Managing flu in children


How do you know whether your child has flu and not just the common cold? And how can you treat your child at home? A virologist gives us the facts.

Children in crèche or school are exposed to all sorts of respiratory viruses with which they will inevitably become infected. They are then likely to bring these infections home to their younger siblings, parents and grandparents.

Influenza, commonly known as the “flu”, is an infection of the respiratory tract caused by influenza virus.  Young children particularly under 2 years of age and children with underlying medical conditions are especially vulnerable to flu and its complications.

Read: Signs that your child has flu

Recognising flu in children

Flu occurs seasonally in winter so at other times of the year it is an unlikely cause of illness. Symptoms of the flu start abruptly within 1-4 days after exposure.

In a very young child, a fever (with irritability or listlessness) may be the only sign of infection with flu. In older children there are usually symptoms linking the fever to the respiratory tract, such as sore throat, cough or runny nose. Other symptoms include body aches, headache, earache and vomiting.

In children, several other viruses can cause illness indistinguishable from flu. Gastrointestinal symptoms (nausea, vomiting and/or diarrhoea) are more common in children than adults.  Luckily, the time frame for flu is short and improvement should occur after 48 – 72 hours, along with the virus’s departure.

Read: Tips for helping babies with stuffy noses

When should I take my child for medical attention? 

Any drop or rise in temperature in a baby under three months, any temperature above 38 degrees Celsius in a child aged three to six, and a temperature above 39 degrees Celsius an older child would require medical advice. A fever persisting more than 48 hours despite treatment with an antipyretic (fever-lowering drug such as paracetamol) also needs medical investigation.

Seek emergency care if your child experiences any of the following:

- Fast breathing or difficulty breathing

- Blueish or grey skin colour

- Not drinking enough fluids

- Severe or persistent vomiting

- Not waking up or not interacting

- Being so irritable that the child does not want to be held

- Flu-like symptoms that improve but then return with fever and worse cough

Severe ear pain may indicate middle ear infection (otitis media), which is the most common complication of flu in young children. In children with asthma, flu can bring on an asthma attack.  Pneumonia (infection of the lung) and rarely flu affecting the brain are the most dangerous complications of flu. 

Read: You, your kid and the flu

What can I do at home?

A child with a high temperature may be at risk for a febrile convulsion (fever fit). The fever should be brought down with paracetamol syrup and sponging the child with tepid water may be helpful.

NOTE: Aspirin is never used in children with a fever because if the fever is caused by a virus there is a risk that the child will develop Reye's syndrome (a rare but fatal condition which affects the brain and liver).

Although there are many cold and flu remedies available over the counter in chemists and supermarkets, these are generally not advisable in young children and should be discussed with a pharmacist or doctor.

There are specific anti-influenza drugs now available (eg. oseltamivir and zanamivir) and these might be prescribed by your doctor if the diagnosis is definite and circumstances warrant this treatment.

Read: Are kids' colds meds dangerous?

Can the flu vaccine be used in children?

The flu vaccine is given yearly due to the changing nature of influenza viruses. 

In South Africa it is recommended by the National Institute of Communicable Diseases that all children aged from 6 months to 5 years receive a yearly flu vaccine. The vaccine is safe for use in children from 6 months of age.

The flu vaccine is especially important for children who have underlying medical conditions such as a heart condition (eg. congenital heart defect) or lung condition (eg. asthma, tuberculosis) or are receiving regular medical care for conditions such as HIV infection.

Children who have a severe egg or poultry allergy will usually not be eligible for the vaccine.

Flu vaccines should be given sufficiently early to provide protection for the winter season. It is available in both the public sector (at designated clinics and hospitals) and the private sector (at pharmacies and healthcare facilities), generally from March or April each year. 

It takes about 2 weeks for the body to produce antibodies for protection. However it is never too late to vaccinate as the season lasts a few months. 

Although the flu vaccine is not 100% effective, it still provides protection therefore it is recommended. 

Also it has been shown in a trial in South Africa that when pregnant women receive the flu vaccine it would not only reduce their risk of flu but also reduce their baby’s risk of flu in the first 6 months of life.

Read: Flu vaccine effective in children

How to prevent the spread of flu

Flu can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces.  Therefore it is important to perform hand hygiene and cough etiquette by covering the mouth and nose with a disposable tissue when coughing or sneezing, then discard the tissue in a waste bin and wash hands with soap and water to prevent the spread of flu.  Alternatively, if there is no tissue available, they can cough/sneeze into their upper arm.  People who are not well should be encouraged to stay home and keep some distance from healthy people, as much as possible.

Read more:

Preventing flu

5 immune-boosting tips

Cold or flu?

Updated and reviewed June 2015, Dr Aabida Khan, NHLS Virology Registrar, Groote Schuur Hospital, Division of Medical Virology, University of Cape Town

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