(Yes, it’s that time of year), by Jerry Byrum M.D. 

We are now routinely seeing children with influenza infection (the flu) in our office.  Kids with the flu usually develop high fever, achey muscles, head ache, tummy ache, chills, rigors, congestion, and cough.  A child with the flu will generally stop playing, lie in bed and cover up with a blanket.  I have come to call this the “flu look”.  Below is a description of the flu and what to do about it.


The flu is a highly contagious viral infection of the respiratory tract. Influenza viruses are from the virus family of orthomyxoviruses of three different types (A, B, and C).  They affect both sexes and all age groups, but their highest incidence is in school children. Although in Arkansas our most recent outbreaks have been in November and December, most outbreaks of the flu tend to occur in the winter and early spring when as many as 10 to 40% of the childhood population canbecome infected. Sometimes, schools have to be closed to control theseepidemics.  Flu epidemics areusually caused by Influenza types A and B.  Because the genetic material in this family of viruses isknown to slightly change periodically, people who have had the flu or the flu vaccine in the past can be susceptible to infection with a type of influenza with which they were previously infected or immunized.  This ability of the virus to change its makeup causes the immune system of the body not to recognize the virus as aninfection which the body has fought off in the past.  This ability of the virus to change leads to periodic epidemics.

Signs and Symptoms:

After an incubation period of 1 to 3 days, an Influenza illness is generally characterized by the sudden onset of fever, frequently with chills or rigors,headache, feelings of tiredness, muscle aches, and a dry cough.  Then, the respiratory signs of sorethroat, nasal congestion, and cough become more prominent.  Less commonly, eye redness and watery discharge, abdominal pain, nausea, and vomiting can also be present with the“flu”.  In some children, influenzacan have the appearance of a simple “cold virus” or it can appear as a feverillness with few respiratory signs. In newborn babies and very young infants, influenza can produce a variety of symptoms which can be more serious.  The infection can look like sepsis in a young infant (a severe, generalized bacterial infection) requiring several tests to investigate this possibility.  Besides theabove routine symptoms of the flu, it can occasionally cause croup, apnea, orpneumonia in these infants.

Someolder children with the flu can have a tendency to develop tenderness of the calf portion of the leg and refuse to walk.  This symptom of the flu may develop several days into the influenza illness.  This is especially prone to happen with Influenza type B infections.  Reye syndrome, a severe disease producing inflammation of the brain and liver, has been associated primarilywith influenza B, but also with influenza A infection.  The development of Reye syndrome inpeople infected with the flu has been associated with the consumption of aspirin.  Obviously you should nottake aspirin if you have the flu to avoid this potential complication.

How It Is Spread:

Influenza is spread from person to person by direct contact,large droplet infection (as from a sneeze), or from articles recently contaminated by nasal secretions. During an outbreak of influenza, the highest attack rates occur in school-age children.  Secondary spread to adults and other children within the family is very common.  The attack rates depend in part on the immunity developed by previous experience (either by natural disease or immunization)with the particular strain of the virus which is encountered.  In Arkansas, our flu epidemics usually occur during the winter months, and peak within 2 weeks of onset of the epidemic and last 4 to 8 weeks or longer. In recent years, activity of two or three types of influenza virus has been common and associated with a prolongation of the influenza season to 3 months or more.  Influenza is highly contagious, especially among institutionalized populations.  People with the flu are most infectiousin the 24 hours before the onset of symptoms and during the period of peak symptoms.  They usually remain contagious until 7 days from the onset of illness have past.  However, the contagiousness of the flucan last longer in young children and immuno-deficient patients.


After five days, fever and other symptoms have usually disappeared. But a cough and weakness may persist for several more days. All symptoms are usually gone within seven to 14 days. Pneumonia, sinusitis, and ear infections are occasional complications of the flu.


Because the flu is a viral illness,antibiotics don’t help.  There are flu medications which can shorten the duration of the illness if begun within 24 to 48 hours of the onset of the illness.  Antiviral flu medications such as Tamiflu can be used.  The CDC recommends Tamiflu (or other antiviral medication) for:

  1. Severe, complicated, or progressive disease
  2. Hospitalized patients
  3. Children less than two years of age
  4. Adults over age 65 years
  5. Persons with the following conditions:
    1.  Pulmonary conditions such as asthma
    2. Heart conditions
    3. Kidney conditions
    4. Liver disease
    5. blood disorder such as Sickle cell anemia
    6. brain and spinal cord disorders
    7. metabolic disorders including diabetes mellitus
  6. Immunosuppressed people (including AIDS)
  7. Pregnant women or post-partum women
  8. people under 19 who are on chronic aspirin therapy
  9. American Indians and Alaskan Native
  10. Obese individual with a body mass index greater than 40
  11. Nursing home resident and other chronic care facilities

Therefore, if your child is less than two years of age, consult us quickly for the treatment of the flu with an anti-viral medication in the first 24 to 48 hours of illness.  Older children who are healthy and don’t fall into the categories listed above need only time and some tender loving care to get over the illness.  If your child is over the age of two and has a medical condition, consult us quickly with the development of fever.  A flu medication is needed.  To treat the flu, give extra fluids and have your child eat nutritious carbohydrate rich foods.   Try to treat your child’s fever only if the fever makes your child very uncomfortable.  Fever helps a person get over the flu quicker.

Lastly, it is better to prevent the flu than to treat it.  It is still not too late to take a flu shot this year.