Influenza

Pediatric HouseCalls Online

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, and bad cough
• 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 age 6 months to 5 years.
• They are recommended for all High-Risk children (see that list) of any age
• New flu vaccine is usually available in October

High Risk Children for Complications From Influenza

• Lung disease (e.g., asthma, cystic fibrosis, bronchopulmonary dysplasia)
• Heart disease (e.g., congenital heart disease, rheumatic heart disease)
• Muscle disease (e.g., muscular dystrophy)
• Metabolic disease (e.g., diabetes mellitus)
• Sickle cell disease
• Renal disease (e.g., nephrotic syndrome)
• Malignancy and other immunocompromised conditions (e.g., HIV)
• Diseases requiring long-term aspirin therapy (e.g., Kawasaki's disease and rheumatoid arthritis)

See More Appropriate Topic (instead of this one) If

• Influenza vaccine reaction suspected, see IMMUNIZATION REACTIONS

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WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

Severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing) 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) Dehydration suspected (no urine in more than 12 hours AND very dry mouth, no tears, ill-appearing, 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 Flu symptoms present less than 48 hours AND HIGH-RISK child (underlying heart disease, lung disease, etc) Continuous (nonstop) coughing Age under 1 month old with any cough Age 1 to 3 months with a cough for more than 3 days Earache or ear discharge also present Sinus pain (not just congestion) is also present Fever present for more than 3 days Fever returns after going away 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

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HOME CARE ADVICE FOR 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, use nasal suction.
   • Apply petroleum jelly to the nasal openings to protect them from irritation.
   • Cleanse the skin first.
3. Nasal Washes for Blocked Nose:
   • Use warm water or saline nosedrops to loosen up the dried mucus, followed by blowing or suctioning the nose. Instill 2-3 drops in each nostril. Repeat nosedrops until clear.
   • Do nasal washes at least 4 times per day or whenever your child can't breathe through the nose.
   • Reason for nosedrops: suction alone can't remove dried or sticky mucus.
   • Caution: if < 1 year old, use 1 drop at a time and do 1 side at a time.
   • Saline nosedrops - add 1/2 tsp of table salt to 1 cup (8 oz) of warm water.
   • Importance: 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:
   • Before 1 year of age, only use 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.
   • After 1 year of age, 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.)
   • After 6 years of age, 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 (See Dosage table) 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.

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Disclaimer: This information is not intended 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: 1/19/2009

Last Revised: 10/25/2008

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.