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Influenza (the flu) Symptoms and Treatment

What is Influenza

Influenza (“the flu”) is a viral illness that strikes millions of people every year. Although many people refer to any winter-time “bug” as “flu,” it’s important to identify the real culprit. Two virus types, called “influenza A” and “influenza B” cause almost all human cases of influenza. There are few real difference in the symptoms these 2 viruses cause, but there are some important differences in treatments and vaccines. Typical flu symptoms begin with a sore throat and fever. After a day or so the person develops headache, cough, and feels generally weak and tired. Many people complain of aching muscles and joints. Eye pain is also common. Some children also have nausea, vomiting, and diarrhea, which are more common with Influenza B infections. In children and adults who are generally healthy, these symptoms last anywhere from 3 – 7 days. They generally get better without medication. Infants, the elderly, and people with weakened immune systems can get much more severely ill. Some deaths occur in these groups every year. People with breathing or heart conditions and some other chronic illnesses can also get very sick with influenza. Influenza viruses also cause illnesses besides influenza itself. These viruses can cause croup, bronchiolitis, and even, rarely, injury of the heart muscles. You can also read our Aftercare Instructions on Croup and Bronchiolitis. This Aftercare Instruction is only about influenza illness.

In the past 20 years we have made great progress in preventing and treating influenza. As a result, doctors now recommend flu vaccine for all children from the ages of 6 to 23 months. In addition, they recommend vaccine for all older children and teens with any respiratory disease, such as asthma or cystic fibrosis. Children with any heart disease, and many other chronic illnesses should also get the vaccine. There are several new medications available that can shorten the illness. Some can even prevent illness after exposure to someone with the flu.

What is the biggest concern?

For most children with the flu, our biggest concern is comfort. People with the flu are miserable. They have high fevers (often up to 104 °F or 40 °C), aching muscles, sore throats, irritating coughs, headaches, and runny noses. Some children also have nausea, vomiting, and/or diarrhea, and they may have mild abdominal pain. Flu is more worrisome in young infants and in children or teens with other illnesses like asthma or heart disease. The biggest concern in these children is the possibility of pneumonia. In rare cases heart, muscle, and brain complications of flu occur.

Influenza treatment

In most healthy children and teens, we can treat just the symptoms of the flu. No special medication is necessary. You can use acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) to relieve fever and discomfort in children over 3 months. Check with your doctor about using it in younger babies. Fever is not dangerous, but it can make your child uncomfortable. If your child seems comfortable there is no reason to give any medication just for fever. Please read our Aftercare Instructions about Fever and giving  Oral Medications.Please do not use aspirin or any product that contains “salicylate” or “salicylic acid.” These medications can cause Reye Syndrome, a severe brain disease, in children with flu.

Doctors usually do not recommend over-the-counter or prescription cough and cold medicines in children under 2 years old. A toddler with the flu is often an exception. If your doctor does recommend any of these medications (such as Dimetapp, Tylenol Cold, Theraflu, and many, many others), please remember that most of them are combination medicines. That means that they contain more than one ingredient. For example, some contain a fever and pain reducer like acetaminophen and a decongestant like pseudoephedrine and an antihistamine. It is important to be very careful when using these medicines to avoid doubling up on ingredients. Please be sure to use these medications exactly as prescribed or as recommended on the label. Some of the night-time medicines, such as Nyquil® and others, are very good at helping children get to sleep. These medicines, however, have many active ingredients, and they can last for up to 12 hours. So again, please be careful when using these with any other medication.

People with the flu usually have a cough. Doctors generally avoid cough suppressant medicines in the short run, because the cough usually clears up as the illness passes. If the cough persists and your doctor has made sure there’s no concern about a more serious illness, s/he may prescribe a cough suppressant medicine for a short period. Please check with your doctor before starting any cough medicine on your own.

You can also use a vaporizer or humidifier in your child’s room, especially at night. This can help to keep the mucous membranes moist and comfortable. Please don’t put any medication in the machine, and be sure to change the water every day. This will prevent mold and mildew from growing in it. Many children with a runny nose develop a sore upper lip from the nasal discharge and from rubbing or blowing their noses. You can apply a little lip balm such as Chapstik® to the lip and nostrils.

In children with any serious pre-existing condition, like asthma, cystic fibrosis, heart disease,sickle cell disease, and many others, flu can be more than just annoying. It can be quite dangerous. There are now several medications to use in such cases. Some doctors now also prescribe these medicines for otherwise healthy people who have unusually severe flu. These medicines can reduce the duration of flu symptoms by about one day in children and teens. They only work if given within the first two days of symptoms. Of course, these medicines also only work in patients who actually have influenza, instead of one of the many other viruses that cause “flu”-like symptoms. For this reason, many doctors still don’t prescribe these medicines often.

Oseltamivir (oh-sell-tammy-veer) (Tamiflu®) works for children as young as one year. It is available as a liquid or as tablets, given by mouth one to two times daily. Tamiflu® can also prevent flu in children who have come into close contact with someone who has the flu. For this purpose the child must take the medicine as soon as possible after the contact, and definitely within 2 days. Tamiflu® can cause nausea, vomiting, or diarrhea. In rare cases it can cause wheezing – if this happens, please stop using it right away and call your doctor.

Zanamivir (Zan-am-uh-veer) (Relenza®) comes only as an inhaler. The inhaler is different from the more common asthma inhalers. It has a tiny amount of powder in a capsule, and the inhaler punctures the capsule and releases the powder so that the child can inhale it. This can be difficult for younger children (under the age of about 8 years) to manage. This medication does not prevent the flu.

Doctors sometimes use one of two older medications, amantadine (Symmetrel®) and rimantadine (Flumadine®) for children with influenza A. These medications have more side effects, however. Most doctors avoid them unless the other medications are not available, or the child cannot take them for some reason. Both of these medications come as oral syrup and oral tablets.

Dangerous Influenza Symptoms

Influenza is a miserable disease, but it goes away in most children and teens after 5-7 days. In some cases it can be more severe, or have complications. Here are some things to look out for:

  • Fever over 104 °F or 40 °C that lasts for more than 3 days
  • Confusion, disorientation, or bizarre behavior
  • Lethargy (excessive sleepiness)
  • Stiff neck
  • A rash of any kind – if your child gets flat red or purple spots on his or her skin, please go directly to an emergency room (these can be signs of a dangerous bacterial infection that is rare)
  • Wheezing (whistling breath sounds) or difficulty breathing
  • Cough that produces phlegm (“flem,” or “flame”) that is green or has blood in it
  • Cough that lasts more than 7 days
  • Headache that lasts more than 2-3 days, or headache that doesn’t get better with pain relievers
  • Pain in the forehead or cheeks, or tenderness in those areas
  • Cloudy yellow or green nasal mucous
  • Vomiting more than once or twice
  • Painful swelling of arms or legs (muscle pain without swelling is common)
  • Weakness of the feet or legs, or difficulty walking steadily
  • Dark red or brown colored urine
  • Chest pain other than with coughing
  • Feeling rapid or irregular heart beats
  • Light-headedness

If any of these occur, please be sure to call your doctor’s office right away. If your child has any of the items listed above in bold print, please go directly to the emergency room.

Other points of concern

Please keep your child or teen with the flu home from school or daycare to avoid infecting other children. Unfortunately, chances are that most everyone in your house will get the flu. If there are elderly people or people on chemotherapy or steroids in the house, please keep your child from having close contact (hugging, kissing) with them.

Some children with influenza develop an inflammation of their muscles called “myositis.” This causes swelling and pain, usually in the legs or calves. The condition itself is not usually serious, but the breakdown of muscle proteins can cause kidney damage. Another rare complication of flu is muscle weakness that also begins in the legs and feet and moves slowly upward. This is called “Guillain-Barré” (Ghee-on-Bear-ay) syndrome. It is easy to confuse muscle weakness with soreness. The bottom line is, if your child experiences difficulty walking during or soon after the flu, please take him or her to your doctor right away.

Other Conditions that Might Be Present with Influenza

Flu season overlaps with the season for many other viral illnesses in children. Younger babies and toddlers can have bronchiolitis (brawn-key-oh-light-us). A virus called RSV causes this condition of wheezing and coughing. It can be hard to tell RSV and flu virus infections apart in babies. Although we treat these and other viral conditions very differently, prevention for all of them is the same. Please be sure everyone in your house practices good hand washing techniques (lots of warm water and a liquid soap, if possible). Please have your children who don’t have a viral illness avoid close physical contact with children who do.

Very rarely, children or teens can develop a serious bacterial infection either during or soon after a flu infection. The bacterium (N. meningitidis) can cause both meningitis and severe blood poisoning (septicemia). Early treatment with antibiotics can be life-saving. If your child develops any of the following, please take him or her to a hospital immediately:

  • Flat red or purple spots on the skin
  • Severe headache
  • Stiff neck
  • Irritability, confusion, or lethargy
  • Either pale, cold skin or red, flushed skin that lasts more than a few minutes

A new vaccine is now available to prevent this kind of infection in older children and teens. Please check with your doctor about having your child immunized before the next flu season. And of course, get the flu vaccine too, if your child needs it.