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Image: Michael Dudas, MD, Chief of Pediatrics, Virginia Mason Medical Center
Michael Dudas, MD
Chief of Pediatrics,
Virginia Mason
Below are some commonly asked questions and answers about children and H1N1 flu. Also, use the following resources to find more information about H1N1 vaccine availability and distribution:

Or call Virginia Mason's flu hotline for the latest updates at (888) 625-5515.

Children and H1N1

  1. What are the recommendations for protecting children from H1N1 flu?
  2. Should my children get the H1N1 and the seasonal flu vaccines?
  3. When does my child need the booster?
  4. If no vaccine is available for a booster, is my child protected?
  5. If my child gets the first vaccine in the injectable form, can the booster be the nasal form? And vice-versa?
  6. If my child is sick, can he or she get the vaccine?
  7. If my child has a chronic condition, should he or she receive the injectable or nasal form of the vaccination?
  8. Is the thimerosal in the H1N1 vaccine safe?
  9. What can I do to help prevent my children from getting the flu?
  10. What are the symptoms of the flu?
  11. When should I call the doctor?
  12. Is Tamiflu an effective option for a child with flu?
  13. What should I do if my children come down with the flu?

1. What are the recommendations for protecting children from H1N1 flu?
First, the prevention, symptoms and treatment of H1N1, seasonal flu and other flu-like illnesses are similar. Usually, you won't know which of them you are dealing with, but the guidance here, except if otherwise noted, apply to the full range of flu and flu-like illnesses.

2. Should my children get the H1N1 and the seasonal flu vaccines?
People between the ages of 6 months and 24 years should get both seasonal and H1N1 vaccines. Health officials recommend that children under the age of 10 (for H1N1 vaccine) and 9 (for seasonal flu vaccine) receive two doses of vaccine, separated by four weeks, if this is the first time receiving either vaccine. Every attempt should be made to obtain the second dose to achieve full protection. More vaccine is on its way, so people should check regularly with their doctor, school and local health departments.

Infants younger than 6 months are too young to get the 2009 H1N1 and seasonal flu vaccines. To protect them, ensure that family members wash their hands often. Keep babies away from close contact with sick people.

3. When does my child need the booster?
CDC recommends the two doses of 2009 H1N1 vaccine be separated by at least 28 days. 

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4. If no vaccine is available for a booster, is my child protected?
Many children receive some immunity from the first dose, though protection for children is significantly better after they have received two doses.

5. If my child gets the first vaccine in the injectable form, can the booster be the nasal form? And vice-versa?
No. The first vaccine and the booster should be the same vaccine type.

6. If my child is sick, can he or she get the vaccine?
Most vaccines can be administered even when your child has a mild illness or is recovering from an illness. If it seems like more than a mild illness, check with your provider.

7. If my child has a chronic condition, should he or she receive the injectable or nasal form of the vaccination?
With most chronic health conditions, it is recommended that children receive the injectable form. The nasal form is approved for healthy children over the age of 2 years.

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8. Is the thimerosal in the H1N1 vaccine safe?
Although some in the public are concerned about health risks from thimerosal, a preservative used in vaccines to prevent bacterial contamination, it has never been shown to cause autism or any health problems. An exhaustive 2004 report by the Institute of Medicine of the National Academies of Science concluded that thimerosal in vaccines does not cause autism, a conclusion also reached by countries around the world. The American Academy of Pediatrics, the Centers for Disease Control and Prevention and the Institute of Medicine have concluded, based on scientific data, that thimerosal-containing vaccines are safe.


9. What can I do to help prevent my children from getting the flu?

  • Make sure your children wash their hands often with soap and water for 20 seconds or by using hand-sanitizing gels. Teach them by setting a good example, but also because you can infect your children through unsanitary practices.
  • Discourage children from touching their eyes, nose and mouth.
  • Keep children away from close contact with sick people.
  • Help yourself and your family stay healthy with sleep, exercise, stress management and eating well.
  • Children should be taught to cough and sneeze into a tissue or into the inside of their elbow; set the example for them.
  • Sick children should stay home from school and daycare until they are improving and have been without a fever for at least 24 hours (without the use of medication).
  • If you are sick with H1N1 influenza, ask for help from family members and friends who are not ill to feed and care for your children. If that's not possible, wear a facemask, if available and tolerable, especially while in close contact.

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10. What are the symptoms of the flu?

  • Young children with the flu may have difficulty breathing and low activity, but few other symptoms.
  • Fever (note: not everyone with flu will have a fever)
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Body aches
  • Headache
  • Chills
  • Fatigue
  • Sometimes diarrhea and vomiting
  • If your child is under 5 years or has a serious pre-existing condition, pay extra attention to the possibility of H1N1 flu.
  • If your child has a sore throat with a fever and doesn't develop a cough, he or she may need to be checked for strep throat.

11. When should I call the doctor?
Seek medical care for a child in a high-risk group or less than a year old showing flu symptoms, or any child having severe symptoms, such as:

  • Difficulty breathing or fast breathing
  • Bluish or grayish skin (call 911)
  • Not able to drink, dehydration
  • Severe, persistent vomiting
  • Not waking or interacting
  • Not wanting to be held
  • Flu symptoms improve then return with fever and worse cough

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12. Is Tamiflu an effective option for a child with flu?
Most children and adolescents who develop a mild illness consistent with uncomplicated flu, or who appear to be recovering from flu, do not need antiviral medications for treatment. However, clinical judgment is always an essential part of treatment decisions. Assessment of a child's or adolescent's clinical presentation and underlying risk factors for flu-related complications should guide medical decisions regarding evaluation, follow-up or treatment. Prompt antiviral therapy with oseltamivir (Tamiflu®) or zanamivir (Relenza®)1 is recommended for children and adolescents of any age with suspected or confirmed flu and

  • severe illness, or
  • evidence of clinical deterioration regardless of previous health, or
  • symptoms of lower respiratory tract involvement, or
  • illness requiring hospitalization.

13. What should I do if my children come down with the flu?

  • Keep sick children home from school for at least 24 hours after their fever is gone, except to seek medical care. (Fever should be gone without the use of a fever-reducing medicine.)
  • Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (e.g., bismuth subsalicylate Pepto Bismol) to children or teenagers 18 years old or younger.
  • Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a health care provider.
  • Follow the prevention advice above (see question 9).
  • H1N1 flu can cause soreness everywhere: headache, back pain, chest pain and leg pain. To soothe sore muscles, give ibuprofen to reduce inflammation. To prevent stomach irritation, always administer pain medication with food. If pain is severe and lasts more than 90 minutes after taking ibuprofen, your child probably should see a doctor.
  • To open a blocked nose, use a nasal wash with saline.
  • For a cough, use one to two teaspoons of honey (do not use for children under 1 year old).
  • Use Ibuprofen to help a sore throat.
  • Encourage extra fluids to prevent dehydration.

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