Tag: flu symptoms

Does My Child Need a Flu Test?

Your child has a fever, cough, runny nose, body aches and chills.

Should you rush them to your pediatrician for a flu test?

Diagnosing the Flu with a Flu Test

While you may want to seek medical attention, depending on your child’s age and how sick they are, believe it or not, you don’t need a flu test to get diagnosed with the flu.

“If your doctor needs to know for sure whether you have the flu, there are laboratory tests that can be done.”

CDC on Diagnosing Flu

A flu test is an option though.

Most people do not need a flu test.
Most people do not need a flu test.

Is it a good option?

A necessary option?

“Most people with flu symptoms are not tested because the test results usually do not change how you are treated.”

CDC on Diagnosing Flu

While a diagnosis of the flu can be made clinically, based on your symptoms, a flu test can be a good idea:

  • to help determine the cause of an outbreak (mostly if there aren’t already a lot of flu cases in your area)
  • if someone is at high risk for flu complications

In general though, most people do not need a flu test, especially during the active part of flu season.

What’s the problem with doing a flu test?

“In January 2017, the FDA reclassified antigen-based RIDT systems into class II. This reclassification was to help improve the overall quality of flu testing. The reclassification was prompted, in part, by recognition that the poor sensitivity of some of antigen-based RIDTs resulted in misdiagnosed cases, and, according to anecdotal reports, even death.”

FDA on CLIA-Waived Rapid Flu Test Facts

Mostly, they are neither as accurate nor as easy to interpret as most folks think, even the newer versions of these tests.

Have you ever heard someone say that they tested positive for both flu A and flu B?

When a flu tests is positive for both A and B flu strains, it invalidates the test. They may have had either flu A or flu B or neither, but they almost certainly didn’t have both.

The antigen-based rapid flu tests that most doctors and clinics use, which give results in 10 or 15 minutes, are also prone to both false positive (you don’t really have the flu, even though your test was positive), and more commonly, false negative (you actually do have the flu, even though your test was negative) results, depending if flu is active at the time.

Other flu tests are available, but are more expensive and take longer to get results, so aren’t used as often. These include “rapid” nucleic acid detection based tests that can be done in a doctor’s office, rapid nucleic acid detection based tests and rapid influenza diagnostic tests that are done in a central lab, PCR tests, and viral cultures.

So why do so many people rush to the doctor to get a flu test?

Many think that if they are positive, then they can take Tamiflu or another flu medicine and get better faster.

The problem with thinking like that is that few people actually need to take Tamiflu, as at best, it only helps you get better about a day quicker than if you didn’t take it. That’s why the recommendations for Tamiflu say to reserve it for children under two to five years of age and others who might be at high risk for flu complications.

Since most other people don’t need to take Tamiflu, they don’t necessarily need a flu test or a definitive diagnosis of the flu. Again, even if they did need Tamiflu, the diagnosis of the flu could be made clinically.

And even more importantly, a negative flu test doesn’t necessarily mean that you don’t really have the flu, especially if you have classic flu symptoms in the middle of flu season. Again, a negative flu test could be a false negative.

“RIDTs may be used to help with diagnostic and treatment decisions for patients in clinical settings, such as whether to prescribe antiviral medications. However, due to the limited sensitivities and predictive values of RIDTs , negative results of RIDTs do not exclude influenza virus infection in patients with signs and symptoms suggestive of influenza. Therefore, antiviral treatment should not be withheld from patients with suspected influenza, even if they test negative.”

CDC on Guidance for Clinicians on the Use of Rapid Influenza Diagnostic Tests

Have you ever had a negative flu test and the doctor still gave you Tamiflu? Then why did they do the test?

Diagnosing the Flu Without a Flu Test

If the results of flu testing aren’t going to change how you are treated, then you probably don’t need to have the flu test done in the first place.

Plus it saves you from having a swab stuck up your nose.

But kids should have flu tests, right?

Although rapid flu tests might be a little more accurate in kids than adults, it is not by much, so you are left with the same issues.

A positive test might reassure you that it really is the flu, but your child could still have the flu if their test is negative. A diagnosis and treatment decision can be made clinically, without a flu test, remembering that most older, healthy kids don’t need to be treated with Tamiflu.

We can’t skip flu season (although we sure can try if we get vaccinated and protected), but we can try and skip flu testing season.

More on Flu Tests

It’s Not Always the Flu When You Get Sick During Cold and Flu Season

We hear a lot about flu season.

It typically starts in late fall, peaks in mid-to-late winter, and can continue through early spring.

Cold and Flu Season Viruses

It’s important to understand that a lot more is going on, and going around, during flu season than just the flu.

That’s why it is likely more appropriate to think of flu season as just a part of the overall cold and flu season that we see during the late fall to early spring.

During cold and flu season, in addition to the multiple strains of the flu, we see diseases caused by:

  • respiratory adenovirus – can cause bronchitis, colds, croup, viral pneumonia, pink eye, and diarrhea
  • Human metapneumovirus (HMPV) – can cause bronchiolitis, colds, and viral pneumonia
  • Human parainfluenza viruses (HPIVs) – can cause bronchiolitis, bronchitis, colds, croup, or viral pneumonia
  • rhinovirus – the classic common cold
  • Respiratory syncytial virus (RSV) – can cause wheezing and bronchiolitis in younger children, but colds in older kids and adults
  • seasonal coronavirus – can cause colds, bronchitis, and viral pneumonia
  • norovirus – diarrhea and vomiting
  • rotavirus – diarrhea and vomiting, was much more common in the pre-vaccine era

That there are so many different respiratory viruses that can cause bronchiolitis, colds, croup, and flu-like illnesses helps explain why some kids get sick so many times during cold and flu season.

It also helps explain why some folks think they might have gotten the flu despite having been vaccinated, especially in a year when the flu vaccine is very effective.

Is It a Cold or the Flu?

So how do you know if you have the flu or one of these flu viruses during cold and flu season?

Signs and symptoms of the flu vs a cold.
Signs and symptoms of the flu vs a cold.

While the symptoms can be similar, flu symptoms are usually more severe and come on more suddenly.

Can’t you just get a flu test?

While rapid flu tests are fast and easy to do, they are likely not as accurate as you think.

“This variation in ability to detect viruses can result in some people who are infected with the flu having a negative rapid test result. (This situation is called a false negative test result.) Despite a negative rapid test result, your health care provider may diagnose you with flu based on your symptoms and their clinical judgment.”

CDC on Diagnosing Flu

If your pediatrician is going to diagnose your child with the flu because of their symptoms, even if they have a negative flu test, then why do the test?

Rapid flu tests are usually invalid if they are positive for A and B, but many folks are told that they have both.
Rapid flu tests are usually invalid if they are positive for A and B, but many folks are told that they have both flu virus strains.

Can you test for all of the other viruses that are going around during cold and flu season?

Tests can be done to detect most cold and flu viruses.
Tests can be done to detect most cold and flu viruses.

Sure.

The real question is should you.

Like the rapid flu test, many pediatricians can do an RSV test in their office. But like many other viruses, there is no treatment for RSV and the American Academy of Pediatrics actually recommends against routine RSV testing. Whether your child’s test is positive or negative, it is not going to change how he or she is treated.

And the other viruses? Not surprisingly, there are respiratory panels that can test for most or all of these viruses. They also usually include flu and RSV.

The problem with these tests is cost. They are not inexpensive, and again, in most cases, the results aren’t going to change how your pediatrician treats your child.

And they all involve sticking a nasal swab far up your child’s nose…

What About Strep?

While strep throat can occur year round, it does seem to be more common in the winter and spring.

And while you can certainly have two different infections at the same time, such as strep throat and the flu, it is important to remember that the rate of strep throat carriers is fairly high. These are kids who regularly test positive for strep, even though they don’t have an active group A strep infection.

During cold and flu season, if kids routinely get a “strep/flu” combo test, it is possible, or even likely, that many of the positive strep tests are simply catching these carriers.

Remember that a cough, runny nose, hoarse voice, and pink eye are not typical symptoms of strep throat and are more commonly caused by cold viruses. Adenovirus is especially notorious for causing a sore throat, fever, pink eye, runny nose, with swollen lymph nodes = pharyngoconjunctival fever.

Kids who are likely to have strep throat usually have a sore throat, with red and swollen tonsils, and may have swollen lymph nodes, fever, stomach pain, and vomiting, but won’t have typical cold symptoms.

Why does it matter?

Viral causes of a sore throat don’t need antibiotics, while a true strep infection does.

And remember that none of the other cold and flu viruses need antibiotics either, unless your child gets worse and develops a secondary bacterial infection.

What to Know About Cold and Flu Season Viruses

Flu isn’t the only virus that is going around during cold and flu season. Many others can cause flu-like illnesses, croup, bronchiolitis, or just a cold.

More on Cold and Flu Season Viruses

How Long Are You Contagious When You Have the Flu?

Do your kids have the flu?

When their kids have the flu, one of the first questions most parents have, after all of the ones about how they can get them better as quickly as possible, is how long will they be contagious?

How Long Is the Flu Contagious?

Technically, when you have the flu, you are contagious for about a week after becoming sick.

And you become sick about one to four days after being exposed to someone else with the flu – that’s the incubation period.

“Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.”

CDC on Information for Schools

That’s why the flu spreads so easily and it is hard to control flu outbreaks and epidemics once they begin.

Most school closures are not to prevent the spread of the flu and clean the school, but simply because so many kids and staff are already out sick.
Most school closures are not to prevent the spread of the flu and clean the school, but simply because so many kids and staff are already out sick.

Another reason it spreads so easily is that most people are contagious the day before they even begin to develop flu symptoms!

And again, they then remain contagious for another five to seven days.

When Can You Return to School with the Flu?

Does that mean kids with the flu have to stay home for at least seven days?

Not usually, unless they have a fever for that long, or severe flu symptoms, which is definitely a possibility for some kids with the flu.

“Those who get flu-like symptoms at school should go home and stay home until at least 24 hours after they no longer have a fever or signs of a fever without the use of fever-reducing medicine.”

CDC on Information for Schools

In general, as with many other childhood illnesses, you can return to school or daycare once your child is feeling better and is fever free for at least 24 hours.

Keep in mind that even if they don’t have a fever, if your child still isn’t feeling well and isn’t going to be able to participate in typical activities, then they should probably still stay home.

But Are They Still Contagious?

Many childhood diseases have contagious periods that are far longer than most folks imagine. That’s because we continue to shed viral particles even as we are getting better, and sometimes, even once we no longer have symptoms.

Teach your kids proper cough etiquette to help keep cold and flu germs from spreading.
Teach your kids proper cough etiquette to help keep cold and flu germs from spreading.

For example, some infants with rotavirus are contagious for up to 10 days and some with RSV are contagious for as long as 4 weeks!

Like the child with flu that doesn’t have a fever, that doesn’t mean that these kids have to stay out of school or daycare for that whole time. But since they are still contagious, it does raise the issue of what to do about non-essential activities.

Should you keep going to playdates after your child had the flu? How about the daycare at church or the gym?

In general, you should probably avoid non-essential activities while your kids are still recovering from an illness, even if they feel better, because they are likely still contagious.

Most parents have the expectation that their own kids won’t be exposed to someone who is sick in these settings.

So you probably don’t want to bring your sick kid to a playdate or birthday party, etc., even if he is already back in school or daycare.

And whether they have a cold or the flu or another illness, teach your kids to decrease their chances of getting sick by washing their hands properly, not sharing drinks (bring a water bottle to school), and properly covering their own coughs and sneezes. They should also learn to avoid putting things in the mouth (fingers or their pencil, etc.) or rubbing their eyes, as that helps germs that could have made their way onto their hands get into their body and make them sick.

What to Know About Staying Home When You Have the Flu

Although your child may be contagious with the flu for up to a week, your child only has to stay home from school or day care until they are feeling better and are fever free for at least 24 hours.

More About Staying Home When You Have the Flu

 

Warning Signs of a Severe Case of the Flu

We all know the classic signs and symptoms of the flu.

They can include the sudden onset of:

  • fever
  • chills
  • cough and chest discomfort
  • headaches
  • fatigue
  • body aches
  • runny nose
  • sore throat

And these symptoms usually last a few days to a few weeks, with the worst of them lasting about five to seven days.

Warning Signs of a Severe Case of the Flu

But what if you don’t just have a classic case of the flu.

While many of the stories of this being the worst flu season are media hype, the flu is always dangerous and this is a severe flu season.

That makes it important to be able to recognize severe flu symptoms or signs that someone with the flu needs immediate medical attention, including:

  • having trouble breathing or fast breathing
  • being unable to eat and drink and getting dehydrated (dry mouth, urinating less, or fewer wet diapers, etc.)
  • not waking up easily
  • being inconsolable or so irritable that your child does not even want to be held
  • having chest pain
  • is suddenly dizzy
  • being confused
  • having seizures
  • having severe vomiting

You should also seek medical attention if your child was getting better, but then got worse again, especially if they again develop a fever and a worsening cough. Or if your child has a chronic health problem, like asthma or diabetes, and the flu is making it hard to control.

How will your child be treated? It depends, on treatments might include oxygen, IV fluids, antiviral medications, and antibiotics (if there is a secondary bacterial infection), etc.

And remember that children under the age of two to five years and those with chronic health conditions, such as asthma, diabetes, neurologic and neuromuscular conditions, and heart disease, etc., are most at risk for severe flu complications.

In four of the last deadliest flu seasons, at least half of the kids had no underlying medical conditions.
In four of the last deadliest flu seasons, at least half of the kids had no underlying medical conditions.

But you don’t have to be at high risk to develop flu complications.

Many of the kids who die with the flu each year don’t have any underlying health problems.

PedFluDeath_Characteristics-ages
And at least half of the kids who die with flu complications are school age children and teens.

Anyone, even previously healthy kids, can develop pneumonia, myocarditis, encephalitis, or septic shock, etc., so get help if you see any of the above signs and symptoms that your child with the flu is getting worse.

And get your kids vaccinated. Tragically, most kids who die with the flu each year didn’t have a flu shot.

What to Know About the Warning Signs of a Severe Case of the Flu

Seek medical attention if your child’s flu symptoms are getting worse, especially if it seemed they were getting better, but then got worse again, which can all be signs of complications of a severe flu case.

More on the Warning Signs of a Severe Case of the Flu

Treating the Flu and Hard to Control Flu Symptoms

It is much easier to prevent the flu with a flu shot than to try and treat the flu after you get sick.
It is much easier to prevent the flu with a flu shot than to try and treat the flu after you get sick.

Unfortunately, like most upper respiratory tract infections, the flu is not easy to treat.

What are Flu Symptoms?

While a cold and the flu can have similar symptoms, those symptoms are generally more intense and come on more quickly when you have the flu.

These flu symptoms can include the sudden onset of:

  • fever and chills
  • dry cough
  • chest discomfort
  • runny nose or stuffy nose
  • sore throat
  • headache
  • body aches
  • feelings of fatigue

And more rarely, vomiting and diarrhea.

In contrast, cold symptoms come on more gradually and are more likely to include sneezing, stuffy nose, sore throat, and mild to moderate coughing. A cold is also less likely to include a headache, fatigue, chills, or aches. And while either might have fever, it will be more low grade with a cold.

As with other infections, flu symptoms can be very variable. While some people might have a high fever, chills, body aches, constant coughing, and can hardly get out of bed, others might have a low grade fever and much milder symptoms.

That variability also applies to how long the flu symptoms might last. Some people are sick for a good 7 to 10 days, while others start to feel better in just a few days.

Treating Flu Symptoms

Although there aren’t many good treatments for the flu, that variability in flu symptoms makes it hard to even know if any you try really work.

For kids older than 4 to 6 years and adults, you could treat symptoms as necessary, including the use of decongestants and cough suppressants.

And of course, almost everyone might benefit from pain and fever relievers, drinking extra fluids, and rest, etc.

Treating the Flu

In addition to symptomatic flu treatments, there are also antiviral drugs that can actually help treat your flu infection.

These flu medications include oseltamivir (Tamiflu), zanmivir (Relenza), and peramivir (Rapivab). Of these, oral Tamiflu is the most commonly used. It can also be used to prevent the flu if taken before or soon after you are exposed to someone with the flu.

“If liquid Tamiflu is not available and you have capsules that give the right dose (30 mg, 45 mg or 75 mg), you may pull open the Tamiflu capsules and mix the powder with a small amount of sweetened liquid such as regular or sugar-free chocolate syrup. You don’t have to use chocolate syrup but thick, sweet liquids work best at covering up the taste of the medicine.”

FDA – Tamiflu: Consumer Questions and Answers

Unfortunately, these flu drugs are not like antibiotics you might take for a bacterial infection. You don’t take Tamiflu and begin to feel better in day or two. Instead, if you take it within 48 hours of the start of your flu symptoms, you might “shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza.”

At best, you are likely only going to shorten your flu symptoms by less than a day. And considering the possible side effects of these medications and their cost, they are often reserved for high risk patients, including:

  • children who are less than 2 years old
  • adults who are at least 65 years old or older
  • anyone with chronic medical problems, including asthma, diabetes, seizures, muscular dystrophy, morbid obesity, immune system problems, and those receiving long-term aspirin therapy, etc.
  • pregnant and postpartum women
  • anyone who is hospitalized with the flu
  • anyone with severe flu symptoms

That means that most older children and teens who are otherwise healthy, but have the flu, don’t typically need a prescription for Tamiflu. The current recommendations don’t rule out treating these kids though.

“Antiviral treatment also can be considered for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset.”

Antiviral Agents for the Treatment and Chemoprophylaxis of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP)

There is a lot of controversy surrounding the use of Tamiflu and other anti-viral flu medications, with some studies and many experts thinking that they should rarely be used, if ever, stating that they are not as useful as others claim. Others state that while they not perfect, they are all we have, and there is enough evidence to recommend their use.

Treating Hard to Control Flu Symptoms

Instead of learning about treating hard to control flu symptoms, which might require medical attention, it is probably much more important to learn how to recognize these severe flu symptoms that might be hard to control.

Your child’s flu might be getting worse and require quick medical attention if you notice:

  • fast or hard breathing
  • complaints of chest pain
  • that it is hard to wake up your child
  • irritability to the point that your child is not consolable
  • signs of dehydration because your child won’t drink any fluids
  • that your child is complaining of being dizzy or is feeling lightheaded

You might also need to seek medical attention if your child with the flu was getting better, but then worsens again, with the return of a fever and more severe coughing, etc.

What to Know About Treating the Flu and Flu Symptoms

In addition to basic symptomatic care for your child’s flu symptoms, including the fever, cough, and runny nose, etc., Tamiflu can be an option to treat high risk kids with the flu.

And remember that it is recommended that everyone who is at least six months old should get a yearly flu vaccine.

More Information on Treating Hard to Control Flu Symptoms