Influenza Exposure

Is this your child’s symptom?

• Exposure (Close Contact) to a person with influenza
• Questions about influenza
• Your child has no symptoms of influenza (no fever, cough, sore throat, runny nose)
• For children with symptoms of influenza, see the Influenza care guide.

Flu Exposure (Close Contact) Definition

• Household Close Contact. Lives with a person with flu.
• Other Close Contact. The CDC defines 6 feet as how far coughing can spread the flu virus. How long the close contact lasts is also important. Close contact includes kissing, hugging or sharing eating and drinking utensils. It also includes close conversations. Direct contact with secretions of a person with flu is also close contact. Includes being in the same child care center room or carpool.
• In Same Building – Not Close Contact. Walking by a person or sitting in a room briefly is not close contact. Being in the same school, church, workplace or building also is not close contact.
• In Same Town – Not Close Contact. Living in a town where there are people with the flu is not close contact. Living in the same state or country (such as Mexico) carries no added risk.

High-Risk Children for Complications from Influenza (AAP)

Children are considered High-Risk for complications if they have any of the following:

• Lung disease (such as asthma)
• Heart disease (such as a congenital heart disease)
• Cancer or weak immune system conditions
• Neuromuscular disease (such as muscular dystrophy)
• Diabetes, sickle cell disease, kidney disease or liver disease
• Down syndrome
• Diseases requiring long-term aspirin therapy
• Pregnancy or severe obesity
• All healthy children under 2 years old are also considered High-Risk (CDC 2009)
• Note: All other children are referred to as Low-Risk

Prescription Antiviral Drugs for Influenza

• Antiviral drugs (such as Tamiflu) are sometimes used to treat influenza. They must be started within 48 hours of when flu symptoms start.
• The AAP recommends they be used for any patient with severe symptoms.
• The AAP also recommends the drugs for most High-Risk children. A list of High-Risk problems is also on the CDC website.
• The AAP doesn’t recommend antiviral drugs for Low-Risk children with mild flu symptoms.
• Their benefits are limited. They usually reduce the time your child is sick by 1 to 1.5 days. They reduce the symptoms, but do not make them go away.
• Side effects: Vomiting in 10% of children.

Care Advice

Influenza Questions and No Close Contact in the Last 7 days

1. What You Should Know About Flu Exposure:
   • For most healthy people, the symptoms of influenza are like those of a bad cold.
   • But, with flu, the onset is more abrupt. The symptoms are more severe.
   • Feeling very sick for the first 3 days is common.
   • The treatment of influenza depends on your child’s main symptoms. It is no different from treatment used for other viral colds and coughs.
   • Most children with flu don’t need to see their doctor.
2. Influenza Symptoms:
   • The main symptoms are fever, cough, sore throat and runny nose.
   • Most often, fever is present. (Exception: Sometimes, no fever if the child has a weak immune system.)
   • Other common symptoms are muscle pain, headache and fatigue.
   • Some people also have vomiting and diarrhea, but never as the only symptom.
3. Influenza Diagnosis and Flu Tests:
   • During influenza season, if your child has flu symptoms, he probably has the flu.
   • Your child won’t need any special tests.
   • You should call your doctor if your child is High-Risk for complications of flu. These are children with chronic diseases. Examples of such diseases are asthma or a weak immune system. See the High-Risk list in Causes. Also, healthy children under 2 years of age are High-Risk.
   • For Low-Risk children, you don’t need to see your child’s doctor.
   • If your child develops a complication of the flu, then call your child’s doctor. Examples of complications are an earache or trouble breathing. These problems are included in the “What to Do” section.
4. Influenza Treatment:
   • For most children, the treatment of flu is based upon symptom relief. It’s no different than the treatment of other viral coughs and colds.
   • Tamiflu is the main antiviral drug used to treat influenza in some children.
   • The AAP recommends it be used for any patient with severe symptoms.
   • The AAP also recommends the drug for most High-Risk children. See that list in Causes. Mainly, it is used for children in the hospital or those with chronic diseases.
   • Treatment is not recommended for Low-Risk children with normal flu symptoms. (AAP)
   • Most patients recover without taking Tamiflu.
   • Antiviral treatment must be started within 48 hours of the onset of flu symptoms. After 48 hours of fever, starting the drug is not helpful.

1. Return to School:
   • Spread is rapid and the virus is easily passed to others. The time it takes to get the flu after contact is about 2 days. The range is 1-4 days.
   • Your child can return to school after the fever is gone for 24 hours. (CDC).
   • The influenza virus is spread in the air from sneezing and coughing.
   • It also can be spread by the hands with flu germs on them.
2. What to Expect:
   • The fever lasts 2 -3 days.
   • The runny nose lasts 1-2 weeks.
   • The cough lasts 2-3 weeks.
3. Call Your Doctor If:
   • You have other questions or concerns

Influenza Prevention Questions

1. How to Protect Yourself from Getting Sick:
   • Wash hands often with soap and water.
   • Alcohol-based hand cleaners work very well.
   • Avoid touching the eyes, nose or mouth. Germs on the hands can spread this way.
   • Try to avoid close contact with sick people.
   • Avoid ERs and urgent care clinics if you don’t need to go. These are places where you are more likely to be exposed to flu.
2. How To Protect Others – Stay Home When Sick:
   • Cover the nose and mouth with a tissue when coughing or sneezing.
   • Wash hands often with soap and water. After coughing or sneezing are important times. Alcohol-based hand cleaners also work well.
   • Limit contact with others to avoid getting them sick.
   • Stay home from school or work while sick with fever. Your child can return to school after the fever is gone for 24 hours. (CDC).
3. Flu Shot:
   • Getting a flu shot is the best way to protect your family from flu.
   • Influenza vaccines are strongly advised for all children over 6 months of age. (AAP)
   • Adults should also get the shot.
   • The flu shot most often prevents the disease.
   • Even if your child gets the flu, the shot helps to reduce the symptoms.
   • A new flu shot is needed every year. Reason: Flu viruses keep changing.
   • After the flu shot, it takes 2 weeks to fully protect from flu. But then, the protection lasts for the full flu season. An antiviral medicine only protects from flu while taking it.
4. Antiviral Drug (such as Tamiflu):
   • The drug Tamiflu may help prevent flu after close contact. But, it is only advised for some very High-Risk patients (CDC). See the High-Risk list.
   • The CDC recommends early treatment if flu symptoms occur, not preventive treatment. Reasons: Even after close contact, some children don’t get flu. Also, Tamiflu is helpful only while your child is taking it. It won’t prevent flu once your child stops taking it. To prevent flu, you would need to take the medicine every day for months.
   • Most doctors also wait until flu symptoms start before treating with drugs.
   • If your child is High-Risk, call your doctor within 24 hours of exposure. Your doctor will decide if an antiviral is needed.
   • High-Risk adults with recent close contact should also call their doctor. The High-Risk adult group includes chronic disease, pregnant, or over 65.
5. Call Your Doctor If:
   • You have other questions or concerns

Tamiflu Prescription Questions

1. Treating Influenza – Tamiflu:
   • Tamiflu is a prescription anti-viral drug. It can be helpful in treating the flu virus.
   • These drugs should be started within 48 hours of when flu symptoms start. After 48 hours of fever, starting the drug is not helpful. It’s taken for a total of 5 days.
   • When to Use: Severe symptoms OR underlying health problems (High-Risk group)
   • For High-Risk children, call your child’s doctor at the start of flu symptoms.
   • Most healthy patients have mild to moderate symptoms. Tamiflu treatment is not needed for these patients.
   • The benefits are limited. Tamiflu reduces the time your child is sick by 1 to 1.5 days. It helps reduce the symptoms, but does not make them go away.
   • Tamiflu also has side effects. It causes vomiting in 10% of children.
   • Also, it is not used to prevent flu. Reason: You would need to take the medicine every day for months.
2. Personal Stockpiling of Tamiflu – Not Advised:
   • Some people want a prescription for Tamiflu for all family members. They want it on hand just in case they come down with flu. They currently are well and have not been exposed to flu.
   • Doctors and the CDC are opposed to this practice. The AAP and your State’s Public Health Department also do not support this.
   • The supply of Tamiflu is limited. It is used for those with severe symptoms OR who are High-Risk.
3. Call Your Doctor If:
   • You have other questions or concerns

Influenza Close Contact Within the Last 7 Days but Low-Risk child

1. What You Should Know:
   • Although your child was exposed to flu, your child does not have any symptoms.
   • Symptoms usually develop within 1-4 days of seasonal flu contact. 7 days is an outer limit.
   • Even if your child gets the flu, your child most likely will do fine. Anti-viral treatment (Tamiflu) is not needed for Low-Risk children.
   • Healthy children get better from flu by treating the symptoms.
2. Call Your Doctor If:
   • You have other questions or concerns

Influenza Minor Contact (same school) but No Close Contact

1. What You Should Know:
   • To catch influenza, your child needs to have close contact with an infected person.
   • Close contact includes kissing, hugging, or sharing eating or drinking utensils. It also includes close conversations within 6 feet (2 meters) (CDC 2013). Being in the same child care group or car pool is also close contact.
   • Being in the same school, church or building is not close contact.
   • If there was no close contact, your child probably will not get the flu.
   • Anti-viral medicine (Tamiflu) is not needed for Low-Risk children.
   • Healthy children get better from flu by treating the symptoms.
2. Call Your Doctor If:
   • You have other questions or concerns

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.