3 things parents should know about flu

We haven’t yet hit peak flu season, but we seem to be approaching peak flu panic.

Flu cases have been climbing for more than two straight months, and hospitalizations for flu have already reached a record high since the Centers for Disease Control and Prevention started using their current tracking system in 2010. The news that 63 kids have reportedly died so far this season from flu has been especially terrifying for parents across the country — and for good reason.

This is shaping up to be a very bad flu year. But more than ever, we need to put some of the facts into context.

The pediatric death rate so far is “terrifying — but it’s looking normal,” said Wendy Sue Swanson, a pediatrician and a spokesperson for the American Academy of Pediatrics.

By that she means that during a typical flu season, pediatric deaths can range from 37 to 171, according to the CDC. While the death rate may climb this year, it’s not above average yet. And this season is not nearly as deadly as the 2009 swine flu pandemic — an outlier that saw 358 pediatric deaths.

Another scary statistic circulating in the media is that one in 10 people who have died in the US during the past week died from flu or pneumonia. While true, it doesn’t mean that people are dying from flu at an exceptionally high rate.

“Influenza deaths are not very, very high compared to previous years,” Dr. Anne Schuchat, acting director of the CDC, told reporters on Friday. Flu season usually peaks in February and March — which means we may be almost or already through the worst.

Still, flu can be a very dangerous disease — and young children are particularly vulnerable to the virus. It can be difficult for parents to know what’s normal, and when to rush to the hospital. Here are three things parents should look out for.

1) Flu comes on a lot faster than a cold

Seasonal flu is a respiratory disease that causes fever, chills, headache, malaise, muscle pain, cough, and a sore throat. These symptoms come on really fast — within 24 hours of so — and should improve over the course of a week (but can last a little longer in young ones). Kids with flu may also experience vomiting, diarrhea, nausea and stomach pain.

Since flu is sometimes confused with the common cold, the Centers for Disease Control and Prevention has a very useful infographic to help tell the difference:

2) Kids under 5 and with certain medical conditions need extra attention if they have flu symptoms

For most kids, flu doesn’t come with serious complications and can be treated at home with lots of rest and fluids.

But there are some groups who should get medical attention sooner if they have flu. Children under the age of 5 — and especially those under 2 — are considered particularly vulnerable to serious flu-related complications, such as pneumonia or encephalitis. And according to UpToDate, the evidence-based physician’s resource, these medical conditions also put children and adults at high risk of flu complications:

• Asthma
• Kidney disorders
• Liver disorders
• Blood disorders (including sickle cell disease)
• Endocrine disorders (including diabetes mellitus)
• Metabolic disorders (including inherited metabolic disorders and mitochondrial disorders)
• Neurologic and neurodevelopmental conditions (including disorders of the brain, spinal cord, and peripheral nerve and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, and spinal cord injury)
• Chronic lung disease (like chronic obstructive pulmonary disease and cystic fibrosis)
• Heart disease (except hypertension)
• Immunosuppression due to disease or medications (including HIV, cancer, and chronic glucocorticoids)
• Long-term aspirin therapy

So if your child is under 5, and/or has any of these conditions, and you suspect he or she has the flu, you may want to seek out medical care.

3) There are warning signs to watch for in all kids — and reasons to rush to the hospital

While flu deaths are uncommon, even children with no underlying medical conditions are still at risk of death from flu. “They are young and immature — immunologically speaking — when it comes to dealing with influenza,” Swanson explained. In one study that looked at pediatric flu deaths in the US between 2004 and 2012, 43 percent occurred in children with no high-risk medical condition, while 33 percent had neurological disorders, and 12 percent had genetic or chromosomal disorders.

So in all children, there are other warning signs to look out for that may require medical care fast:

If your child keeps getting worse, not better: Children with flu should gradually improve during the course of a week (though symptoms can last longer). But if their symptoms worsen over time — the fevers or pain are getting more serious each day — you may want to seek immediate medical attention.

If your child recovers, then gets sick again: Every year, about half of pediatric flu deaths are in otherwise healthy children, and Swanson said she’s been hearing anecdotal reports that some of the deaths this year involved kids who got over the flu, but then got sick again from another secondary infection. “That tells me they had a viral infection from flu, their body did a decent job of trying to get rid of the virus, but in that process they got set up for secondary infection — severe ear infection or pneumonia,” Swanson said. So if your child is getting better and then takes a turn for the worse, see a doctor.

If your child has any of these other emergency warning signs from the CDC:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In infants, warnings signs include:

• Being unable to eat
• Has trouble breathing
• Has no tears when crying
• Significantly fewer wet diapers than normal

“If your child is not staying hydrated, can’t keep anything down, or has a febrile seizure — or if something is really different than a regular cold, trust your instinct,” Swanson added. “It’s worth getting seen right away.”

If your child didn’t get the flu vaccine: Flu vaccines, while imperfect, do minimize the risk of getting the flu — and this can be especially important for vulnerable groups like children. In one study of pediatric flu deaths and vaccination status, researchers found that only 26 percent of those who died had gotten the vaccine.

Unfortunately, there’s no sure-fire cure for the flu. Antivirals don’t always work well, but are most effective when started within 48 hours of onset of flu (and are recommended for high-risk groups, like young children). Otherwise, lots of rest and fluids are essential, and over-the-counter painkillers like acetaminophen or ibuprofen can manage pain and fever. (Vitamin C doesn’t really help.)

So look out for the warning signs, but also remember: the vast majority of kids with flu, like most adults, will get over it.