Caitlin Whyte (Host): Welcome to Children's Health Checkup, where we answer parents' most common questions about raising healthy and happy kids. I'm Caitlin Whyte, and with me today is Dr. Kelley Smith, a Pediatrician at Children's Health. Today we're diving into flu season prep and how to protect your child from the flu this year.

Well, let's start with the basics here today. Why is it so important for kids to get the flu shot every year, especially before the flu season starts?

Kelley Smith, MD, FAAP: Okay, so first of all, I'm going to geek out a little bit about flu vaccines because you know there's been a lot of press about them. Plus also, I actually was part of a pilot study back when I was a resident. So here we go. The preservative thimerisol has made the news a lot lately. It's in the multi-dose flu vaccine vial. Specifically the shots, not the nasal flu. We try to get vaccines in before someone gets exposed because we know it's going to take about two weeks for your antibodies to really be revved up.

Kind of like when you download a software update for your iPhone or whatever device you use. Sometimes the kinks need to be worked out. It takes a minute before you're really comfortable using it. So the idea is let's get you your flu vaccine in before the flu season starts. Typically, we start seeing a ramp up of cases starting around October.

Some flu seasons are a little earlier. Some flu seasons are a little later. Now the goal of flu vaccine is to prevent severe illness, and we medically define that as you are in the hospital or you had a death. In a perfect year, we also prevent you from getting the flu altogether, however, some years don't match very well.

So you may have a child that did still get the flu after flu vaccine. However, I tell everybody they're not sick as long and they're not as severely ill. So even if your child gets the flu, they will still have benefit. Another benefit we will see, we found that in the study that I was part of; if we vaccinate the kids, it actually impacts our older adult members of the community so that when we've got less flu circulating around, the older adults are healthy too.

So if you have grandparents, if you're lucky enough to have great grandparents, not only does it help your child not miss so much school, but it also helps to protect those grandparents. Now, I carefully use the term vaccine. We have available for kids, both a flu shot and the nasal flu vaccine. Not all clinics stock the nasal flu vaccine.

There was a while that it wasn't working as well. They've got it improved and it's now offering better protection. But, it's an individual clinic decision who's stocking what. So I will say, if you're interested in that, please talk to your individual clinic. Also that one just got approved for use at home, where you'd go pick it up from the pharmacy and potentially give it to your child at home.

I will say with that, everybody listening, you know the kid that you got, and I have some that would sit there and take it perfectly from any adult, and I have some that absolutely would not let mom or dad do it, but a total stranger, okay, sure.

Host: Well, what is the ideal time for families to start prepping for flu season? Is there such thing as being too early or too late?

Kelley Smith, MD, FAAP: So I'm going to answer the last part first.

Host: Okay.

Kelley Smith, MD, FAAP: Too late in flu season just means we have literally declared an end to the flu season. That usually happens somewhere in March. What Children's does is it looks at how much flu is coming back positive on all of the hospital and clinic tests. So if they've declared an end to the flu season, probably not worth getting flu vaccine at that point, although there might be a few individual cases where it would be beneficial. So I'd say if you're hitting like February, March and are thinking about flu vaccine, talk to your individual provider. As far as the too early part; okay. So I asked that question one year when our shipment of flu vaccines arrived in August, and here was the information. In a temperate climate like Texas, flu seasons tends to start off a little earlier. So you're trying to get your vaccine in before exposure. Hey, as soon as your clinic has it available, if it's August, if it's September, go ahead and start getting it. Now, some years I just am pulling out my hair mid-September, where are my flu vaccines? So that may depend on where the shipments are coming from and that sort of thing.

But we usually make a big announcement once we got those flu vaccines in. As far as preparing for flu season, I would even say now back to school, even though I don't have my flu vaccines available, this is still the time to start thinking about flu season. Going back over all that we learned in the joy that was 2020, about washing your hands and covering your coughs and trying to stay away from other people when you're sick. Definitely when you're having a fever. Also, I will go over with families, you know, Hey, you may not be able to get them to wash their hands as much at school, but when they come home, send them off to the bathroom. Let's wash those hands. Possibly even change clothes. Let's do some things to minimize our exposure risk here at the house.

Host: Well beyond getting vaccinated then, you just kind of mentioned this with the hand washing, but what are some other simple daily habits or routines that can help kids stay healthy during the flu season?

Kelley Smith, MD, FAAP: So yes, I'm going to repeat again, hand washing because we cannot overemphasize hand washing. Hand sanitizers are popular, but I am an eczema sufferer, so I'll say that can be irritating and drying to the skin. That would be something that you and as a family should discuss and see what works better for you guys.

Also, this sounds very basic, but, ensuring that your kids are getting proper nutrition and proper sleep actually does play a role in keeping them healthy. Now, I'm not saying that they can't have the occasional slumber party, you know, some sort of weekend getaway, but the whole point of trying to get them in bed not only is to make sure they're well rested and ready to learn for school, but also will help keep them healthier.

Host: And then on that note, what else can parents do to help their kids stay protected in environments they can't really control, such as schools or daycares where there might be more germs?

Kelley Smith, MD, FAAP: Some of those places, you know, I only half joke that, mall play areas keep me in business. But, okay, so in environments where we have less control, it's really going to depend on the age of the child and also the risk factors in your own household. Now, I know for a lot of reasons, a lot of people are not super fond of the masks, but depending what you've got going on and the age of your child, it may be beneficial if you're going to certain places where you're likely to be more exposed to things. Now, less controversial,a lot of daycares have a habit of having out the hand sanitizer; that can help. Schools sometimes will have it, sometimes not. Often the teachers are just as invested as keeping in keeping your children healthy as you are. So, if you have the extra money, gift those teachers some soap and hand sanitizer.

Full boxes of Kleenex, you know, again, kind of work on that. And then the final thing I will talk to families about, some germs live longer on surfaces than others, so it's not a terrible idea if you've been out in the world, when you come home, change clothes. You know, the concept that our parents had of putting on the play clothes, not only to keep the school clothes nice, but also hey, any germs that attach themselves to you that have managed not to invade you yet, don't stand a chance because they're heading off to the washer.

It also works for my allergy sufferers. Because I will tell everybody if you suffer from allergies before you touch the bed, I need clean clothes from the drawer, not the floor.

Host: I love that the drawer, not the floor. Well, doctor, let's say our child does get sick and you know, sometimes it's hard to tell if it's the flu or just a regular cold, maybe even allergies, like you said. What signs should parents watch for when it comes to the flu, and then when should they go ahead and call the doctor?

Kelley Smith, MD, FAAP: So first of all, I'm going to start off allergies. Now, allergies can make you feel pretty bad, but they're not going to make you run a fever. So if your child doesn't have a fever; the odds are against it being the flu. I will occasionally see some flu kids that manage not to run fever, but I'd say the overwhelming majority are going to be running a fever.

Also if we're talking just regular cold versus flu, you might run a fever, but we'll be talking a much lower temperature, like maybe like 101, whereas flu kids will often get 103, 104, 105, and then I like to say, some kids when they walk in the door, I'm like, oh, you look Fluey. The flu kids tend to get this glassy-eyed look and you can just look around the waiting room and be like, that kid doesn't feel well.

They're generally not the ones that are maybe at 102, you know, under my table climbing up and down on things playing. Yes, I have seen children do that, even with 102 impresses me. They are the ones that you can kind of tell in the waiting room as another parent. It's like, oh honey, come play next to me. That child is definitely sick.

Host: Mm-hmm.

Kelley Smith, MD, FAAP: Other things I'll say about kind of differentiating between Flu, allergies and when to speak to a doctor; if your child is complaining about a particular symptom, like my ear hurts, my throat hurts, I'm having trouble breathing. Now, that last one I like to say that's probably captain obvious, that everyone would say, oh, you need to go to the doctor.

But I'd say pain in a location would probably be a good clue that yeah, maybe we should go get checked out. If you need a note for school, I'm sorry, that's going to have to be an office visit.

 Finally, if you are thinking that there is a possibility that you might want to start anti-flu medications, then I need to catch you in the first two days of being sick. If we've gotten beyond that, my anti-flu medications really aren't going to help you out. So I can tell you rest and fluids and some things to kind of help some of the other symptoms, but it's going to be too late for them.

So that kind of goes into my decision making when I'd recommend someone comes in. The other thing that would factor into it would be age and household contacts. For example, the under five-year-old group, they tend to have more complications, especially if we're talking the group under two that may not be very verbal yet.

Then I have families where either the child I am seeing or one of the other members of the household has certain medical conditions. Like I'm thinking, I've got some kids who've had transplants. I've got some kids who are on immunosuppressants for certain illnesses. And so even if I'm not seeing that child directly, one of their siblings, I would definitely want to make sure we know what's loose in the house and how much quarantining mom and dad may need to look into doing so that we don't get sick someone who would be much more vulnerable.

Host: And then wrap it all up for us today, Doctor, are there any other common myths or misconceptions about the flu or flu prevention that you'd like to clear up for parents?

Kelley Smith, MD, FAAP: Well, I'm going to start with an herbal element that sometimes gets passed around. I will say,there is weak evidence that elderberries may help you recover from the flu faster. That's why you'll see all that extract. I will say echinacea really, you're, you're just paying for something that's not really helping you there, so I'd stay away from that one. And then a lot of people talk stomach flu, now, medically speaking, usually when we are talking flu, we are talking fever, cough, body ache. Occasionally I'll see some vomiting, but if you have both vomiting and diarrhea, this is not the flu virus. I'm not saying your child's not sick, might not need fluids and, and an office visit, but it's not the official influenza virus.

Host: Thank you to Dr. Smith for joining us today. For more information, please visit children's.com/flu. And if you're in North Texas, Children's Health Pediatric Primary Care offers trusted care close to home- from newborn checkups to care for common illnesses and more. Find a location near you at children's.com/primarycare. If you found this episode helpful, p lease rate and review or share it and follow Children's Health on all your social channels. And thank you for listening to Children's Health Checkup.