Managing influenza in children

Symptoms to look for in children

Children older than five years of age and adolescents with influenza may have the same symptoms as adults, but here are some differences in babies and toddlers. Seasonal influenza is more severe in children younger than five years of age and especially, for those younger than two years of age.

Watch for the following symptoms in babies and toddlers:

• Fever may be the only symptom of influenza that a young child has.
• Severity of fever in young children with influenza, especially those under the age of three years can vary significantly. Toddlers and babies usually have higher temperatures, often over 39.5C (103.1F) although some infants may have only a very mild fever or no fever at all.
• Some babies may not be able to drink fluids or breast feed.
• Seizures or stiff neck may appear in some babies. Young children may also have headache, vomiting, irritability and sensitive eyes.
• About half of children three years of age or younger have symptoms such as nausea, vomiting, diarrhea and stomach pain.
• Influenza viruses may cause croup (coughing), pneumonia or bronchitis in young children.
• Ear infections and red, sore eyes are more frequent in young children. Sore muscles are also common.

Note: Toddlers and babies are not able to tell people they have sore muscles or a headache. They may be irritable and eat poorly. They sometimes have a hoarse cry and a barking cough.

How to care for a child with influenza

For fever and muscle aches:

• Take the child's temperature (if you are able).
• Use Acetaminophen (Ibuprofen is another option, but it should not be used for babies younger than six months of age).
• Do not wake the child to give the medication.

Note: Children younger than 18 years of age should not take acetylsalicylic acid (ASA) or any products containing ASA. ASA may cause Reye’s syndrome, a very serious condition affecting the nervous system and liver.

• Dress the child in lightweight clothing and keep room temperature at 20C (68F).
• Breast feed or offer oral rehydration solution e.g. Pedialyte®, water or juice often while the child is awake. Oral hydration solution can be purchased from pharmacies and grocery stores.
• Do not give cool baths or use alcohol rubs.
• Encourage the child to rest or involve them in quiet activities.
• Try saline nose drops to relieve a stuffy nose or calm a cough.
• Elevate the head of the bed for toddlers and older children.
• Use a humidifier, except with asthmatic children.
  • Failure to maintain your humidifier can result in additional health problems.
  • Always follow the manufacturer’s directions for the use and proper care of your humidifier.

Over-the-counter medication

For children younger than six years of age

• Health Canada recommends that over-the-counter cough and cold medications should not be used in children younger than six years of age.
  • These products have not been shown to reduce symptoms in children.
  • There have been reports of overdose, misuse and rare side effects.
  • Some of the serious side effects reported include such symptoms as convulsions, increased heart rate, decreased level of consciousness, unusual heart rhythms and hallucinations.
• Do not use VapoRub-type products on children younger than two years of age.

For children six years of age and older

• Do not give children medications labelled only for use in adults and/or those that do not include instructions for children.
• Over-the-counter medications should only be considered if the other suggestions previously described have not worked.
• Talk to your pharmacist or health care provider before using over-the-counter medications. They will help you to decide:
  • if an over-the-counter medication will lessen your
    child's symptoms; and
  • if the medication is safe for your child to take.
• When using over-the-counter medications to treat
  children older than six years of age:
  • Talk with your pharmacist or health care provider about: 
  • how long the medication should be taken;
  • the dosage;
  • the possible side effects; and
  • when the product should not be used.
• Follow all the instructions carefully including the dosing and length-of-use directions.
• Use the medication dosing device, if one is included with the product, to ensure accurate dosing.
• Do not give more than one kind of cough or cold medication to children.

When to seek medical care for a child

Seek medical care if a child is ill and has any of the following conditions:

• Is younger than six months old.
• Has fever which continues to rise or stays the same after being treated with fever medication.
• Has a change in breathing (such as breathing fast) or difficulty breathing.
• Is very listless and loses interest in playing, watching TV, eating or drinking
• Is very irritable and cries a lot.
• Urinates less than usual, for example:
  • has a dry diaper for more than three hours if younger than six months of age;
  • has a dry diaper for longer than six hours if six – 23 months of age; and
  • goes to the bathroom less often than every six hours while awake if two years of age or older.
• Looks very ill and the caregiver is worried.
• Has heart or lung disease or any other chronic medical condition requiring regular medical attention.
• Has a disease or is receiving treatments that weaken the immune system.
• Takes ASA regularly for a medical condition.

When to take a child to the emergency room

Call 9-1-1 right away if the child:

• Has severe trouble breathing that is not caused by a stuffy nose;
• Has blue lips or hands, suddenly becomes pale, or has cold legs up to their knees;
• Is very tired and unable to move;
• Is so sleepy and does not respond when you try to get them up;
• Shows signs of pain, such as headache or stiff neck, especially if they also have fever, are listless and their eyes are sensitive to light;
• Seems confused; and
• Has a seizure.