Some parents think the flu is a stomach bug. But while children may have nausea and/or vomiting with flu, the key influenza symptoms in children include a high fever, chills and shakes, body aches, and a dry hacking cough.

What causes flu in children?

The flu is caused by one of three types of influenza viruses. Types A and B are responsible for the yearly flu epidemics, and type C flu virus causes sporadic illness. Type A flu virus is further divided into different subtypes based on the chemical structure of the virus.

How is flu spread among children?

Flu symptoms are highly contagious, particularly when people share close quarters as children do in school classrooms. Flu is spread among children when a child either inhales infected droplets in the air (coughed up or sneezed by an infected person) or when the child comes in direct contact with an infected person's secretions. This can happen, for example, when they share pencils at school or play computer games and share the remotes or share utensils such as spoons and forks. Hand-to-hand contact is also important to consider when thinking about how flu is spread.

What are flu symptoms in children?

The symptoms of flu in children are more severe than symptoms of a childhood cold. Symptoms of flu in children start abruptly and usually cause kids to feel the worst during the first two or three days of onset. Flu symptoms in children may include:

• a high-grade fever up to 40°C
• chills and shakes with the fever
• extreme tiredness
• headache and body aches
• dry, hacking cough
• sore throat
• vomiting and belly pain

Can there be complications of flu in children?

Some complications of flu in children may include a sinus infection, ear infection, or pneumonia. Call your pediatrician if your child's fever lasts more than three to four days or if your child complains of trouble breathing, ear pain, congestion in the face or head, or a persistent cough. Young children under age 2 -- even healthy children -- are more likely than older children to be hospitalized from the complications of flu.

What's the best way to treat flu symptoms in children?

There are useful home remedies and over-the-counter medications to help children with the flu feel better. Keep in mind that antibiotics are ineffective against the flu. Antibiotics are useful to treat bacterial infections. However, the flu is a viral infection and antibiotics will not help. Some common home remedies for flu in children include:

• getting plenty of rest
• drinking plenty of liquids
• using acetaminophen or ibuprofen to lower fever and reduce aches (Both are available in children's formulations.)

Do not give aspirin to children or teenagers who have flu-like symptoms, particularly fever. Aspirin may increase risk of Reye's syndrome, a rare disorder that occurs almost exclusively in children under the age of 18 and can cause severe liver and brain damage.

Talk with your doctor before giving any child under age 6 an over-the-counter cold or flu medicine. Do not give these medications to any child under the age of 2.

In very young children with congestion, use a nasal bulb to remove mucus. You may also spray three drops of saline nasal spray into each nostril.

Should I take a child with flu symptoms to the hospital?

If your child has one of the following signs, go to the hospital ER or call 911 for emergency care:

• The child has difficulty breathing and does not improve even after nasal suctioning and cleaning.
• The child appears sicker than in any previous episode of illness. The child may not be responding normally. For example, the child does not cry when expected or make good eye contact with the mother, or the child is listless or lethargic.
• The child is not drinking fluids well or is showing signs of dehydration. Common signs of dehydration include absence of tears with crying, decrease in amount of urine (dry diapers), dry mucous membranes (lips, tongue, eyes), and dough-like skin that fails to snap back flat when pinched.
• The child has a fever that does not get better with acetaminophen or ibuprofen. However, the number one reason that the temperature fails to come down after these medications is an inadequate dose. A proper dose is based on the child's weight, not age. Be guided by your doctor's instructions or the package label.
• A seizure occurs.

Are antiviral drugs used to treat flu in children?

In general, antiviral drugs can be offered to anyone 1 year of age to help prevent and/or treat the flu. If your child is at high risk of serious complications from the flu, your doctor may wish to prescribe this antiviral drug.

In some cases, antiviral drugs can also be used to prevent infection from flu. These drugs block the replication of the flu virus, preventing its spread. In healthy children, antivirals such as zanamivir (Relenza) and oseltamivir (Tamiflu) may shorten the duration of flu and reduce the severity of flu symptoms.

Talk to your child's doctor about antiviral drugs because to be useful they must be given as soon as flu symptoms start.

Are there ways to prevent the flu in children?

Canada’s National Advisory Committee on Immunization (NACI) and Health Canada recommend that all children ages 6 months through 18 years receive the flu vaccine to prevent influenza. Vaccinating children with the specific influenza vaccine each fall helps protect them against flu.

FluMist, a nasal spray flu vaccine, can be given to healthy children over age 2 who don't wheeze, have a history of asthma, or have a weakened immune system. All children over age 6 months are eligible for the traditional flu shot.

WebMD Medical Reference

Sources:
American Lung Association: "Cold and Flu Guidelines: Influenza."
American Lung Association: "Influenza Fact Sheet."
FDA: "Influenza: Vaccination Still the Best Protection."
Mayo Clinic: "Flu Shot: Your best shot for avoiding influenza."
CDC: "Cold and Flu Guidelines: Influenza."
CDC: "CDC Advisory Committee Recommends Nasal Spray Flu Vaccine for Children Ages Two to Five."
American Academy of Pediatrics, AAP News, January 2007; vol 28(1): p 1.

Reviewed by Brunilda Nazario, MD on Sept. 17, 2008.
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