Children - FAQs:

Certain groups of children are at increased risk for seasonal flu complications. Children at greater risk of serious flu-related complications include:

1. Children younger than 6 months old

The flu vaccine is not approved for use in infants younger than 6 months old; however, the risk of flu complications is higher in these young infants than it is for any other child age group. The best way to protect children younger than 6 months is to make sure members of their household and their caregivers are vaccinated.

2. Children aged 6 months up to their 5th birthday

It is estimated that each year in the U.S., there are more than 20,000 children younger than 5 years old who are hospitalized due to flu. Even children in this age group who are otherwise healthy are at risk simply because of their age. In addition, children 2 years of age up to their 5th birthday are more likely to be taken to a doctor, an urgent care center, or the emergency room because of flu than healthy older children. To protect their health, all children 6 months and older should be vaccinated against the flu each year. Vaccinating young children, their families, and other caregivers can also help protect them from getting sick.

3. Children aged 6 months and older with chronic health problems, including:

• asthma or other problems of the lungs;
• immune suppression;
• chronic kidney disease;
• heart disease;
• HIV/AIDS
• diabetes;
• sickle cell anemia; or
• long-term aspirin therapy;
• any condition that can reduce lung function (cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders).

Febrile seizures can occur when a child is sick with influenza virus infection or other childhood illnesses that may cause fever, and therefore, are usually seen during cold and flu season in the United States. However, several studies of children in the United States have shown no increased risk for febrile seizures following receipt of seasonal flu vaccines.

One study evaluated more than 45,000 children aged 6 months through 23 months of age who received influenza vaccines during 1991 through 2003 and did not find an association with seizures. In addition, there was no indication that seasonal flu vaccines or the 2009 H1N1 flu vaccines used in the United States during the 2009-2010 flu season were associated with an increased risk of febrile seizures.

However, during the 2010 influenza season in the Southern Hemisphere, febrile seizures were found to be associated with one formulation of influenza vaccine produced by CSL. Although this vaccine is not recommended for children in the United States, systems are in place to monitor adverse events, including seizures, after seasonal flu vaccines.

Students and staff with symptoms of flu should stay home for at least 24 hours after they no longer have fever or do not feel feverish, without using fever-reducing drugs.  

Sick people should stay at home, except to go to the doctor’s office, and should avoid contact with others. Keeping people with a fever at home may reduce the number of people who get infected. Because high temperatures are linked with higher amounts of virus, people with a fever may be more contagious.

If flu conditions become more severe, CDC recommends that a sick person stay home for 7 days. A person who is still sick after 7 days should stay home until 24 hours after the symptoms have gone away.  In addition, this longer period should be used in health care settings and in any place where a high number of high-risk people may be exposed, such as childcare facilities for children less than 5 years of age.

Reported side effects of oseltamivir are nausea and vomiting. Among children treated with oseltamivir in clinical studies, 14% had vomiting, compared with 8.5% of children getting a “placebo.” (A placebo is an inactive substance that looks the same as, and is given in the same way as, a drug in a clinical trial.) Nausea and vomiting might be less severe if oseltamivir is taken with food.

In addition, there have been reports of self-injury or delirium among persons with influenza who take oseltamivir. Most of these reports have been in teenagers from Japan, and it is still not certain whether oseltamivir or the influenza virus was responsible for these behavior changes. The U.S. Food and Drug Administration advises that people taking either of the two medications recommended for influenza (oseltamivir and zanamivir) be monitored closely for abnormal behavior.

Side effects from zanamivir have been reported in fewer than 5% of people participating in clinical trials and have been reported at the same rate in people receiving zanamivir as those being given a “placebo.” Reported side effects have included diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose, and throat infections. Also, zanamivir should not be used in people with underlying respiratory disease, including asthma.

Children at increased risk of pneumococcal infections include those with anatomic or functional asplenia (including sickle cell disease), patients taking immunosuppressive chemotherapy, those with congenital and acquired immune deficiency (including HIV infections), those with chronic renal disease and healthy Native American, Alaskan Native, and African American children. Children less than 60 months of age in out-of-home child care are at 2-3 fold higher risk of experiencing invasive pneumococcal infections than children in home care.

If you or someone you know has a baby that may be sick, it is very important to take the baby for medical assessment.

The symptoms of the flu include:

• fever,
• lethargy (lack of energy),
• lack of appetite, and
• coughing.

Some people with flu from seasons past have also reported:

• runny nose,
• sore throat,
• nausea,
• vomiting, and
• diarrhea.

In children, emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve, but then return with fever and worse cough

The flu can vary in severity from mild to severe. Severe disease with pneumonia (a lung infection), respiratory failure, and even death is possible with flu infection. Certain groups might be more likely to develop a severe illness from flu infection, including children younger than 5 years old. Sometimes bacterial infections may occur at the same time as or after infection with flu viruses and lead to pneumonias, ear infections, or sinus infections.

Also, persons with a flu virus infection should be considered potentially contagious (able to spread disease) for up to 7 days after illness onset. Persons who continue to be ill longer than 7 days should be considered potentially contagious until symptoms have resolved. Children, especially younger children, might be contagious for longer periods. People who are sick should stay home until at least 24 hours after they no longer have a fever (100°F or 37.8°C) or signs of a fever (without the use of a fever-reducing medicine, such as Tylenol®). Read detailed information about how long to stay away from others.

Flu is more dangerous than the common cold for children. Each year, seasonal flu places a large burden on the health and well-being of children and families.

• Children commonly need medical care because of influenza, especially before they turn 5 years old.
• Each year an average of 20,000 children under the age of 5 are hospitalized because of influenza complications.
• Some children will die from the flu each year. During the 2007-08 flu season, CDC received reports that 86 children died from influenza-related complications.
• Severe influenza complications are most common in children younger than 2 years old.
• Children with chronic health problems like asthma and diabetes are at especially high risk of developing serious flu complications.

This year there is a new and very different flu virus spreading worldwide among people called 2009 H1N1 flu. This virus may cause more illness or more severe illness than usual. Children are at high risk from this influenza virus as well.

Yes, prior to an outbreak, employers may inquire which employees may need to stay home, telework or work an alternate schedule to care for children in the event students are dismissed from school and child care centers are closed.  

Please keep in mind that asking employees questions, prior to a pandemic, about their health conditions or related absenteeism may raise issues under the Americans with Disabilities Act¹ (ADA).

Although there are no Federal privacy laws that are applicable in these circumstances, there may be state laws governing privacy of which you should be aware.  It is recommended that prior to any pandemic influenza outbreak, you consult with legal counsel and human resource specialists to develop a plan of action specific to your workplace.

_______________________________

¹The EEOC enforces Title I of the ADA.  The ADA’s provisions in regards to disability-related inquiries, medical examinations, and confidentiality apply to all applicants and employees of covered employers, regardless of whether those individuals have disabilities, as defined by the ADA.  By contrast, other ADA requirements apply only if an applicant or an employee is an individual with a disability under the ADA.

It cannot be definitively established in advance, however, whether a future pandemic influenza would rise to the level of a disability under the ADA.  Therefore, this answer provides guidance for employers that would comport with the ADA even if a future pandemic illness was found to be an ADA disability.

Note: As an overall matter, employers should be guided in their relationship with their employees by federal, state, and local employment law, and by the company-specific application of these laws as reflected in employee handbooks, manuals, and contracts (including bargaining agreements).

Not all of the employment laws referenced apply to all employers or all employees, particularly state and local government agencies.  For information on whether a particular employer or employee is covered by a law, please use the links provided for more detailed information.  This information is not intended for federal agencies or federal employees -- they should contact the U.S. Office of Personnel Management (OPM) for guidance.

Antibiotics have no effect on any type of influenza vaccine.

In general you should always talk to your doctor before getting a flu shot if you:

If you are sick with a fever when you go to get your flu shot, talk to your doctor or nurse about getting your shot at a later date. However, you can get a flu shot if you have a respiratory (breathing) illness without a fever; or if you have another mild illness

• Have ever had a severe allergic reaction to eggs;
• Have ever had a severe allergic reaction to a previous flu shot
• Have a history of Guillain-Barré syndrome (GBS)

If you have questions or concerns about your child getting the seasonal flu vaccine (or any) vaccine, talk with their doctor.

Anyone with asthma is at higher risk for flu-related complications, such as pneumonia. Along with everyone else, if your child has asthma you should:

• Follow an updated, written Asthma Action Plan developed with your doctor. Follow this plan for daily treatment and for controlling your asthma symptoms.
   
• Make sure that his or her updated, written Asthma Action Plan is on file at school and/or at the child care center. Be sure that the plan and medication(s) are easy to get to when needed.
   
• Everyone with asthma who is older than 6 months should get a flu shot every year to protect against the seasonal flu. Children aged 6 months to 8 years who never have had a seasonal flu shot may need two doses the first time. Persons with asthma should not use the inhaled "FluMist®" vaccine.
   
• Certain antiviral drugs, prescribed by health care professionals, are medicines that fight the flu virus by stopping it from growing in your body. They make you feel better faster and may prevent serious flu problems. Flu treatments work best if they start within two days of when you get flu-like illness.
   
• Persons with flu infections might also get bacterial infections. These persons will also need to take antibiotics to fight the bacterial infection. Some signs of bacterial infection are severe or prolonged illness, or illness that seems to get better but then gets worse.
   
• Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu. This can cause a rare, but serious, illness called Reye’s syndrome.