Frequently Asked Questions About 2009 H1N1 Influenza (Swine Flu)

1. What can families do to protect themselves from H1N1 influenza (swine flu)?
2. Should my child get the flu vaccines?
3. Is the 2009 H1N1 (swine flu) vaccine safe?
4. Where can I get the flu vaccine?
5. What are the symptoms of flu in children?
6. How do you know whether or not to be concerned about swine flu in your area?
7. What’s the most important thing parents can do now, just in case infections are reported in their own area?
8. What advice do you have for parents with children in school or child care?
9. What should parents do if their child has flu-like symptoms?
10. What are the signs that my child with flu-like symptoms is getting worse?
11. Are any medicines recommended to help children with swine flu?
12. If my child has flu, how can I keep myself and other family members from getting sick?
13. Is flu more dangerous for very young children?
14. How is the 2009 H1N1 flu (swine flu) different than the "regular" flu?
15. Should I use antibacterial soaps and/or alcohol-based hand rub products?
16. Are face masks necessary?
17. Can mothers who have swine flu continue to breastfeed?

1. What can families do to protect themselves from H1N1 influenza (swine flu)?

• Wash hands often with soap and water, especially after you cough or sneeze. Wash hands for 20 seconds, which is about as long as it takes to sing the “Happy Birthday” song twice. Alcohol-based hand cleaners also work well. Keep in mind that alcohol-based products are toxic if ingested by children. (The amount left on hands after use is not a concern.)
• Cough or sneeze into your elbow or upper sleeve. If you use a tissue instead, cover your nose and mouth with it when you cough or sneeze. Throw the tissue in the trash right after you use it.
• Avoid touching your eyes, nose or mouth. Germs spread that way.
• Stay at least 6 feet away from people who are sick. Avoid crowds. This will limit the spread of illness.
• Stay home when sick to keep from spreading illness.
• All sick children and/or sick adults should stay home until 24 hours after they have no more fever (or signs of fever) without the use of fever-reducing medications. A fever is considered to be a temperature of at least 100.4°F.
• Seek medical care if you are severely ill, such as having trouble breathing. Antiviral medicines may help.

The CDC answers common questions about swine flu .

2. Should my child get the flu vaccines?

• Even healthy children can get the flu, which can make any child very sick – and can even be fatal.
• There are several kinds of flu illnesses, and children can get all of them.
• Children should get flu vaccines to protect themselves from the flu. Each flu vaccine comes as a shot or a spray up the nose.
• All children ages 6 months through 18 years should get the vaccine to protect against the seasonal flu. If your child is less than 9 years old and this is his or her first time getting a flu vaccine, s/he will need two doses.
• Parents and caretakers of infants under 6 months of age should also get the seasonal flu vaccine now to protect these children who are too young to be vaccinated.
• A separate H1N1 (swine flu) vaccine is needed to protect against the 2009 H1N1 (swine flu) strain. This vaccine is starting to become available now, and the CDC expects more doses to be available each week.
• The 2009 H1N1 (swine flu) vaccine is a good match for the strains of the virus now circulating in communities. This means it should work well against the 2009 H1N1 flu virus.
• Certain high-risk groups of people should be first in line to get the H1N1 (swine flu) vaccine. That includes all children ages 6 months through 24 years of age, caretakers of children younger than 6 months, pregnant women, health care workers and emergency services personnel, and adults ages 25 to 64 with chronic medical conditions that increase their risk of flu complications.
• Adults need one dose of the H1N1 vaccine.
• Children ages 10 through 17 years need one dose of the H1N1 vaccine.
• Children under 10 years of age need 2 doses of the H1N1 vaccine.

3. Is the 2009 H1N1 (swine flu) vaccine safe?

• The H1N1 (swine flu) vaccine is being manufactured in the same way as seasonal influenza vaccine, which has a 60-year safety record.
• Many careful, repeated studies have shown that vaccines, including influenza vaccines, are safe and effective. For more information about vaccine safety .
• The H1N1 (swine flu) vaccine is being tested in adults, children and pregnant women to evaluate its safety and effectiveness. Some results have been reported from the studies of this vaccine in adults and children. These studies found the vaccine is safe and is similar to seasonal flu vaccine. No serious harmful side effects were reported.

4. Where can I get the flu vaccine?

• Seasonal flu vaccine is available now. Call your pediatrician to learn the best way for your child to receive this vaccine.
• H1N1 (swine flu) vaccine is being distributed by the government through state and local public health agencies. Distribution will vary by community, but it may be available at doctors’ offices or special clinics set up in schools and other public facilities. Check with your local health authorities and news sources to learn about distribution in your area.
• Preservative-free flu vaccines without thimerosal are available.

5. What are the symptoms of flu in children?

• Children with influenza have a sudden onset of fever, chills, sore throat, cough, and runny nose. It may also cause headache, muscle aches, tiredness, nausea, vomiting and belly ache.
• Influenza is different from the common cold, but it can be hard to tell which illness someone has. Typically, a child with a cold can have a stuffy nose, sneezing, scratchy throat, hoarse voice, dry cough (usually from mucous dripping down the throat), and slight fever. Even with cold symptoms, people generally can keep up with their usual activities.

6. How do you know whether or not to be concerned about swine flu in your area?

• Know what the public health authorities in your area are saying.
• Follow their recommendations to reduce your risk of catching the virus.

7. What’s the most important thing parents can do now, just in case infections are reported in their own area?

• Consider what you will need to do to arrange for child care at home for your children, if they came down with the flu.
• Stock up on supplies and non-perishable food at home.
• Be prepared to create a “sick room” for an ill family member. Needed supplies include clean washcloths, household disinfectant, a thermometer, fever-reducing medications, a humidifier, tissues, a waste basket and trash can liners.
• Have your pediatrician’s contact information handy.
• Be aware of what’s going on in your area and follow the recommendations of public health authorities.
• Learn the symptoms of flu so you can detect illness in your children early. 
• Plan now what you would do if your child’s school or child care center were to close.

The CDC offers advice for parents on talking to their children about H1N1 .

8. What advice do you have for parents with children in school or child care?

• Parents should not take healthy children out of child care or school to prevent illness unless public health authorities have recommended such a step.
• If the virus is causing significant illness in a particular area, authorities may close child care programs and public events. However, closing schools is not always the best way to prevent further spread of infection.
• If the school or child care program closes and your children are healthy, parents should still keep them home and not participate in social activities or sports activities.
• Working parents may team up with other parents to take turns staying home with children; such groups should be kept to small numbers of children (fewer than 6) to minimize the risk of spreading germs.
• Parents should remind their children about proper hygiene, including sneezing and coughing into a tissue or sleeve, and frequent handwashing.
• Parents should advise children to go to the school nurse if they start to feel sick during school. Children who are sick should stay home until 24 hours after they have no more fever of at least 100.4°F (or signs of fever) without the use of fever-reducing medications.
• Normal body temperature is different for each child. In general, a temperature of 100.4°F (38°C) or higher is a sign of fever. Note: Schools and child care centers may have different rules about when children need to stay home.

 
9. What should parents do if their child has flu-like symptoms?

• If your child has mild illness, he should stay home from school or child care until he has been fever-free for 24 hours without the use of fever-reducing medications.
• Any child younger than 3 months who has a fever (rectal temperature of 100.4°F or higher) should see a pediatrician.
• In a child older than 3 months, how high the fever is, is not as important as how he or she feels and acts. Bring your child to the pediatrician if she is very sleepy or has little energy to play, is very irritable and cannot be comforted, has trouble breathing, is not drinking well or is otherwise not acting normally.
• If your child has underlying health problems (for example, heart or lung problems, weakened immune system, chronic kidney disease, sickle cell disease, asthma, or a severe neurological disorder not including ADHD or autism), see a pediatrician as soon as mild flu symptoms start.
• If your child is otherwise healthy, call your pediatrician to see if an appointment is needed.
• If your children are uncomfortable because of the fever, you can give them medicine such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Do not give aspirin-containing products.
• Encourage them to drink liquids, especially if they are not eating well. Chicken soup can provide liquids and has been found to alleviate symptoms.
• If your child has severe symptoms, has been to an area where there have been cases of swine flu, or been directly exposed to a swine flu patient, call your doctor for advice. Your doctor can help you decide whether your child needs to be seen or if they may need to be treated with an antiviral medicine.

The AAP offers advice on taking a child’s temperature.
                                       
10. What are the signs that my child with flu-like symptoms is getting worse?

• Trouble breathing or fast breathing
• Not drinking well
• Not urinating as much as usual
• Bluish or gray skin color
• Being irritable even after the fever goes down
• Not waking up normally or not interacting normally
• Rash
• The fever goes down and flu symptoms seem to be getting better, but then get worse again a day or two later

11. Are any medicines recommended to help children with swine flu?

• Children with influenza should never receive any product that contains aspirin. Acetaminophen (Tylenol) and ibuprofen (Advil and Motrin) are fine to treat fever and body aches in children.
• Cough and cold medications do not help, and should not be used, especially in young children under 4 years of age.  
• Most adolescents, adults and children do not need antiviral medicines. Overuse of these medications could be counter-productive and lead to resistance.
• People who are at high risk of complications from flu should talk with their doctor in advance about what to do if they notice flu-like symptoms.
• Only children who are at higher risk of flu complications (such as those with chronic disease or cancer, or very young children) should receive antiviral medicine for flu symptoms or close contact with a person with the 2009 H1N1 flu (swine flu).
• It is expected that oseltamivir (Tamiflu) will be more effective if taken soon after the onset of symptoms, rather than later in the course of the illness. Based on a recent study, Tamiflu may have more side effects in children than in adults; your pediatrician can help you decide if this medication is right for your child. Zanamivir (Relenza) is not for young children under 7 years of age.
• The use of antiviral medications is not a substitute for getting a flu vaccine.
• Your pediatrician will decide when treatment is indicated and which drug is best to treat your child.

The CDC offers advice for taking care of a sick person with swine flu.

12. If my child has flu, how can I keep myself and other family members from getting sick?

• Keep your sick child in a room separate from other people in the house. Have supplies including a thermometer, clean washcloths, household disinfectant, tissues, a trash can (and liners) available in that “sick” room.
• Choose 1 adult to care for the sick child and limit visitors to reduce the spread of infection.
• If possible, the sick person should use a separate bathroom from the other members of the household. The bathroom should be cleaned daily with household disinfectant.
• When holding a small child who is sick, place the child’s chin on your shoulder so that he or she will not cough in your face
• Wash your hands with soap and water often, or use an alcohol-based hand gel if soap is not available.
• Keep surfaces (including toys and bedside table) clean – wipe them down with a household disinfectant.
• Wash bed sheets and towels with laundry detergent in hot water. Avoid “hugging” the dirty laundry on the way to the washing machine, and wash your hands thoroughly after handling dirty laundry.

13. Is flu more dangerous for very young children?

• Children under age 2 have a higher risk of complications and hospitalization from influenza than older children.
• Children of any age who have an underlying medical condition, such as asthma, diabetes, another metabolic disease, chronic kidney disease, or sickle cell disease are also at greater risk of complications.

14. How is the 2009 H1N1 flu (swine flu) different than the "regular" flu?

• At this point the 2009 H1N1 virus does not appear to be more severe than seasonal flu.
• Unlike seasonal flu, which tends to cause more significant illness in elderly people and very young children, H1N1 flu (swine flu) is most common in people 5 to 24 years old.
• While seasonal flu usually peaks in January or February, the 2009 H1N1 virus has caused illness during the summer months and remains active as we head into the fall and early winter.

15. Should I use antibacterial soaps and/or alcohol-based hand rub products?

• Washing hands with warm running water and soap (antibacterial soap is fine but not necessary) for at least 20 seconds (the time it takes to sing the “Happy Birthday” song twice) has been shown to kill the flu virus.
• Alcohol-based rubs can be used when soap and water are not available, such as after hand shaking or touching objects that carry germs. Keep in mind that alcohol-based products are toxic if ingested by children. (The amount left on hands after use is not a concern.) Keep these products out of the reach of children and supervise their use.

16. Are face masks necessary?

• Handwashing and avoiding close contact with sick people are more important than wearing face masks to prevent the spread of the virus.
• If you are caring for a child or other person who has swine flu, a face mask can be used to help reduce the chance of spreading germs.
• Follow the recommendations of local and state public health authorities.

The CDC offers guidance on face masks.

17. Can mothers who have swine flu continue to breastfeed?

• The influenza virus is not transmitted by breastmilk.
• Mothers who believe they may be infected should be sure to wash their hands before breastfeeding.
• Be sure to use clean burp cloths, and consider wearing a face mask.
• Parents and caregivers of infants under 6 months of age should receive the flu shot to prevent illness.

The CDC offers guidance on breastfeeding with swine flu.