Survival Guide: Influenza
What Is Influenza? What Are The Symptoms?
Influenza is a virus that infects the nose, throat, and lungs (also known as the respiratory tract). It usually occurs in the winter and affects children of all ages. The most common symptoms include high-grade fevers, congestion, cough, sore throat, headache, muscle aches, fatigue, and low appetite. Symptoms can last a full week, though may be less severe or of a shorter duration if your child has already received the Influenza vaccine.
Should I Get My Child Tested?
While testing isn’t essential, it’s helpful since timing of diagnosis affects treatment options. If you’re worried, see your Pediatrician or an Urgent Care to get a rapid test. These are available at most clinics, and often combined with testing for other viruses (e.g., COVID-19 and RSV) in one swab.
What Does Treatment Look Like?
Supportive Care:
Hydration: With Influenza, children usually have a lower appetite, vomiting, and sweating from high fevers. This combination can lead to dehydration and an ER visit for IV fluids. To avoid this, give liquids often. As a note, I’m comfortable with kids that don’t want to eat, as long as they’re taking in fluids other than water which will have sugar and electrolytes. It’s normal to have some weight loss during illness, and children usually rebound quickly, so don’t get too worried about appetite itself. It’ll return in time.
If your child is less than 1 year of age, you can give either breastmilk, formula, or an oral rehydration solution (such as Pedialyte).
If your child is older than a year, you can offer water, Pedialyte, milk (if it doesn’t make their symptoms worse), clear juices or Gatorade that have been diluted with water in a 1:1 ratio , or Jello.
If your child is refusing liquids, I recommend starting small. Use a medicine syringe to slowly give fluids, or offer 1 tablespoon (1/2 ounce) every 10-15 minutes. If they vomit, wait 30 minutes prior to trying again.
Fever Control: While it’s not necessary to treat a fever, it makes your child much more comfortable. In children <6 months, you can give Tylenol every 6 hours as needed (check with your doctor for weight-based dosing, or use this handy dosing guide from the AAP). In children >6 months, you can give either Tylenol or Motrin every 6 hours as needed. It is OK to alternate these medications if needed for fevers that refuse to go down. While it’s tempting to focus on the temperature, focus more on the trend over time to help discern if your child is starting to turn the corner.
Cough/Cold Management: Congestion and cough can be severe and last for weeks. My favored treatments are natural ones. I recommend nasal saline drops and nasal suctioning (prior to meals and bedtime for a total of 4x/daily), honey only for >1 year of age, and a cool mist humidifier as the mainstay of care. It’s not recommended to use over-the-counter cough syrups in children under 6 years, since overdoses of the main ingredients can cause sedation, convulsions, and heart rhythm issues. I know it’s hard to not have these as an option! I also recognize that culturally, there are treatment options that are accepted norms, so I work with families if they’re desperate for more.
Zarbee’s Infant Cough & Cold is a syrup that is honey/agave and herbs, and I have many families that use this instead for rough nights. Just note that as a homeopathic product, it’s not FDA-approved (and honestly, honey will work just as well and cost much less). If your child is <1 year, don’t use the version with honey, as it can cause infant botulism, which is life-threatening.
I have a lot of families use BabyRub, which is OK over 3 months as long as it’s not applied underneath the nose. In children >2 years, regular Vaporub can be used in smaller amounts to help with chest congestion.
If older than 6 years, cough drops are safe, and there are brands like Lolleez that are lollipop-based, making them less of a choking hazard.
Product Recommendations:
What About Tamiflu?
Tamiflu is an antiviral medication that is FDA-approved for treatment in children over 2 weeks old. It can shorten duration of symptoms by 1-2 days and lessen the severity. However, it’s only recommended if you’ve had symptoms for <48 hours. If it’s been longer, your child is only eligible if they are high risk (due to either age, immunosuppression, or underlying medical issues). I also recommend thinking about your entire household. If there are family members with complicated medical histories (like elderly grandparents), and your child is the first to test positive for Influenza, it’s worth getting that family member tested and evaluated for Tamiflu eligibility.
The medication is taken twice daily for 5 days. The most common side effects are nausea, vomiting, and diarrhea, so if your child already is struggling with these symptoms, it may not be worth it. There have also been neuropsychiatric side effects reported (delirium, nightmares, etc.), though they’re rare. With all eligible kids, I walk through risks and benefits with families, and we make a joint decision about whether to move forward with Tamiflu.
Should My Child Get The Influenza Vaccine? Will It Prevent The Flu?
Yes! I highly recommend the Influenza vaccine to all children >6 months of age. It’s worth noting that the first year your child gets the shot, they will need two doses spaced 1 month apart. With every year afterward, they need just the single annual vaccine. The side effects are mild fever, fussiness, fatigue, and local discomfort at the injection site. I know there’s many families wary about getting Influenza from the vaccine, and I hear them! It’s frustrating to get a shot, only to get sick soon after, and this seems to happen frequently. There’s a lot of research on this, and it’s been determined that you can’t get Influenza from the flu shot. What’s the culprit, then? It appears to be other viruses that get picked up in the waiting room prior to the visit! To help prevent this, make sure to wear your mask for the entire visit.
I make it clear that the flu shot does not fully protect against getting Influenza. However, what it does do is protect against the complications of Influenza, and this is huge. In most cases, children do well with Influenza and recover quickly. However, rarely, children can get pneumonia and heart or brain inflammation, which can sometimes lead to death. These are scary complications, and the vaccine has been proven to prevent these outcomes.
The most effective treatment for flu is prevention.
When Should I Go To The ER?
In general, most children can be treated at home. However, if your child is dehydrated (urinating <3x/daily, not making tears when they’re crying, very dry and cracked mouth), if they are having difficulty breathing or severe chest pain, if they seem “out of it” and lethargic, or if their fevers are not improving after 5 days, I recommend the ER.
When Can My Child Return to School?
This may vary depending on school policy. I recommend after at least 24 hours fever-free without the use of fever-reducing medications (e.g., Tylenol / Motrin) and when your child is having improving symptoms (e.g., cough, congestion, vomiting, etc.).
