Influenza: How to Identify and Treat the Flu
I am not sure where each of you live, but here in North Carolina, flu rates are extremely high. As of writing this blog, the US weekly map shows that only 3 states in the US, with two being Hawaii and Alaska, are experiencing “low” numbers of flu. So, it only seems appropriate to write on influenza. What is the flu? How do you get it? How can you help your kid at home if they start to show flu symptoms? What should raise red flags at home? When do you need to seek a professional medical opinion?
Let’s unpack all of that!
What is the flu?
The flu is a virus, meaning it cannot be treated with antibiotics as a cure. There are many different strands of the flu that circulate each year, but the most common are Influenza A and Influenza B. These are the stands most commonly tested for in doctor’s offices. Influenza is easily spread through respiratory droplets which can be shed when people cough, sneeze, or even talk in public. This is why it spreads like wildfire, especially among children who don’t always practice the best hand or cough hygiene.
Most people show symptoms between 1-4 days after being exposed. However, like most viruses, people are contagious prior to showing symptoms. Another reason that viruses tend to spread quickly.
What does the flu look like?
Symptoms of flu can vary but there are some that point providers to suspect a diagnosis of flu versus other viruses. Flu symptoms tend to have a very rapid onset. Children can be playing normally in the morning and get hit hard with a fever, muscle aches, cough, congestion and fatigue in the afternoon. The flu is typically not a “slow burn”.
Influenza A is most commonly the “classic flu” with headache, fatigue, fever (sometimes high), body aches accompanied by upper respiratory symptoms like sore throat, cough, and congestion. This tends to hit in the peak of “flu season”; October to February with peaks in January/February in a lot of places.
Influenza B tends to be, but not always, the less severe of the flu strains. It tends to come with lower fevers, fatigue, some upper respiratory symptoms but also nausea, stomach upset and possibly vomiting. It is known among providers as more of the “stomach flu”.
Diagnosis & What to Watch for at Home:
So, how do providers diagnose and treat the flu? Influenza is a virus, which means it will run its course in time. Most often, symptoms will resolve within 5-7 days, however this year, my primary care friends have shared that flu symptoms have been lingering longer than before. There is a simple nose swab test that confirms a diagnosis of influenza in the doctor’s office. Testing is largely up to the provider and parent if they want a definitive diagnosis because most of available treatments for flu are just treating the symptoms, unless you plan to use Tamiflu (more on that below).
My main concerns with influenza are dehydration and breathing difficulty! When babies and children do not feel well, they do not drink or eat well. Dehydration is especially a concern because of the fevers that are typically associated with flu. The body uses its fluid faster when it is hot. Overall, I like to let fevers ride without fever reducing medications such as tylenol or motrin as long as a child is comfortable. Fevers serve a purpose; they burn up the virus faster than if we reduce the temperature. Of course there are always special circumstances when discussing fevers, but largely, it is safe to let a fever ride.
I always want my babies to be taking in at least half of their typical fluid intake when sick and wetting 3-4 diapers in a 24 hour period. Same goes for older children. They should be peeing at least 3-4x/day. I am less concerned with food intake, but fluid intake should support being able to pee at least every 6-8 hours. If kids are nauseous, frequent small sips is recommended to prevent vomiting.
Check out my instagram @nuanced_newborns to learn more about red flags of pediatric respiratory distress and when to seek medical attention. You can also find a discussion on pediatric fevers there.
Home Remedies for Flu:
Home treatment for the flu is largely symptom management. Parents can use a Cool Mist Humidifier in their child’s room to help with cough and congestion. Honey naturally helps break down mucous and can help with sore throat and post-nasal drip. There are natural sore throat pops on the market. My favorites are the Little Remedies Sore Throat Pops and BeeKeepers Natural Pops. Nasal saline drops or rinses are also great with helping with congestion. Little Remedies makes great versions for both babies and older children.
Tamiflu
Tamiflu is an antiviral medication on the market that has been shown to decrease the duration of flu symptoms. However, when I worked in primary care, I did not often prescribe the medication. Why?
It has to be started within the first 48 hours of symptoms to have any efficacy. Often parents ride out viruses at home for the first 2-3 days, which is appropriate when children are drinking and breathing well. At that point, the medication is rendered useless.
The research shows when it is taken within the first 48 hours of symptoms, it really only decreases symptom duration by about 12-24 hours.
It carries some nasty side effects. Most commonly, nausea, vomiting, and diarrhea. If I am already concerned about hydration in a child, this is not the medication I want to give them. In a small number of children, it can also cause neurologic symptoms such as hallucinations and nightmares.
Overall, in healthy children, Tamiflu can cause more symptoms in the form of side effects to an already sick child. In the instances that I did prescribe it, I would thoroughly go through possible side effects with parents and tell them that unlike antibiotics, once they start Tamiflu, they do not have to complete the course. If a child negatively reacted to the medication, it is completely safe to stop its use immediately.
There are always special circumstances in which Tamiflu is recommended. For instance, children who are at higher risk for serious complications or death related to the flu are recommended to be prescribed Tamiflu. These include, children with asthma, heart disease, chronic lung disease and those who are immunocompromised, just to name a few. Parents who have children with these special considerations should speak with their provider at length regarding the risk/benefit of taking Tamiflu.
I hope this was helpful and that your family is staying healthy and happy this winter! March will be here before we know it and hopefully we can kiss this sick season goodbye!
