Pediatrics South's Managment of the

H1N1 Influenza A (SWINE FLU) 2009-2010

H1N1 is a strain of Influenza. It is epidemic and our expectation that one third of our children will get this influenza this season.  The symptoms are well known at this point: fever, chills, muscle aches, sore throat, cough, headache, runny nose, congestion, and in some children, vomiting.  The fever is signigicant, up to 104 F in some children, although it does respond to therapeutic doses of Motrin and Tylenol. It generally will last 3-5 days, although some children will be more in the one to two week range. The muscle aches are also significant and make a child reluctant to move. They look ill.

Our job is to determine which children need emergent care and which children can be best treated at home, which is the best place for them. We do not send children for diagnosis as it makes no difference in our treatment and there are a significant number of false negatives (children who do have the flu but the test comes back negative).

Children who need to be seen through an emergency facility include:

1. Those who have a fever that does not respond to Motrin or Tylenol and come down by at least one degree. We are not concerned if the fever is initially up as high as 103-104 F as this is usual. Temperature should be documented as rectal or oral.
2. Those that are getting behind on their fluids and are dehydrated. The best thing to follow is the urine output. We want children to urinate at lease every 6-8 hours. You can give them any and all fluids, not just oral rehydration drinks unless they are starting to get behind.
3. Those who have respiratory distress. This illness includes a cough, chest congestion and chest pain. Signs and symptoms of respiratory distress include rapid, labored respiration in between the coughing, difficulty breathing, wheezing and shortness of breath. If your child has trouble breathing when lying down, this may also be signigicant.
4. Those children who are lethargic and do not perk up when the fever comes down or who develop signigicant local discomfort. They will have sore throat as part of the overall illness, and do not need to come in for a throat culture when this symptom is part of the overall flu presentation.  We are currently seeing more viral illness than streptococcal sore throat in the community.

 The indications for Tami Flu are being fine tuned and are complicated by the shortage of this antiviral drug. Tami Flu is being used for the more severly ill who are in the hospital. Very few children with H1N1 needs Tami Flu.  Over 50% of those who get the drug get significant vomiting and GI side effects and it only shortens the duration of the disease by one half a day.

You can best treat your child at home. The current recommentation is not to return to school until they are 24 hours without fever. We will probably not be able to halt the spread of the illness. We would urge you to think of this a building up your child's immunity early and "getting it over".  Unless your child has an underlying immune problem, or significant medical problem he or she should be able to handle this just fine.  The news has, in large part, sensationalized the illness, and spread fear tactics. While there have been some deaths, there are these in seasonal flu and most of them have been in individuals with inderlying conditions or extenuating circumstances.

Please help us in keeping the phone lines free for those who have complicated illness. If you have questions, this message is not answering, call the office and we will try to get back to you as soon as possible.

A vaccination for H1N1 is becoming available. The nasal vaccine is being distributed to target children 5-9 years of age who have no asthma. The reason for this age group is that this is the population that is experiencing the highest number of cases and they are the ones that tend to spread it to other individuals.  We have not yet received any vaccine and will keep the website and phone messages updated when it becomes available.  The injectible vaccine is not yet available.  It is recommended for children 6 months to 24 years of age.

We care about your child and want nothing bu the best care for him or her, and have full confidence that you are the best person to provide this at home.

For further information you can visit the CDC website at www.cdc.gov