H1N1 Flu - When to Worry

When to call your doctor about H1N1 Flu (sometimes referred to Swine Flu) is a common question. The easiest answer is to always call if your child has flu symptoms and is in the High-Risk group for complications. High-Risk children include the following: those with lung disease (such as asthma), heart disease (such as a congenital heart disease), weak immune system (such as cancer), neurological disease (such as muscular dystrophy), diabetes, sickle cell disease, kidney disease, diseases requiring long-term aspirin therapy or other chronic diseases. Being pregnant is also a risk factor. Healthy children are only at increased risk if they are less than 2 years old. These risk factors are the same ones used for treating regular seasonal flu.

If your child is Low-Risk, in other words, over age 2 and healthy, you need to call your health care provider if any of the following emergency symptoms occur:

• First: Your child develops difficulty breathing or rapid breathing. This means he could be getting pneumonia. Another sign of pneumonia is retractions. Retractions mean sucking in between the ribs with each breath.
• Second: Your child stops taking fluids, hasn't passed urine in over 12 hours, doesn't make tears and has a dry mouth. This means your child is becoming dehydrated and needs to get fluids in a medical setting.
• Third: Your child looks or acts very sick. While sick children always sleep more, they should be alert when they are awake. If your child is not alert and able to interact with you, always call.

If your child is Low-Risk, also call for any of the following nonurgent symptoms:

• First: Your child acts like he's having an ear ache or is unusually cranky. This points to an ear infection. So does a yellow or cloudy discharge coming from the ear canal. An ear infection is the most common complication of the flu, occurring in 10% of young children.
• Second: Your child develops pressure or pain on the face overlying a sinus (that means around the eye or over the cheekbone). Your child can't breathe through the nose because it's blocked with thick yellow secretions that can't be removed with nasal washes. The openings of the nose become raw and scabbed over. Any of these mean your child could have a sinus infection. However, don't worry about nasal secretions that become yellow or green. They are a normal part of the body's reaction to a cold. As an isolated symptom, they do not mean your child has a sinus infection.
• Third: The fever lasts for more than 3 days or comes back after being gone for over 24 hours. This increases the chances that your child has developed a bacterial complication, such as an ear or sinus infection.
• Fourth: The flu symptoms last too long. Normally the nasal discharge shouldn't last over 2 weeks nor the cough last over 3 weeks.

In summary, call your health care provider if you think your child needs to be seen. Don't call to report that your child has symptoms of H1N1 Flu. You don't need any confirmation or testing to decide your child has the flu. If parents call about healthy children with expected symptoms, it creates call volume overload and important calls can't get through. Knowing that your child doesn't have any of the worrisome symptoms should help you sleep better. And remember: most children can easily be treated at home with symptom care.

If you think your child may need to be seen, call your healthcare provider for advice.

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. FAAP

Last Review: 9/28/2009

Last Revised: 9/28/2009

Copyright 1994-2009 Barton Schmitt, M.D. Parent Advice Messages.