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                           Influenza (the flu)

What is Influenza?

• Influenza, or the flu, is a highly contagious respiratory illness caused by influenza viruses.
  
• Flu season occurs most commonly in the winter but the season can begin as early as October and last as late as May.
  
• Although similar to a cold, children with influenza are usually sicker and they typically get worse over a very short period of time.
  
• There are different types of the flu virus and each can change year after year therefore making it possible to get the flu every year.
  
• Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications.
  
• Each year, the highly contagious influenza (flu) bug sends 20,000 kids under age 5 to the hospital.
  
  

• A study, appearing in the 2008 October edition of Pediatrics and based on an analysis of reported flu deaths from the 2004-05 through 2006-07 seasons found that 166 deaths occurred during these three seasons in children younger than 18 years of age.

• Flu deaths in children during those seasons totaled 47, 46 and 73, respectively. According to the CDC, more recent data suggest flu deaths among children have continued to rise, with 86 tallied for the 2007-08 season.

• Yet a mere 1 in 5 babies and toddlers (who are especially at risk) receives the annual vaccine, according to the CDC.
  
  
  

How does a child get the flu?

• Flu viruses are spread from person to person by respiratory droplets caused by coughing and sneezing.
  
• People can become infected by touching something with flu viruses on it and then touching their mouth or nose.
  
  

How long will it take my child to become ill after being exposed to someone else with the flu?

• Remember, just because your child is exposed to an ill person does not necessarily mean they too will become ill.
  
• But if your child is to become ill with the flu, symptoms usually develop 1 - 3 days after coming in contact with someone else who is sick with the flu.
  
• People that most contagious the day before they develop symptoms and during the time they have their symptoms.

• fever, which can be high, comes on quickly along with:
  
  
• headache
  
• extreme tiredness
  
• dry cough
  
• chills
  
• muscle aches

       These symptoms are usually followed by:

• sore throat
  
• runny nose
  
• nausea, vomiting and diarrhea may occur
  

How long will my child be sick with the flu?

• Symptoms usually worsen over the first 3-5 days and then gradually improve over the next few days as long as no complications arise.

Are there any complications of the flu?

• The flu can lead to complications, especially in young children and the elderly and in anyone with other chronic medical problems.
  
• Complications of flu can include dehydration and several different types of infection including bacterial or viral pneumonia, ear infections, and sinus infections.
  
• A serious but rare complication in school-age children is Reye syndrome, probably related to the use of salicylates (Aspirin) during the illness.
  
  o Reye syndrome is a serious liver and brain disease
  
  
• Children may need to be hospitalized for dehydration or breathing problems.
  
  
• Of those children who have reportedly died from the flu from 2004 - 2007, the percentage of those who  had bacterial infections jumped from 6% to almost 36%. Most had Staphylococcus infections, and 64% of those involved the dangerous MRSA (methicillin-resistant staph aureus) bug (see MRSA).
  

How can the flu be diagnosed?

• The flu is usually a clinical diagnosis meaning that the diagnosis is based on the child’s symptoms and physical examination.
  
• There may also be information from local public health officials about whether a flu epidemic is present in your community.
  
• There are tests available to see if your child does have the flu. These include rapid tests that are performed on samples taken from a throat or nasal swab.

What is the treatment for the flu?

• Plenty of rest and fluids
  
• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for fever and discomfort
  
• DO NOT give your child aspirin
  
• Antibiotics do not treat the flu
  

In some children, such at those at risk for developing complications of the flu, your doctor may recommend an antiviral medication to lessen your child’s symptoms and shorten the course of the illness, but they must be given before or within the first two days of the illness.

• Amantadine is effective against only one type of the flu (type A)
  
• Zanamivir and Oseltamivir (tamiflu) treat type A and B
  
• These drugs are expensive and do have possible side effects so the risk versus the benefit should be discussed with your pediatrician.
  
  
• The Food and Drug Administration has very recently approved the use of Tamiflu in children as young as 1 year who have had close contact with someone infected with influenza A or B.
  
• Up until now, Tamiflu was only approved for the treatment of children older than 1 year who were themselves infected.

When can my child return to daycare or school?

• For influenza, it will depend on how quickly your child’s symptoms go away, especially their fever.
  
• Each facility may have its own rules, but in general, children can return to school when they:

               - Have no fever
               - Can eat and drink normally
               - Are rested and alert enough to pay attention in class

When should I call my pediatrician concerning flu-like symptoms in my child?

• It is best to call for specific instructions when you first suspect that your child has been exposed to someone else with the flu or has the flu themselves.
  
• You should also call your doctor anytime your child’s illness is worsening such as signs of dehydration, difficulty breathing, or increased irritability or lethargy.

How can the flu be prevented?

• Frequent hand washing is recommended to decrease the chance of becoming infected. Click on how to prevent infection for more details.
  

The single best way to prevent the flu is to get a flu vaccination each fall. There are two types of vaccines:

• The flu vaccination can be given as a shot in children over 6 months or as a nasal spray in children 2 years or older.
  
• Children up to 8 years of age who are getting a flu shot for the first time will need two doses given 30 days apart so begin the process sooner rather than later.

Which children should get vaccinated?

People recommended for vaccination during the 2008-09 flu season by the CDC are:

Children aged 6 months up to their 19th birthday
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
People who live with or care for those at high risk for complications from flu, including:
Health care workers
Household contacts of persons at high risk for complications from the flu
Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

Who should not get the vaccination?