As Flu Season Continues, Symptoms to Look Out For

Many news outlets are reporting that this year’s flu season is one of the worst in recent years. It is widespread and has tragically proven fatal for dozens of children. Those of us in CHIL who work at children’s hospitals have definitely seen emergency departments swell with flu patients the past few weeks, and doctors warn that the flu may remain a major problem for some time.


Since 2018, it may seem difficult to believe that the flu could still be so lethal. However, it is true that children, especially ones who already have chronic health conditions, are at risk. Media outlets like the New York Times have assembled lists of symptoms to look out for in children that could signal the need to seek medical care right away. The most common causes of complications from the flu include pneumonia, sepsis, and dehydration. Warning signs that a child may need immediate medical attention include: a fever that goes away only to return, confusion, extreme pain, severe vomiting, and a tinted blue color to the skin.


Of course, most cases of the flu are less serious than these, and healthy children can usually get over them with medication, proper rest, and hydration. However, the article says that some doctors still recommend the flu vaccine at this point, since there are at least “several weeks” left in the season.


The article in the New York Times referenced here gives important information, but what was also insightful was the comment section for this piece. Quite a few comments touched on some several themes, including the importance of vaccination (and the consequences of refusing it for a child), as well as socioeconomic factors that may increase a child’s risk factors for severe flu. However, many readers agreed with the theme of the article — we need to balance finding prompt care for sick children while avoiding overcrowded emergency rooms. If emergency rooms are overwhelmed, less timely care is available for everyone. Questions that remain unanswered by this sort of advice should probably be directed to a child’s pediatrician or primary care provider.  




Navigating Sick Days

The question of whether or not a child should stay home when they’re feeling under the weather inspires a lot of varying advice. According to an article recently published in NPR, rules in elementary schools about when to keep a sick child at home are more liberal than those in daycare centers. Also, surveyors of 1,442 parents with kids who are 6 to 18 years old found that parents had different attitudes about their children missing school based on their children’s age.


Some common reasons cited by parents for keeping their kids at home included: diarrhea, a single episode of vomiting or a slight fever. Interestingly, parents of older children were more likely to worry about their kids missing tests at school than parents of younger children did, suggesting that tests and exams might complicate the stay-at-home decision for parents when their children are sick. My own parents definitely also strictly adhered to the “No fever? No skipping” rule.


Another important factor parents consider is how contagious they perceive their children’s conditions to be. Evidence on how contagious kids can be are less definitive in older school children since they are usually not confined in a single space all day with ill classmates. For younger children who are in daycare all day, however, they may be prone to stomach bugs, ear infections, and colds than young children who stay at home.


Different daycare centers may also have varying suggestions for parents when it comes to children’s attendance. Some daycare facilities may have guidelines that recommend children to stay at home even though their rules don’t always align with pediatricians’ suggestions. This can be aggravating especially if parents cannot stay at home with their sick children, or cannot bring their kids with them to work.


Sick days are something we all experience at one point or another growing up. Since there is little uniformity about what symptoms are considered severe or contagious, it’s challenging to find or apply one suggestion to all parents or all students. Keeping an eye out for further research is probably the best thing to do as we continue to adhere to healthy behaviors such as washing our hands, staying hydrated, eating nutritious food, and getting plenty of exercise.

The Flu Vaccine is Back!

It’s flu season again. Each fall, public health officials, doctors, and the Center for Disease Control (CDC) urge Americans to get their flu shots in time for the winter. This week, we will discuss one of the best preventive measures we can take to fight against the flu.

Flu shots are the best way to safeguard children against the spread of the flu virus, according to a recent article on NPR. However, doctors interviewed in the article contend that the flu is underestimated even though it leads to more hospitalizations and deaths among children than any other diseases preventable by vaccinations. And yet, about a third of children in the U.S. are not getting vaccinated because parents either deem flu shots unnecessary or they believe that flu vaccines actually causes their child to become ill with the flu. However, these preconceived notions are untrue.

  1. There are greater implications to flu shots than parents realize. Children in school spend most of their time in classrooms with other children, and the likelihood that at least some of them are ill during the winter is quite high. Vaccines greatly reduce this risk. They are commonly used as examples in classes that teach about positive externalities - all members of society benefit from them in addition to the original individual that received the vaccine. Of course, relying on someone else to be vaccinated and flu-free to ensure one’s own health for an entire season is a risky bet to take.
  2. With regard to the second point, there are many respiratory viruses and colds that circulate in the fall around the time that flu vaccines may be administered, which leads parents to mistakenly assume a causal relationship between the vaccine and a child’s brief illness. However, according to a doctor interviewed in the NPR article, the timing of the flu shot and the “flu symptoms” are coincidental - a child is likely showing symptoms for a different infection altogether. Vaccines are made up of inactive parts of a virus that stimulate an immune response, but do not cause the flu virus to be reconstructed or activated inside the body to make us sick.

Historically, the flu has been a devastating disease, especially for children. We are lucky that modern medicine has reduced it to little more than an annual nuisance, but we must still take care to provide the youngest members of society with the means to fight off infections. The CDC publishes an up-to-date, informative page that explains the different types of flu vaccines available, as well as where to obtain them.  

For the transcript of Dr. Schaffner’s visit on NPR, click here.

Accurate Dosages for Children's Cold Medicine

Cold and flu season is approaching, which means parents will soon be giving their children liquid medications to relieve symptoms. According to a study published in this month’s issue of Pediatrics, many parents make errors giving liquid dosage medication, yet research on ways to improve dosage techniques and clarifying medication labels for parents has been limited.

In their findings, a team of researchers used a randomized control trial in three urban pediatric clinics, and assigned English or Spanish-speaking parents into one of five treatment arms. After parents were separated into groups, they were asked to measure nine doses of medication by filling three different dosages using three different tools, including a cup and oral syringes with varying increments. The team found that more than 80 percent of the parents made at least one dosing error, with more than 20 percent who doubled the intended dosage amount.

Different health literacy groups also found that parents made more errors with dosage cups than they did with syringes. After all, if a cup is not held at eye level, it is easy to misread the amount of liquid actually in the cup. In addition, a higher rate of error was made when using a teaspoon-only label rather than using a mL-only label. Researchers concluded that using syringes instead of cups would improve accuracy overall, but simply replacing the tool without proper language support will not have the desired effect.

Medication for children is unique in their liquid formulation, but this poses a challenge for consistent accuracy. The FDA and the American Academy of Pediatrics (AAP) recommend the use of tools when administering children’s liquid medications, but no national guidelines for the provision of these tools to parents currently exist.

The FDA and the AAP’s establishment of these guidelines would greatly benefit parent’s health literacy, which is an important factor in their children’s health. The amount of medication they give their children is only a part of the big picture. Parents of all language and income backgrounds who work closely with their children’s pediatricians should ensure that they are using correct methods and tools for their children.

Click here to read the full study.