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Influenza - Swine Flu (H1N1)

1. Does this describe your child's symptoms?

Definition

  • Swine Flu (H1N1) is a viral infection of the nose, throat, trachea, and bronchi
  • You think your child has Swine Flu because other family members have it
  • You think your child has Swine Flu and it's prevalent in the community
  • In August 2010, the World Health Organization declared that the H1N1 Flu pandemic had ended.  They predicted, however, that the H1N1 virus would continue to circulate at low levels for several years. The topic has been kept in the content because much of the information may apply to future outbreaks of novel strains of influenza.

Symptoms of Swine Flu:

  • The symptoms of Swine Flu are the same as those seen with regular, seasonal influenza
  • The main symptoms are fever, cough, sore throat and runny nose
  • Fever is usually present. If there is no fever, your child probably doesn’t have flu.
  • Other common symptoms are muscle pain, headache and fatigue
  • Some people also have vomiting and diarrhea, but never as the only symptom

Diagnosis: How to Know Your Child Has Swine Flu (H1N1 Flu)

If Swine Flu (H1N1 Flu) is widespread in your community and your child has Swine Flu symptoms with a fever, then he or she probably has Swine Flu. You don't need to get any special tests. You should call your doctor if your child is HIGH-RISK for complications of the flu (see the following list). For LOW-RISK children, you don't need to call or see your child's doctor, unless your child develops a possible complication of the flu. (See the "When to Call Your Doctor" section).

HIGH-RISK Children for Complications From Swine Flu (CDC)

Children are considered HIGH-RISK for complications if they have any of the following conditions:

  • Lung disease (such as asthma)
  • Heart disease (such as a congenital heart disease)
  • Cancer or weak immune system conditions
  • Neuromuscular disease (such as muscular dystrophy)
  • Diabetes, sickle cell disease, kidney disease OR liver disease
  • Diseases requiring long-term aspirin therapy
  • Pregnancy
  • Healthy children under 2 years old are also considered HIGH-RISK (CDC: September 2009)
  • Note: All other children are referred to as LOW-RISK

Swine Flu (H1N1 Flu): General Information

  • Cause: The H1N1 virus is a combination virus that contains genes from swine flu, avian flu and human flu. Cases of swine flu in humans were first detected in Mexico during March 2009. An outbreak of swine flu in humans occurred in the U.S. and Canada in April 2009. By June 2009, the WHO declared it a global pandemic.
  • Severity of Symptoms: Symptoms of swine flu can be mild to severe, just as with regular human flu. Thus far in the US and Canada, the symptoms have generally been mild to moderate.
  • Transmission: The swine flu virus is spread via airborne droplets, from sneezing and coughing, just like other influenza viruses. It also can be transmitted by hands contaminated with secretions. It no longer has anything to do with pigs; it is only spread person-to-person. Swine flu is NOT transmitted by eating pork.
  • Expected Course: Like regular flu, the fever lasts 2-3 days, the runny/congested nose 1-2 weeks and the cough 2-3 weeks. With some flu viruses, the fever lasts 4 or 5 days.
  • Contagious Period: A person is contagious for 1 day prior to and for 7 days after the onset of symptoms (e.g., the fever and cough)
  • Incubation Period: After exposure, a person will come down with swine flu symptoms in 4 to 6 days (5 days on the average). An outer limit rarely could be 7 days. This virus has a longer incubation period than seasonal flu (1 to 3 days).
  • Attack Rate: The chance of getting swine flu depends on the degree of exposure and is always higher for household contacts. While the attack rate is unknown for this virus, it should be high (20-50%) because there is no natural immunity to swine flu viruses.
  • Diagnostic Test: At this time, testing is mainly indicated for patients with severe disease (CDC, May 2009). Accurate testing takes 2 or 3 days.
  • Treatment: See below.
  • Prevention: Prevention measures include avoiding sick people and crowds (social distancing). Hand washing is very important. A complete list of preventive tips is available on the CDC website.
  • Vaccine: The best way to prevent Swine (H1N1) Flu is to get a yearly seasonal flu vaccine. This year, H1N1 is included in the regular flu vaccine and no separate flu shot is needed.

Complications of Swine Flu

Children who develop the following complications need to be seen by their doctor:

  • Ear infections and sinus infections occur in 10% of children
  • Pneumonia: both viral and secondary bacterial (mainly in HIGH-RISK children)
  • Influenza-induced flare-ups in those with asthma
  • Dehydration, often due to a severe sore throat that limits fluid intake
  • Muscle pains (viral myositis) in the legs can be severe and cause limping or refusal to walk

Prescription Antiviral Drugs for Swine Flu

  • For optimal results, antiviral drugs (such as Tamiflu) should be started within 48 hours of the start of flu symptoms. They can be started later in some cases.
  • The CDC recommends they be used for: 1) any patient with severe symptoms AND 2) for all HIGH-RISK children (see that list) with any flu symptoms.
  • The CDC doesn't recommend antiviral drugs for LOW-RISK children with mild or moderate Swine Flu illness.
  • Their benefits are limited: they usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not cure the disease.
  • Side effects: Vomiting in 10% of children.

Return to School

  • If you or your child get sick with Swine Flu, the CDC recommends that you stay home from work, school or child care until at least 24 hours after the fever is gone (CDC: August 2009).

Internet Resources For U.S.

2. When to Call Your Doctor

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • HIGH-RISK for complications of flu (children with other chronic diseases (See that list) OR healthy children under 2 years)
  • You think your child needs to be seen, but not urgently
  • Continuous (nonstop) coughing
  • Age under 3 months old with any cough
  • Earache or ear discharge also present
  • Sinus pain (not just congestion) is also present
  • Fever present for more than 3 days
  • Fever returns after gone for more than 24 hours

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Age over 6 months and needs flu shot
  • Coughing has kept home from school for 3 or more days
  • Nasal discharge lasts over 2 weeks
  • Cough lasts more than 3 weeks
  • Swine Flu symptoms last over 3 weeks

Call 911 Now (your child may need an ambulance) If

  • Severe difficulty breathing (struggling for each breath, making grunting noises with each breath, unable to speak or cry because of difficulty breathing)
  • Lips or face are bluish when not coughing

Parent Care at Home If

  • Probable Swine Flu with no complications, your child is LOW-RISK, and you don't think your child needs to be seen
  • Tamiflu Questions
  • Prevention of Swine Flu

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Difficulty breathing (under 1 year old) not relieved by cleaning the nose
  • Difficulty breathing (over 1 year old) present when not coughing
  • Breathing becomes very rapid
  • Lips or face have turned bluish during coughing
  • Wheezing (tight, purring sound with breathing out)
  • Stridor (harsh sound with breathing in)
  • Ribs are pulling in with each breath (retractions)
  • Chest pain and can't take a deep breath
  • Dehydration suspected (no urine for more 8 hours AND very dry mouth, no tears, ill-appearing, etc.)
  • Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc)
  • SEVERE HIGH-RISK patient such as chronic lung disease (exception: mild asthma), heart disease, bedridden, etc.
  • Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen)
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
  • You think your child needs to be seen urgently

3. HOME CARE ADVICE FOR INFLUENZA - SWINE FLU (H1N1)

  • Reassurance:
    • Since Swine Flu is widespread in your community and your child has flu symptoms (cough, sore throat, runny nose) with fever, your child probably has Swine Flu.
    • Special tests are not needed.
    • You don't need to call or see your child's doctor unless your child develops a possible complication of the flu (such as an earache or difficulty breathing).
    • For healthy people, the symptoms of Swine Flu are similar to those of the common cold.
    • With flu, however, the onset is more abrupt and the symptoms are more severe. Feeling very sick for the first 3 days is common.
    • The treatment of Swine Flu depends on your child's main symptoms and is usually no different from that used for other viral respiratory infections.
    • Bed rest is unnecessary.
  • Treating Swine Flu - Tamiflu:

    • Tamiflu can reduce the symptoms of Swine Flu illness.
    • The benefits are limited: they usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not cure the disease.
    • For optimal results, antiviral drugs (such as Tamiflu) should be started within 48 hours of the onset of flu symptoms.
    • Indications: Severe symptoms OR underlying health problems (HIGH-RISK group)
    • Most patients have mild to moderate symptoms and Tamiflu treatment is not necessary.
    • Unnecessary overuse of Tamiflu causes resistant strains of the virus. (8/2009 some resistance has occured)
    • Tamiflu also has side effects: Vomiting in 10% of children.
  • How to Protect Yourself From Getting Sick:
    • Wash hands often with soap and water.
    • Alcohol-based hand cleaners are also effective.
    • Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way.
    • Try to avoid close contact with sick people.
    • Try to avoid unnecessary visits to the ER and urgent care centers because those are the places where you are more likely to be exposed to Swine Flu, if you don't have it.
  • Runny Nose with Profuse Discharge - Blow or Suction the Nose:
    • The nasal mucus and discharge is washing viruses and bacteria out of the nose and sinuses.
    • Blowing the nose is all that's needed.
    • For younger children, gently suction the nose with a suction bulb.
    • Apply petroleum jelly to the nasal openings to protect them from irritation. ( Cleanse the skin first.)
  • Preventing Swine Flu - Tamiflu:
    • The drug Tamiflu may help prevent Swine Flu (prophylaxis).
    • Indications: Recent close contact with person with confirmed Swine Flu AND the exposed person is in HIGH-RISK group (see that list)
    • It is effective only while your child is taking it and ceases once your child stops taking it.
    • Your child should only take Tamiflu if your child's physician recommends it.
  • How To Protect Others - Stay Home When Sick:
    • Cover the nose and mouth with a tissue when coughing or sneezing.
    • Wash hands often with soap and water, especially after coughing or sneezing.
    • Limit contact with others to keep from infecting them.
    • Stay home from school or work for at least 24 hours after the fever is gone (CDC, August 2009).
  • Nasal Washes To Open a Blocked Nose:
    • Use saline nose drops or spray to loosen up the dried mucus. If not available, can use warm tap water.
    • STEP 1: Instill 3 drops per nostril. (Age under 1 year, use 1 drop and do one side at a time)
    • STEP 2: Blow (or suction) each nostril separately, while closing off the other nostril. Then do other side.
    • STEP 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
    • Frequency: Do nasal washes whenever your child can't breathe through the nose.
    • Saline nasal sprays can be purchased without a prescription.
    • Saline nose drops can also be made: add 1/2 teaspoon (2 ml) of table salt to 1 cup (8 ounces or 240 ml) of warm water.
    • Reason for nose drops: suction or nose blowing alone can't remove dried or sticky mucus.
    • Another option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
    • For young children, can also use a wet cotton swab to remove sticky mucus.
    • Importance for a young infant: can't nurse or drink from a bottle unless the nose is open.
  • Personal Stockpiling of Tamiflu - Not Recommended:
    • Definition: Some people request a prescription for Tamiflu for all family members just in case they come down with flu symptoms. They currently are well and have not been exposed to Swine Flu.
    • Doctors are opposed to this practice, as is the CDC and your State's Public Health Department.
    • The supply of Tamiflu is limited and needs to be kept available for patients who have severe symptoms OR have underlying health problems.
  • Face Masks:
    • Face masks refer to disposable masks labeled as surgical or dental masks.
    • Face masks may help reduce the risk of getting swine flu in crowded settings.
    • Avoiding sick people and frequent handwashing are more effective preventive measures.
    • HIGH-RISK people: If crowded setting cannot be avoided, face masks are recommended.
    • LOW-RISK people: Face masks are not necessary. (Possible exception: households where a family member has Swine Flu).
    • Sick people with suspected influenza should wear a face mask if they must leave their home to seek medical care.
  • Cold Medicines:
    • Cold medicines are not recommended at any age. (Reason: they are not helpful. They can't remove dried mucus from the nose. Nasal washes can.)
    • ANTIHISTAMINES are not helpful, unless your child also has nasal allergies.
    • DECONGESTANTS: OTC oral decongestants (Pseudoephedrine or Phenylephrine) are not recommended. Although they may reduce nasal congestion in some children, they also can have side effects.
    • AGE LIMIT: Before 4 years, never use any cough or cold medicines. (Reason: unsafe and not approved by FDA) (Avoid multi-ingredient products at any age.)
    • NO ANTIBIOTICS: Antibiotics are not helpful, unless your child develops an ear or sinus infection.
  • Vaccine:
    • The best way to prevent Swine (H1N1) Flu is to get a yearly seasonal flu vaccine.
    • This year, H1N1 is included in the regular flu vaccine and no separate flu shot is needed.
  • Homemade Cough Medicine:
    • Goal: reduce the irritation or tickle in the throat that triggers a dry cough
    • AGE 3 months to 1 year: Give warm clear fluids (e.g., water or apple juice) to treat the cough. Dosage: 1-3 teaspoons (5-15 ml) four times per day when coughing. Avoid honey until 1 year old.
    • AGE 1 year or older: Use Honey 1/2 to 1 tsp (2 to 5 ml) as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. (If not available, can use corn syrup.) Drugstore cough medicines are not as helpful as honey.
    • AGE 6 years or older: Use Cough Drops to coat the irritated throat. (If not available, can use hard candy.)
  • Anti-Viral Medication:
    • Tamiflu can be used for prevention following close contact with a person who has Swine Flu.
    • It is only recommended for HIGH-RISK patients (CDC).
  • Sore Throat Relief: For mild sore throat, use warm chicken broth over 1 year old and hard candy over 6 years old. For throat pain more than mild, Ibuprofen is very effective (see Dosage table).
  • Fluids: Encourage adequate fluids to prevent dehydration.
  • Fever Medicine:

    • For fever above 102° F (39° C) or discomfort, use acetaminophen or ibuprofen (See Dosage table)
    • AVOID ASPIRIN because of the strong link with Reye syndrome.
    • FOR ALL FEVERS: Give cold fluids in unlimited amounts. Avoid excessive clothing or blankets (bundling).
  • Pain Medicine: For pain relief (e.g., muscle aches or headaches), give acetaminophen every 4 hours OR ibuprofen every 6 hours as needed. (See Dosage Table)
  • Humidifier: If the air in your home is dry, use a humidifier. Moist air keeps the nasal mucus from drying up.
  • Prescription Antiviral Drugs for Swine Flu:
    • For optimal results, antiviral drugs (such as Tamiflu) should be started within 48 hours of the onset of flu symptoms. They can be started later in some cases.
    • The CDC recommends they be used for any patient with severe symptoms AND for all HIGH-RISK CHILDREN (see that list).
    • The CDC doesn't recommend antiviral drugs for LOW-RISK children with mild or moderate Swine Flu illness.
    • Their benefits are limited: they usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not eliminate them.
    • Side effects: Vomiting in 10% of children.
  • Contagiousness and Return to School:
    • Symptoms usually start within 4-6 days of exposure to a person with Swine Flu (7 days is an outer limit).
    • Your child can return to child care or school after the fever is gone for 24 hours and your child feels well enough to participate in normal activities. (CDC, August 2009).
  • Expected Course: The fever lasts 2-3 days, the runny nose 7-14 days and the cough 2-3 weeks.
  • Call Your Doctor If:
    • Breathing becomes difficult or rapid
    • Retractions (pulling in between the ribs) occur
    • Dehydration occurs
    • Earache or sinus pain occurs
    • Fever lasts over 3 days
    • Nasal discharge lasts over 14 days
    • Cough lasts over 3 weeks
    • Your child becomes worse
  • And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer

  • This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
  • Author and Senior Reviewer: Barton D. Schmitt, M.D.
  • Last Reviewed: 11/14/2011 6:58:01 PM
  • Last Revised: 11/14/2011 6:58:01 PM
  • Content Set: Pediatric HouseCalls Symptom Checker
  • Copyright 1994-2012 Barton D. Schmitt, M.D.
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