Influenza - Seasonal

• Your child has symptoms of influenza (Flu) and it's in your community
• Main symptoms: fever AND one or more respiratory symptoms (cough, sore throat, very runny nose)
• Influenza (Flu) is a viral infection
• You think your child has influenza because other family members have it
• You think your child has influenza because close friends have it

Symptoms of Influenza

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

Cause of Influenza

• 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 "What to Do" section.

High-Risk Children for Complications from Influenza (AAP)

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 or severe obesity
• Healthy children under 2 years old are also considered High-Risk (CDC)
• 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. After 48 hours of fever, starting the drug is not helpful.
• The AAP recommends they be used for any patient with severe symptoms.
• The AAP recommends the drugs for most High-Risk children with underlying health problems. 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 on Tamiflu.
• Most healthy children with flu do not need an antiviral drug.

Call 911 Now

• 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

Go to ER Now

• Ribs are pulling in with each breath (called retractions)
• Not alert when awake ("out of it")

Call Doctor or Seek Care Now

• Trouble breathing, but not severe
• Breathing is much faster than normal
• Lips or face have turned bluish during coughing
• Wheezing (high-pitched purring or whistling sound when breathing out)
• Stridor (harsh sound with breathing in) is heard now
• Chest pain and can't take a deep breath
• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• Severe High-Risk child (see that list in Causes). This includes lung disease, heart disease, and bedridden.
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Fever over 104° F (40° C)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• High-Risk child for complications of flu. Includes children with other chronic diseases. (See that list in Causes). Also, includes healthy children less than 2 years old.
• Nonstop coughing spells
• Age less than 3 months old with any cough
• Earache or ear drainage
• Sinus pain (not just congestion)
• Fever lasts more than 3 days
• Fever returns after being gone more than 24 hours
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Age more than 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
• You have other questions or concerns

Self Care at Home

• Influenza with no other problems and your child is Low-Risk

Care Advice for Influenza

1. What You Should Know About Influenza:
   • Flu symptoms include cough, sore throat, runny nose, and fever. During influenza season, if your child has these symptoms, he probably has the flu.
   • Most parents know if their child has flu. They have it too or it's in the school. It's also in the news. You don't need any special tests when you think your child has flu.
   • 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 "What to Do" section.
   • For healthy people, the symptoms of influenza are like those of a bad 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.
   • Most children with flu don't need to see their doctor.
   • 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 are washing germs out of the nose and sinuses.
   • Blowing the nose is all that's needed. Teach your child how to blow the nose at age 2 or 3.
   • 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 Saline to Open a Blocked Nose:
   • Use saline (salt water) nose spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water.
   • Step 1. Put 3 drops in each nostril. If under 1 year old, use 1 drop.
   • 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 saline rinses when your child can't breathe through the nose.
   • Limit. If under 1 year old, no more than 4 times per day or before every feeding.
   • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
   • 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 Flu:
   • Cold Medicines. Don't give any drugstore cold or cough medicines to young children. They are not approved by the FDA under 6 years. Reasons: not safe and can cause serious side effects. Also, they are not helpful. They can't remove dried mucus from the nose. Nasal saline works best.
   • 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 flu. 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 6 months to 1 year: give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: use a dose of 1-2 teaspoons (5-10 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 decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking.
6. Sore Throat Pain Relief:
   • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
   • 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 - Offer More:
   • 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 Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Avoid Aspirin because of the strong link with Reye syndrome.
   • Note: Fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
9. Pain Medicine:
   • For muscle aches or headaches, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
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. After 48 hours of fever, starting the drug is not helpful.
    • 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 in Causes.
    • If your child has a chronic disease and gets the flu, call your doctor. The doctor will decide if your child needs a prescription.
    • 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 ½ days. They reduce the symptoms, but do not make them go away.
    • Side effects: Vomiting in 10% of children on Tamiflu.
    • Most healthy children with flu do not need an antiviral drug.
    • Also, it is not used to prevent flu. Reason: You would need to take the medicine every day for months.
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).
15. Flu Shot and Prevention:
    • Getting a flu shot is the best way to protect your family from flu.
    • 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.
    • A new flu shot is needed every year. Reason: Flu viruses keep changing.
    • After the flu shot, it takes 2 weeks to fully protect from flu. But then, the protection lasts for the full flu season. An antiviral medicine only protects from flu while taking it.
16. Call Your Doctor If:
    • Trouble breathing occurs
    • Retractions (pulling in between the ribs) occur
    • Dehydration occurs
    • Earache or sinus pain occurs
    • Fever lasts more than 3 days or goes above 104° F (40° C)
    • Nasal discharge lasts more than 14 days
    • Cough lasts more than 3 weeks
    • You think your child needs to be seen
    • Your child becomes worse