When to Worry About the Flu in a Child

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Influenza symptoms of high fever and trouble breathing are just a few of the signs that it’s time to worry about flu in a child, which can prove fatal. Many flu-related deaths aren’t the direct result of the viral infection, but rather a complication of an existing illness like asthma.

Or, the flu itself can lead to pneumonia and spark an overreactive immune response or cause organs like the heart or lungs to shut down. This can lead to fatal organ failure or sepsis. Very young children are especially vulnerable to potentially deadly flu-related complications like pneumonia or sepsis.

This article is meant to help you identify warning signs to watch for if your child has the flu. It offers information for a parent or guardian to consider when deciding if it’s time to contact a healthcare provider.

Tatyana Tomsickova Photography / Getty Images

Typical Flu Symptoms in Children

Many flu symptoms in children bear watching but are not cause for alarm. Typical symptoms in kids include:

Babies may be especially vulnerable, so watch for irritability and difficulty or refusal with feeding. Keep in mind there is no vaccine for children age 6 months or younger.

Should You Call a Healthcare Provider?

With the help of lots of fluids and plenty of rest, most children will recover from the flu within a week. But contact your healthcare provider about their symptoms to discuss whether they should be evaluated. It’s important to ensure the proper diagnosis and start treatment right away. Antivirals, for example, are most effective if given within two days after symptoms emerge. Expect flu symptoms to peak in two to three days and begin improving on day four.

Flu Danger Signs

Certain symptoms of the flu, like severe dehydration, suggest that the child in your care needs immediate medical attention. These signs in babies can include:

  • Changes in level of consciousness
  • Difficulty breathing
  • No improvement in comfort level, even if the fever goes down
  • Fever and flu symptoms that come back after they go away
  • No tears when crying
  • No wet diapers, and no urine (pee) in the last 8 hours

Other danger signs in children can include extreme irritability and severe headaches. The following signs in all children can be red flags for severe flu or emerging complications.

High or Prolonged Fever

Spiking a temperature is a pretty standard symptom of the flu. Fevers can actually be helpful in fighting infection, but a very high fever for days at a time may be a sign that more help is needed.

A fever with the flu can be as high as 103 F (39.4 C) to 105 F (40.5 C). If you’re worried that the child’s temperature is too high, or if they start to have seizures from the fever (this can occur at 100.4 degrees F or higher, usually during the first day) call your child’s healthcare provider immediately.

Turning Blue or Changes in Breathing

If your child seems short of breath or is breathing too quickly, the symptoms may signal a complication like pneumonia. This means the body isn’t getting enough oxygen, and organ damage and other serious consequences can result.

Kids who are having issues breathing may need additional medical treatment such as antibiotics for pneumonia, or even hospitalization to ensure they are getting enough oxygen.

Severe Headaches or Stiff Neck

Severe headaches and/or a stiff neck can indicate meningitis or swelling around the brain and spine. This can have a long-term or even fatal effect on kids.

If your child can’t tell you if their head hurts or if you aren’t sure if their neck is stiff, see if their chin can touch their chest. Gently tilt their head forward, and if it can’t reach, this could be a sign of meningitis, and you should seek immediate medical attention.

Other warning signs along with a severe headache include:

  • Fever with the symptoms of headache and stiff neck
  • Vomiting that doesn’t get better
  • Sleepiness or having difficulty walking and talking

Not Drinking Enough Fluids

Vomiting can contribute to dehydration. The flu also can make kids very tired and want to sleep all day and all night until they recover—something that can be made worse by dehydration. Keep an eye on the number of times they go to the bathroom. Also check for:

  • A dark urine color, or no urine at all
  • Dry lips
  • Pale hands and feet
  • Sunken eyes
  • Depressed anterior fontanelle (soft spot) in infants

If those signs appear, your child’s medical provider may want to see them or direct you to a hospital or other location to receive IV fluids.

Being Unresponsive

The flu can cause bad headaches and aches all over the body, not to mention a fever and bout of fatigue that can sap every last bit of energy. But there’s an obvious difference between not feeling good and being unresponsive.

If a normally very interactive child isn’t answering any questions, or you can’t wake them up from a nap, call your healthcare provider immediately.

Appearing to Get Better, Then Getting Worse

A relapse could be an indication that your child has a secondary infection or complication as a result of the flu, such as pneumonia. If your child gets sick again shortly after they showed signs of getting better, check with your healthcare provider as soon as you notice the change.

Risk Factors for Severe Flu in Kids

Certain individuals are more likely than others to have severe complications from the flu, including children under 5 years old, but especially children under 2. A child may be at higher risk of flu complications when they have: 

  • A chronic (long-term) or congenital (at-birth) heart or lung condition
  • Diabetes or other endocrine disorder
  • Underlying kidney or liver disease
  • Weak immune system from HIV/AIDS or long-term use of immune-suppressing medicines
  • A blood disorder such as sickle cell disease

It’s important to note that healthy children and adults with no history of medical issues die from the flu and its complications.

Kids With Asthma and the Flu

Even with well-controlled asthma, the influenza virus can irritate sensitive airways and provoke a severe asthma attack or pneumonia. Asthma is the medical condition most common among children hospitalized for influenza.

How to Treat the Flu in Children

Most of the time, children can be treated at home and recover from the flu in a few days. Rest, along with plenty of fluids, can help to keep kids hydrated and comfortable as they get better. Certain medications can help with their recovery.

OTC Medications and Home Remedies

Fever and pain symptoms can be treated with over-the-counter medications including Tylenol (acetaminophen), Motrin or Advil (ibuprofen), and, for older kids, cough medicines.

Use caution, though, as the U.S. Food and Drug Administration (FDA) does not recommend the use of cough and cold medications in children under age 2. Instead, you can try:

  • Inhaling steam
  • Using a cool mist humidifier
  • Saline nose drops or sprays
  • Nasal suctioning

Other home remedies and OTC treatments include:

  • Vapor rubs (like Vicks) applied to the chest
  • Vitamin C lozenges to ease throat discomfort
  • Tea with honey (honey should only be used in kids older than 1 year)

Avoiding Aspirin for Kids With Flu

Keep in mind that aspirin is not a safe choice for children. Its use to treat flu symptoms can lead to Reye’s syndrome, which can prove fatal in kids. Always check the labels of other products that may contain aspirin (like Pepto-Bismol).

Anti-Viral Treatment

Antivirals given within 48 hours offer the greatest benefits when treating the flu. Drugs like Tamiflu also can be given to prevent flu if your child has been in contact with an infected person but it does not play the same preventive role as a vaccine.

In the United States, there are four antivirals approved for use in treating flu in children:

  • Tamiflu (oseltamivir): Available as a capsule or liquid for children 2 weeks and over, but its safety is not established in children younger than age 1
  • Rapivab (peramivir): Delivered intravenously (into a vein) for children 2 years and over
  • Relenza (zanamivir): Delivered in inhaled powder form for children 5 years and over
  • Xofluza (baloxavir marboxil): Available as a tablet or a liquid for children 5 years and over, but its safety is only established in those older than 12

Flu Prevention

Flu vaccines can help kids and adults avoid infection, recover from flu faster, and avoid hospitalization or death. Getting vaccinated is one of the most important things you can do to protect your children from a serious or fatal case of the flu. That’s because getting vaccinated helps your child’s body build up defenses they need to fight the flu.

Without vaccination, it can often take weeks for your body to build up enough defenses to fight off an infection. It’s your child’s best defense, along with:

  • Avoiding people who are sick
  • Careful handwashing and hygiene

Everyone age 6 months and older can get a flu vaccine, which is formulated specifically for each year’s season. For example, there are nine different flu vaccines available for the 2023–2024 flu season. All of them protect against the same four strains of flu.

According to the Centers for Disease Control and Prevention, the five types approved for children are:

  • Afluria Quadrivalent
  • Fluarix Quadrivalent
  • Flucelvax Quadrivalent
  • FluLaval Quadrivalent
  • Fluzone Quadrivalent

Most people need just one dose and should get it by October each year, but it’s still important for your child to get a shot even if it’s later in the flu season. Some kids need two shots and should start their doses in July or August, if possible.

Summary

Influenza is a common childhood infection and most kids recover quickly. But certain conditions, like underlying diabetes or a weaker immune system, can put a child at risk of more severe symptoms, including a case of flu that could prove fatal.

Over-the-counter treatments and home remedies often are effective in treating kids with the flu. But “red flag” symptoms of a high fever, trouble breathing, and severe dehydration are among the signs that you should seek medical attention.

It’s important to have an early and accurate diagnosis. so contact your healthcare provider immediately if you have concerns about the flu. You also should consider flu vaccination for your before flu season begins each year.

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