Spotting Your Child’s Cold and Flu Symptoms at Every Age

When adults get hit with the flu, there’s no mistaking it. You’re feverish, your head feels stuffed up and you ache everywhere. But with kids, the signs aren’t always as easy to detect.

“Young children with the flu can run the whole gamut of symptoms,” says Dr. Martha Snyder, a pediatrician and assistant professor of pediatrics at Duke University School of Medicine. “Some children have the mildest of mild symptoms, while for others, symptoms are very severe.”

Below is your guide to spotting flu symptoms no matter what your child’s age, and ways to bring relief.

Infants Under Six Months

Babies in the first six months of life are at the greatest risk of complications from the flu, says Snyder, because their immune system is not fully mature yet and their very small airway makes it easy for them to experience respiratory distress.

If your infant has a fever, call your doctor and watch for other signs of illness, such as dehydration. “When babies this age don’t feel good, they usually don’t want to drink,” she adds. Provide plenty of water to keep an infant hydrated.

Children Six Months to 2 Years

Kids under the age of 2 who come down with the flu often have respiratory symptoms (cough, runny nose, sneezing), high fevers (sometimes as high as 104 F), diarrhea and vomiting. “But while many kids have all of these symptoms, others may only have one,” says Snyder.

Recognizing the early signs in toddlers is especially important, she says, because they can also get dangerously dehydrated very quickly. In addition, because of their smaller airways, babies can quickly progress to having wheezing and labored breath, which requires medication. Signs that a child’s breathing is compromised include wheezing, fast breathing or shortness of breath, and nose flaring.

Children 2 to 4 Years

A child who can’t talk yet (or can’t talk well) obviously can’t tell you that his body aches all over, so you need to be alert for behavioral changes, says Snyder. For instance, in many cases, children with the flu will have shaking chills and refuse to walk, because their legs are very achy.

“With kids under the age of 4, you really have to watch them to see how they’re acting. Respond to anything that seems out of the ordinary,” adds Snyder. “Young kids often have a limp look to them. Or they’re so uncomfortable they just want to be held.”

Children 4 to 6

Once kids can tell you how they feel, listen for complaints similar to an adult’s. But be aware that if your child is under the age of 6, oral over-the-counter cold and flu medications are not recommended. “You should never give children this age decongestants, cough suppressants and other OTC cold remedies, because of the side effects,” says Snyder.

But there are other things you can do. “It’s OK to give your child acetaminophen or ibuprofen for fever or pain reduction,” adds Snyder. It’s also safe to apply topical soothers to help relieve symptoms. And some children don’t mind saline nasal sprays for stuffy noses but be careful not to use them too often (more than six times a day), since overuse can cause swelling of a child’s nasal passages.

Other beneficial non-drug treatments for colds and flu include chamomile tea with honey, and a cool mist humidifier. Just be sure to use one that has a humidity gauge and to keep the level at no higher than around 50 percent to avoid a mold problem.

Children Over 6

For children over the age of 6, symptoms are essentially the same as adults’. And at this point, OTC decongestants and cough suppressants are generally safe, although they’re not recommended for children with certain health conditions. For instance, if your child is taking medication for ADHD, ask your doctor before giving your kid a decongestant, since the combination of the two drugs has been shown to cause heart problems.

In addition, kids with asthma or any kind of respiratory problem should stay away from cough suppressants, says Snyder, because these products may make it harder for them to clear secretions from their lungs, which can lead to pneumonia.

National Influenza Vaccination Week

The Centers for Disease Control and Prevention (CDC) urges parents to vaccinate themselves and their children from the seasonal flu and H1N1 influenza during National Influenza Vaccination Week (NIVW). NIVW is a national observance established to educate the public about the importance of influenza vaccination and is being held January 10-16, 2010. Originally scheduled to be held in December of 2009, the date was changed to a time that demand for flu vaccines usually decreases significantly. The CDC hopes to encourage more people to get vaccinated to help curb the spread of both H1N1 and the seasonal flu.

“Vaccination is your best protection against seasonal and 2009 H1N1 flu viruses,” says Dr. Anne Schuchat, Director of the National Center for Immunization and Respiratory Diseases at CDC. “Influenza is a contagious disease that can cause symptoms such as fever, sore throat, cough, extreme tiredness, runny or stuffy nose, and sometimes vomiting and diarrhea. Complications can include pneumonia, bronchitis, sinus infections and ear infections, and worsening of chronic medical conditions such as asthma, diabetes, and some neurodevelopmental conditions.”

“This year, more than ever, do all you can do to protect yourself and your children from the flu,” says Schuchat. “The 2009 H1N1 flu virus is spreading rapidly. We’re already seeing it attack otherwise healthy children, teens, and young adults. Medical clinics on college campuses are being flooded by persons with influenza. So keep informed, wash your hands often, cover your coughs and sneezes, keep sick children at home, and if you’re sick, stay home from work and get you and your family vaccinated against seasonal flu and 2009 H1N1 flu.”

Children are in the high-risk category for the H1N1 influenza virus, as it seems to have a stronger impact on young, healthy kids than the seasonal flu usually does. It is recommended by the CDC to vaccinate all people ages 6 months to 24 years for H1N1 influenza and seasonal flu and especially any person who has a medical condition that would make them more susceptible to complications of influenza, such as asthma or an immune disorder.

Many people wonder why it is necessary to get an influenza vaccine yearly instead of once, or every few years like other vaccines. The CDC states:

Flu vaccines are effective for a year from the time they are administered. For children ages six months to eight years who have never received a seasonal flu vaccine before, two doses are needed, spaced four weeks apart. One dose will suffice for older children. For the 2009 H1N1 flu vaccine, all children through age 9 years should receive two doses.

As for infants younger than six months, the CDC says this:

Children under six months are too young to receive flu vaccine, but they are among the most vulnerable to developing serious, even fatal, complications from flu. This makes vaccination of their family members and caregivers especially critical for their protection.

CDC also recommends that close contacts, especially family members and caregivers of all children less than six months old, get a seasonal flu vaccine each year to provide added protection to this high‐risk group.

If you have questions about whether your child should or should not receive either type of influenza vaccine, please talk with your child’s doctor who can help you determine whether or not to vaccinate and which type of administration (injection aka “flu shot” or the flu mist nasal spray) is the best for your child if you do choose to vaccinate.

 For more information and resources about protecting your children from H1N1 and seasonal influenza, please visit www.Flu.gov/getvaccinated

Cold and Flu Guide

Cold and flu season is once again upon us. When kids get sick during this time of year, many parents aren’t sure how to tell the difference between a cold and the flu, and at what point they should take their child to the doctor. Cold and flu symptoms can be similar and confusing. The rapidly spreading 2009 H1N1 influenza virus is also a growing concern for parents. Using the guide below can help you determine whether your little one needs symptomatic treatment at home, or whether it is time to seek a doctor’s help.

Winter colds:

• Cold symptoms may include: Stuffy nose, sneezing, cough/chest discomfort (mild to moderate; hacking cough), mild to moderate sore throat, mild aches and pains, mild fatigue.
• Complications from a cold can include: Sinus infection and/or ear infection, lower respiratory infection such as bronchitis.
• Prevention of a cold: Thorough hand-washing and avoiding contact with others who have colds as much as possible. Disinfect toys if a sick child has played with them. Disinfect household surfaces and doorknobs.
• Treatment for a cold: Treat symptomatically with clear liquids, over-the-counter (OTC) medications, and get plenty of rest. For young children, ask your doctor’s advice before giving OTC medications. Never give more than one medication containing acetaminophen (Tylenol) See your doctor if symptoms worsen or if they are not getting better after a week.

Seasonal Flu and 2009 H1N1 Influenza

• Flu symptoms may include: High fever (102 to 104), headache (may be severe), aches and pains (moderate to severe), extreme exhaustion (early on in the illness and prominent), fatigue and weakness (can last up to 2-3 weeks), cough/chest discomfort (can become severe). May have stuffy nose, sore throat, and/or sneezing.
• Complications from the flu can include: Bronchitis and/or pneumonia, which may require hospitalization.
• Prevention of the flu: Same as for colds. In addition, an annual flu shot or flu mist, upon your doctor’s recommendation. Anti-viral drugs may be prescribed if you have been exposed to the flu.
• Treatment for the flu: If you suspect that you or a family member has the flu, contact your doctor right away. He or she can tell you whether an office visit is necessary, based on symptoms and previous health history. For any child who has an underlying health condition (especially asthma or other respiratory problem), an office visit is in order, as soon as possible, or go to the emergency room if it is after office hours. Influenza is a serious illness and requires monitoring for complications. If necessary, Amantadine or rimantadine (anti-viral drugs) should be started within the first 24-48 hours after onset of symptoms. Follow your doctor’s advice for treatment of symptoms.

If your child has any signs of respiratory distress (trouble breathing) such as:

• Shortness of breath
• Labored breathing (watch for retractions – chest muscles being sucked in when inhaling)
• Paleness or grayish/blue tint in the skin, especially in the face and lips
• Wheezing
• Severe coughing

..call 911 or seek emergency medical help immediately.

These guidelines are of a general nature and not intended to replace the advice and supervision of your physician or pharmacist.

Copyright 2009 Tamara Walker, R.N. All Rights Reserved. May be used only with author’s permission.

What’s New with Swine Flu: Keep Your Family Safe & Have a Laugh Too

What do you do when you hear “global pandemic?” Is it time to build a bunker? Should you and your family lock yourself in with enough PB&J for weeks of sustenance? The novel H1N1 virus commonly known in the US as swine flu has officially been deemed a global pandemic. Somehow, though, the initial flutter seems to have died down. Parents now alternate between worrying about how to protect their families from this illness and wondering if they should purposefully expose their children now when the virus is “mild.”

Though the media buzz has calmed a bit and my friends are surprised to hear it, our pediatric practice in San Francisco is seeing huge numbers of children infected with swine flu. Since it is clear that this virus will be with us for some time, I will review what we know about the 2009 H1N1 influenza virus. A strain of flu that infects pigs has mutated so that it can make humans sick, and also be transmitted between humans. It has spread across borders and has caused human-to-human transmission in many countries. It was officially elevated to the level of a “global pandemic,” by the World Health Organization in early June.

It is now clear that this strain of flu will cause illness in tens or hundreds of thousands of people, but that most people who get sick will have a mild to moderate illness. Experts are debating the likelihood of the current virus mutating to a form that is much more virulent by the fall or winter, but the virus may well stay mild. Only time will tell the extent and severity of the 2009 H1N1 influenza.

Being on the front line of a pandemic is quite an experience, and at times I am tempted to feel a little nervous myself. At the moment, however, the best thing that all of us can do is use common sense, stay informed, and, as usual: don’t panic.

Here are some basic facts about this flu virus so far. Things continue to change: please visit a reliable source like the CDC’s website for up-to-date information.

• The symptoms of this swine flu are the same as “regular” seasonal flu: fever, cough, runny nose, sore throat, and body aches. Some people have vomiting or diarrhea and headache along with these symptoms.
• So far the cases in the US have been mild, but there have been deaths, mostly in people with chronic health conditions.
• Many people do not know that seasonal influenza causes an average of 35,000 deaths yearly. These deaths are mostly in the elderly.
• The virus spreads in the same way that seasonal flu spreads: mainly from person to person through coughing and sneezing.
• The swine flu germ can also be spread by touching an object or surface contaminated by the virus. Some germs can live on surfaces for up to 2 hours.
• The swine flu virus cannot be transmitted by eating pork products.
• People with the swine flu may be contagious one day before getting symptoms and up to 7 or more days after they become ill.
• If you are exposed to swine flu you may become ill 1 to 7 days after exposure.
• The current flu shot does not protect against this strain of flu virus. A swine flu vaccine is being manufactured, but will not be ready for several months.
• There are medications to treat swine flu but these medications are only effective when given within the first 24-28 hours of symptoms and only shorten the duration of the illness by one day. Most health authorities are currently recommending the selective treatment of people who are very ill or who have chronic illnesses. These recommendations are also changing: you may read the details on the CDC website or contact your health care provider.

Tips for parents:

• As always, try to prevent your child (and you!) from getting sick.
  • Wash hands frequently with soap and water or use hand-sanitizing cleaners.
    • Having your child sing the ABC song during the hand washing may get them close to the recommended 15-20 seconds.
  • Cover little mouths and noses when sneezing or coughing.
  • Try to avoid close contact with sick people.
  • If you are sick, try to limit your contact with others as much as possible. (I know, this is all *much* easier said than done).
• If your child has a mild illness, it may be best to stay home, give them your usual excellent care, and closely observe them for signs of serious illness.
• If your child is moderately ill, please contact your health care provider.
• If your child is extremely ill, please go to the local emergency department.
• There is gobs of good and bad information about the swine flu available on TV, the radio and on the internet. Try to get your information from a trusted source.
  • Keep yourself updated about the situation by following the updates by the CDC’s website.
  • In many states, the public health department has a website that is being updated with local information and recommendations. California’s swine flu site has local recommendations.
  • A lover of maps, I like watching this attempt at mapping the number of cases as the virus races around the globe. Since I diagnosed about 12 cases (not laboratory confirmed) last Monday without telling these guys, however, I can only imagine that the real numbers are much larger.

 On the Lighter Side:

A firm believer that humor eases our stress in times of crisis, I wrote a post on my blog about my favorite moments in the virus-formerly-known-as-the-swine-flu epidemic (now pandemic). But they just keep coming. Here are several that hit my funnybone recently.

• Thanks to Dr. Rahul Parikh for pointing me to the variety of multimedia tools that the CDC  has pulled out for this one!
  • You can send your coworkers and friends an e-card to remind them to wash their hands, cover their sneezes, and keep their snotty little ones out of your kid’s school. But please “send all”– I’m pretty certain I would be offended if I received one of these directed just at me.
  • You can browse flikr to see electron micrograph pictures of the dastardly flu virus itself. There are also pictures of people getting immunizations, presumably part of a vaccine campaign: don’t miss the black and white photo of a woman getting an immunization from a device that looks like a nail gun. Now that’s going to make the kids rush in to get their flu shots!
• Dr Parikh also highlighted the potential of this outbreak to start a whole new fashion movement. I’m heading in to work today with a sharpy and my favorite red lipstick to make sure that my N95 mask is tres chic.
• Many of my patients ask me about the prudence of so-called “chicken pox parties” but the idea of a swine flu party is altogether batty. I agree with US officials who call it a “bad idea.” Though most people who get swine flu have only a mild or moderate illness, young healthy people–both children and adults–have developed very severe illness and even died. I would try to make a joke about swine flu parties about I cannot touch the British humor of Bryony Gordon.

Are you finding some humor amidst the chaos and tragedy of this pandemic? If so, please share. We can all use a laugh in these trying times.

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LINK INFORMATION

• WHO: http://www.who.int/csr/disease/avian_influenza/phase/en/index.html
• CDC (linked to twice in this section): http://www.cdc.gov/h1n1flu/
• Calif swine flu site: http://www.cdph.ca.gov/HEALTHINFO/DISCOND/Pages/SwineInfluenza.aspx
• Flu map: http://flutracker.rhizalabs.com/
• My blog: favorite moments: http://drkimmd.com/2009/05/11/humor-in-chaos-watching-the-swine-flu-epidemic-evolve/
• Rahul Parikh’s blog post: http://open.salon.com/blog/rahul_k_parikh/2009/04/26/the_web_20_guide_to_swine_flu
• CDC swine flu site: http://www.cdc.gov/h1n1flu/
• Ecards: http://www2a.cdc.gov/eCards/browse.asp?act=brs&chkcategory=&keywords=&page=2
• Flikr: http://www.flickr.com/photos/cdc_e-health
• Dr. Parikh on flu fashion: http://www.flickr.com/photos/cdc_e-health
• US official on swine flu parties: http://www.google.com/hostednews/afp/article/ALeqM5i-VB_9IP5TEVmozh2Ua58D_6miqQ
• Bryony Gordon telegraph article: http://www.telegraph.co.uk/comment/columnists/bryonygordon/5712631/A-swine-flu-party-sounds-fun-but-Ill-stick-to-the-wine-flu.html