When Children Should be Tested and Treated for H1N1 Flu

By Stan Matthews
County Communications Program Manager

Children are more likely than older adults to have their health jeopardized by H1N1 flu, however most children who come down with the flu will have relatively mild symptoms and not require testing or treatment.

However special attention needs to be paid to children with existing health problems and to otherwise healthy children who develop certain symptoms. Tests available here often do not detect flu infections so when fever and cough or sore throat are present, it should be treated as influenza.

So children with flu symptoms and conditions that put them at increased risk or with the additional symptoms listed below should always be treated with antiviral drugs.

Asthma is the most common condition that requires a higher level of concern. Asthma can predispose a child to a greater risk of hospitalization or even death when infected with H1N1 virus and 5-8 % of the children in our community have asthma.

Very obese children have not formally been added to the at-risk group, however the number of very obese children among those hospitalized as a result of the H1N1 flu is significant.

Other Conditions that should trigger testing and treatment.

1. Neurological disorders including epilepsy, cerebral palsy, brain or spinal cord injuries and neuromuscular disorders such as muscular dystrophy.
2. Chronic respiratory diseases including those associated with impaired pulmonary function, difficulty handling secretions and children requiring oxygen, tracheostomy, or a ventilator.
3. Moderate to profound mental retardation or developmental delay.
4. Deficiencies in immune function or conditions that require medications or treatments that result in significant immune deficiencies
5. Cardiovascular disease including congenital heart disease
6. Significant metabolic (e.g., mitochondrial) or endocrine disorders
7. Kidney, liver or blood disorders (including sickle cell disease)
8. Children receiving chronic aspirin therapy

Caregivers of any child should contact the child’s healthcare provider if symptoms worsen (e.g., shortness of breath, persistant fever) or if the caregiver has further questions or concerns about the child’s health. (Answer to general questions about H1N1 is available 24 hours/day in San Juan County by dialing 2-1-1.)

Symptoms that should trigger testing and treatment for any child with influenza like illness.

1. Fast breathing (see below) or difficulty breathing or retractions present
2. Dehydration (no urine output in 8 hours, decreased tears or no tears when child is crying, or not drinking enough fluids)
3. Severe or persistent vomiting/unable to keep fluids down
4. Lethargy (excessive sleepiness, significant decrease in activity level, and/or diminished mental status)
5. Irritability, cranky, restless behavior – the child does not want to be held or wants to be held all the time)
6. Flu-like symptoms improve but return or worsen within one or a few days
7. Chest or abdominal pain (for 5 years or older who can reliably report)
8. Fast breathing or difficulty breathing
9. Dizziness or lightheadedness
10. Severe or persistent vomiting/unable to keep fluids down
11. Pain in the chest or abdomen

Definition of “Fast Breathing”

Age                      Respiratory rate

Birth up to 3months  > 60/min

3 months up to 1 year    > 50/min

1 to < 3 years          > 40/min

3 to < 6 years          > 35/min

6 to <12 years         > 30/min

12 to 18 years          > 20/min

Additional information on caring for children and adults who H1N1 or flu-like symptoms is available on San Juan County’s web site at https://sanjuanco.com/flu