Flushed cheeks. Glassy eyes. That first crackly cough. The signs a child is getting sick are far from fun. But last winter, these symptoms had moms and dads more than merely bummed, thanks to the ultimate F-bomb of parenthood: flu.
Between fall 2017 and spring 2018, tens of millions of Americans came down with one of the nastiest and most unpredictable flu viruses in recent history. Schools in at least 14 states closed temporarily due to outbreaks. Hospitals in Pennsylvania, California, and a handful of other states scrambled to set up tents to accommodate flu patients, and 180 children died.
All of this made 2017-2018 the second-deadliest flu season for kids since the Centers for Disease Control and Prevention (CDC) began tracking pediatric-flu deaths 14 years ago. Put simply, it was scary.
How to get through this year? Well, you could hibernate with jumbo bottles of hand sanitizer and a stockpile of frozen dinners—or you could relax, enjoy the season, and protect your family. To show you how, we asked epidemiologists, immunologists, and public-health experts for razor-sharp insights on what to expect and what you can do about it.
As you read their answers, keep in mind one big takeaway: The flu may be frightening, but with the right precautions, you can keep your kids safe.
First, it was long. “The flu came early and hit hard,” says Aaron Milstone, M.D., associate professor of pediatric infectious diseases at Johns Hopkins University School of Medicine, one of six Centers of Excellence for Influenza Research and Surveillance. “Kids started trickling in with flu in early November, and in late April, labs were still reporting positive tests in the thousands.”
Plus, the predominant viral strain, A/H3N2, was a monster that came on fast—often with a skyrocketing fever—and caught parents off guard. (Nearly half the kids who died from flu last season had no high-risk medical problems.) The strain also proved a difficult match for the flu vaccine because it mutates when grown in chicken eggs, where the vaccine is made. The vaccine’s effectiveness for A/H3N2 was 25 percent, and the overall effectiveness was estimated to be 40 percent (the low end of typical).
Flu may be harder to forecast than a good poker hand. “The strains that will circulate each year are very hard to predict,” says Kathryn Edwards, M.D., professor of pediatrics in the Division of Infectious Diseases at Vanderbilt University Medical Center, in Nashville. “The virus is changing all the time, even in the course of a single flu season.” (This year’s vaccine, like last year’s, will consist of two strains of influenza A—H3N2 and H1N1—and two strains of influenza B.)
Recent research published by the CDC, however, may indicate that another nasty flu season is underway. As of January 5, 2019, between 6.2 to 7.3 million people showed symptoms of the flu. In addition, there have been 2.9 – 3.5 million medical visits and 69,300 – 83,500 hospital visits related to influenza.
Experts unanimously agree that the answer is yes. “Think of it this way,” says Dr. Milstone. “The vaccine may not protect all people from getting the flu, but it usually lessens disease duration and severity. Why not do something that protects you from a virus that can kill you? It’s the same reason you wear a seat belt. It’s not a guarantee that you won’t die in a car accident, but it reduces the risk.”
Studies show that if your child gets the flu, having been vaccinated will cut her chance of hospitalization in half. And the earlier you get vaccinated, the better. Parents advisor Wendy Sue Swanson, M.D., likes the motto, “If not by Halloween, then definitely by Thanksgiving.” (Keep in mind that the vaccine needs two weeks to take full effect.)
Of course, if Valentine’s Day rolls around and you still haven’t taken your kids for their shots, it’s not too late. Remember, the flu ran rampant through mid-March in 26 states and Puerto Rico last flu season.
A survey by researchers from Dartmouth College and the University of Exeter in the United Kingdom found that 43 percent of people believe this is true. “That’s just wrong,” says Dr. Edwards. “The vaccine is made up of either totally inactive or weakened forms of the virus. Neither of those will give you the flu.”
If your child develops a low-grade fever, headache, or muscle ache after the vaccine, it’s because her body is mounting a healthy immune response that should go away in a day or two. However crummy she feels, her discomfort doesn’t compare with the misery of the real deal. Children who have the flu may miss up to a week of school and experience lingering symptoms for two weeks or more.
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Two years after the CDC advised against using the nasal spray due to poor performance against certain flu strains, the organization has green-lit a new version. But there’s a catch: The American Academy of Pediatrics still advises that kids get the shot, citing its own independent data review. Of course, if your child is truly needle-phobic, go ahead and ask your doctor for the spray. It’s better than skipping vaccination.
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Flu viruses are survivors, especially in cooped-up spaces. A recent study from the University of Pittsburgh and Virginia Tech showed that microscopic flu droplets hang around indoor air for up to an hour, and University of Maryland researchers found that the infection may be spread by normal breathing, not just coughs and sneezes.
“The most practical thing to do is keep air circulating in our homes and vehicles, and push our kids’ schools to do the same,” says Seema Lakdawala, Ph.D., senior author of the Pittsburgh–Virginia Tech study. Update old HVAC units, install air-purifier systems, use a fan, and crack a window or two during the winter. On airplanes, keep overhead fans going, and consider putting your kid in a window seat. Passengers on the aisles have more exposure to others’ germy exhalations, research has found.
Of course, flu-virus droplets also land on hard surfaces, where they can stay for up to two days. To fight those germs, have your kids wash with soap and water for 20 seconds or slather their hands with alcohol-based hand sanitizer before meals and throughout the day. When cleaning after a flu bout, mix 1/4 cup of laundry bleach with a gallon of water, then wipe down “high-touch” surfaces like countertops, doorknobs, faucets, and toilets, suggests Dr. Lakdawala.
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It isn’t always easy to tell that your child is coming down with the flu, but if the illness had a calling card, it would be a sudden fever and a cough. Other symptoms might include a sore throat, body aches, headache, a stuffy or runny nose, and a feeling of incredible tiredness. Children are also more likely than adults to have vomiting and diarrhea, says Angela Campbell, M.D., a pediatric-infectious-disease specialist in the CDC’s influenza division.
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Seeing a doc is a must for kids under age 5 and for those who are at a high risk of breathing or heart complications. But any child who feels poorly should go to the doctor, says Dr. Milstone. If last year’s flu season taught us anything, it’s that a well child can take a turn for the worse very quickly. He urges parents to go to their regular doctor rather than to urgent care.
“As a doctor, you can often just look at a patient you know well and see that he’s in bad shape and needs close observation or to be hospitalized. Walk-in clinics frequently have rotating staff that may not work often with children and have never seen your child, and the same person won’t be able to see you the next day,” he says.
Flu testing, on the other hand, is not always a must. The rapid flu test—a somewhat uncomfortable Q-tip swab that goes deep into your child’s nostril—can produce false negatives, and the results usually do not change how a child is treated. Doctors always err on the side of caution and diagnose, monitor, and treat children for flu based on their symptoms, not the test, says Dr. Campbell.
If he seems to have trouble breathing, has bluish skin, is not drinking enough, is not interacting, or is so irritable that he doesn’t want to be held, you should head to the E.R. or call 911. If your child’s fever goes away and then suddenly spikes again, it could be a sign of a bacterial infection that requires emergency care, says Dr. Campbell.
More than one third of children who die from the flu lose their lives before getting admitted to the hospital, according to the CDC. When in doubt, go.
This antiviral flu medication blocks certain proteins that spread viral particles from cell to cell and shortens the illness by about a day. Although the CDC recommends it for children at high risk for flu complications, the upside is less clear for healthy kids. One in 20 children experience vomiting after taking Tamiflu, and for many kids, another day on the couch is preferable to a day spent hovering over the toilet. The decision is ultimately up to you and your pediatrician.
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Rest and time are most important, but the following symptom soothers can help too.