Intro

The most difficult question for parents and caregivers is when to call the doctor with concern about flu symptoms. Many people fear the child may have pneumonia. Here are some guidelines about when to call the doctor:

• Fever continues after 3 days.
• Nasal discharge lasts more than 10 days.
• Nasal discharge becomes thick and yellow
• Discharge is coming from the eyes.

When to go to the hospital

The child has difficulty breathing and does not improve even after nasal suctioning and cleaning.

The child appears sicker than 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 dehydrated include absence of tears with crying, decrease in amount of urine (dry diapers), dry mucous membranes (lips, tongue, eyes), and doughlike skin that fails to snap back flat when pinched.

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 medication 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.

seizure occurs.

Self-Care at Home

Flu symptoms may last more than a week. Caregivers can relieve and soothe children's aches and pains with basic home care.

• Rest in bed.
• Allow the child to drink lots of fluids of the child's choice.
• Treat fever with acetaminophen (Children's Tylenol, Infant's Feverall, Junior Strength Panadol) or ibuprofen (Children's Advil, Children's Motrin) taken according to package instructions or consult the child's doctor (do not give aspirin because it poses a risk of causing Reye syndrome).
• Use a humidifier in the child's room to make dry air easier to breathe.

Children may need more careful attention for these symptoms.

• Runny nose: Younger infants usually breathe through their nose and cannot breathe through the mouth. Even older children have difficulty breathing through the mouth and sucking on something at the same time. Therefore, it is very important that the child's nose should be clean before feeding and before putting the child to sleep.
• Suctioning is the method to clean the nose. For younger infants, use a rubber suction bulb to remove the secretions gently. Older children can blow their noses, but forceful blowing can push the secretions into the ear tubes or sinuses. Encourage the use of tissues and gentle nose blowing.
• Dry or stuffy nose: It is important to remember that most stuffy noses are blocked by dry mucus. Blowing or sniffling alone cannot remove dry mucus. Use of saline nosedrops is helpful in loosening the mucus. These nosedrops are available at most drug stores. One minute after using the nosedrops, use a soft rubber suction bulb to gently suck out the loosened mucus.

Prevention

Hand washing with soap and water or an alcohol hand gel is an important way to prevent picking up a flu virus. Avoid touching the mouth, nose, or eyes prior to handwashing.

Vaccination is the mainstay of flu prevention. The killed flu vaccine (a flu shot) should be given during the fall. In children, the flu vaccine can be given to children older than 6 months and in 2 separate doses for children younger than 9 years who have not been previously vaccinated.

The flu vaccine is also available as a nasal spray (FluMist) for healthy children aged 5 years or older, adolescents, and adults aged 49 years or younger. Children aged 5-8 years who have not received the flu vaccine as a nasal spray before require 2 doses about 2 months apart. Children who take aspirin should not receive the live vaccine.

Keep children with the flu at home while the fever lasts. Once the fever is gone, children may return to school and daycare.

Outlook

It often takes a few weeks to return to normal activity after the flu. The cough may last for weeks. All anti-influenza drugs have been shown to shorten the duration of illness by 1-2 days when therapy is started within 48 hours of symptom onset.