Influenza (Flu) in Children | Johns Hopkins Medicine
What is the flu in children?
Influenza (flu) is a very contagious viral infection that affects the air passages of the lungs. It causes a high fever, body aches, a cough, and other symptoms. It's one of the most severe and common viral illnesses of the winter season. Most children are ill with the flu for less than a week. But some children have a more serious illness and may need to be treated in the hospital. The flu may also lead to lung infection (pneumonia) or death.
Because of COVID-19, the CDC says getting a flu vaccine is more important than ever to protect yourself and the people around you from flu. Flu vaccines and COVID-19 vaccines can be given at the same time. Talk with your healthcare provider about vaccines.
What causes the flu in a child?
The flu is caused by flu viruses. Flu viruses are divided into 3 types:
Influenza types A and B. These 2 types of viruses cause widespread illness (epidemics) almost every winter. They often lead to more people needing to go to the hospital, and more people dying from the flu. Public health officials focus on stopping the spread of types A and B. One of the reasons the flu remains a problem is because the viruses change (mutate) often. This means that people are exposed to new types of the viruses each year.
Influenza type C. This type of virus causes a very mild respiratory illness or no symptoms at all. It does not cause epidemics. It does not have the severe public health impact that influenza types A and B do.
A flu virus is often passed from child to child through sneezing or coughing. The virus can also live for a short time on surfaces. This includes doorknobs, toys, pens or pencils, keyboards, phones and tablets, and countertops. It can also be passed through shared eating utensils and drinking. Your child can get a flu virus by touching something that was touched by an infected person, and then touching their mouth, nose, or eyes.
People are most contagious with the flu 24 hours before symptoms start, and while symptoms are most active. The risk of infecting others often ends about day 5 to 7 of the illness. Because the flu can be spread before symptoms start, it’s easy to pick up a flu virus. This is true especially with children, who often touch many surfaces and then their mouth, nose, or eyes.
Which children are at risk for the flu?
A child is more at risk for the flu if they:
Are around people infected with the flu
Have not had the flu vaccine
Do not wash their hands after touching infected surfaces
Young children and children with certain underlying health conditions are at increased risk for a hospital stay or severe or complicated influenza infection.
What are the symptoms of the flu in a child?
The flu is a respiratory disease, but it can affect the whole body. A child can become suddenly ill with any or all of these symptoms:
Fever, which may be as high as 103°F (39. 4°C) to 105°F (40.5°C)
Body aches, which may be severe
Cough that gets worse
Runny or stuffy nose
In some cases, your child may also have symptoms such as:
Most children recover from the flu within a week. But they may still feel very tired for as long as 3 to 4 weeks.
It’s important to note that a cold and the flu have different symptoms:
Low or no fever
Sometimes a headache
Headache in most cases
Stuffy, runny nose
Clear nose, or stuffy nose in some cases
Sneezing in some cases
Mild, hacking cough
Cough, often turning severe
Mild body aches
Severe body aches
Extreme tiredness that can last weeks
Sore throat in some cases
A cold is usually mild and often goes away after a few days. The flu can cause severe symptoms and lead to problems such as pneumonia and even death. Many flu symptoms may be caused by other health problems. Make sure your child sees their healthcare provider for a diagnosis.
How is the flu diagnosed in a child?
The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam. The symptoms are often enough to diagnose the flu. Other tests may be done such as a nose or throat swab. This depends on your child’s symptoms and overall health.
How is the flu treated in a child?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. The goal of treatment is to help prevent or ease symptoms.
Treatment may include medicines such as:
Acetaminophen. This is to help lessen body aches and fever. Don't give aspirin to a child with a fever.
Antiviral medicine. This may help to ease symptoms, and shorten the length of illness. The medicine can lessen the chance of developing an ear infection from the flu. It may also be able to decrease other complications including the need for hospitalization. The medicine is most useful if started within 2 days after symptoms start. But it may be started later if the child is having complications or is at high risk for them.
Antibiotics aren’t effective against viral infections, so they are not prescribed. They may be used, though, if your child has developed bacterial pneumonia. Otherwise, treatment focuses on helping ease your child’s symptoms until the illness passes.
Talk with your healthcare providers about the risks, benefits, and possible side effects of all medicines.
Also make sure your child:
What are possible complications of the flu in a child?
The flu can cause severe breathing problems. A child with severe symptoms may need to stay in the hospital. The flu can lead to a lung infection called pneumonia. In some cases, the flu can lead to death.
Children who have other health conditions that affect breathing, such as asthma, are at greater risk for flu complications. Their asthma or other lung condition can also be triggered by the flu.
Children with the flu are also more likely to develop ear infections.
How can I help prevent the flu in my child?
The best way to prevent flu is to have the yearly flu vaccine. Each year, a new flu vaccine is available before the flu season starts. Flu shots and nasal spray are available. Talk with your healthcare provider if you have questions about how vaccines work and how well they prevent flu.
The flu vaccine is most often given as a shot into the muscle. For babies and young children, it's given as a shot in the thigh muscle. In older children, it's given as a shot in the upper arm muscle. It's also available as a nasal spray for healthy children over the age of 2, including teens who are not pregnant. Check with your child’s healthcare provider to see which is the best choice for your child.
The first time a child between the ages of 6 months and 8 years gets a flu vaccine, they will need a second flu vaccine 1 month later. This is to build up protection against the flu. Get your child’s first dose as soon as the vaccine is available. This allows the second dose to be given by the end of October. This will give your child the best protection for the flu season. After the first flu season, your child will need only 1 dose.
The vaccine is advised for all children 6 months and older. But for some children, it’s more critical for them to get a flu shot because they are more likely to have complications from the flu. The flu shot should be given to any child who has any of these:
A long-term heart or lung condition
An endocrine disorder such as diabetes
A kidney or liver disorder
Weak immune system from HIV/AIDS, long-term steroids, or other immune-suppressing medicines
A blood disorder such as sickle cell disease
A flu shot should also be given to:
A child who has a family member with a chronic health condition
A child or teen taking aspirin as long-term therapy
A child with parents or caregivers at high risk of complications from the flu
Some side effects of the vaccine can seem like mild flu symptoms. But the vaccine doesn't cause the flu. Side effects can be prevented by taking over-the-counter medicines such as acetaminophen. Never give your child aspirin without talking to your child's healthcare provider first. Possible side effects of the flu vaccine include:
Soreness in the arm where the shot was given
Short-term symptoms such as mild headache or a low-grade fever for about 1 day after the shot
In rare cases, an allergic reaction in a child who has a severe allergy to eggs. Vaccines are available for those with an egg allergy.
In addition to the flu vaccine, you can do other things to help reduce your child’s risk of getting the flu. You can also:
And you can help prevent your child spreading the flu to others if you:
Have your child cover their nose and mouth when coughing or sneezing. Use a tissue or cough or sneeze in the crook of the arm.
Wash your hands before and after caring for your child.
Clean surfaces in the home that others may touch.
When should I call my child's healthcare provider?
Call the healthcare provider if your child has:
Key points about the flu in children
Influenza (flu) is a very contagious viral infection of the respiratory system.
It causes a high fever, body aches, a cough, and other symptoms.
Most children are ill with the flu for less than a week. But some children have a more serious illness and may need to be treated in the hospital. The flu may also lead to lung infection (pneumonia) or death.
The flu may be treated with acetaminophen, cough medicine, and antiviral medicine. Your child will also need lots of rest and plenty of fluids.
The best way to prevent flu is to have the yearly flu vaccine. The vaccine is advised for all children 6 months and older.
Because of COVID-19, getting a flu vaccine is more important than ever to protect yourself and the people around you from flu.
Tips to help you get the most from a visit to your child’s healthcare provider:
Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
Influenza in children | Caring for kids
Influenza (or “flu”) is a respiratory infection caused by influenza virus. Influenza outbreaks happen every year, usually between November and April. Because influenza viruses change – often from year to year – people don’t stay immune for very long. That’s why people can catch the flu more than once. The term “seasonal flu” is used for the influenza viruses that spread every year.
How does influenza spread?
Influenza viruses are found in the nose and throat. Children can catch influenza from siblings, parents, other family members, playmates or caregivers.
Germs usually spread in one of 3 ways:
Direct contact —such as kissing, touching or holding hands—with an infected person. If you have a virus, you will have germs in your nose, mouth, eyes or on your skin. By touching other people, you can pass on the virus.
Indirect contact means touching something—a toy, doorknob or a used tissue—that has been touched by an infected person and now has germs on it. Some germs, like the ones that cause colds and diarrhea, can stay on surfaces for many hours.
Through the air when a person coughs or sneezes. Droplets from the cough or sneeze may reach another person’s nose or mouth.
How do I know if my child has influenza?
The flu strikes more quickly than a cold, and makes people feel worse. Children with colds usually have energy to play and keep up their daily routines. Children with influenza are usually in bed.
Typical influenza symptoms include:
chills and shakes,
sore throat, and
loss of appetite.
Children with the flu may have many of the same symptoms as adults, but there can be differences:
Newborns and babies may have a high fever that can’t be explained, and no other signs of sickness.
Young children usually have temperatures over 39.5°C and may have febrile seizures (convulsions).
Upset stomach and pain, vomiting, and diarrhea are common in younger children. Earaches and red eyes are also common.
In some cases, muscle inflammation can lead to severe leg or back pain.
Can the flu cause any other complications?
Most healthy people recover from the flu without any serious problems. Fever and muscle aches usually last only 2 to 4 days, but cough and tiredness can continue for 1 to 2 weeks or more.
In young children, flu can cause croup (an infection of the throat and vocal cords causing hoarseness, barking cough, noisy breathing), pneumonia (lung infection) and bronchiolitis (infection of the tiny airways that lead to the lungs causing wheezing and difficulty breathing).
Influenza can weaken the immune system, leading to bacterial infections of the ear (otitis), lung (pneumonia) or sinuses (sinusitis).
Influenza is more severe in children under 2 years of age and in children with certain chronic conditions such as heart, lung or neurological problems.
In rare cases, influenza can affect the brain or heart.
What can I do if my child has influenza?
Keep your child as comfortable as possible. Offer plenty of fluids and small, nutritious meals.
If they have a fever, dress them in lightweight clothing and keep the room temperature around 20°C.
To ease pain, aches or a fever with a temperature greater than 38.5°C, use acetaminophen. Ibuprofen may be used for children over 6 months old. Unless your doctor says otherwise, give the dose recommended on the package every 4-6 hours until the child’s temperature comes down. Don’t give acetylsalicylic acid (ASA [eg, Aspirin])—or any medicine containing it—to children and teenagers with colds because it can lead to brain and liver damage (Reye syndrome).
Don’t give over-the-counter (OTC) cough and cold medicines to children younger than 6 years old unless your doctor prescribes them.
Gargling with warm water will ease a sore throat. For children 3 years of age or older who can safely suck on hard candy without choking can use sugarless hard candy or lozenges containing honey, herbs or pectin. Throat lozenges containing medications that numb the throat (dyclonine, benzocaine, hexylresorcinol, menthol and phenol) should not be used by young children because they can make it hard for them to swallow.
If your child has lung or heart disease, an illness that affects the immune system or some other chronic condition that requires regular medical attention and you think your child may have influenza, call your doctor right away. Your doctor may prescribe an antiviral drug. These drugs may also be prescribed for healthy people with severe influenza. They should be taken within 48 hours of the first symptoms to be most effective.
When should I call my doctor?
Call your doctor or take your baby to an emergency department if your baby is under 3 months of age and:
is having trouble breathing,
is not eating or is vomiting, or
has a fever (rectal temperature of 38.5°C or higher).
Call your doctor or take your child to an emergency department if your child is:
breathing rapidly or seems to be working hard to breathe,
having chest pain, or is coughing up bloody sputum (phlegm or saliva),
coughing so bad that they are choking or vomiting,
drinking very little fluid and have not urinated (peed) at least every 6 hours when awake,
vomiting for more than 4 hours, or has severe diarrhea,
much sleepier than usual, doesn’t want to feed or play, or is very fussy and cannot be comforted,
not feeling better after 5 days and still has a fever, or was feeling better and suddenly develops a new fever, or showing signs of the flu and has a serious chronic illness.
Take your child immediately to a hospital emergency department or call 911 if your child:
has severe trouble breathing or blue lips,
is limp or unable to move,
is hard to wake up or does not respond,
has a stiff neck,
seems confused, or
has a seizure (convulsion).
How can I prevent the spread of influenza?
Influenza can be prevented through immunization. Children over 6 months old should get a flu shot each year.
If there are children younger than 5 years old or someone with a serious chronic condition in your home, everyone living in the house should get a flu shot. This is especially important if there are children under 6 months old in the home, since babies this age can’t get the flu shot themselves and could become infected if a family member gets the flu.
Handwashing is the most important way to reduce the spread of viruses.
Keep babies under 3 months old away from people who are sick, if possible.
Teach your children to cover their nose and mouth with tissues when they sneeze or cough, or to cough into their upper sleeve or elbow.
Avoid sharing toys that young children place in their mouths until the toys have been cleaned.
Avoid sharing cups, utensils or towels until they have been washed.
If your child attends daycare, tell the caregiver about any symptoms and ask if your child should stay home that day.
Make sure your child receives all of the recommended vaccines. They will help prevent some of the complications, such as bacterial infections of the ears or lungs.
More information from the CPS
Reviewed by the following CPS committees
Infectious Diseases and Immunization Committee
Last updated: August 2021
Influenza in children
Children get the flu 4-5 times more often than adults. This is because their immune system is imperfect. Children of the first 3 years of age have the most severe course and a high risk of complications at any time from the onset of the disease. Children of large cities attending children's organized groups (kindergartens, schools, sports clubs) are at particular risk. In children living in big cities, immunity can be reduced due to polluted air and malnutrition.
Influenza is an acute, highly contagious infectious disease that affects the upper and lower respiratory tract and is caused by a virus.
The influenza virus is transmitted by airborne droplets through coughing, sneezing and talking and is highly contagious. It is very easily transmitted when children are in the same room for a long time.
The incubation period (the period from the moment of infection to the onset of the first symptoms) is from 1 to 5 days.
Flu symptoms :
The disease develops rapidly, acutely with the onset of chills and fever from 38. 5 to 40 gr. during the first day
In children of the first year of life at the peak of fever, convulsions may occur
Pain and pain in the eyeballs
Pain in the joints, muscles
In young children
marbling of the skin, pallor
May present with catarrhal symptoms such as runny nose, sore throat, dry cough
Breastfeeding, restlessness, sleep and wake disturbances may occur in infants.
Children of the neonatal period
Children of the first six months of life
Children attending preschool institutions
From 6 months to 5 years the course of the disease can be very severe with the development of encephalitis.
Most often influenza is complicated by inflammation of the lungs (pneumonia), bronchitis, and damage to the nervous system. Otitis, sinusitis, inflammation of the heart muscle (myocarditis). In the worst case, inflammation of the brain and its membranes may develop.
It is not uncommon for children to develop laryngotracheitis, which can lead to false croup (an attack of suffocation that causes the airways to close). False croup can be fatal.
Joint complications such as rheumatoid arthritis are also possible, which leads to limited mobility and deformity of the joints.
Treatment of influenza in children
If a child is ill, the first thing to do is to see a doctor. During treatment for influenza, the following guidelines should be followed:
Follow your doctor's instructions
Stay in bed
Drink plenty of water (liquid speeds up the elimination of toxins that are formed during the vital activity of viruses)
Don't force your child to eat if he doesn't want to. Appetite decreases during the flu. It is necessary to follow a diet (light meals in small portions)
Do not wrap the child
It is necessary to ventilate the children's room as often as possible.
Most often, influenza is treated at home, but sometimes it becomes necessary to hospitalize the child in a hospital in case of a severe course of the disease or the development of a complication.
Prevention of influenza in children:
The main type of influenza prevention in children is vaccination. It is indicated for children attending preschool institutions, children who often suffer from colds, children with chronic diseases of the cardiovascular and respiratory systems. Vaccination is carried out from the beginning of autumn. Vaccination helps to develop immunity against the influenza virus. Even if a vaccinated child becomes ill, he will have a mild illness, and the chance of complications in such children is small. Vaccination can be used in children from 6 months. Vaccination should be done annually.
In addition to vaccination, there are other methods of prevention aimed at improving immunity, such as walking in the fresh air. Physical development, hardening.
Before visiting schools, kindergartens, polyclinics, it is recommended to lubricate the nose with oxolin ointment.
It is recommended to avoid crowded places.
Hands should be washed frequently and thoroughly. Do not touch your face with dirty hands, there may be virus particles on your hands.
If there is a sick person in the house, it is necessary:
Isolate the patient with influenza in a separate room
Regularly ventilate the room where the patient is located
When caring for the sick, use a medical mask
Wash hands with soap and water after each contact
Daily wet cleaning.
Dear parents, watch your child's health! At the slightest sign of a viral infection - consult a doctor!
Influenza in children: symptoms and treatment
Every year in autumn and winter there is a period of influenza epidemics. And if adults tolerate this disease relatively easily, then in children it can cause severe complications. The younger the child, the more dangerous the flu is for his health and life. Therefore, it is so important for parents to know how to act in order to reduce the possible risk.
• Influenza is a viral disease. Fighting the virus when a person is already sick is very difficult. Usually the body copes with such an invasion on its own, but the flu is fraught with the development of complications. • Antibiotics may be needed by a child with the appearance of bacterial complications of the disease, but they have no effect on viruses. • To prevent influenza, you should avoid contact with sick people, wash your nose with saline and get vaccinated.
Symptoms and development of the disease The disease goes through several stages. The first - the incubation period - can last from 2 hours to 3 days, it all depends on the state of the child's immune system. In this phase, weakness and drowsiness may appear.
In the second stage, there is a headache, pain in the joints and muscles, the temperature rises, it can reach up to 40.5°C. It is painful for the baby to move his eyes, an almost transparent liquid flows from the nose, the nasopharynx swells strongly, the child cannot breathe through the nose. Then a barking cough appears, intestinal disorders may occur.
Gradually, the body copes with the virus and, although the temperature still persists, the ache in the bones and muscle pain disappears, and the discharge from the nose becomes thicker. After this, recovery occurs, however, with improper treatment, complications can develop.
What causes influenza in children?
The causative agent of influenza is a virus that constantly mutates, that is, changes, so every year new varieties of it appear and it is necessary to re-vaccinate. In wet, cold weather, when our immunity is also reduced, influenza viruses become especially active. They are transmitted from one person to another by airborne droplets - with particles of saliva and sputum.
Once in the body, the influenza virus is embedded in the cell and changes its work, forcing to reproduce new microbes. When their number reaches a certain value, symptoms of the disease appear.
Consequences of influenza
Influenza in children is known for its severe complications. If the child's immunity is reduced, meningitis may develop, inflammation of the kidneys may begin - nephritis. These are the consequences of the spread of the virus throughout the body.
In tissues damaged by a microbe, including airways filled with sputum, various bacteria begin to multiply rapidly, so the flu has so-called bacterial complications. These include inflammation of the lungs (pneumonia) and otitis media (inflammation of the middle ear).
How is influenza diagnosed and treated in children?
For an accurate diagnosis, a nasopharyngeal swab should be taken, and only after a while it will become clear whether the child has the flu. But in practice, of course, not in all cases it is necessary to take tests, and treatment, as with many other infectious diseases, is prescribed without waiting for the results of the study.
It must be understood that viruses cannot be destroyed by antibiotics. Therefore, influenza therapy is aimed at maintaining immunity, which fights the virus. In addition, there are drugs that suppress its reproduction.
A child may need antibiotics only if there are bacterial complications, and a doctor should diagnose them and prescribe such drugs.
What can parents do?
First of all, as with any infection of the respiratory tract, you need to ventilate the room where the patient is, do not dress him too warmly and give him plenty to drink (preferably plain water). With influenza, it is advisable not to give the child antipyretics until the temperature reaches 38.5 ° C, if he tolerates it well, since high temperature slows down the reproduction of viruses.