Flu Questions

To read more about the flu and current flu activity, go to CDC: Flu in the United States.

What is the flu?

The flu is a respiratory illness caused by a virus. Fever is usually present and often above 102°F, and there are also headache, sore throat, cough, runny nose, and body aches. Tiredness is often prominent, and cough and fatigue may last more than a week.

It commonly causes complications such as ear infection, wheezing (especially in known wheezers), sinusitis or pneumonia.

In children, complications requiring prescription medications or hospital admission are most common under age 2 years, and in those with underlying conditions such as asthma, diabetes, or a weak immune system.

The federal Centers for Disease Control (CDC) have underlined the potential seriousness of the flu in your child on a short YouTube video.

Besides vaccination, what can I do to prevent getting the flu, or my children getting the flu?

Flu is spread by direct contact with saliva or mucous from an infected person, up to 48 hours before they know they are sick. You can also get flu by direct contact with shared objects, like touching the same counter/faucet/doorknob or cloth item as an ill person, and then touching your eyes, nose or mouth with the flu germs on it. You might be served food prepared or carried by an ill person.

Aside from vaccination, prevention of the flu comes down to common sense and basic hygiene more than anything else.

Some people will want to take more precautions than others, due to being pregnant, having an infant under 6 months in the home, or having a child with a chronic medical problem like asthma requiring daily medication. Young children typically have poor hygiene, touch their noses and mouths frequently, and touch each other frequently.

Some experts believe that having an adequate level of Vitamin D in the body can help fight infections like flu and colds. The recommended daily intake for most children is 400iu Vitamin D/day. Children who don’t normally have common supplemented foods such as cold processed breakfast cereal, supplemented yogurt or 32 ounces of milk (!) a day can benefit from a daily Vitamin D drop or pill.

The Centers for Disease Control have old fashioned advice, like what mom always said, here.

Which kids should be seen by a doctor?

There is good reason to check in with us within the first 48 hours of symptoms if your child is under age 5 years, or older but has a chronic health problem (like asthma requiring daily preventative medication). Please call during office hours unless you think it’s an emergency. I may recommend an office visit or specific medication due to your child’s age or health status.

Public health specialists and infectious disease doctors want to make sure that prescription drugs are used wisely and not over-prescribed for the flu. Therefore, for most people, staying away from doctors and emergency rooms, unless your child’s flu case is severe or complicated, is a good idea to help reduce the risk of unnecessary tests and overprescribing.

There are some indicators that an illness may be severe or complicated and needs a visit. These problems include repeated vomiting and shortness of breath (not just due to a clogged nose). In young children this may be seen as nostril flaring or extra muscle involvement on viewing the child’s chest and stomach during breathing.

Other reasons to call for a visit include fever lasting more than about 4-5 days, earache, chest pain not relieved by albuterol, confusion or irritability that you can’t soothe.

What treatment is there for the flu?

The mainstay of treatment is rest at home, and pain and fever relievers. Asthmatics usually need to use reliever medications, such as albuterol, too. They may have severe enough symptoms to need to take prednisone.

Fever is often above 102°F, and in younger children can go to 106°F. Make sure you have a reliable thermometer. Digital thermometers are easy to obtain, and forehead scan ones are a convenient alternative that costs a little more. For children under 2 years, I recommend a digital thermometer that can go in the bottom if other thermometers show a temperature above 103°F-104°. I would definitely recheck with a bottom reading if a surface (forehead or ear) thermometer reads above 104°F.

You will need acetaminophen and ibuprofen in the house. Acetaminophen comes in suppositories which is handy if your child is vomiting and can’t keep down oral fever reducers. No prescription is required; ask the pharmacist if you can’t find them.

DO NOT give aspirin to children with the flu, it can cause a serious disorder called Reye’s Syndrome.

Antibiotics don’t help the flu, but they may be prescribed to treat flu complications such as ear infections, sinusitis or pneumonia. I would suspect one of these for fever lasting more than 5-6 days, or if fever comes back after having disappeared for 24 hours or more.

There are prescription anti-viral medications available, but they are only somewhat effective in reducing the severity and duration of the flu. Like any medication, anti-virals also pose risks, with the most common being nausea and vomiting and the most severe including severe confusion.

The Centers for Disease Control has practical advice for parents caring for a child with H1N1 flu at home here.

If you want detailed advice and information, go to these longer documents, Flu: What You Can Do in:

How can I tell whether my asthmatic’s cough is asthma or flu?

Whether or not a child has asthma, s/he will often have a bad cough for days or longer, with the flu. This often disturbs sleep. If your child has asthma, you will need to try to distinguish what is asthma needing more treatment. Children 5 and older who are used to doing peak flows may not be able to produce a reliable peak flow value when sick. Often times they feel too weak, dizzy, or nauseated, or have sore throat, headache or earache that prevents them from blowing a good peak flow. So you will have to make a jugement call: can I believe this number?

There are other indicators of whether the cough is asthma. A flu cough is usually dry, and there is no wheezing. When the child is not hot, their breathing looks easy and not labored. (Breathing speeds up with a fever, but unless there is asthma or pneumonia, breathing will not be labored.) Flu cough doesn’t go away with asthma medicines. Asthma causes a tight-feeling chest; some kids complain of throat or chest pain especially in the breastbone area.

If your child has asthma, and someone in your home gets a flu like illness, make sure you have enough of your child’s asthma medicines, and call the office during office hours if you are low on anything.

What can I do about the cough? My child can’t sleep and sometimes it makes him/her throw up.

If your child has been diagnosed previously with asthma, or if you have albuterol or Xopenex for your child, try that before any other “cough medicine.”

For children under 4 with difficulty sleeping, consider whether the child needs acetaminophen or ibuprofen for the headache, sore throat, or ear pain. For troublesome cough, you can give honey and lemon in warm water or a tea, and you can also give diphenhydramine (Benedryl) to help calm cough and allow sleep at night.

For children over 4, in addition to the above ideas, you can use other over the counter medicines, but don’t use ones with too many ingredients. I wouldn’t use something that contained acetaminophen or ibuprofen and something else. Avoid cough suppressants that include antihistamine, if you are also giving plain antihistamine (like Benedryl). Make sure you know the active ingredients of any “over the counter medicine” so you are not overdosing your child on something. For example, if the “cough syrup” contains chlorpheniramine (an antihistamine), avoid giving diphenhydramine (Benedryl), for at least the next 4 hours.

Finally, if the cough seems a lot worse than it was a day or so earlier during the flu, especially if your child also seems sicker, consider whether they may have pneumonia. If pneumonia is present as a flu complication, the child should seem sicker than they were, not just have a bad cough. The breathing may be fast or labored, the child’s appetite and fatigue worse, and a fever that went away or was a lot lower is back again or went higher again. Or maybe your child has had fever for more than 5 days already.

Call or consider self referring to an ER if it's after hours and you think your child may have pneumonia.