If you have tried to seek any kind of medical care for a sick child recently, you have likely
experienced difficulty in being seen. We are off to a very busy and early start to the winter sick
season. In fifteen years of practicing medicine in the Twin Cities, I have never seen such a
demand for health care both this early and with kids as sick as we have seen. One common
virus that has started circulating in our community is influenza. Influenza can spread anytime
between October and May. We usually see a peak around January. There is already a steep
climb happening in Minnesota.
Many times you hear someone say the have “the flu.” People use that term for all kinds of
illnesses. When your health care provider is talking about the flu, they are talking about
“influenza” which is typically a respiratory germ. Some kids may have upset stomachs and
vomiting with the flu but it is not a typical symptom. Kids with influenza usually experience
high fever, headaches, sore throat, body aches, cough, and congestion. They are contagious
starting the day before they show symptoms until around day 5-7 after symptoms begin
(although they are most contagious the first 3-4 days of symptoms). Kids can be sick
anywhere from a couple of days to a solid week. It is no fun! However, worse than the
symptoms of flu are the more serious complications that can occur. Statistics on deaths in
children from the flu began to be collected by the CDC in 2004. Since then, yearly deaths have
ranged from 37-199 children. The highest group with mortality from the flu were babies under
six months followed by kids six months to two years of age.
The best way you can prevent your child from getting the flu is to get them vaccinated. If you
have a baby under six months who is too young to be vaccinated, get yourself and the
caregivers for that child the flu vaccine. We typically start offering the influenza vaccine in
early September when we receive our first shipments. I have had parents concerned that it
may be too early to receive the flu shot. Kids can be vaccinated as early as July or August and
maintain immunity throughout the flu season. The vaccine can be given either as a shot, which
contains dead pieces of the influenza virus, or as a mist in the nostrils, which is a live,
weakened form of influenza. The shot can be given to kids as young as six-months-old. The
mist can be given to kids over two years of age. Since the mist it is a live vaccine, it is not
recommended for people with weakened immune systems. We also use caution with the mist
in children who wheeze or have asthma. In general, they are about equal in effectiveness
although there have been years, in hindsight, when one turns out to be more effective than the
other. People need to be vaccinated against the flu yearly because the virus is always
changing. We adjust the four strains the vaccine covers each year to try and match what we
think will circulate. If your child is eight-years-old or less and has never received the flu
vaccine, they will need to receive two doses four weeks apart.
It is not unusual to have a family say they had the flu shot but their child still got the flu. Why
should they bother giving it? On average, the flu vaccine is about 50% effective. I can’t tell
you exactly how effective this year’s vaccine will be until we get through the season and can
analyze the data. While that doesn’t sound great, 50/50 is much better odds than zero
protection. In addition to the personal benefit of a flu vaccine, if we reduce the burden of
illness from flu by 50% in our country, thousands of lives and hospitalizations are saved. While
not perfect, it is our best option to protect ourselves and our kids against the flu.
If your child does get the flu, we usually recommend symptomatic care. Acetaminophen,
ibuprofen (if they are older than six months), rest, and fluids are helpful. Tamiflu is an anti-viral
drug that can be used against influenza. It is recommended for hospitalized patients as well as
kids with risk factors for severe flu such as asthma, a weakened immune system, or diabetes.
It can be given to healthy children but we don’t typically prescribe it. Why not? Well, many
kids vomit when they take Tamiflu. Plus, it only reduces the duration of illness by about a day.
While it is important in a critically ill child, it has much less of a role for our healthy patients. It
would be a very rare case where “prophylaxis” against the flu with Tamiflu is recommended.
This is a ten day course of Tamiflu (rather than a five day course given for treatment) that
someone would take after having exposure to the flu. It would need to be a very specific
circumstance (think someone on chemo in the house) where we would consider prescribing it
for this purpose.
The most common complication of the flu is pneumonia. If your child was doing better and
suddenly has a much worse cough, a return of the fever, or difficulty breathing, they should be
seen by a health care professional. Our clinicians and triage nurses are here to help you if your
child gets the flu. If you are unsure what to do or if your child should be seen, please call our
office and we will be happy to guide you!
