • Children may cry, cough, or sneeze in this process. Repeat until nose sounds clear. This process will need to be repeated 4 or more times a day.
  • A Neti pot can be used to flush out the nose as well.
  • Cool-mist humidifiers may also help at night with congestion.
  • Warm foods and drinks, especially chicken soup, can help congestion and sore throat.
  • Decongestants can be tried in children 6 and up, though they are of limited benefit and may have side effects.
• Acetaminophen or ibuprofen can be used for fever, sore throat, headache and/or body aches. Fever should be treated only if it makes your child feel bad.
• Cough can be treated with warm drinks or soup, 1-2 teaspoons of honey, a humidifier, and washing out the nose with saline spray.
• Coughs are also sometimes relieved by sucking on hard candy or cough drops (children 4 and up).
• In children 6 years and up, you can try the expectorant guaifenesin (sold as Robitussin and Mucinex), and/or cough suppressant dextromethorphan (usually abbreviated as “DM”.)
• Do not use diphenhydramine (Benadryl) for colds. It can help dry up a runny nose but it does so by making mucous thicker. It can make congestion worse and prevent the nose from draining, and can increase the chance of developing a sinus infection. 

• Dehydration can occur if fluid intake is inadequate. A poor appetite is normal, but be sure child is drinking adequate fluids and urinating at least once every 8 hours.
• Ear infections typically start several days to a week into the illness and are characterized ear pain, not just fullness or feeling stopped up.
• Sinus infections start when the flu starts to go away; the congestion will be thick, will worsen after the 7-10th day instead of getting better, and will last longer than 10-14 days. Often the child will have headaches, sinus or facial pain as well.
• Pneumonia usually starts several days into the illness when the child should be getting better. Usually, a fever develops, along with a worsening cough. The child may have more rapid breathing and shortness of breath.
• Sometimes these viruses cause wheezing, and some children tend to wheeze when they get respiratory infections. If the child is wheezing, then she should be examined. 

• Breathing difficulty (wheezing, labored breathing).
• Initial fever lasts longer than 5 days.
• Initial fever goes away for 2 days and then fever returns.
• Not drinking enough fluid (not urinating at least once every 6-8 hours).
• Ear pain (not just fullness or “popping”).
• Congestion that lasts more than 10-12 days or that worsens after the 10^th day.
• Cough lasts longer than 14-21 days or that worsens after the 14th day.

• The flu is spread by saliva and secretions from the nose. This can come from direct contact with people who are sick, or with germs present on surfaces such as door handles.
• You can try to avoid exposing young children to people with colds and flu in daycares, church nurseries, etc.
• Handwashing is the best means of prevention in older children and adults. They should always be washed before eating and before touching the eyes, nose or mouth.
• An annual flu vaccine is recommended for all children age 6 months and older. It is usually available from September to February. Flu season usually begins around November-December.
• Exposure to tobacco smoke makes colds and flu more common and more severe, so children should avoid any exposure.