December 6, 2023

The flu is common, but for some children, complications can be serious. Children under 5 and children with certain underlying conditions are at higher risk for flu complications.

Influenza, or the flu, is common. About one in 10 children in the United States experience flu symptoms each year, said Dr. James Antoon, a pediatrician and children’s flu researcher at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Flu season tends to pick up steam around October each year and peter out around May.

“Children’s flu can also have many different complications associated with it, including ear infections, pneumonia, sinusitis and – rarely – effects on the brain.”

“Flu is usually thought of as a relatively mild illness, but in children, especially children under 5, it can be life-threatening,” Antoon said. “Children’s flu can also have many different complications associated with it, including ear infections, pneumonia, sinusitis and – rarely – effects on the brain. It can cause brain inflammation and can also make underlying conditions worse.”

In fact, Antoon recently published research showing that these brain-related complications in children’s flu are 10 times more likely in those who have underlying psychiatric conditions and 100 times more likely in children with pre-existing neurologic conditions. While still a rare complication affecting less than 1% of children who get the flu each year, the complications can be serious and include brain inflammation, seizures and sudden behavior changes like suicide attempts.

“The neuropsychiatric events, while rare, are still to be avoided wherever possible, and importantly, we also did see cases in our research of these neuropsychiatric events in children who did not have any underlying conditions,” Antoon said.

Therefore, vaccination – especially for high-risk groups – tops Antoon’s list of recommendations for this flu season, among his top-five tips.

1. Vaccination is important, especially for high-risk groups

Antoon’s latest research highlights the dangers of flu complications for children with existing psychiatric and neurologic conditions. This comes in addition to long-established data showing that children under 5, and especially those under 2, are at increased risk for flu complications and serious illness, as well as children with asthma, obesity and suppressed immune systems, and children living in a chronic care facility. Pregnant and postpartum women are also at elevated risk for complications from flu.

“The good news is that we can likely avoid many of the worst flu complications through vaccination,” Antoon said.

2. Testing for flu is becoming increasingly important

If your child is experiencing flu-like symptoms, ask your doctor if they should be tested for the flu, COVID-19 and/or RSV (respiratory syncytial virus) so they receive the correct treatment. In the past, the flu was the main respiratory illness to worry about during this time of year, but now, the seasons for these three illnesses overlap.

“We’re moving toward testing to confirm flu,” Antoon said. “This is important because the high-risk groups need to be treated as soon as possible to shorten the duration of symptoms and prevent flu complications, and testing is the first step to getting them started on the right course of treatment.”

Symptoms of the flu often come on suddenly and can include:

  • Fever (not everyone will experience fever)
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches
  • Fatigue
  • Vomiting and diarrhea (this is more common in children than adults)

3. High-risk children should be treated for flu with antivirals

Antiviral medications like Tamiflu, Xofluza or Relenza work best when they are started quickly, typically within one or two days after flu symptoms begin. Antiviral treatment decreases duration of symptoms (including fever) and prevents influenza-associated complications like ear infections, pneumonia and hospitalization.

“However, in the high-risk groups for children, the treatment guidelines recommend treatment regardless of how long they’ve had symptoms,” Antoon said. “Parents of any high-risk child should be on the lookout for symptoms so they can act fast, but should also still take action even if it has already been a few days.”

4. Vaccination for the flu is good for the whole family

The CDC recommends that everyone 6 months and older be vaccinated each flu season, not only to protect themselves, but to prevent spreading flu within the household to other vulnerable family members.

“There are studies that show that protecting young children from the flu also protects their grandparents and vice versa,” Antoon said. “Those other 65 are another high-risk population. When we protect one group, we protect the other group as well.”

5. Already had the flu? It’s still important to get vaccinated

Finally, Antoon notes that it’s never too late to get the flu shot – even if you have already had the flu once this flu season.

“The predominant flu strain can switch toward the end of the season,” Antoon said. “Just because you had flu early in the season doesn’t necessarily mean that you’re immune from getting it later in the season with a different strain. The vaccines typically have all the circulating strains in them.”

Baby with doc listening to lungs

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