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Recognizing Flu Symptoms in Children

How do you know if your child has the flu? Dr. Andrew Modic, Board Certified Pediatrician and Internal Medicine physician, breaks down flu symptoms and how to make your little one feel better.
Recognizing Flu Symptoms in Children
Andrew Modic, MD
Dr. Andrew Modic is board certified in both Internal Medicine and Pediatrics. He sees patients of all ages. He is proud to serve the city of Ridgecrest as a member of the National Health Service Corps, which comes with a commitment to provide primary care in areas with shortages of physicians.

He previously served as the Co-Chief Resident of Internal Medicine-Pediatrics at the University of South Alabama where he was voted to receive the Les Sockwell Humanitarian Award by his colleagues. He graduated from the University of Connecticut School of Medicine, and from the University of Virginia with a BS in Chemical Engineering with High Distinction.

Prakash Chandran (Host): How do you know when your child has the flu or just a really bad cold? During flu season, it’s understandable for parents to worry about their children contracting the flu. But it’s not always easy to know what symptoms they should be looking for. I’m Prakash Chandran and in this episode of Ridgecrest Regional Hospital Podcast; we’ll be talking about recognizing flu symptoms in children and what you can do to help your children stay protected. Here to help, is Dr. Andrew Modic, a board-certified physician in both internal medicine and pediatrics at Ridgecrest Regional Hospital. Pleasure to have you here Dr. Modic. Now, when children start exhibiting symptoms like sneezing, fatigue, or they come down with a fever; I think every parent wonders what’s going on and how serious is it. So, the first question really is how do you separate flu symptoms from those of a really bad cold?

Andrew Modic, MD (Guest): It’s difficult. The flu virus is caused by the influenza virus so in general, those symptoms tend to be a little bit worse than the viruses that cause say the common cold. But when you think about the flu; about 95% of kids will have a fever. Many of those over 102 degrees Fahrenheit. So, generally, if the kid doesn’t have the fever, it’s probably not the flu. But the other symptoms, the cold, the runny nose, headache, muscle aches and even younger kids sometimes they can have nausea, vomiting, and tummy pain. And typically, these symptoms tend to have an abrupt onset. So, classically, a parent will tell me my child was perfectly fine in the morning and felt great and then by the afternoon they just look and feel miserable. And these symptoms can last anywhere from usually less than a week, but some kids can have cough or even fatigue for up to two weeks.

Host: So, what I’m hearing you say is that if your child has a fever and these symptoms come on very quickly; then it’s probably the flu. Is that correct?

Dr. Modic: It’s difficult to tell. It is difficult and there’s no great perfect criteria. But fortunately, we also do have the flu test which we have the Rapid Flu test which is used in most pediatric practices and generally, it’s a good test if it says you have the flu. So, if it says this is a positive test, you have the flu, then you can be about 99% sure that you have it. But unfortunately, if the test is negative; then – it only detects the flu in about 50-70% of cases. So, in these cases, your physician may look at your child’s symptoms, exposures to the flu, what is the rate of the flu in the community and still may decide that this is the flu or may decide to treat for the flu if they are suspicion is high enough.

Host: Okay that makes sense. I didn’t know that there was that test. So, it seems like if you’re suspecting that your child has the flu, the best thing to do is go ahead and bring them in to do this test just to make sure and to be on the safe side. So, my question is if you find out that your child does have the flu; what should you do? Is there – is it just rest? Is there antibiotics or medicine that you should take? Talk a little bit about that.

Dr. Modic: Yes, we do have an antiviral treatment for that and the most common one that is used is called Tamiflu, also called oseltamivir and it’s a five day course and just like you were saying; the earlier that your child is treated for the flu; the better that they will be. For example, if you start Tamiflu within the first 12 to 24 hours after your child starts showing signs of being sick; then it can shorten the illness by up to three days in some cases. If it is started around 48 hours after the onset of your child being sick; it can shorten it by about a day or so. But even this – if you have had the flu, even this can be significant and also it can shorten the complications and decrease the rate of complications from the flu like ear infections, and pneumonia and in general, there’s been minimal resistance at least among last year for the Tamiflu in terms of treating the flu virus. So, if you think your kid has the flu; get them in early and if you are within 48 hours, it’s probably a good time to start treating for the flu with the Tamiflu. And even in some cases, for kids that are say high risk for problems with flu complications let’s say they are less than five years old or they have asthma or heart conditions or some other chronic illness; their pediatrician may decide to treat even after they have had symptoms for 48 hours.

And in general, I get this question a lot. In general, the side effects from Tamiflu – Tamiflu is generally very well tolerated. About 14% of patients will have some nausea or some tummy pain from it. But certainly, this is much better than having the flu.

Host: It certainly is. So, you mentioned a couple of times the importance of trying to bring your child in early if you start recognizing those symptoms; so, I want to focus a little bit more on those symptoms. Specifically, you mentioned nausea, you mentioned some weakness and it happening quickly. But what other things should parents be looking out for to really tell them heh, you know what this is a problem, I should bring my child in to the doctor?

Dr. Modic: It’s tough and it’s difficult for parents. Think about if it’s fever, and again 95% of kids with the flu will have a fever so if the kid doesn’t have a fever, it’s probably not the flu. But cough, runny nose, headache, muscle aches, and think about an abrupt onset and general think about the fever. But again, it’s tough even for pediatricians to tell sometimes. And we do have the Rapid Flu test which helps, but sometimes you just kind of have to know is this a high time for flu, is this community affected by the flu and that’s difficult for parents to do. So, any questions, any concerns please see the pediatrician.

Host: Yeah, that’s really good advice. And I think the thing that I picked up on right there is just knowing when you are in flu season especially, you can never be too cautious. It’s always better to just bring your child in and get tested. So, I want to shift a little bit to preventative measures. Let’s talk about the best ways that a parent that is concerned, can keep their child protected especially during flu season.

Dr. Modic: Absolutely. Well the best way to prevent the flu is to get the flu shot. That is the best way. There are other things you can do too. The flu is spread via contact with contaminated oral secretions so, sneezing, coughing, talking or touching and generally you need to be within about six feet of someone who has the flu in order to get it. But the caveat being if that person sneezes on their hand and they touch a contaminated surface and then you touch that surface or your child touches that surface and then they touch their mouth, their eyes or their nose; certainly, the flu can be spread that way. So, wash your hands, wash your hands, wash your hands, avoid touching your eyes, your nose or your mouth. If you can clean surfaces, if you come in contact with someone who might be sick; clean surfaces with disinfectant and finally in some cases, and this is decided on a case by case basis, there are some kids who will benefit from taking Tamiflu prophylactically which means either they take it before or after an exposure to the flu. And generally, these kids tend to be at high risk for complications of the flu. For example, they might be less than five years old, they might have severe asthma and there might be an outbreak in the community, and this is something to discuss with your pediatrician.

Host: So, it’s interesting. With everything that we’ve heard and so many people say that the best thing that you can do is to get the flu shot. It still seems like there are parents that are hesitant to get it. So, can you speak to why that is and maybe some of the hesitations that parents might be feeling in doing so?

Dr. Modic: Absolutely and I talk to parents a lot about this subject and when it’s brought up, I just – I first remind them that we are on the same team. We both want to keep their child healthy and happy. The most common reasons I hear is really two main ones. Which are one is I don’t want them to get sick and two, is I don’t want them to get the flu. And so first, you cannot get the flu from the flu vaccine. The flu vaccine is a dead flu virus and so it can’t give you the flu. So, just like a dead crocodile isn’t going to bite you, a dead flu vaccine isn’t going to give you the flu. And second, if the flu vaccine if it does have a problem with it; it’s that the immunity only lasts about six months. So, most kids will get between three and eight colds per year, but they are not spread out evenly throughout the year. Most of them occur between November and March and that’s also flu season.

So, we give the flu vaccine before the start of the flu season and so I understand when these parents tell me that their kid has been healthy during the entire summer, during half of the fall, all of the sudden they get the flu vaccine and then they get sick. But in those cases, I just try and counsel them that the flu vaccine is not the cause of their illness rather it’s one of the things that they can do to protect their child.

And in terms of side effects from the flu vaccine; very rare. Some people will have side effects, most common being soreness or redness at the injection site, low grade fever, headache, muscle aches, but usually these are very mild, usually last one day sometimes two. And what’s more important, they don’t carry the complications of the flu that in some cases can be life threatening.

Host: Love that metaphor you gave there about the crocodile a dead crocodile can’t bite you just like the flu shot cannot give you the flu. Well that’s really good to know. The last question that I had is I’m actually – my wife and I are expecting, and I was curious as to what is the earliest age parents should consider taking children to get the flu shot? Is it too young for a newborn? Is it one year old? Maybe talk a little bit about the right age to start doing that.

Dr. Modic: Absolutely. First off, congratulations to both you and your wife. So, kids who are six months old and older can get the flu shot. And just of note, if it’s your child’s first time getting the flu shot and they are less than nine years old; then actually they have better immunity if they get two flu shots that flu season and separated by about a month. But to also answer your question, kids who are less than six months old, they are not given the flu shot, but certainly they can still get the flu and in fact, they have a higher rate of complications from the flu once they do get it. But unfortunately, giving the flu vaccine to them is not going to help them because they have immature immune systems and therefore, they don’t- after the flu vaccine they don’t develop the antibodies that can protect them against the flu.

So, there’s no point giving it to them. But instead, these kids rely on what’s called herd immunity which means that everyone around them shot get the flu shot and that’s the best way to protect them. So, another reason to get the flu shot even if you don’t believe that the benefits to you are significant.

Host: Yeah, if you are not doing for yourself, you are definitely doing it for the people around you. Well Dr. Modic I just want to thank you so much for taking the time today to share all these tips. I’m assuming that all parents listening feel much better about things and it’s just really important for those listening to go out and get your flu shot. So, for more information please visit My guest today has been Dr. Andrew Modic. I’m Prakash Chandran. Thank you so much for listening.