Influenza (Child)

Updated for the 2022-2023 flu season

Your child has the flu (influenza). It's a viral illness that affects the air passages of your child's nose, sinuses, throat and lungs. It's different from the common cold. The flu can easily be passed from one child to another. It may be spread through the air by coughing and sneezing. It can also be spread by touching the sick person and then touching your own eyes, nose, or mouth.

Symptoms of the flu may be mild or severe. They can include extreme tiredness (wanting to stay in bed all day), chills, fevers, muscle aches, soreness with eye movement, headache, and a dry, hacking cough.

Your child may be treated with an antiviral medicine if there is risk for or signs of complications. Your child may need antibiotics but only if they have a bacterial infection along with the flu. This might be an ear or sinus infection or pneumonia. Antiviral medicine works best if started within 48 hours of the first symptoms.

Home care

Follow these guidelines when caring for your child at home:

  • Fluids. Fever increases the amount of water your child loses from their body. For babies younger than 1 year old, keep giving regular feedings (formula or breast). Talk with your child’s healthcare provider to find out how much fluid your baby should be getting. If needed, give an oral rehydration solution. You can buy this at the grocery or pharmacy without a prescription. For a child older than 1 year, give them more fluids and continue their normal diet. If your child is dehydrated, give an oral rehydration solution. Go back to your child’s normal diet as soon as possible. If your child has diarrhea, don’t give juice, flavored gelatin water, soft drinks with caffeine, lemonade, fruit drinks, or frozen ice pops. These may make diarrhea worse.

  • Food. If your child doesn’t want to eat solid foods, it’s OK for a few days. Make sure they drink lots of fluid and has a normal amount of urine.

  • Activity. Keep children with fever at home resting or playing quietly. Encourage them to take naps. Your child may go back to daycare or school when the fever is gone for at least 24 hours. The fever should be gone without giving your child acetaminophen or other medicine to reduce fever. Your child should also be eating well and feeling better.

  • Sleep. It’s normal for your child to be unable to sleep or be irritable if they have the flu. A child who has congestion will sleep best with their head and upper body raised up. Or you can raise the head of the bed frame on a 6-inch block.

  • Cough. Coughing is a normal part of the flu. You can use a cool mist humidifier at the bedside. Don’t give over-the-counter cough and cold medicines to children younger than 6 years of age, unless the provider tells you to do so. These medicines don’t help ease symptoms. And they can cause serious side effects, especially in babies younger than 2 years of age. Don’t let anyone smoke around your child. Smoke can make the cough worse.

  • Nasal congestion. Use a rubber bulb syringe to suction the nose of a baby. You may put 2 to 3 drops of saltwater (saline) nose drops in each nostril before suctioning. This will help remove secretions. You can buy saline nose drops without a prescription. You can make the drops yourself by adding 1/4 teaspoon table salt to 1 cup of water.

  • Fever. Use acetaminophen to control pain, unless another medicine was prescribed. In babies older than 6 months of age, you may use ibuprofen instead of acetaminophen. If your child has chronic liver or kidney disease, talk with your child’s provider before using these medicines. Also talk with the provider if your child has ever had a stomach ulcer or digestive bleeding. Don’t give aspirin to a child or teen who is ill with a fever. It may cause a serious illness called Reye syndrome. This can affect the brain and the liver.

Follow-up care

Follow up with your child’s healthcare provider, or as advised.

When to get medical advice

Call your child’s healthcare provider right away if any of these occur:

  • Fever (see Fever and children below)

  • Fast breathing. If your child is:

    • Age 6 weeks to 2 years, this is more than 45 breaths per minute

    • Age 3 to 6 years, this is more than 35 breaths per minute

    • Age 7 to 10 years, this is more than 30 breaths per minute

    • Older than 10 years, this is more than 25 breaths per minute

  • Earache, sinus pain, stiff or painful neck, headache, or repeated diarrhea or vomiting

  • Abnormal fussiness, drowsiness, or confusion

  • Your child doesn’t interact with you as they normally do

  • Your child doesn’t want to be held

  • Your child isn't drinking enough fluid. This may show as no tears when crying, or sunken eyes or dry mouth. It may also be no wet diapers for 8 hours in a baby. Or it may be less pee than normal in older children.

  • Rash with fever

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

  • A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

  • Rectal or forehead: 102°F (38.9°C) or higher

  • Ear (only for use over age 6 months): 102°F (38.9°C) or higher

  • A fever of ___________ as advised by the provider

In these cases:

  • Armpit temperature of 103°F (39.4°C) or higher in a child of any age

  • Temperature of 104°F (40°C) or higher in a child of any age

  • A fever of ___________ as advised by the provider

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