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American Academy of Pediatrics

 
Frequently Asked Questions About H1N1 Flu (Swine Flu)
(Updated February 2010)

Frequently Asked Questions About 2009 H1N1 Influenza (Swine Flu)

1. Should my child get the flu vaccines?
2. Where can I get the flu vaccine?
3. Is the 2009 H1N1 (swine flu) vaccine safe?

4. What else can families do to protect themselves from H1N1 influenza (swine flu)?
5. What are the symptoms of flu in children?
6. What can parents do to prepare in case a child or family member becomes ill?

7. What advice do you have for parents with children in school or child care?
8. What should parents do if their child has flu-like symptoms?

9. What are the signs that my child with flu-like symptoms is getting worse?
10. Are any medicines recommended to help children with swine flu?
11. If my child has flu, how can I keep myself and other family members from getting sick?
12. Is flu more dangerous for very young children?

13. How is the 2009 H1N1 flu (swine flu) different than the "regular" flu?
14. Should I use antibacterial soaps and/or alcohol-based hand rub products?
15. Are face masks necessary?
16. Can mothers who have swine flu continue to breastfeed?

1. Should my child get flu vaccines?

  • Flu pandemics often come in “waves,” and a third wave of H1N1 flu illness could occur this spring. Getting the flu vaccine will protect you and your loved ones.
  • 2009 H1N1 influenza vaccine is now widely available. If you, your children or members of your family have not been vaccinated yet, now is a good time.
  • Even healthy children can get the flu, which can make any child very sick – and can even be fatal.
  • Children should get flu vaccines to protect themselves from the flu. Each flu vaccine comes as a shot or a spray up the nose.
  • 2009 H1N1 influenza vaccine is recommended for everyone, 6 months of age and older. Enough vaccine is available now for everyone who wants it.
  • It is best to vaccinate as many people as possible, as quickly as possible. Some groups are especially at risk for being infected with this virus and are more likely to be ill with complications. Every effort should be made to protect these people with vaccine, including:
    • Everyone under age 25
    • Parents and caretakers of infants younger than 6 months
    • Pregnant women and those who delivered in the past 2 weeks
    • Health care workers and emergency services personnel
    • Adults ages 25 through 64 with chronic medical conditions
  • Adults need one dose of the H1N1 vaccine.
  • Children under 10 years of age need two doses of 2009 H1N1 (swine flu) influenza vaccine to receive the most protection. Ideally, they should get their second dose four weeks after the first dose.
  • For the 2009 H1N1 (swine flu) influenza vaccine given by injection, the second dose may be given as early as 21 days after the first dose. For the nasal spray vaccine, it is best to wait at least 28 days between doses.
  • People ages 10 and older need only one dose of H1N1 (swine flu) vaccine.
  • There are several kinds of flu illnesses, and children can get all of them. All children ages 6 months through 18 years also should get the vaccine to protect against the seasonal flu. If your child is less than 9 years old and this is his or her first time getting a flu vaccine, s/he will need two doses.
  • Parents and caretakers of infants under 6 months of age should also get the seasonal flu vaccine to protect these children who are too young to be vaccinated.

2. Where can I get the flu vaccine?

  • More than 147 million doses of 2009 H1N1 influenza vaccine have been distributed, so check with your physician.
  • The Centers for Disease Control and Prevention (CDC) also has a vaccine locator on its Web site .
  • Preservative-free flu vaccines without thimerosal are available.
  • Call your pediatrician to learn the best way for your child to receive seasonal flu vaccine.

3. Is the 2009 H1N1 (swine flu) vaccine safe?

  • The 2009 H1N1 influenza vaccine is being made the same way as annual seasonal influenza vaccine. To date, the 2009 H1N1 influenza vaccine has been as safe as the seasonal influenza vaccine we have been using for many years.
  • Federal agencies are monitoring very closely reports of events occurring after people receive H1N1 vaccine. The reports so far show the same safety pattern as seasonal influenza vaccine.
  • The viruses included each year in the seasonal influenza vaccine may be changed when a new virus is expected to cause influenza that year. The 2009 H1N1 virus was discovered too late to be put in this year’s seasonal vaccine, so it is being given separately. Next flu season, 2009 H1N1 influenza virus will probably be included as one of the viruses in the seasonal vaccine.
  • Many careful, repeated studies have shown that vaccines, including influenza vaccines, are safe and effective. For more information about vaccine safety, visit http://www.aap.org/featured/vaccinesafety.html .

4. What else can families do to protect themselves from H1N1 influenza (swine flu)?

  • Getting the vaccine is the best way to protect you and your family from getting this disease.
  • Wash hands often with soap and water, especially after you cough or sneeze. Wash hands for 20 seconds, which is about as long as it takes to sing the “Happy Birthday” song twice. Alcohol-based hand cleaners also work well. Keep in mind that alcohol-based products are toxic if ingested by children. (The amount left on hands after use is not a concern.)
  • Cough or sneeze into your elbow or upper sleeve. If you use a tissue instead, cover your nose and mouth with it when you cough or sneeze. Throw the tissue in the trash right after you use it.
  • Avoid touching your eyes, nose or mouth. Germs spread that way.
  • Stay at least 6 feet away from people who are sick. Avoid crowds. This will limit the spread of illness.
  • Stay home when sick to keep from spreading illness.
  • All sick children and/or sick adults should stay home until 24 hours after they have no more fever (or signs of fever) without the use of fever-reducing medications. A fever is considered to be a temperature of at least 100.4°F.
  • Seek medical care if you are severely ill, such as having trouble breathing. Antiviral medicines may help.

The CDC answers common questions about swine flu.

5. What are the symptoms of flu in children?

  • Children with influenza have a sudden onset of fever, chills, sore throat, cough, and runny nose. It may also cause headache, muscle aches, tiredness, nausea, vomiting and belly ache.
  • Influenza is different from the common cold, but it can be hard to tell which illness someone has. Typically, a child with a cold can have a stuffy nose, sneezing, scratchy throat, hoarse voice, dry cough (usually from mucous dripping down the throat), and slight fever. Even with cold symptoms, people generally can keep up with their usual activities.

6. What can parents do to prepare in case a child or family member becomes ill?

  • Consider what you will need to do to arrange for child care at home for your children, if they came down with the flu.
  • Stock up on supplies and non-perishable food at home.
  • Be prepared to create a “sick room” for an ill family member. Needed supplies include clean washcloths, household disinfectant, a thermometer, fever-reducing medications, a humidifier, tissues, a waste basket and trash can liners.
  • Have your pediatrician’s contact information handy.
  • Be aware of what’s going on in your area and follow the recommendations of public health authorities.
  • Learn the symptoms of flu so you can detect illness in your children early. 
  • Plan now what you would do if your child’s school or child care center were to close.

The CDC offers advice for parents on talking to their children about H1N1.

7. What advice do you have for parents with children in school or child care?

  • Parents should not take healthy children out of child care or school to prevent illness unless public health authorities have recommended such a step.
  • If the virus is causing significant illness in a particular area, authorities may close child care programs and public events. However, closing schools is not always the best way to prevent further spread of infection.
  • If the school or child care program closes and your children are healthy, parents should still keep them home and not participate in social activities or sports activities.
  • Working parents may team up with other parents to take turns staying home with children; such groups should be kept to small numbers of children (fewer than 6) to minimize the risk of spreading germs.
  • Parents should remind their children about proper hygiene, including sneezing and coughing into a tissue or sleeve, and frequent handwashing.
  • Parents should advise children to go to the school nurse if they start to feel sick during school. Children who are sick should stay home until 24 hours after they have no more fever of at least 100.4°F (or signs of fever) without the use of fever-reducing medications.
  • Normal body temperature is different for each child. In general, a temperature of 100.4°F (38°C) or higher is a sign of fever. Note: Schools and child care centers may have different rules about when children need to stay home.

8. What should parents do if their child has flu-like symptoms?

  • If your child has mild illness, he should stay home from school or child care until he has been fever-free for 24 hours without the use of fever-reducing medications.
  • Any child younger than 3 months who has a fever (rectal temperature of 100.4°F or higher) should see a pediatrician.
  • In a child older than 3 months, how high the fever is, is not as important as how he or she feels and acts. Bring your child to the pediatrician if she is very sleepy or has little energy to play, is very irritable and cannot be comforted, has trouble breathing, is not drinking well or is otherwise not acting normally.
  • If your child has underlying health problems (for example, heart or lung problems, weakened immune system, chronic kidney disease, sickle cell disease, asthma, or a severe neurological disorder not including ADHD or autism), see a pediatrician as soon as mild flu symptoms start.
  • If your child is otherwise healthy, call your pediatrician to see if an appointment is needed.
  • If your children are uncomfortable because of the fever, you can give them medicine such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Do not give aspirin-containing products.
  • Encourage them to drink liquids, especially if they are not eating well. Chicken soup can provide liquids and has been found to alleviate symptoms.
  • If your child has severe symptoms, has been to an area where there have been cases of swine flu, or been directly exposed to a swine flu patient, call your doctor for advice. Your doctor can help you decide whether your child needs to be seen or if they may need to be treated with an antiviral medicine.

The AAP offers advice on taking a child’s temperature.
                                       
9. What are the signs that my child with flu-like symptoms is getting worse?

  • Trouble breathing or fast breathing
  • Not drinking well
  • Not urinating as much as usual
  • Bluish or gray skin color
  • Being irritable even after the fever goes down
  • Not waking up normally or not interacting normally
  • Rash
  • The fever goes down and flu symptoms seem to be getting better, but then get worse again a day or two later

10. Are any medicines recommended to help children with swine flu?

  • Children with influenza should never receive any product that contains aspirin. Acetaminophen (Tylenol) and ibuprofen (Advil and Motrin) are fine to treat fever and body aches in children.
  • Cough and cold medications do not help, and should not be used, especially in young children under 4 years of age.
  • Most adolescents, adults and children do not need antiviral medicines. Overuse of these medications could be counter-productive and lead to resistance.
  • People in high-risk groups may need antiviral medicine, which can help shorten the length of illness when taken soon after the symptoms of the flu start.
  • If your child has more severe influenza symptoms OR is in a high risk group, and you suspect your child has influenza, call your pediatrician. High risk groups include children with asthma, diabetes, another metabolic disease, chronic kidney disease, or sickle cell disease.
  • It is expected that oseltamivir (Tamiflu) will be more effective if taken soon after the onset of symptoms, rather than later in the course of the illness. Based on a recent study, Tamiflu may have more side effects in children than in adults; your pediatrician can help you decide if this medication is right for your child. Zanamivir (Relenza) is not for young children under 7 years of age.
  • The use of antiviral medications is not a substitute for getting a flu vaccine.
  • Your pediatrician will decide when treatment is indicated and which drug is best to treat your child.

The CDC offers advice for taking care of a sick person with swine flu.

11. If my child has flu, how can I keep myself and other family members from getting sick?

  • Keep your sick child in a room separate from other people in the house. Have supplies including a thermometer, clean washcloths, household disinfectant, tissues, a trash can (and liners) available in that “sick” room.
  • Choose 1 adult to care for the sick child and limit visitors to reduce the spread of infection.
  • If possible, the sick person should use a separate bathroom from the other members of the household. The bathroom should be cleaned daily with household disinfectant.
  • When holding a small child who is sick, place the child’s chin on your shoulder so that he or she will not cough in your face
  • Wash your hands with soap and water often, or use an alcohol-based hand gel if soap is not available.
  • Keep surfaces (including toys and bedside table) clean – wipe them down with a household disinfectant.
  • Wash bed sheets and towels with laundry detergent in hot water. Avoid “hugging” the dirty laundry on the way to the washing machine, and wash your hands thoroughly after handling dirty laundry.

12. Is flu more dangerous for very young children?

  • Children under age 2 have a higher risk of complications and hospitalization from influenza than older children.
  • Children of any age who have an underlying medical condition, such as asthma, diabetes, another metabolic disease, chronic kidney disease, or sickle cell disease are also at greater risk of complications.

13. How is the 2009 H1N1 flu (swine flu) different than the "regular" flu?

  • The 2009 H1N1 virus does not appear to be more severe than seasonal flu.
  • Unlike seasonal flu, which tends to cause more significant illness in elderly people and very young children, H1N1 flu (swine flu) is most common in people 5 to 24 years old.
  • While seasonal flu usually peaks in January or February, the 2009 H1N1 virus has caused illness during the spring summer months and remained active into the fall.

14. Should I use antibacterial soaps and/or alcohol-based hand rub products?

  • Washing hands with warm running water and soap (antibacterial soap is fine but not necessary) for at least 20 seconds (the time it takes to sing the “Happy Birthday” song twice) has been shown to kill the flu virus.
  • Alcohol-based rubs can be used when soap and water are not available, such as after hand shaking or touching objects that carry germs. Keep in mind that alcohol-based products are toxic if ingested by children. (The amount left on hands after use is not a concern.) Keep these products out of the reach of children and supervise their use.

15. Are face masks necessary?

  • Handwashing and avoiding close contact with sick people are more important than wearing face masks to prevent the spread of the virus.
  • If you are caring for a child or other person who has swine flu, a face mask can be used to help reduce the chance of spreading germs.
  • Follow the recommendations of local and state public health authorities.

The CDC offers guidance on face masks.

16. Can mothers who have swine flu continue to breastfeed?

  • The influenza virus is not transmitted by breastmilk.
  • Mothers who believe they may be infected should be sure to wash their hands before breastfeeding.
  • Be sure to use clean burp cloths, and consider wearing a face mask.
  • Parents and caregivers of infants under 6 months of age should receive the flu shot to prevent illness.

The CDC offers guidance on breastfeeding with swine flu.