Ethan Lasorsa, 12, of Macungie, Pa., was treated for flu and an ear infection in the pediatric ward at Lehigh Valley Hospital-Cedar Crest in Allentown, Pa. Joshua Bright for The New York Times
The standard prescription for flu is to stay home and rest, drink plenty of fluids, and keep pain and fever under control with over-the-counter drugs like acetaminophen.
But this flu season has been a particularly scary one for parents. At least 53 children across the country have died from flu-related illness, and parents need to know how to tell if a child takes a turn for the worse — and if it’s time to rush to the hospital.
It’s not an easy question to answer, experts say.
“Every once in a while, even among healthy children, this influenza strain and others can make a person very, very sick, really fast,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University School of Medicine. “It’s deceptive.”
Most parents know they need to closely monitor children under 5 for any signs their illness is getting more severe. It’s important to pay even closer attention to babies and toddlers under 2, making sure they are getting enough liquids because they can easily become dehydrated.
Emergency Warning Signs in Children With Flu
The following symptoms in children with the flu call for immediate medical care, according to the C.D.C.
Fast breathing or trouble breathing
Bluish skin color
Not drinking enough fluids
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
Fever with a rash
And while the vast majority of otherwise healthy children will ride out a bout of influenza and recover rather quickly, a small number will develop potentially life-threatening complications that require immediate medical attention, Dr. Schaffner said.
Children with chronic health conditions like asthma, diabetes, cystic fibrosis, cerebral palsy, heart conditions or seizures are also at increased risk for developing influenza-related complications, and the illness can exacerbate their underlying medical problems.
But half of the children hospitalized with influenza this flu season did not have any of the underlying chronic conditions that make children susceptible to complications from influenza, according to the Centers for Disease Control and Prevention, and that’s not unusual.
What to Watch For
Signs to watch for in children are persistent high fevers that don’t subside and fevers that abate only to flare up again after the child seems to be over the worst of the illness, experts say.
When that happens, time is of the essence; a persistent or recurrent fever may mean the child has developed a complication such as pneumonia or a dangerous inflammatory response, and parents must seek prompt medical attention.
Parents should also be on the lookout for sepsis, a life-threatening complication caused by the body’s overwhelming attack against an infection. The condition is characterized by fever or chills, extreme pain or discomfort, clammy or sweaty skin, confusion or disorientation, shortness of breath, and a high heart rate.
“The trick with the flu is that it happens very quickly,” said Dr. Flor M. Munoz, associate professor of pediatrics and infectious diseases at Baylor College of Medicine in Houston. “You have to be really paying attention. Things can progress within 48 hours or so.”
Symptoms that call for immediate medical care are if a child’s breathing becomes labored, and he or she is taking fast, shallow breaths or feels chest pain or pressure; if the child’s lips turn blue or purple; if he or she is less responsive than usual; if the child’s skin becomes clammy; or if the child refuses to eat or drink or has diarrhea and is vomiting, raising the risk of dehydration.
In general, if a child is particularly irritable, is sleeping too much, seems confused, dizzy or not mentally alert, and not acting like his or her usual self, parents should seek medical help. Severe vomiting and seizures are also danger signs.
Concerns for Babies and Toddlers
For children under 2, parents must be vigilant about making sure their child is getting enough fluids, and watch for urine that becomes dark in color, a sign of dehydration that calls for immediate medical care. Other symptoms to watch for in infants are trouble breathing, inability to eat, significantly fewer wet diapers than normal and crying without producing tears.
Ibuprofen or acetaminophen can be used in older children, but acetaminophen is the preferred drug for fever in infants. It should be used only in appropriate doses, as instructed on the package (aspirin should never be used in children).
“For a baby under 1, there’s a lower threshold to see the doctor,” Dr. Munoz said. “I would be willing to wait a little longer on a 12-year-old who can tell me how he feels, but for a baby that age, it’s hard for a parent to know what’s going on. You have to watch them very carefully and be attuned to changes.”
While it may not sound scientific, most experts say parents should trust their instincts. They know their children better than anyone else, and if they think something is wrong, they should call a doctor and ask for advice, or take the child to an urgent care center or emergency room.
“When mom is really worried, that should not be trivialized — the pediatrician should look at that child closely,” Dr. Schaffner said.
What Is Normal?
For most children, a typical course of influenza starts with an abrupt spike in temperature, a sore throat, cough and muscle aches, said Dr. Shikha Garg, medical officer in the C.D.C.’s influenza division. Younger children may also have nausea and vomiting.
But in most healthy children, the illness will run its course relatively quickly. The fever will subside after three to four days, and the cough will abate within one to two weeks, Dr. Garg said.
“If this is what a parent is seeing, it’s probably fine to have the child stay home and not go to school; you want them to rest and stay hydrated,” she said. “The majority of healthy children who have a mild course of disease do not need to go to see the doctor, and they do not need to go to the hospital or the emergency room.” They also don’t need to be tested for influenza, she said.
While children hospitalized with influenza are generally treated with antiviral medication such as Tamiflu, the decision to prescribe it for outpatients is a complicated one that requires a careful balancing of risks and benefits, since the treatment can cause side effects, including nausea, vomiting and, rarely, neurological side effects, Dr. Schaffner said.
Parents need to take care of themselves too, especially pregnant women, who are especially susceptible to complications from flu. Wash your hands frequently and if you’re holding a sick child, keep their chin on your shoulder so they don’t cough on you.
It’s still not too late to be vaccinated against flu, Dr. Garg said. “We think this flu activity will continue for many weeks to come.”