12 ms·

How to Know When a Child’s Flu Turns Serious

203 points by montrose 9y ago

3chelon 9y ago
The problem for parents is it is so hard to diagnose flu. Flu-like symptoms cover so many illnesses, and no doctor wants you to visit them with a virus they cannot cure and that most people will recover from in about a week. But this statement: "fevers that abate only to flare up again after the child seems to be over the worst of the illness" reminded me of something that happened to my son. When he was 7, he came down with a flu-like illness that lasted a week, and because it was a bad flu season we were told to stay away from the doctor's surgery. After about 4 days of fever and no eating my wife railed against the advice and took him along, only to be fobbed off by her regular doctor who said there was nothing to worry about, he had an ear infection, and prescribed some antibiotics. So for the next day or two he seemed to improve. Then, on the Sunday, he suddenly faded away again and seemed to lose all interest in getting better. The only thing he complained about was a perpetual pain in his neck. I took him back to the surgery, and because it was a weekend I saw a visiting doctor rather than our regular one. The guy took one look at him and phoned the hospital, told me to get him there urgently. It transpired he had a very advanced pneumonia, and had to be transferred to a bigger hospital for an operation to remove 1 litre of fluid from his lung. That was what had been causing the neck pain: the sheer weight of the fluid on one side of his chest. After the op, they managed to treat the infection with about the fourth antibiotic they tried (I think there were only a couple left after that, which was scary). Another week later and he went home, and made a full recovery, thankfully. When questioned, our family doctor very defensively said she had never come across such an advanced case of pneumonia in "someone who could still stand up", and so she had discounted it. This fact seemed to be borne up by the fact that our son was a prize exhibit at the teaching hospital he'd been transferred to, surrounded on a daily basis by medical students listening through stethoscopes and being told "this is what a pleural empyema sounds like in a child - note the lack of the classic rattling noise you associate with pneumonia" ... so maybe our doctor was correct. Anyway, we were just glad to have our son well again and were not interested in lawsuits. But every time either of our kids gets a fever or anything that seems like the flu now, we play extra close attention and refused to be fobbed off by over-worked doctors.
- msla 9y ago
  The right answer for your son would have been for them to jump right into surgery (or whatever you Brits call it, seeing as you apparently call a doctor's office a "surgery"... the act of cutting into skin for medicinal purposes) for something which looked like a flu complicated by an ear infection. Reaching that diagnosis would likely have involved magic on the part of the MD (or whatever you call a physician) and MDs don't get their licenses from Hogwarts, not even in the UK.
  - 3chelon 9y ago
    Yeah, we call the doctor's examination room a "surgery", and the place you get the actual surgery done is an "operating theatre". Divided by a common language and all that... but obviously it comes from a time when your local doctor would have performed surgery (presumably with leeches) in his front room. But he ended up in surgery pretty quickly after we arrived at the hospital. It took them a day to analyse his X-rays and realise he was not responding to regular antibiotics, and the decision was made to transfer him to the larger hospital for the operation. As for the misdiagnosis made by our family doctor (G.P. or General Practitioner, we call them), I'm not qualified to comment on whether it was a reasonable error or not.
    - liveoneggs 9y ago
      all doctors should be able to hear large amounts of fluid in the lungs and, furthermore, should be on the lookout for pneumonia when someone had flu and then got worse. Your doctors, in this case, performed terribly.
      - 3chelon 9y ago
        I suspect you are correct. The fact that the second doctor I saw immediately sent him to hospital makes me think the first doctor was not doing her job properly. I guess that's why they say you should always get a second opinion.
        9y ago
ransom1538 9y ago
Oseltamivir. (Tamiflu) My ex-girlfriend (7years) is a big deal chemist at GILD. So I share some under the covers knowledge here. GILD produces some of the best anti-virals on the market [i] (HIV is now a condition). When GILD discovered the power of Oseltamivir it knew they would not be able to produce the scale needed. They sold their rights to Roche. Roche being a sick pro-profits-first company basically shelved the product. Roche wasn't interested in the 'cure' for the flu they were interested in treating the symptoms. But, as it turns out, china was impacted with bird flu during this period -- and gave no shit about patents and wanted to just save their population. Phone calls were made and china basically was going to produce it at at massive scale. Thus, Roche quickly started producing the product. Oseltamivir is amazing at fighting the flu virus. The original purpose was to take Oseltamivir when you have sick family members or know you might be coming down with symptoms. Recently, I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold. It could save lives. Doctors know this and are reluctant to prescribe it -- since they know it is in short supply and critical populations should get it first. Ironically, doctors reluctance to prescribe it - actually reduces the supply. I say to you, get it, keep it in your refrigerator -- when your 65+ year old dad gets the flu give it to him immediately. [i] https://www.bizjournals.com/sanfrancisco/news/2018/02/07/gilead-gild-biktarvy-hiv-aids-genvoya.html https://www.bizjournals.com/sanfrancisco/news/2018/02/07/gil...
- neves 9y ago
  Cochrane Collaboration is a network of independent scientists. They analyzed the evidence and said that Tamiflu is no more effective than Paracetamol: http://www.cochrane.org/news/tamiflu-and-relenza-getting-full-evidence-picture http://www.cochrane.org/news/tamiflu-and-relenza-getting-ful...
  - neves 9y ago
    A little more info: "Tamiflu (the antiviral drug oseltamivir) shortens symptoms of influenza by half a day, but there is no good evidence to support claims that it reduces admissions to hospital or complications of influenza." https://www.sciencedaily.com/releases/2014/04/140411091937.htm https://www.sciencedaily.com/releases/2014/04/140411091937.h... Or the complete review: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965.pub4/abstract;jsessionid=D0952B85723A29FF11B3087DB5F71938.f03t02 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965...
walshemj 9y ago
The thing is to know when your child (or you for that matter) have the Flu and not just a Cold.
nuna 9y ago
my elderly mother (70 yrs) who was visiting, came down with very bad flu symptoms. Having a newborn at home I took her to urgent care to get Tamiflu. They did the rapid test that came negative so they sent her off with nothing. Considering her age, the fact that I had a newborn and that rapid testing has a high false negative rate, I was pretty upset that they didn't give her tamiflu as a precaution. Maybe reports that it was in low supply are true
- Broken_Hippo 9y ago
  We used to give antibiotics "just in case", because of reasons like this and we now have antibiotic resistant bacteria. We've seen the same thing with antiviral drugs. Shortage or not, giving antivirals to make a caregiver feel better seems like a dangerous way to make people in the future sicker. It really would have been more prudent to put one or both of them in the hospital for observation, and it is awful that we don't have such wards available (I imagine they wouldn't need staffing greater than a nursing home because most are simply there just in case). The test having a high false negative rate isn't actually a good enough reason to treat folks, rather a reason to develop a better test.
batter 9y ago
Those who can't get Tamiflu/Oseltamivir: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0014320 http://journals.plos.org/plosone/article?id=10.1371/journal.... You can buy it anywhere on web to make you own spray (100 g will be enough for whole family for at least year). Just 2 things: 1.Use only boiled water. 2.Spray throat and nose. From my personal experience - it's really helpful also from other viral infections. Sadly if virus already in blood and lot of time has passed - it's not gonna help :( Zinc might help a bit... depends on person and Vit B6 status.
DoreenMichele 9y ago
I am so glad I was able to be home with my kids. My oldest was also really hard to place with a babysitter, so I rarely got a break. I spent enormous amounts of time with him. This meant that I knew what he ate or drank and what was normal for him. I knew when it was serious. Dehydration kills a great deal faster than starvation. Sunken eyes is a sign of serious dehydration in a child. The child either needs to be fed fluids orally by the spoonful until this improves, which can take two hours of devoted care, or they need an IV. I once treated serious dehydration at home with spoons of fluids to prevent my 4 year old from being subjected to an IV. This is a technique taught in developing countries where IV fluids may not be available. If a child is vomiting but keeps drinking, they are much less likely to dehydrate, even if it does not stay down. When my youngest son had Winter Vomiting, a deadly flu from many years ago, I told him to drink or I would take him to the ER for an IV. He had had an IV once when he had been sick while relatives watched him.* He didn't want another. So he would drink a whole lot of water and eat a few crackers, go projectile vomit it back up and go back to bed. * That is not a criticism of my relatives. It is just another example of how much of a difference it makes for a child to have a devoted full time caretaker who knows them well. Children are not good at explaining that they have a serious issue. It is vastly better if there is an adult who is in a position to just recognize that their behavior is seriously off and something is just not right. People who don't take full-time care of a child are just less able to recognize that the problem is serious, even when they are otherwise very competent and devoted caregivers.
- 3131s 9y ago
  I'm not a doctor, but AFAIK it's best to just get an IV straightaway if you're really dehydrated and continually vomiting. The pain from an IV is not bad at all and it seems beneficial for children and everyone else to be able to tolerate a minimal amount of harmless pain.
  - DoreenMichele 9y ago
    I didn't want my 4 year old unnecessarily traumatized. He was frequently sick and had to see doctors regularly. He had enough baggage over that, and was later diagnosed with a genetic disorder. I knew what I was doing. If a parent doesn't know, sure, get the IV. But if a parent does know and wishes to spare their child some pain, I see no reason that should not be supported. The comfort of my children mattered to me. I cannot imagine that it wouldn't matter to most other parents.
jakeogh 9y ago
Paracetamol is something to be careful with, along with it's ease of overdose, we are still learning about it's neurological effects. I stick to Ibuprofen. https://www.theatlantic.com/health/archive/2013/04/whats-tylenol-doing-to-our-minds/275101/ https://www.theatlantic.com/health/archive/2013/04/whats-tyl...

203 points by montrose 9y ago

The problem for parents is it is so hard to diagnose flu. Flu-like symptoms cover so many illnesses, and no doctor wants you to visit them with a virus they cannot cure and that most people will recover from in about a week. But this statement: "fevers that abate only to flare up again after the child seems to be over the worst of the illness" reminded me of something that happened to my son. When he was 7, he came down with a flu-like illness that lasted a week, and because it was a bad flu season we were told to stay away from the doctor's surgery. After about 4 days of fever and no eating my wife railed against the advice and took him along, only to be fobbed off by her regular doctor who said there was nothing to worry about, he had an ear infection, and prescribed some antibiotics. So for the next day or two he seemed to improve. Then, on the Sunday, he suddenly faded away again and seemed to lose all interest in getting better. The only thing he complained about was a perpetual pain in his neck. I took him back to the surgery, and because it was a weekend I saw a visiting doctor rather than our regular one. The guy took one look at him and phoned the hospital, told me to get him there urgently. It transpired he had a very advanced pneumonia, and had to be transferred to a bigger hospital for an operation to remove 1 litre of fluid from his lung. That was what had been causing the neck pain: the sheer weight of the fluid on one side of his chest. After the op, they managed to treat the infection with about the fourth antibiotic they tried (I think there were only a couple left after that, which was scary). Another week later and he went home, and made a full recovery, thankfully. When questioned, our family doctor very defensively said she had never come across such an advanced case of pneumonia in "someone who could still stand up", and so she had discounted it. This fact seemed to be borne up by the fact that our son was a prize exhibit at the teaching hospital he'd been transferred to, surrounded on a daily basis by medical students listening through stethoscopes and being told "this is what a pleural empyema sounds like in a child - note the lack of the classic rattling noise you associate with pneumonia" ... so maybe our doctor was correct. Anyway, we were just glad to have our son well again and were not interested in lawsuits. But every time either of our kids gets a fever or anything that seems like the flu now, we play extra close attention and refused to be fobbed off by over-worked doctors.

msla 9y ago
The right answer for your son would have been for them to jump right into surgery (or whatever you Brits call it, seeing as you apparently call a doctor's office a "surgery"... the act of cutting into skin for medicinal purposes) for something which looked like a flu complicated by an ear infection. Reaching that diagnosis would likely have involved magic on the part of the MD (or whatever you call a physician) and MDs don't get their licenses from Hogwarts, not even in the UK.
- 3chelon 9y ago
  Yeah, we call the doctor's examination room a "surgery", and the place you get the actual surgery done is an "operating theatre". Divided by a common language and all that... but obviously it comes from a time when your local doctor would have performed surgery (presumably with leeches) in his front room. But he ended up in surgery pretty quickly after we arrived at the hospital. It took them a day to analyse his X-rays and realise he was not responding to regular antibiotics, and the decision was made to transfer him to the larger hospital for the operation. As for the misdiagnosis made by our family doctor (G.P. or General Practitioner, we call them), I'm not qualified to comment on whether it was a reasonable error or not.
  - liveoneggs 9y ago
    all doctors should be able to hear large amounts of fluid in the lungs and, furthermore, should be on the lookout for pneumonia when someone had flu and then got worse. Your doctors, in this case, performed terribly.
    - 3chelon 9y ago
      I suspect you are correct. The fact that the second doctor I saw immediately sent him to hospital makes me think the first doctor was not doing her job properly. I guess that's why they say you should always get a second opinion.
      - 9y ago

ransom1538 9y ago

Oseltamivir. (Tamiflu) My ex-girlfriend (7years) is a big deal chemist at GILD. So I share some under the covers knowledge here. GILD produces some of the best anti-virals on the market [i] (HIV is now a condition). When GILD discovered the power of Oseltamivir it knew they would not be able to produce the scale needed. They sold their rights to Roche. Roche being a sick pro-profits-first company basically shelved the product. Roche wasn't interested in the 'cure' for the flu they were interested in treating the symptoms. But, as it turns out, china was impacted with bird flu during this period -- and gave no shit about patents and wanted to just save their population. Phone calls were made and china basically was going to produce it at at massive scale. Thus, Roche quickly started producing the product. Oseltamivir is amazing at fighting the flu virus. The original purpose was to take Oseltamivir when you have sick family members or know you might be coming down with symptoms. Recently, I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold. It could save lives. Doctors know this and are reluctant to prescribe it -- since they know it is in short supply and critical populations should get it first. Ironically, doctors reluctance to prescribe it - actually reduces the supply. I say to you, get it, keep it in your refrigerator -- when your 65+ year old dad gets the flu give it to him immediately. [i] https://www.bizjournals.com/sanfrancisco/news/2018/02/07/gilead-gild-biktarvy-hiv-aids-genvoya.html https://www.bizjournals.com/sanfrancisco/news/2018/02/07/gil...

neves 9y ago
Cochrane Collaboration is a network of independent scientists. They analyzed the evidence and said that Tamiflu is no more effective than Paracetamol: http://www.cochrane.org/news/tamiflu-and-relenza-getting-full-evidence-picture http://www.cochrane.org/news/tamiflu-and-relenza-getting-ful...
- neves 9y ago
  A little more info: "Tamiflu (the antiviral drug oseltamivir) shortens symptoms of influenza by half a day, but there is no good evidence to support claims that it reduces admissions to hospital or complications of influenza." https://www.sciencedaily.com/releases/2014/04/140411091937.htm https://www.sciencedaily.com/releases/2014/04/140411091937.h... Or the complete review: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965.pub4/abstract;jsessionid=D0952B85723A29FF11B3087DB5F71938.f03t02 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965...

walshemj 9y ago

The thing is to know when your child (or you for that matter) have the Flu and not just a Cold.

nuna 9y ago

my elderly mother (70 yrs) who was visiting, came down with very bad flu symptoms. Having a newborn at home I took her to urgent care to get Tamiflu. They did the rapid test that came negative so they sent her off with nothing. Considering her age, the fact that I had a newborn and that rapid testing has a high false negative rate, I was pretty upset that they didn't give her tamiflu as a precaution. Maybe reports that it was in low supply are true

Broken_Hippo 9y ago
We used to give antibiotics "just in case", because of reasons like this and we now have antibiotic resistant bacteria. We've seen the same thing with antiviral drugs. Shortage or not, giving antivirals to make a caregiver feel better seems like a dangerous way to make people in the future sicker. It really would have been more prudent to put one or both of them in the hospital for observation, and it is awful that we don't have such wards available (I imagine they wouldn't need staffing greater than a nursing home because most are simply there just in case). The test having a high false negative rate isn't actually a good enough reason to treat folks, rather a reason to develop a better test.

batter 9y ago

Those who can't get Tamiflu/Oseltamivir: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0014320 http://journals.plos.org/plosone/article?id=10.1371/journal.... You can buy it anywhere on web to make you own spray (100 g will be enough for whole family for at least year). Just 2 things: 1.Use only boiled water. 2.Spray throat and nose. From my personal experience - it's really helpful also from other viral infections. Sadly if virus already in blood and lot of time has passed - it's not gonna help :( Zinc might help a bit... depends on person and Vit B6 status.

DoreenMichele 9y ago

I am so glad I was able to be home with my kids. My oldest was also really hard to place with a babysitter, so I rarely got a break. I spent enormous amounts of time with him. This meant that I knew what he ate or drank and what was normal for him. I knew when it was serious. Dehydration kills a great deal faster than starvation. Sunken eyes is a sign of serious dehydration in a child. The child either needs to be fed fluids orally by the spoonful until this improves, which can take two hours of devoted care, or they need an IV. I once treated serious dehydration at home with spoons of fluids to prevent my 4 year old from being subjected to an IV. This is a technique taught in developing countries where IV fluids may not be available. If a child is vomiting but keeps drinking, they are much less likely to dehydrate, even if it does not stay down. When my youngest son had Winter Vomiting, a deadly flu from many years ago, I told him to drink or I would take him to the ER for an IV. He had had an IV once when he had been sick while relatives watched him.* He didn't want another. So he would drink a whole lot of water and eat a few crackers, go projectile vomit it back up and go back to bed. * That is not a criticism of my relatives. It is just another example of how much of a difference it makes for a child to have a devoted full time caretaker who knows them well. Children are not good at explaining that they have a serious issue. It is vastly better if there is an adult who is in a position to just recognize that their behavior is seriously off and something is just not right. People who don't take full-time care of a child are just less able to recognize that the problem is serious, even when they are otherwise very competent and devoted caregivers.

3131s 9y ago
I'm not a doctor, but AFAIK it's best to just get an IV straightaway if you're really dehydrated and continually vomiting. The pain from an IV is not bad at all and it seems beneficial for children and everyone else to be able to tolerate a minimal amount of harmless pain.
- DoreenMichele 9y ago
  I didn't want my 4 year old unnecessarily traumatized. He was frequently sick and had to see doctors regularly. He had enough baggage over that, and was later diagnosed with a genetic disorder. I knew what I was doing. If a parent doesn't know, sure, get the IV. But if a parent does know and wishes to spare their child some pain, I see no reason that should not be supported. The comfort of my children mattered to me. I cannot imagine that it wouldn't matter to most other parents.

jakeogh 9y ago

Paracetamol is something to be careful with, along with it's ease of overdose, we are still learning about it's neurological effects. I stick to Ibuprofen. https://www.theatlantic.com/health/archive/2013/04/whats-tylenol-doing-to-our-minds/275101/ https://www.theatlantic.com/health/archive/2013/04/whats-tyl...