WHAT ARE THE SYMPTOMS I SHOULD WATCH FOR IN MY CHILD?

The flu is an infection of the nose, throat, and (sometimes) lungs. Your young child with the flu will most often have a fever of 100°F (37.8°C) or higher and a sore throat or a cough. Other symptoms you may notice:

• Chills, sore muscles, and headache
• Runny nose
• Acting tired and cranky much of the time
• Diarrhea and vomiting

When your child's fever goes down, many of these symptoms should get better.

HOW SHOULD I TREAT MY CHILD'S FEVER?

Do not bundle up a child with blankets or extra clothes, even if your child has the chills. This may keep their fever from coming down, or make it higher.

• Try one layer of lightweight clothing, and one lightweight blanket for sleep.
• The room should be comfortable, not too hot or too cool. If the room is hot or stuffy, a fan may help.

Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes, your provider will tell you to use both types of medicine.

• Know how much your child weighs, and then always check the instructions on the package.
• Give acetaminophen every 4 to 6 hours.
• Give ibuprofen every 6 to 8 hours. Do not use ibuprofen in children younger than 6 months old.
• Never give aspirin to children unless your child's provider tells you to use it.

A fever does not need to come all the way down to normal. Most children will feel better when the temperature drops by even 1 degree Fahrenheit.

• A lukewarm bath or sponge bath may help cool a fever. It works better if the child also is given medicine -- otherwise the temperature might bounce right back up.
• Do not use cold baths, ice, or alcohol rubs. These often cause shivering and make things worse.

WHAT ABOUT FEEDING MY CHILD WHEN HE OR SHE IS SICK?

Your child can eat foods while having a fever, but do not force the child to eat. Encourage your child to drink fluids to prevent dehydration.

Children with the flu often do better with bland foods. A bland diet is made up of foods that are soft, not very spicy, and low in fiber. You may try:

• Breads, crackers, and pasta made with refined white flour.
• Refined hot cereals, such as oatmeal and Cream of Wheat.
• Fruit juices that are diluted by mixing half water and half juice. Do not give your child too much fruit or apple juice.
• Frozen fruit pops or gelatin (such as Jell-O) are good choices, especially if your child is vomiting.

WILL MY CHILD NEED ANTIVIRALS OR OTHER MEDICINES?

Children aged 2 to 4 years without high-risk conditions and with mild illness may not need antiviral treatment. Children 5 years and older will often not be given antivirals unless they have another high-risk condition.

When needed, these medicines work best if started within 48 hours after symptoms begin, if possible.

Oseltamivir (Tamiflu) is FDA approved in young children for treatment of the flu. Oseltamivir comes as a capsule or in a liquid.

Serious side effects from this medicine are quite rare. Providers and parents must balance the risk for rare side effects against the risk that their children can become quite sick and even die from the flu.

Talk to your provider before giving any over-the-counter cold medicines to your child.

WHEN SHOULD MY CHILD SEE A DOCTOR OR VISIT AN EMERGENCY ROOM?

 Contact your child's provider right away or go to the emergency room if:

• Your child does not act alert or more comfortable when their fever goes down.
• Fever and flu symptoms come back after they had gone away.
• There are no tears when they're crying.
• Your child is having trouble breathing.

SHOULD MY CHILD GET VACCINATED AGAINST THE FLU?

Even if your child has had a flu-like illness, they should still get the flu vaccine. All children 6 months or older should receive the vaccine. Children under 9 years will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time.

There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose.

• The flu shot contain killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older.
• A nasal spray-type swine flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years. It should not be used in children who have repeated wheezing episodes, asthma, or other long-term (chronic) respiratory diseases.

WHAT ARE THE SIDE EFFECTS OF THE VACCINE?

It is not possible to get the flu from either the injection or shot flu vaccine. However, some people do get a low-grade fever for a day or two after the shot.

Most people have no side effects from the flu shot. Some people have soreness at the injection site or minor aches and low-grade fever for several days.

Normal side effects of the nasal flu vaccine include fever, headache, runny nose, vomiting, and some wheezing. Although these symptoms sound like symptoms of the flu, the side effects do not become a severe or life-threatening flu infection.

WILL THE VACCINE HARM MY CHILD?

A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have not been shown to cause autism, ADHD, or any other medical problems.

If you have concerns about mercury, all of the routine vaccines are also available without added thimerosal.

WHAT ELSE CAN I DO TO PROTECT MY CHILD FROM THE FLU?

Everyone who comes in close contact with your child should follow these tips:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it.
• Wash hands often with soap and water for 15 to 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners.
• Wear a face mask if you have had flu symptoms, or preferably, stay away from children.

If your child is less than 5 years old and has close contact with someone with flu symptoms, talk with your provider.

Centers for Disease Control and Prevention website. Influenza (flu): frequently asked influenza (flu) questions: 2022-2023 season. www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm. Last Reviewed December 27, 2023. Accessed January 16, 2024.

Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices - United States, 2022-23 influenza season. MMWR Recomm Rep. 2022;71(1):1-28. PMID: 36006864 pubmed.ncbi.nlm.nih.gov/36006864/.

Havers FP, Campbell AJP. Influenza viruses. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 285.

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 01/16/2024.