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Colds and Flu
Dealing with a reality of childhood

As most parents know, children seem to pick up every virus that is making the rounds at day care or school. The most common ailments are flu and common colds.

Influenza

The word flu is often applied to anything that makes us feel unwell. Flu (more accurately called influenza), however, is a specific infection caused by the influenza virus. Children of all ages are susceptible and the attack rate for influenza is highest in children. In older children and teenagers, the flu begins with a sudden onset of chills and fever, headache, body aches, sore throat and a dry hacking cough. The worst of the illness lasts for three to four days. The cough and tired feeling may go on for a week or more.

Preschool children tend to have an illness more like a severe cold. They have a high fever (often over 103°F, 39.5°C), runny nose and cough. They may be irritable and have a poor appetite, and some develop a hoarse cry and a barking cough (croup). Diarrhea and vomiting may also occur. Young children usually feel better in three to five days, although a cough may linger for one to two weeks.

Not all flu is severe. Even in the same family, one child may be very sick while another has only a mild illness with a mild cough, but no fever.

Why is flu a winter disease?

The answer is not clear. It may be that viruses spread more easily with people being so close together indoors during the winter.

How many types of influenza are there?

There are two main types of flu: influenza A and influenza B with several subtypes. During the flu season, most cases in Canada are due to influenza A.

Common colds

The common cold is also a viral infection. It can result in a runny or stuffed up nose, sore throat, hoarse voice and sinus pressure. A cold is usually of short duration, lasting less than two weeks and does not have the severe symptoms that may accompany influenza. However, mild cases of influenza may resemble a cold.

Diagnosis

If the disease comes on quickly, is not too severe and resolves in one to two weeks it is usually the common cold. Fever and more severe symptoms, especially muscle aches and cough, suggest the flu.

A cold can be mistaken for hay fever (allergy) or bacterial disease such as a sinus infection or strep throat. The differences are that allergies usually recur and can last for an entire season. Strep throat causes soreness in the throat and neck glands but spares the nose and chest. Sinus infection symptoms include green nasal discharge and pain or tenderness often in the cheeks or upper teeth. In children, there is often a worsening of the condition one week after a cold starts. When this happens parents often notice foul smelling breath and cough.

When should you call the doctor?

You should call your family doctor if you feel worried about any aspect of your child's illness. Call the doctor immediately if your child:

• has difficulty breathing or a bluish tinge to the lips
• has stiff neck, light sensitivity or is irritable or jumpy
• vomits for several hours or seems drowsy and sluggish
• complains of an earache or, in an infant, pulls at the ears
• becomes increasingly cranky or keeps waking at night
• develops a deep cough with lots of mucus
• has fever (over 100°F, 37.8°C) lasting more than four days.

Outbreaks

Outbreaks of flu usually begin abruptly. As the disease spreads through communities, the number of cases peaks in about three weeks and subsides after another three or four weeks. Twenty to 50 per cent of a population may be affected with the highest rate of illness in five to 14-year-olds. Schools are an excellent place for the spread of flu viruses. Families with school-age children have a higher rate of infection than other families, with an average of one-third of the family members infected each year.

Besides the rapid onset of outbreaks and the large numbers of people affected, flu is important because of the serious complications that can develop. Most people who fall ill recover within a week. However, for elderly people, newborn babies, and people with certain chronic illnesses, flu complications can be life threatening.

Vaccine

A vaccine to prevent flu is recommended for children with special high risk conditions. If your
child has cancer or chronic disease of the heart, lungs, kidneys or nervous system, speak with your doctor to see whether it would be advisable to start yearly influenza shots. Flu shots are also often suggested for children with asthma, diabetes or anemia.

If anyone in your household is 65 years or older or falls into a high risk category, the whole family should receive flu vaccine yearly to reduce the chance that one of you will carry the virus home .

Prevention

The flu is highly contagious and spreads so rapidly that it is difficult to stop. Older children should be taught to cover their mouths and noses when they cough or sneeze. They should use tissues for cleaning their noses and wash their hands afterwards. Sick children should be kept away from elderly persons and anyone with a chronic illness.

The flu vaccine is in an inactive form, meaning it can not cause the illness. It provides defense by stimulating the immune system to create antibodies. These in turn prevent infection or reduce the severity of the illness. Since the immune system takes time to respond to vaccination, the vaccine should be given six to eight weeks before flu season begins. This allows time for antibodies to form.

The vaccine may cause side effects, especially in children who previously have not been exposed to the flu virus. The most common side effect in children and adults is soreness at the vaccination site. Others include fever, tiredness and sore muscles that may begin six to 12 hours after vaccination and last up to two days. People who have a serious allergy to eggs should not receive flu vaccine since egg protein may be present in the vaccine.

The anti-viral drugs rimantadine and amantadine (Symmentrel™) can also be used to prevent influenza A. Their use is for family members or close contacts of influenza A patients and by nursing home residents who have been vaccinated but need added protection. The drugs need to be taken for about six weeks during the flu season or may be used immediately after vaccination during a flu epidemic. They protect during the two to four-week period before antibodies develop from vaccination. Drugs are also used when the influenza epidemic is caused by virus strains other than those covered by the vaccine.

Complications

Flu complications (either accompanying or following the illness) can result from bacterial infections in the lower respiratory tract. Symptoms of bacterial complications usually appear after the flu patient starts feeling better. This brief period of improvement is followed by sudden high fever, shaking chills, chest pain with each breath, and coughing that produces thick, yellow-green sputum. Most people recover after treatment with antibiotics.

People who are seriously allergic to eggs should not receive flu vaccine since egg protein may be present in the vaccine Other complications of flu that affect children are fever-related convulsions, croup and ear infections. Newborns recently out of intensive care units have a particularly high risk.

Is it possible a new strain like the one in 1918-1919 that killed many people could arise again? Has there been preparation for this?

The flu virus changes slightly every year. For this reason a yearly flu shot is recommended. Four or five times a century, however, the influenza virus may undergo a major change. This may result in the worldwide spread of a new virus. This situation is called a pandemic.

Canada has had a contingency plan for pandemic influenza since 1985 and it has been recently updated. Health Canada monitors flu annually from autumn to the following spring through the Laboratory Centre for Disease Control's influenza surveillance activities.

Treatment

Once a child has the flu, treatment usually consists of resting in bed and drinking plenty of fluids to prevent dehydration. Medication such as ibuprofen or acetaminophen can relieve fever and discomfort. Acetaminophen can be given every four hours and ibuprofen every six to eight hours. Children with flu should not take aspirin. Antibiotics are not effective against flu viruses.

Flu usually takes away a child's appetite for the first few days. Encourage fluids, however, especially when fever is present. Any juice or soft drink your child likes is acceptable. Forcing fluids is not necessary.

Active play can make a cough worse. Although children generally restrain themselves quite well, quiet activities are recommended, especially at the early stages of the illness. The drug amantidine can be prescribed by your doctor to treat influenza type A viral infections. When taken within 48 hours after the onset of illness, it reduces the duration of fever and other
symptoms. This medication is not effective against influenza B infections. It is not recommended for children under one year of age.

Influenza A treatment with amantidine should be considered for children with underlying conditions that might lead to severe complications. Children who are otherwise healthy but have severe flu may also be treated. Treatment should be started as soon as possible after the onset of the illness and continued for two to five days or for one to two days after the child has recovered.

When should a child return to school?

Children may return to their usual activities when their temperature is normal and they feel better. A lingering cough is not necessarily a reason to keep your child at home.