It can be hard to tell when a child's flu is bad enough to go to the emergency room or doctor's office - or whether toughing it out, perhaps with some physician phone advice, is enough. With widespread publicity about deaths and serious flu complications in children, alarmed parents are flooding doctors' offices.
"I'm seeing mostly kids now who would have been OK with a phone call,'' says Dr. Jeff Mjaanes of Chicago's Rush University Medical Center. "We're all in a terrible kind of predicament here. A couple of cases were very severe; there's a lot of hype out there and a lot of very concerned parents.''
Here are answers to some common questions:
Q: Is flu more dangerous to kids this year?
A: Most children bounce back fine from a week of flu misery. It's not yet clear if this season really is harsher for kids, or if serious illnesses are getting more attention because influenza struck earlier than usual and because a strain is spreading that the vaccine doesn't protect against as well as usual.
The government's best estimate suggests some 92 children under 5 die from flu annually. So far this year, the Centers for Disease Control and Prevention has received reports of about three dozen deaths among children of all ages.
Q: How can my child get vaccinated?
A: Remaining flu shots are being reserved for children at high risk of flu complications - those ages 6 months to 23 months, or who have asthma, a weak immune system or other chronic illness. Ask the child's pediatrician about local availability; CDC will ship another 150,000 doses to hard-hit areas next month.
Healthy children 5 and older can get the new nasal vaccine, FluMist, so they won't spread flu to unvaccinated siblings. There's plenty of it so far. Unlike the less-expensive shots, FluMist is made of live but weakened flu virus, so it isn't for younger or chronically ill children.
If a high-risk child isn't vaccinated and a family member becomes sick, ask your pediatrician about Tamiflu. Taken soon enough, that drug can prevent flu.
Q: How can I tell if it's influenza or just a cold?
A: With flu, the child becomes sicker, faster. Symptoms include high fever, extreme fatigue, muscle aches, chills, dry cough, sore throat, headache or runny nose. Child symptoms can differ. Infants may show solely a fever; toddlers often vomit or have diarrhea. Very young children can't explain symptoms - be suspicious if they quit playing and refuse to eat or drink.
Q: What's a flu emergency?
A: Get immediate medical care for signs of bacterial infection or other flu complications:
- Trouble breathing. Breaths may be rapid, heavy or gasping; you may see skin around the rib cage suck in or nostrils flare.
- Dehydration. Common signs include dry diapers, a lack of tears while crying, sunken eyes, dry lips and mouth.
- Appearing very pale or bluish; limp or floppy; or not waking up and interacting.
- Being inconsolable, or too irritable even to be held or consoled.
"Any normally sick kid is going to want to be held or comforted. If they don't, that's something to be worried about,'' says the University of Maryland's Dr. Margaret Rennels, an American Academy of Pediatrics flu specialist.
Q: My 5-year-old's fever hit 103. Is that too high?
A: Fever itself isn't damaging; it shows the body is fighting infection. What to do depends on the child's age and fever's extent. Call the doctor about any temperature over 101 in a baby younger than 1 year. For toddlers and older, Mjaanes and Rennels say call the doctor if fever persists beyond several days, reaches as high as 104 or doesn't drop despite medication.
Q: What treatments help?
A: First, never give a child or teenager aspirin. Use acetaminophen or ibuprofen for fever. There are four anti-flu drugs, one approved for children as young as 1, that can slightly shorten flu's misery when taken within 48 hours of first symptoms. They're important for high-risk children. For most kids, drinking enough fluids is the main prescription. Keep them comfortable; no sweating out a fever. Over-the-counter remedies offer little help.
Q: My toddler seemed to be getting better but now her fever's back. Is it a relapse?
A: Call the doctor. Once the original fever's gone, it should stay gone. If not, a bacterial infection might be setting into flu-damaged airways.
Q: Will my daughter spread her flu to the rest of the family?
A: Probably. Remember, kids put their hands in their mouths and noses and then touch, well, everything you touch. So wash her hands and yours frequently. Wipe off doorknobs and faucets. Use alcohol hand gels when soap is unavailable, like after leaving the pediatrician's office. Keep sick children home to cut flu's spread. Teach them to cover mouth and nose when coughing or sneezing.