
How to Know When a Child’s Flu Turns Serious - montrose
https://www.nytimes.com/2018/02/07/well/family/children-flu-infants-deaths-influenza-complications-fever-breathing-symptoms.html
======
3chelon
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.

~~~
mrexroad
I lost my daughter 6 years ago this month to a very, very similar scenario.
Multiple visits to doctor over the week, small improvements, then on Sunday a
decline. Went to ER, where she fought the nurse enough such the nurse wasn’t
too concerned. She went into shock while getting chest X-rays.

~~~
3chelon
I am so very sorry to hear that. I don't really know what else I can say. We
were so lucky in comparison, we have nothing to complain about.

------
DoreenMichele
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
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
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.

~~~
PostOnce
I think 3131s's theory is that the amount of pain from a needle is much less
than say scraping your knee, hardly traumatic, and is guaranteed to work
better, faster, and more reliably than a spoon. Why risk the spoon not working
(and therefore further dehydrating the child and increasing risk of something
really bad happening) when all we are talking about is an IV, not something
actually traumatic like an amputation.

~~~
DoreenMichele
This varies a lot. Some people seriously don't deal well with needles. Your
cavalier attitude towards them is not universally shared.

~~~
tmp-20150107
This is odd to me - how would a four year old develop a fear of needles? At
worst they're an instantaneous sharp pain that lasts milliseconds, most of the
time they aren't even felt...

------
ransom1538
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/gil...](https://www.bizjournals.com/sanfrancisco/news/2018/02/07/gilead-
gild-biktarvy-hiv-aids-genvoya.html)

~~~
robbiep
Tamiflu will shorten flu by 1 day in Most good studies.

In Aus Tamiflu is often prescribed. In fact, significantly over prescribed.
$100+ for a box of tablets, that someone needs to start taking before we even
have actual PCR confirmation of flu virus? Does the benefit outweigh the
costs? Probably in elderly or in situations with decreased immunity.

For the rest of people, it is probably good to go through a fever cycle once
in a while. Your immune system needs something to run at, or else it can end
up attacking itself, or missing cancers. The firm evidence base for this is
low but my belief (as a biochemistry major and doc with heavy interest in
immunology) is that if you are otherwise healthy and you get the flu, then it
is probably doing ok for you. We need to stop pathologising all sickness. It’s
normal to be sick sometimes, in fact it’s probably necessary for optimum
function.

[0] - quick link from google as I am on mobile but well known to me in my
professional capacity - [http://www.center4research.org/tamiflu-not-
tamiflu/](http://www.center4research.org/tamiflu-not-tamiflu/)

~~~
shrimp_emoji
On the other hand, a lot of diseases (including lifelong, autoimmune ones) are
triggered, at least in part, by infections[0]. Without ever experiencing even
a common cold, it stands to reason that some cases of those diseases could be
precluded. Also, for the elderly, respiratory illness should be avoided
because it puts undue stress on the cardiovascular system[1].

We need to be come robots[2]!

[0] [https://www.labroots.com/trending/health-and-
medicine/4999/a...](https://www.labroots.com/trending/health-and-
medicine/4999/autoimmune-diseases-triggered-infection-how)

[1] [https://www.cbsnews.com/news/flu-tied-to-heart-attack-
risk-i...](https://www.cbsnews.com/news/flu-tied-to-heart-attack-risk-in-
elderly/)

[2]
[http://i.dailymail.co.uk/i/pix/2015/12/02/00/2EF55A550000057...](http://i.dailymail.co.uk/i/pix/2015/12/02/00/2EF55A5500000578-3341000-According_to_the_calculator_waiters_and_waitresses_have_a_94_per-a-26_1449015200147.jpg)

~~~
robbiep
And there’s also strong evidence that infection with ie. parasites decrease
lifetime autoimmune infections, and fevers have been known to send cancer into
remission

~~~
knowThySelfx
You maybe down voted because people here want links and proofs.

------
jakeogh
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-
tyl...](https://www.theatlantic.com/health/archive/2013/04/whats-tylenol-
doing-to-our-minds/275101/)

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

------
batter
Those who can't get Tamiflu/Oseltamivir:
[http://journals.plos.org/plosone/article?id=10.1371/journal....](http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0014320)
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.

------
nuna
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
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.

