Your baby and the flu
Babies and the flu; Your infant and the flu; Your toddler and the flu
The flu is an easily-spread disease. Children under age 2 have a higher risk of developing complications if they get the flu.
The information in this article has been put together to help you protect children under age 2 from the flu. This is not a substitute for medical advice from your health care provider. If you think your baby may have the flu, you should contact a provider right away.
Your head is throbbing. Your throat is burning. You're coughing nonstop, and your whole body aches. This is no run-of-the-mill cold. You may have the flu. Let's talk about influenza, also known as the flu. Winter is a time for sledding, snowball fights, and flu. Every winter, millions of Americans come down with this respiratory ailment and feel absolutely miserable. Like the common cold, the flu is caused by a virus. But with the flu, it's the influenza virus that makes people so sick. The flu virus comes in a few different forms. Influenza A is most common between early winter and spring. You can catch influenza B year-round. Swine flu, or H1N1, is a specific type of influenza A. You catch the flu from someone who has it. When people with the flu sneeze or cough, they send a spray of droplets filled with the flu virus into the air. If you're unlucky enough to be nearby, you could breathe in those droplets. Or, you might touch a surface that the droplets have fallen on and then touch your nose or mouth. Two to three days later, the first flu symptoms will appear. Usually you'll start running a fever. Then you'll feel achy and tired. You may have the chills and feel sick to your stomach. After a couple of days, the sore throat and cough will set in. So, how do doctors treat the flu? Because a virus causes the flu, antibiotics won't treat it, they only kill bacteria. There are antiviral medicines, but you need to start taking them within the first 2 days after your symptoms appear. Until the illness runs its course, help yourself feel better by getting a lot of rest and drinking extra fluids. You can take an over-the-counter cold medicine to relieve your congestion and cough. Tylenol, Advil, or Motrin can bring down your fever and take some of the pain out of your sore throat. Aspirin isn't recommended during the flu, especially under age 18, because it could increase the risk for a rare, but serious, condition called Reye syndrome. By itself, the flu usually isn't harmful. But it can make existing conditions like asthma and breathing problems worse. In older people or those with a weakened immune system, the flu can turn into pneumonia, bronchitis, and other more serious diseases. For most healthy people, the flu is a short-term annoyance. They're stuck in bed for a week or two, and then their symptoms go away and they're back up and around. But thousands of people each year get very sick from the flu, especially the elderly, young children, and pregnant women. Many are hospitalized, and about 36,000 people die from flu complications. To avoid getting the flu, eat well, get plenty of exercise and sleep, and practice good hygiene. Wash your hands often with warm water and soap or use an alcohol-based hand sanitizer. Don't share cups, plates, or utensils, especially during flu season. And most effective, get your flu shot every fall to protect you through the whole flu season.
FLU SYMPTOMS IN INFANTS AND TODDLERS
The flu is an infection of the nose, throat, and (sometimes) lungs. Call your baby's provider if you notice any of the following signs:
- Acting tired and cranky much of the time and not feeding well
- Diarrhea and vomiting
- Has a fever or feels feverish (if no thermometer available)
- Runny nose
- Body aches and general ill feeling
HOW IS THE FLU TREATED IN BABIES?
Children younger than 2 years old will often need to be treated with medicine that fights off the flu virus. This is called antiviral medicine. The medicine works best if started within 48 hours after symptoms begin, if possible.
Oseltamivir (Tamiflu) in liquid form will likely be used. After talking about the risk of side effects against the possible complications of the flu in your baby, you and your provider may decide to use this medicine to treat the flu.
Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes, your provider will tell you to use both types of medicine.
Always check with your provider before giving any cold medicines to your infant or toddler.
SHOULD MY BABY GET THE FLU VACCINE?
All infants 6 months or older should get the flu vaccine, even if they have had a flu-like illness. The flu vaccine is not approved for children under 6 months old.
- Your child will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time.
- There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose.
The flu shot contains killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older.
A nasal spray-type flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years.
Anyone who lives with or has close contact with a child younger than 6 months old should also have a flu shot.
WILL THE VACCINE HARM MY BABY?
You or your baby can NOT get the flu from either vaccine. Some children may get a low-grade fever for a day or two after the shot. If more severe symptoms develop or they last for more than 2 days, you should call your provider.
Some parents are afraid the vaccine could hurt their baby. But children under 2 years of age are more likely to get a severe case of the flu. It is hard to predict how ill your child may get from flu because children often have a mild illness at first. They may become sick very fast.
A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have NOT been shown to cause autism, ADHD, or any other medical problems.
However, all of the routine vaccines are also available without added thimerosal. Ask your provider if they offer this type of vaccine.
HOW CAN I PREVENT MY BABY FROM GETTING THE FLU?
Anyone who has flu symptoms should not care for a newborn or infant, including feeding. If a person with symptoms must care for the child, the caretaker should use a face mask and wash their hands well. Everyone who comes in close contact with your baby should do the following:
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it.
- Wash your hands often with soap and water for 15 to 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners.
If your baby is younger than 6 months old and has close contact with someone with the flu, inform your provider.
IF I HAVE FLU SYMPTOMS, CAN I BREASTFEED MY BABY?
If a mother is not ill with the flu, breastfeeding is encouraged.
If you are sick, you may need to express your milk for use in bottle feedings given by a healthy person. It is unlikely a newborn can catch flu from drinking your breast milk when you are sick. Breast milk is considered safe if you are taking antivirals.
WHEN SHOULD I CALL THE DOCTOR?
Talk to your child's provider or go to the emergency room if:
- Your child does not act alert or more comfortable when the fever goes down.
- Fever and flu symptoms come back after they have gone away.
- The child does not have tears when crying.
- The child's diapers are not wet, or the child has not urinated for the last 8 hours.
- Your child is having trouble breathing.
How do you treat congestion in babies? I'm Dr. Alan Greene and particularly when over-the-counter decongestants became clear they're not good for babies, parents have been wondering all the more how do you deal with it then? There are a few things. First of all, there's the bulb syringe which you probably went home from the hospital with. And it actually can be effective at helping to pull some of the mucous out - some of the viral load out as well of the nose. They're very easy to use. The trick is you just squeeze everything as much air as you can out of the bulb syringe to start, then gently push it as far as it will go up into the nose and release. Then it will pull both virus and mucous out. You can get more out if you put a few drops of saline nose drops in first. That'll help make it more difficult for the virus to reproduce. It'll help loosen things up so you can pull more out. They can act a bit as a natural decongestant as well. Do the nasal drops, wait maybe 10 minutes, and then do the bulb syringe. Other things that help - gravity can be your friend. All of us tend to be more congested when we're lying flat when our head is about the same level as our heart. And that's even more true for babies. They're more responsive to gravity. So if you're holding the baby upright against your shoulder with their head above their heart, they will naturally and quickly be less congested. Another thing that can be very helpful is a vaporizer. And the way that works a vaporizer humidifier by putting extra moisture in the air will help to thin the mucous so the mucous will draw that extra moisture in and will be thinner and easier to get out either by the bulb syringe, by sneezing, or just the baby's own mechanisms. So there are gentle and natural ways you can help relieve congestion in your young baby.
Centers for Disease Control and Prevention. Influenza (flu). Frequently asked influenza (flu) questions: 2019-2020 season.
Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices - United States, 2018-19 influenza season. MMWR Recomm Rep. 2018;67(3):1-20. PMID: 30141464
Havers FP, Campbell AJP. Influenza viruses. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 285.
Last reviewed on: 7/3/2019
Reviewed by: Liora C. Adler, MD, Pediatric Emergency Medicine, Joe DiMaggio Children’s Hospital, Hollywood, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.