Why children are at risk for dangerous complications from the flu

Last year’s unusual flu numbers have some people on edge, not knowing what to expect from this year’s strain. After a record number of flu-related pediatric deaths during the 2017-2018 season, it is important that parents know the facts and what to do in case their child catches the virus.

Children are one of a few groups that are most at-risk when contracting the flu. What makes this fact even more difficult to deal with is that kids are typically exposed to environment that best carries viruses and illness, like in daycares, at school and even at home.

“They haven’t been exposed to previous bouts of the flu or the flu vaccine,” said Robert M. Jacobson, M.D., Medical Director of the Mayo Clinic’s primary care immunization program. “They lack the sort of protection that older people have.”

Different strains of the flu make their rounds each year. Sometimes the vaccine gets them right and other times it doesn’t, but for adults who have been exposed to some strains over time they can still fight the flu better than a child who has never experienced anything.

Children are also placed in environments with other children who are just as susceptible to new viruses like the flu. In these close quarters, young children do not know what may happen from sharing a water bottle or being sneezed on by a classmate.

“Toddlers in a daycare, school-aged children in a school setting are often placed in a setting with other children who are ill,” said Jacobson. “It is very difficult for them to protect themselves from being touched or exposed to others germs.”

Complications in children

The Centers for Disease Control says that children five years old and under, especially those under two, run the highest risk of flu and flu-related complications. Any complications that do occur can range in severity, from more minor issues such as sinus infections to more severe illnesses like pneumonia.

Pneumonia is the most common of the uncommon complications from influenza, said Aaron Milstone, M.D. associate professor of Pediatrics at Johns Hopkins University School of Medicine and associate hospital Epidemiologist at The Johns Hopkins Hospital.

"We worry about the lungs because the flu likes to irritate the respiratory track and that area normally has bacteria," said Milstone. "When it irritates the lining and lets the bacteria in, it can causes the complication.”

If any parent suspects their child has developed pneumonia they should consult with a medical professional because to treat pneumonia, their child would need antibiotics.

Complications can arise with the preexisting conditions, too. Children with asthma, for example, can experience complications because of their existing respiratory issues. The flu, which causes respiratory distress, can aggravate or worsen the existing condition.

Although it is rare, complications from the flu can lead to death in children. Monitoring of pediatric cases of the flu by the CDC has shown that since the 2004-2005 season there has been an range of 7,000 to 26,000 hospital visits for pediatric flu and a yearly death toll of anywhere from 37 to 185. This excludes the pandemic in 2009, were the CDC reported 358 pediatric flu-related deaths.

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“The highest peak of flu season could account for a good percentage of pediatric [patients] coming to the [hospital] because it can present with so many different symptoms,” said Ari Cohen, M.D., chief of Pediatric Emergency Medicine at Massachusetts General Hospital. “It affects everyone from newborns to teenagers.”

The complications of the flu virus do not count anyone out, even children who are active and healthy without a medical history or condition.

Last year, 185 children died of the flu, exceeding the previous record, according to the CDC. About 80 percent of these children that died as a result of the flu they were not vaccinated against it.

“If you take two people who are healthy and have influenza you don’t know why one gets complications and one does not,” said Milstone.

Preventative measures

“Number one is immunization,” said Cohen. “That is our best line of defense, even if it is not particularly effective it does not mean it doesn’t lessen your symptoms if you do get the flu.”

Children under six months of age can not be vaccinated, so it is imperative that everyone that comes in contact with the child is properly vaccinated. It is a good practice, however, for the families of older children to all get vaccinated and lessen the chance of the virus spreading throughout the family.

Doctors emphasized good hand hygiene, sneezing and coughing into your sleeve, not sharing food or drinks, staying hydrated and receiving adequate, regular sleep.

All of these are habits are extremely important practices in order for children to stay healthy this flu season. They may not prevent the flu if a child comes into contact with it, but it can lessen the chances of that contact being made.

Jacobson recommends parents not only advise their kids to practice these habits outside the home but also make an example of them inside the home.

“When I’m with my patients in the exam room, I say out loud that I am washing my hands and I am washing the germs off my hands,” said Jacobson. “Parents can do the same thing.”

How to spot the flu

The flu is often associated with the common cold because of the similar symptoms they share. Doctors note, however, that there are signs to look out for in differentiating the two.

“Parents should be thinking about the flu during flu season when they have a child with a sudden onset of illness marked by a fever and cough or a fever and sore throat,” said Jacobson.

Any child with a fever and one or both of these symptoms should consult with their primary care physician. Fevers at or exceeding 104 degrees should seek emergency attention.

Children experience more respiratory issues connected to the flu, according to both Jacobson and Cohen. Shortened breaths and breathing after every sentence could be a clear indicator of respiratory distress in a child.

Dehydration is also another symptom and complication of the flu. Children can become dehydrated much quicker than adults, so it is important that parents are constantly encouraging their children to drink water, especially when they begin complaining about feeling ill. Jacobson notes in infants, specifically, it is difficult to express thirst and they may also have trouble breathing when trying to ingest fluids.

Most children typically recover from the flu without any complications, but not knowing if your child has it can still be concerning for most parents.

“If you, as a parent, are really concerned, you should not worry at home alone,” said Cohen. “Make a phone call to your pediatrician and certainly an emergency room as a backup if you think things are not going in a good direction.”

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