Tis the season for all things warm and cozy. Holiday preparations are ongoing and there is a festivity bubbling under the surface even in mundane daily activities. But with all the family gatherings and celebrations, it is also the season of illness. Although the seasonal flu may not be knocking at your door yet, it will be here soon. Do you know what to do when “It’s the Flu”?
What is the Flu?
The flu is a respiratory virus. It peaks each year between November and March. The flu affects the nose, throat, and lungs. Most cases of both type A and B influenza virus are uncomplicated and consist of typical flu symptoms as follows: High fever, sore throat, cough, congestion, muscle aches, chills, and headaches. Symptoms of the flu usually last 3-5 days.
How do you get the flu?
The flu is spread thru tiny droplets that are spread when we sneeze or cough. We also spread tiny droplets from talking. If these little droplets land on a hard surface, they can live for 24 hours potentially infecting anyone else who touches them. Gross? You betcha.
To make matters worse, we are contagious for a full 24 hours before we even show signs of the flu. Once you’ve come into contact with the virus, symptoms develop 1-4 days later. Anyone else feel like disinfecting their homes?
What’s the big deal?
We hear about viruses all the time. So what’s the big deal about the flu? Unfortunately, all cases of the flu aren’t mild. Some kids (and adults) get very sick very fast. And some kids die. 80,000 Americans died from seasonal flu last flu season. Does this scare you? As a pediatrician, it scares me. I work every day to try to protect other people’s kids. I don’t like giving bad news. When my patients or their parents die, I mourn and always remember them. As a mom, it scares me. Flu is just as likely to kill a pediatrician’s kid as anyone else’s.
Some people are higher risk for complications from the flu. Chronic illness? Asthma? Pregnant? Babies? Elderly? All at high risk. But the flu will also kill totally healthy normal people too. It does not discriminate.
What can you do for prevention?
You cannot totally prevent getting sick, but you can certainly lower your odds of illness and at the minimum, of complications.
Flu shot
Get your flu shot. Does it always work? Nope, afraid not. But it’s the best we’ve got. 80% of child deaths from the flu last flu season were in unvaccinated kids. Last year, the flu shot prevented illness in only 20-40% of those vaccinated. I’m well aware of this. After a stellar flu-free run in my home, our stats came crashing down last year when BOTH of my kids ended up with it. We should have purchased stock in Lysol and tissues.
Healthy Habits
This sometimes feels like a lost cause in kids, but it’s never too early to start teaching healthy habits. Since influenza virus can live up to 24 hours on hard non-porous surfaces (tables, toilet handles, doorknobs, light switches), it’s best to minimize the amount of virus that makes it there.
If you can get your kiddos to sneeze or cough into a tissue, that is the best. Flu virus only lives for 15 minutes or so on tissues. You can read more about that here. But if tissues aren’t readily available, sneezing or coughing into the elbow works decently too. Influenza virus lives 8-12 hours on clothes.
Sanitize
Unless you are a super-sanitizer-extraordinaire (not me), it will be difficult to keep the virus exposure to zero. But you can cut down on germs in your home by hitting the heavy touch points, especially if someone in your house already has the flu.
Think about the places that lots of fingers touch frequently and disinfect those. Refrigerator and sink handles. Pantry doors. Doorknobs of entry ways and into bathrooms. Light switches. Toilet handles.
How is flu diagnosed?
Flu is diagnosed most often through rapid screens performed in the office from a nasal swab. These tests are less accurate later in the disease process. If the flu is rampant in the community and the patient has all the right symptoms, the doctor or practitioner may diagnose clinically rather than with rapid testing. Results from the first 72 hours of illness are the most accurate. False negatives can and do occur.
When to worry
Although most cases of the flu are uncomplicated, we are always concerned with development of severe symptoms or secondary infections. Common complications from the flu include pneumonia, otitis media (ear infections), and sinus infections. Serious complications such as influenza associated myocarditis are rare, but can and do happen. Most secondary infections are easy to treat, however, serious invasive infections can occur resulting in hospitalization and in some cases, even death. Children younger than 5 years old are at increased risk for complications from the flu. There is also an increased risk in children with chronic disease (asthma, diabetes, congenital heart disease, hemoglobinopathy, cystic fibrosis, chronic lung disease, and chronic renal disease).
If things seem to be taking a turn for the worse, go back in to see your doctor. Any difficulty breathing should be taken seriously. If your symptoms seem to be improving and then start worsening again, you may have developed a secondary infection.
Treatment
Treatment of flu is primarily comfort care. Tylenol and ibuprofen (in children > 6 months) can be given for fever. Aspirin should NEVER be used in children due to risk of Reye’s syndrome. Tamiflu is recommended for children with flu who are younger than 24 months old. Tamiflu must be started in the first 48 hours of the illness. Children with chronic illness (as listed above) may also be treated with Tamiflu. Children who live in households which include other individuals at high risk may be considered for treatment as well.
Tamiflu is NOT recommended for all children and adults with influenza. Nausea and vomiting are the most common side effects from Tamiflu. However, there are also more serious side effects that are possible. Hallucinations, confusion, and unusual behavior are among the less common side effects. If your child has any strange symptoms while taking tamiflu, make sure to let your doctor know.
You should also know that tamiflu decreases the duration of flu symptoms by 1-2 days. But it doesn’t make you feel better. Only time will do that.
Supportive care remains the best treatment for influenza. The Cold and Flu Survival Guide gives ideas for helping your littles (and you!) feel better. Information about fevers can be found here.
What about elderberry syrup?
There’s a whole lot of buzz lately about using elderberry syrup to prevent and treat illness. Unfortunately, there is not a whole lot of science to back up the claims. Many of the available preparations are syrup and contain a lot of sugar. A Pubmed study, Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections, does suggest that use of elderberry syrup may decrease length of influenza. But it was a VERY small study. More research is needed.
Final Thoughts
The flu can be scary. Noone likes being sick or having sick kids. Missed work and missed school can be big inconveniences. Knowing what to expect and what to do can help. If you’re not sure how prevalent flu is in your area, you can check the CDC flu activity map. It gets updated weekly and you can get a good idea of how much flu is in your area. As always, check with your pediatrician if your child is sick and seems to be taking a turn for the worse. We never mind the questions. We love your kids too.