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Family Health Magazine
CHILDHOOD

Influenza
What to do when your kids have the flu

Most Canadian parents have concerns about the approach of ‘flu season.’ The influenza virus causes this illness, commonly known as flu. Outbreaks usually begin abruptly. As influenza spreads, the number of cases peaks in about three weeks, dropping after another month. Twenty to 50 per cent of the population may be affected, with the highest rate of illness in five to 14 year olds.

Schools are an excellent place for flu to spread. Families with school-age children have a higher rate of infection than other families. Usually, a third of family members will be infected each year. If your child is healthy, a bout of flu is usually short, uncomplicated and clears up on its own.

What are the symptoms of influenza?

Flu usually begins abruptly with fever, headache, muscle aches and fatigue. Cough, sore throat, and runny nose may also appear. As young children have not been exposed to these viruses, they have less immunity than older people. Children also tend to run higher fevers, and have more ‘tummy problems’ such as nausea, vomiting or poor appetite. When they first become sick, older children are more affected by coughs, sore throats and runny noses. Younger children do not usually complain of muscle tenderness or headache.

Children with uncomplicated influenza usually improve gradually over two to five days. A cough can last longer. However, older children may feel weak and tired for several weeks.

Can complications occur?

Common complications include ear infections, pneumonia and dehydration. Another is sinusitis, or inflammation of the sinuses (air filled spaces behind the forehead, cheeks and eyes.) Recent studies have shown that children under five years of age are more likely to develop serious complications than are older children.

How does flu differ from the common cold?

A variety of viruses cause the common cold. Mild cases of flu may resemble a cold. However, colds do not have the severe symptoms that can accompany influenza.

Colds often cause irritation and discharge in the upper airway. The nose, sinuses, throat and voice box can be affected. Colds are usually short-lived, lasting less than two weeks. If the illness is mild and disappears in a week or two, it is most likely a cold. Fever and more severe symptoms, especially muscle aches and cough, suggest flu.

Diagnosing flu is more difficult in infants and young children than in adults. Other viruses can cause similar symptoms in children at the same time that flu outbreaks occur. Confirming diagnosis requires testing respiratory secretions in a lab. Unfortunately, accuracy of testing varies.

How does flu virus spread?

Flu usually spreads through respiratory droplets. When an infected person coughs or sneezes, droplets are propelled through the air. They can land in a place where the virus can grow, such as the nose or throat of an individual close by. The cycle repeats itself when a newly infected person coughs or sneezes.

How long does the infectious period last?

The time between first exposure to the virus and the appearance of symptoms is one to three days. Kids are contagious from the day before symptoms appear until seven days after flu begins.

How can I prevent the spread of the flu?

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw away the used tissue.
  
• Wash your hands with soap and water as soon as possible after sneezing or coughing.
  
• Use an alcohol based hand sanitizer if you are not near a water supply.
  
• As much as possible, keep away from people who are coughing or sneezing.
  
• Avoid touching your eyes, nose, or mouth.
  
• If you are working in an early education or child care program, do not go to work if you are sick with the flu.
• If you have the flu, avoid contact with the elderly and other people at risk.

How does flu vaccination work?

Vaccination is a good idea for anyone at increased risk of severe or complicated influenza, along with household members and other out of home caregivers.

Since the flu virus changes from year to year, annual vaccination against the flu is recommended. The body’s immune (defence) system takes time to respond, so vaccination should be done four to eight weeks before flu season begins. Your system then has time to form antibodies. Flu season may begin as early as October and last as late as May. It usually peaks between December and March.

Which children should be vaccinated?

• Children six months up to five years of age.
  
• Those with chronic disorders of the heart or lungs.
  
• Children who have any condition that can affect breathing or the ability to handle respiratory secretions, or conditions that increase the risk of difficulty with breathing, such as seizure disorders, neuromuscular (nerve and muscle) disorders, spinal cord injuries, or cognitive (thinking) dysfunction.
  
• Those requiring regular medical follow-up after hospitalization in the previous year because of chronic metabolic conditions such as diabetes, a depressed immune system, or kidneys that are not working properly.

Are there any side effects?

The most common side effect is soreness at the vaccination site. Others include tiredness and sore muscles that may begin six to 12 hours after vaccination. This may last for up to two days. Those allergic to eggs should not be vaccinated against flu since egg protein may be in the vaccine.

Can medication help cure the flu?

Several prescription antiviral medications can be used to treat influenza. These medications work against the virus. They are most effective when given within 48 hours of the start of flu. In otherwise healthy children, these medications can shorten the illness by about a day.

Such treatment is recommended only for children at greatest risk for severe disease or complications. Children who are otherwise healthy should not receive these medications since, if they are used too often, the viruses may develop a resistance to them.

Antibiotics are only used for proven complications of acute influenza, such as bacterial pneumonia, ear infections and sinusitis.

Acetaminophen and ibuprofen can help relieve fever and general discomfort. Ibuprofen is approved for use in children six months of age and older. However, do not give it to a child who is dehydrated or vomiting continuously.

Acetaminophen can be given every four hours and ibuprofen every six to eight hours.  Give the correct dose based on your child’s weight, and never use more than the recommended maximum daily amount after taking into account all sources.

Over-the-counter treatments for respiratory symptoms often dry respiratory passages and make nasal secretions even thicker. They tend to cause side effects such as drowsiness. Coughing is a protective mechanism that clears mucus from the respiratory tract. Suppressing a cough is not usually necessary. Ask your doctor or pharmacist if over-the-counter medications are appropriate for flu symptoms.

Children under 13 years of age should not be given ASA (Aspirin™).

Should I call my doctor?

If you are worried about any aspect of your child’s illness, contact your family doctor or a member of the health care team. Call your doctor immediately if your child:

• has difficulty breathing or a bluish colour to the lips
  
• has a stiff neck, is sensitive to light, or is irritable or jumpy
  
• vomits for several hours or seems drowsy and sluggish
  
• complains of an earache or, if an infant, pulls at the ears
  
• becomes increasingly cranky or keeps waking at night
  
• develops a deep cough with lots of mucus
  
• has a fever (over 100 F, 37.2 C) lasting for more than four days.

When should your child return to school?

A child may return to usual activities when he or she has a normal temperature and is feeling better. A lingering cough is not necessarily a reason to keep a child at home.

Influenza is a viral disease commonly affecting school-aged children. With care, time away from school and medical attention when necessary, your child should quickly recover.