Transcription:
Flu Season Tips for Kids

Tiffany Kaczorowski (Host):  Welcome to Inside Pediatrics, a podcast brought to you by Children’s Hospital of Alabama in Birmingham. I’m Tiffany Kaczorowski. We are in the middle of flu season and joining me today is Dr. Kathy Monroe. She is a Professor at the University of Alabama at Birmingham, UAB in the Department of Pediatrics and is the Medical Director of the Emergency Department here at Children’s of Alabama. So, welcome Dr. Monroe.

Kathy Monroe, MD (Guest):  Thank you Tiffany. Glad to be here.

Host:  Flu season, generally speaking October through February, right?

Dr. Monroe:  That is correct. It usually starts around October and peaks November, December but can last all the way through February.

Host:  Okay. So, how can the flu be dangerous? We’ve talked about a lot of times people get the flu; hundreds of people get the flu around this area. Sometimes schools even have to close because of it but when does it get really dangerous for a person?

Dr. Monroe:  That’s a great question. I know every year you see the stories on the news at night of the patients who end up in the intensive care units or the patients who die and there are some predictors of who those patients might be. So, children who are young, under five but especially under two and the elderly are definitely at higher risk from complications of the flu. Also the patients who are not vaccinated definitely seem to have a higher incidence of complications. And there are certain patients who have underlying medical conditions. For example, patients with asthma, seizures, underlying lung conditions; all of those patients have higher risk for complications.

Typically, the complications include pneumonia, which can make someone very, very ill. Dehydration which also puts them at high risk and then there are rare cases of some overwhelming viral sepsis kind of picture where they just- they are overwhelmed by the flu itself. Again, these are rare in healthy otherwise healthy individuals.

Host:  Okay. If a person has a confirmed case of the flu, how long should they stay home?

Dr. Monroe:  Your flu can last anywhere from one to two weeks. But typically, you should be at least 24 hours fever free and that is fever free without the help of Tylenol or ibuprofen. So, once you are fever free for 24 hours with no meds, then you are safe to reenter the world.

Host:  Okay.

Dr. Monroe:  Everyone six months and older, everyone, should be vaccinated preferably early. It takes about two weeks before the vaccine truly kicks in to be protective. But hopefully, early, but if you haven’t gotten it yet, definitely still in the timeframe even until the end of February it is still recommended, get it but don’t wait until then. Go ahead and do it now.

Host:  Okay and you said it takes a good two weeks for it to really kick in and settle into your body.

Dr. Monroe:  Right. The virus itself stimulates your own immune system and so it takes about around one to two weeks before it really has created the immunity that you need to protect you from the flu.

Host:  Okay. What about those people that say the last time I got my flu shot, I ended up having a low grade fever, I didn’t feel well so I think I “got the flu.”

Dr. Monroe:  Right. They did not get actually the flu but they did probably get kind of an achiness and a fever so many people take the flu shot and have no side effects at all. They feel great. And those people are lucky and fortunate, it’s wonderful. But anytime you get a vaccine of any kind, you are at risk for the next 48 hours of having a low grade fever and with that fever, we typically don’t feel great. But it’s sort of a sign that the flu shot worked because obviously your immune system is reacting to it in the way it should. But I do recommend often that if you are getting the flu shot, go ahead and take some Tylenol or some ibuprofen, drink lots of liquids and plan that day to maybe not wear yourself completely out, take it a little bit easier that day. It should be over in about 48 hours. As opposed to if you get the actual flu, you are out for up to two weeks feeling terrible.

Host:  Right, absolutely. And then we talked about with young children, so the vaccine is not recommended until you are six months of age or older. What about those young babies, those newborns?

Dr. Monroe:  So, the reason it’s not recommended for them is their immune system is not fully functioning to the point of making the flu shot effective in them. So, we need to protect them in other ways. And one of those ways is everyone in the household get their flu shot so that we don’t bring it home to the house where the baby is but also limiting their exposure. And it’s one of the things I typically recommend during flu season, try to avoid places where there’s lots of people who are sick. Big crowds, and of course the holidays are coming up and lots of family gatherings, it’s really important that everyone gets their flu shot before you are around those wonderful babies who are under six months of age.

Host:  Right, before you start passing the baby around all the relatives to hold. Okay very good. What kinds of things do you guys see in the Emergency Department when it comes to the flu?

Dr. Monroe:  Okay so that’s a good question and when to come and when not to come. So, certainly those complications need to be at a doctor’s office or in the Emergency Department for sure and some of the signs that you are having one of the complications would be someone who is having difficulty breathing. And by that, I don’t mean the stuffy nose, it’s hard to breathe, it annoying; I mean the children who are working using their chest muscles when you look at them, you can see their ribs when they are taking a breath or they’re having any kind of discoloration, they are having like dusky spells or blue spells certainly those children need to be in the Emergency Department.

There also are children with the flu who just feel bad and won’t drink well and so we do see a lot of children who are mildly or moderately dehydrated from the flu and those are appropriate visits to come. Sometimes we do have to give some IV fluids for kids who are dehydrated. Most of the time, flu can and should be handled at home with Tylenol, ibuprofen, lots of rest, lots of liquids, just it’s a time to spoil your child, just take care of them, hug them, sit around on the couch with them. For the most part, it’s best to do that. If you have any questions, and you are not sure, almost everyone does have contact with a pediatrician, and they can kind of talk it through and say do I need to come in for this and we can kind of judge. Certainly if your child’s having difficulty breathing or you are concerned, they haven’t urinated in eight hours and you are worried they are dehydrated; come in see either your doctor or to the Emergency Department.

Host:  And you mentioned giving your child acetaminophen or ibuprofen to get the fever down when they are at home. But we also have on our handy dandy flu tip sheet to never give a child aspirin. Why is that?

Dr. Monroe:  Yes, that is correct. Aspirin has been shown in the past to be directly linked to this rare illness called Reye’s Syndrome. Reye’s Syndrome is a very bad illness that ends up with liver failure and the patients are really sick and can die from it. And there was a direct link between a viral illness such as the flu and aspirin. So, we recommend never ever take the aspirin or never give your child aspirin during this illness and that includes products that contain aspirin. So, Goody powders were an old example that people had that contained aspirin but even some of the cold medicines, cough flu medicines be sure to look and make sure there is no aspirin in them. If you have questions, ask the pharmacist before you buy. You don’t want anything that has aspirin in it.

Host:  Okay. When it comes to fever, what’s too high?

Dr. Monroe:  So, that’s sort of a concern for a lot of parents and technically, there is not a certain set temperature that is too high. There are those children who at 103 are still running around and they feel fine and they are acting fine and they are eating and drinking they are miracles but it’s true. Whereas as an adult at 99 we are on the bed. But also, there are those children at 100.7 that feel awful. So, it really does depend on the individual child. There are things called febrile seizures that every parent worries about and even that, it’s not a set degree, it’s more each child’s set is different. So, you don’t really know that. So, what’s more important is how’s your child acting? If they appear miserable and they have a fever whether it’s small or high; you do want to treat it because it helps them feel better but also helps you to be able to better judge how ill, they are, and do we need to go to the hospital or are we okay at home. So, treat them with the Tylenol or the ibuprofen and if they are still febrile or they are still feeling kind of bad, you can do lukewarm baths. We don’t want to do cold ones; it will make them shiver. But certainly not too warm. You want to try to get the temperature down with sort of this cooler bath.

Now we do not recommend alcohol baths. Many – the old wives’ tales are use the alcohol bath and it will potentially bring the fever down, that’s not untrue; but it can potentially be dangerous. Because when you are febrile, you can absorb a lot more of that alcohol and so it can actually get into the child’s system and can sometimes cause some dangerous low blood sugars. So, we don’t want to do the alcohol baths anymore.

Host:  And some parents might be thinking out there I thought the fever was actually your body telling you that it’s working. The fever is working. Is your body working to prevent to fight the virus. So, do we need to take acetaminophen and ibuprofen to get the fever down?

Dr. Monroe:  Again, I think it all depends on how your child is acting. Because that – the fever is a sign that your body is doing it’s fight. But it’s sort of a byproduct that tells us heh, body’s working to get rid of this. It’s not necessarily the fever is burning out the illness. I can see what is a myth and I can see where it comes from, because yes, it’s a byproduct when your body’s fighting it. But if your child is happy and playful, leave them alone. If they are not happy and playful, and they are lethargic and they are clinging and they are whining, then maybe they do need that temperature to come down. It won’t stop the body from fighting the illness.

Host:  Okay good. When should we contact just the doctor versus the Emergency Department? I think we addressed some of that.

Dr. Monroe:  We talked a little bit about it. But calling your pediatrician for any questions you have about it is acceptable. If you are worried that your child is not eating well, maybe not to the point of we know they are dehydrated and need to go to the hospital, but they are just not feeding well. Talking to them, if they are kind of miserable and you can talk to them about what you can give. Unfortunately, cough and cold medicines of any kind are not recommended for children under the age of six. So, none of those are recommended. Some of them are actually dangerous. And for the most part, they don’t work anyway. So, but if your child is older than that, you can certainly talk to the doctor about what you might can do to try to help them feel better.

Host:  Right and certainly some people want to go to an antibiotic for everything. With a virus, doesn’t work.

Dr. Monroe:  It doesn’t work, right. Now occasionally, there are those children who have a viral illness such as the flu who with the complications like sometimes and ear infection or pneumonia; you would need an antibiotic because that’s a bacteria that has taken advantage of your low immune system that you have because of the flu but with the flu itself, if that is all you have; antibiotics will not help and potentially would give you diarrhea and some other things you don’t want to add on top of the flu already. So, they are not indicated.

Host:  Okay and there are some other treatments of the flu that may or may not be indicated. What do you guys do in the Emergency Department?

Dr. Monroe:  So, typically, there are many different viruses that can cause a flu like illness. The same symptoms of aching and fever and cough and cold and vomiting and diarrhea. It’s not always influenza. So, those other viruses, there are no treatments for except rest, fluids, Tylenol, ibuprofen. Influenza, if you are positive for influenza, then there is a treatment, there’s a medicine called oseltamivir. Although most people know it as Tamiflu and that medicine can be indicated at times. Typically, in the Emergency Department, we sit down with the parents and as a team the parents and the physician we kind of decide when to prescribe that and when not to. It has been shown to decrease the length of illness by about a day, a day and a half and some of that depends on your age and who you are. It’s different. But it also in some of the younger children can cause hallucinations and vomiting. So, you do have to weight it based on age, based on a lot of different things. Talk to your doctor about it and have a conversation. As a parent, you need to know both risks and benefits and help make that decision of when to take it and when not to.

Host:  Okay and when to wait. And it’s also pretty expensive too from what I have experienced.

Dr. Monroe:  Yes, I’ve heard that too. Yes.

Host:  Okay so one thing I wanted to go back to when we were talking about the vaccine or yes, the vaccine is flu mist versus flu shot.

Dr. Monroe:  Right.

Host:  Is there one that’s more effective?

Dr. Monroe:  Well so there is a mist that is sprayable into the nose and many parents like that better because it’s not a needle involved. There are some differences in it and it all depends on the year and what the flu vaccine has in it and the age of your child. So, it’s truly best if you are interested in that to talk to your doctor, say heh what about the mist and then they can go over if your child qualifies for that versus the shot. And you can make a decision based on the year and the age and the time.

Host:  Okay. One other thing I wanted to address about this time of year toward the end of the year, every flu season, the CDC will come out and say that the flu vaccine that they have put out on the market this year is X percent effective. And then you may have people who say well I don’t need to go get the flu vaccine because it’s only X percent effective. What do you say to that?

Dr. Monroe:  So, I think that’s a very confusing statement. So, it is interesting because for an individual person, it is either 100% effective or somewhat less. So, you may be one of the people who even though it’s 40% effective you may get full benefit but there’s also benefit in preventing you from ever getting the flu, which is one thing and then there’s the benefit in helping you not get the complications of the flu. So, you may get the flu, but you are protected against the pneumonia and the dehydration and the severe form of it. We have seen in the past that some of the sickest patients that we see, the patients who get the complications were the patients who had never had a vaccine at all.

Host:  So, the vaccine is obviously the best way to prevent. And then also your hand washing, good hygiene.

Dr. Monroe:  Yes, all of those things. Getting plenty of rest at this time of year is really hard. Life is very busy right now, but rest does help your immune system to fight off infections. Handwashing, avoiding places where known flu is, and you mentioned the schools closing. Sometimes, that’s why they do it because there are so many people with the flu that taking a break is a good idea to protect those who haven’t had it.

Host:  So, in summary, during this flu season, give us your best tips.

Dr. Monroe:  All right, best tips are prevention first and we just covered that, but if you or your child have flulike illness, first tip is avoid others, let’s don’t spread it but also let’s let your child get rest, fluids, Tylenol, ibuprofen if you need it. If you have concerns, that there might be getting a little toward the dehydrated side or maybe there’s a little more work of breathing than you are comfortable with; call your doctor early especially is your child has any of the underlying medical conditions call early. See them, they can help you kind of judge. If it’s in the middle of the night or you are really concerned about working of breathing or you know that it’s been more than eight hours since there’s been any urine output, and you are really worried; please come. We are here 24/7 Emergency Departments are available.

Host:  Thank you so much Dr. Monroe for visiting with us today. if you would like any more information about the flu or our flu tip sheet you can go to www.childrensal.org/ed to download and print our flu tip sheet or you can check out our cold and flu resources on the Children’s website. Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at www.childrensal.org/insidepediatrics.