Prickly Pear Pediatrics

All About The Flu

flu virus

All About The Flu

It’s that time of the year: the days are cold, the nights are long, January seems to be never ending, and the flu is surging. We’ve seen lots of kids in the office over the last few weeks with fever, fatigue, and general misery who are testing positive for the flu. If you’ve been lucky enough to avoid it so far this year, call it a win and keep washing your hands and run away from the coughing, miserable looking people.

I want to share with you some information and advice that I give to families when one (or all) of the family members have the flu. I hope it helps you get through this tough season.


  1. What is the flu?

Influenza is a virus that does a very good job of latching onto the lining of the human respiratory tract. Once it is able to latch on, it infects the cells in the respiratory tract with its viral DNA and begins to replicate in the body. The virus causes inflammation of the nose, throat, lungs, sometimes eyes and ears, and even the stomach. There are 2 main strains of the flu: A and B. There is also a C strain that we do not see very often. There are also subtypes of each strain, for example H1N1 (a flu A subtype) which killed more than 280,000 people in the 2009-2010 season.


  1. How does it spread?

Unfortunately, the influenza virus spreads very easily. Tiny respiratory droplet particles from an infected person that are spread through the air by sneezing, coughing, talking, and breathing (yes, just breathing) can then land in the respiratory tract of a person nearby and infect them. It can also be spread by fomites (contaminated objects), which means if someone coughs a spit particle onto the countertop and then you touch the countertop with your hand and then touch your own nose, eye, or mouth, you can become infected. The incubation period for the virus is 1-4 days. So if you are at a birthday party with a kid who has the flu on Sunday, then your child could come down with the flu symptoms anywhere from Monday until Thursday.


  1. What are the symptoms?

Flu type A and type B can be a bit different in their symptom profile. Also, you have to keep in mind that viruses can cause different symptoms in one person vs another. However, in general, these are the symptoms that are most commonly seen in patients with the flu: fever, fatigue, runny nose, cough, sore throat, headaches, decreased appetite, and muscle/body aches. Some people have vomiting and/or diarrhea, but these symptoms are less common than the 7 listed above. Flu B seems to be a bit more likely to cause the stomach symptoms and muscle pain, but both strains can do it. The fever with the flu can last a full 7-10 days and it can be a high fever (103-104) which often causes a lot of worry in parents and a lot of misery for the children. It usually takes a full 2 weeks to recover from the flu completely, although the fatigue from fighting off the flu can last closer to 3-4 weeks in some kids.


  1. What do we do?

If your child has fever and fatigue along with any of the other symptoms listed and we are in the late fall/winter/early spring months, they could certainly have the flu. It is reasonable to get them checked out by their doctor. We can do a swab that tests for the flu (if it’s indicated). If they test positive for the flu and their symptoms started less than 48 hours ago, they are within the window of time to start taking Tamiflu or a similar antiviral medicine (more on this below). If your child has the flu, the most important thing to do is to keep them hydrated and let them rest. They should lay around all day and take as many naps as they feel like taking. Offer sips of water all throughout the day. For their fever, you can read my last blog post that talks all about how to handle a kid with fever. Offer gentle foods such as soup, crackers, toast and avoid anything adventurous, spicy, and fried. Try to avoid really sugary stuff too (juice, soda, ice cream, cookies) although an occasional popsicle to soothe the throat is fine. Try to keep them in a room by themselves so that maybe you can keep your whole house from getting the flu. If your child is over 1 and has an irritating cough, 1 tsp of warm honey mixed with fresh lemon juice can help to soothe their throat and cough. If they have a lot of nasal congestion and are not old enough to blow their nose, nasal saline drops followed by bulb suction or a nose Frida a few times per day can help make them more comfortable. Sitting in a steamy bathroom for 10-15 minutes before bedtime can sometimes help swelling in the nasal passages and improve their ability to breathe through their nose during sleep.


  1. What medicine can I give for their cough and congestion?

I typically do not recommend buying or using any OTC cough or cold medicines to treat the flu. This is not because I don’t care about the child’s misery, but because there is no evidence that those medicines actually work, they can have unwanted side effects, and they are an unnecessary expense for families. Of course, this blog is for education purposes and not specific medical advice tailored to your child, so I always recommend discussing a plan for your child’s illness with their doctor. If your child has a history of asthma or wheezing, we usually have specific recommendations that will need to be discussed with your doc. Unless your child has been diagnosed with a bacterial infection along with the flu, antibiotics will not help your child to recover from the flu faster.


  1. What about Tamiflu?

There are a few antiviral medications that have been created in an attempt to try to decrease the duration and severity of the flu (Tamiflu, xofluza, etc). They can decrease the duration of flu symptoms by about 24 hours if taken in the first 48 hours of symptoms. In very young people (less than 2 years old), older folks (older than 65 years), anyone sick enough to be hospitalized with the flu, and other individuals who are at high risk for complications from the flu (history of asthma or chronic lung disease, heart disease, diabetes, cerebral palsy, seizure disorders, blood disorders, immunocompromise, severe obesity, etc), tamiflu can decrease the likelihood that they will develop severe illness from the flu. In those people, I do recommend that we try Tamiflu. The tricky thing about these antiviral medications is that they can have side effects, especially stomach upset with vomiting and or diarrhea in up to 10-15% of children who take the medication. There is a very small number of kids (less than 1%) who can have some hallucinations, delirium, or confusion while taking the antiviral. For these reasons, I always have a discussion with parents/guardians about the risks vs benefits of the medication and together we decide what is right for each child based on their history and risk of severe disease from the flu.


  1. When do we worry?

There are several complications that can occur as a result of having the flu. A few examples are ear infections, pneumonia, dehydration, and muscle breakdown (called myositis).  If at any point in their illness, your child appears to be breathing fast or hard, sucking in underneath their ribs with each breath or can’t catch their breath, they need to be seen by a doctor immediately. The same is true if they are so tired that you cannot get the child to wake up at least for a moment. If they have recurrent vomiting or diarrhea and are unable to keep down fluids or start to have significantly less urination than normal, they need to be evaluated. If they begin to complain of significant ear pain, get them checked out. If they complain of severe arm or leg pain and refuse to bear weight or use the affected limb, they need to be seen. If they are under 2 and run fever more than 5 days in a row, or over 2 and run fever more than 7 days in a row, I recommend getting them rechecked in clinic. Or if you notice anything that you are really worried about and seems off, let us (the doctors) take a look.


  1. When do we go back to normal life?

Kids will need to be out of school until the fever is gone for at least 24 hours without the use of Tylenol/motrin and their symptoms have started to improve. This varies for each child but is usually between 5-14 days. Kids can stay contagious a bit long than adults, especially if it is their first flu infection and they have not received a flu vaccine. Most kids are no longer contagious after about 7 days of symptoms, but this also depends on how long their symptoms last. I find that most kids need about 2 weeks from onset of symptoms before they are ready to go back to playing sports or doing vigorous physical activities.


  1. How do we prevent getting the flu?

During peak flu season, it can be very difficult to avoid getting exposed to the flu. Practicing good handwashing, avoid hanging out with anyone that you know is sick, and avoiding large crowds during high flu times can help. The best thing that you can do to protect your family against the flu is to get them the flu vaccine (if 6 months or older), as this provides your body with a certain level of immunity against this year’s strains and helps you to fight off the virus faster with less chances of severe illness than if you are not immunized against the flu. If you are helping to take care of someone who you know has the flu, wearing a mask around that person definitely cuts down on the chance that one of those respiratory particles will land in your mouth, nose, or eyes.  Other things that help your immune system work better in general are to get good quality sleep for at least 8-10 hours per night, eat whole foods packed with nutrients (fruits, vegetables, whole grains, proteins), avoid processed foods as much as possible, hydrate well, and exercise several days per week. If your child struggles to eat fruits and vegetables, then a daily multivitamin can help to support their immune system (although fruits and veggies are better). There is no supplement or immune support gummy that is a substitute for what I have listed above. You have to treat your body well in order for it to work well.



CDC: Flu Information

flu sickness in children