Flu in Children: Symptoms, Contagion and When to See a Doctor

This morning, he was fine. At lunchtime, the nursery calls: 39.5 °C, he is shivering, will not play any more and complains that everything hurts. By evening, he is coughing. This sudden arrival, within a few hours, is the signature of flu.

In most healthy children, seasonal flu can be managed at home and clears up in about a week. Yet it is more than a “bad cold”: it wears children out, spreads very easily in group settings and can lead to complications, especially in babies. Here is how to recognise it, care for it and know when to see a doctor.

Flu or cold: how can you tell the difference?

The difference comes first from how fast it sets in and how your child looks overall. The UK’s NHS sums it up: flu arrives within hours and affects the whole body, whereas a cold builds up over a day or two and stays mostly in the nose and throat.

This table draws on guidance from the US CDC and French health insurance (Assurance maladie). The NHS adds that a child with flu may have earache, sore eyes, swollen glands, or simply seem much less active than usual. For a runny nose with no fever or listlessness, our guide to colds in babies will be more useful.

Why are babies and young children more at risk?

The WHO places children under 5 among the people most at risk of severe forms, along with pregnant women and people with chronic illness. The CDC specify that the risk is higher still before age 2.

In infants under 6 months, flu is serious and often leads to hospital admission, according to Assurance maladie. Yet they cannot be vaccinated before that age.

Children of any age are also more vulnerable if they have:

• asthma or another respiratory condition (see our article on asthma in children);
• heart disease, diabetes, or a kidney or neurological condition;
• weakened immune defences;
• obesity.

According to the CDC and Assurance maladie, possible complications are pneumonia, ear infection, sinusitis, dehydration, worsening of a chronic condition and, more rarely, involvement of the heart or brain.

How long is flu contagious?

A child with flu is contagious for longer than an adult: up to 7 days after symptoms begin, compared with 5 days for an adult, according to Assurance maladie. Symptoms appear on average 2 days after infection, and the WHO points out that the virus spreads very fast in places with many children, such as schools.

The virus spreads through droplets from coughs and sneezes, and through hands. The NHS says germs can survive up to 24 hours on hands and surfaces. Hence a few simple rules at home:

• wash hands often with soap and water;
• cough and sneeze into the elbow, and throw tissues away straight away;
• air the rooms every day;
• keep the sick child as far as possible from a younger brother or sister under 6 months;
• avoid visits from the extended family during the days of fever, especially if there is a newborn or a pregnant woman at home.

Nursery, school: your child stays home as long as they have a fever and are not well enough for their usual activities, the NHS advises. Flu is one of the viruses behind the repeated winters described in our article on nursery illnesses.

How do you care for flu at home?

Flu is treated with rest, fluids and treating the fever if it is hard to bear. There is no miracle medicine.

1. Offer drinks often, even without thirst, as long as there is a fever. For a baby, more frequent breastfeeds or bottles.
2. Do not overdress them: light clothes, no thick duvet, a cool, aired room at about 18 to 20 °C. No cold bath.
3. Let them rest: tiredness can drag on for 3 to 4 weeks, the dry cough for two.
4. Treat the fever only if it is poorly tolerated, with a single medicine. Assurance maladie favours paracetamol; ask your doctor or pharmacist for the dose suited to your child’s weight, and do not combine it with a “flu remedy” that may already contain it.
5. Clear the nose if it is blocked, especially before meals and bedtime.

Our article on fever in babies details the temperature benchmarks and the right steps.

What about antivirals?

They are often unnecessary. According to Assurance maladie, the doctor may offer them to people at risk of complications, including some children, or when the flu is severe from the start. They only work if started within 2 days of the first symptoms. The WHO also recommends prompt antiviral treatment for people at risk or with severe symptoms.

That is a good reason to call the doctor on the very first day if your child is under 2 or has a chronic illness.

The vaccine: who is it for?

The WHO recommends yearly vaccination for children aged 6 months to 5 years, because the immunity the vaccine gives fades over time and viruses change. In Morocco, this vaccine is not part of the free national schedule: it is something to discuss with your paediatrician, as we explain in our article on vaccines recommended on top of the national schedule.

For a baby under 6 months, protection comes through those around them: vaccination of the mother during pregnancy, presented in our article on vaccines during pregnancy, and hygiene habits among close contacts.