Thus far the 2018 flu season has been rough for the providers, families, and patients in my practice. Thousands of people in the area where I live have gotten sick, and a great deal of stress has been caused by the awful stories we’re reading about in the news. Consequently, I decided to summarize some FAQs/guidelines to help families cope with flu this season.
1. What are the symptoms of flu (influenza)?
Classic flu symptoms include fever, cough, nasal congestion, body aches, and sore throat. Kids who are just starting to come down with flu may also have vomiting, but this usually isn’t the primary complaint. Sometimes people with a mild case of the flu will present with cough and congestion, but no fever. Some children with flu will be coinfected with strep, so anyone who has flu-like symptoms and a particularly bad sore throat should also get tested for strep, especially if the tonsils are red and swollen.
2. How long do the symptoms of flu last?
Typical flu symptoms (cough and congestion) can last 1-2 weeks, but the more severe symptoms (high fever and bad body aches), usually resolve within 3-5 days.
3. What should I do if my child has a fever from the flu (or some other viral illness), but I can’t seem to bring down the temperature with medication?
Small children with viral illnesses tend to spike very high fevers at night. Looking on the bright side, fever is an excellent defense mechanism that helps children fight infections like influenza faster. Some studies have shown that bringing down a fever with medication will cause viral illnesses to last longer. Because fever isn’t dangerous to children, parents should not feel obligated to treat fever with medications like Tylenol (acetaminophen) or Advil (Motrin/ibuprofen), unless a child is uncomfortable or has a history of febrile seizures (see blog post # 17, Managing Fever in Children, for more information on this topic). For better or worse, fever medications are wonder drugs that quickly make children feel better—causing them to resume normal activities when they ought to be resting.
Importantly, a fever’s response to treatment does NOT reflect upon the severity of the illness. Panic frequently ensues when parents administer meds and a temperature continues to rise. Yet sometimes it isn’t possible to bring down a high temperature, especially at night. Allowing a child to sleep while waiting for a fever to resolve on its own may be the best (and only) solution. Placing a febrile child in a lukewarm bath isn’t helpful and will probably just make the child feel cold.
4. How useful is a rapid flu test?
A rapid flu test in a medical provider’s office is only useful if it comes back positive. A negative flu test doesn’t tell you much, because many people who are infected with flu will test negative. In other words, there is a high false-negative rate with rapid flu tests. Therefore, if a person clinically looks like she has the flu, there may be no point to doing a flu test, as a negative test will NOT rule out the flu. If you and your doctor think you have the flu, but you test negative, you should still consider taking Tamiflu.
5. How useful is Tamiflu, the antiviral medication that treats flu?
Tamiflu will shorten the course of the flu (but no other viral illnesses) by about one day. Importantly, Tamiflu helps to prevent some of the secondary complications of the flu, such as staph pneumonia and bacterial sepsis. Consequently, I usually recommend the medication if the timing is right. Tamiflu works best when administered 1-2 days into the illness. After 3-4 days, it’s probably not that helpful. Although Tamiflu frequently causes GI side effects, like diarrhea and vomiting, psychiatric side effects (such as hallucinations, delusions, and suicidal ideation) are very rare.
6. Aside from taking Tamiflu, what else can I do to fightthe flu at home?
Take a few days off from work/school/sports and give your body a chance to rest. Get plenty of sleep, drink fluids with electrolytes (Gatorade is better than water for intravascular hydration), and eat healthy food. For sick teenagers, getting adequate sleep is essential for recuperating and staying healthy. Many of the teens I see in my office are vulnerable to infections like influenza because they are chronically sleep deprived. For the parents of these individuals, confiscating electronic devices at nighttime may be helpful.
7. How useful is a flu shot?
This year’s flu shot wasn’t a great match for the current circulating strains. Nonetheless, studies are showing that people who were vaccinated are typically having a milder course if they do get sick with flu, especially if they’re infected with the more virulent H3N2 strain. Consistent with CDC guidelines, I always recommend flu vaccines to people of all ages in my practice, even if it’s late in the season. This year we are likely to see cases of flu into May or even early June.
8. What if my pharmacy is out of generic liquid Tamiflu, and I don’t want to spend $300 on name-brand Tamiflu?
Inexpensive Tamiflu capsules are available in pediatric doses. The capsules can be opened and emptied into yogurt, apple sauce, or any other food.
9. What is the chance of dying from flu?
People who are pregnant, immunocompromised, very young, and very old are at higher risk for having severe complications from flu. The overall risk of dying from flu in this country is about .1 %, a very low number.
While the news media is helpful for raising awareness about complications from influenza, flu-related articles tend to focus on the most tragic cases—unexpected deaths in otherwise healthy young people. As a mother and pediatrician, my heart goes out to the families who have lost loved ones this year to the flu. Thankfully, most people who get the flu recover without any residual problems.
10. What are signs that an adult or child is developing a secondary bacterial infection or severe inflammatory response from the flu?
Even for medical providers, it can be difficult to differentiate worrisome signs from typical symptoms. Here are some things to watch for that could indicate a child or adult is developing significant complications from flu:
-The initial fever has gotten better, but it suddenly spikes up again, usually to a high level.
-The heart is beating very quickly, out of proportion to what would be expected from fever alone.
-A blotchy, red rash resembling a sunburn is developing on the chest and back; bacterial staph infections frequently present with “erythroderma” on the trunk.
-A child has labored or rapid breathing; the chest wall may be caving in or “retracting” around the ribs. Central cyanosis, or blueness around the lips, is never a good sign.
-The skin feels cold and clammy, and the perfusion (blood flow) doesn’t look right. Normally, fingertips should be nice and pink, and the color should return within a second or two after gently pinching a child’s fingertips. If a child’s fingertips look purple or blue, or the color is slow to return after pressing on the fingertips, then it might be time to seek medical care in the emergency room—especially if the child has other worrisome symptoms. Note that in children, at the onset of fever, fingertips can look a little bluish, but this usually isn’t persistent.
-Intractable/progressively worsening vomiting isanother reason to seek medical care right away.
-A child who hasn’t been eating or drinking well, has sunken eyes/dry lips, and is urinating less than normally may be dehydrated and need intravenous fluid.
-Extreme irritability, lethargy, confusion, and/orunresponsiveness always warrant an immediate evaluation.