7 Things Parents Should Know About the Flu in Children

Updated: Jun. 30, 2022

Anyone who has endured the flu knows it isn't fun—and that's especially true of the flu in children. Here's how to read the flu symptoms in children, tell them apart from Covid-19, and how to manage the virus.

Girl getting vaccine
iStock/Christopher Futcher

The best flu treatment is prevention

While it’s true that the effectiveness of the flu vaccine varies from year to year, the experts agree it is well worth it to get vaccinated. “For kids, the flu is the most common vaccine-preventable illness to result in hospitalization,” says Mary Anne Jackson, MD, a pediatric infectious disease specialist at Children’s Mercy Kansas City in Kansas City, Missouri. She adds that 50 percent of flu-related pediatric deaths happen in children who were otherwise healthy, but didn’t get a vaccination.

Dr. Jackson says all people six months of age and older should get the flu vaccine, which not only helps immunize them but also protects those who are too young—meaning under the age of six months—to be vaccinated. The Centers for Disease Control and Prevention (CDC) recommends children who receive a flu vaccine for the first time get a booster approximately one month later. This is especially critical as cold and flu season is approaching and health experts predict a second wave of coronavirus to occur simultaneously in the upcoming months.

Girl sneezing
Stephanie Frey/Shutterstock

Is it a cold or the flu or coronavirus?

It’s easy to confuse flu symptoms in children with symptoms of the common cold and SARS-CoV-2, the virus that causes Covid-19. “Many parents will say that they knew their child wasn’t feeling well because he or she was fussier or sleepier than usual, or weren’t as hungry as usual,” says Annapolis, Maryland-based pediatrician Christina Johns, MD, senior medical advisor at PM Pediatrics. She adds that although these symptoms are fairly non-specific, they are sure flu giveaways when accompanied by a very high fever. (If your child’s fever tops 103 degrees, call your doctor immediately. For babies under three months old, that call-the-doctor-ASAP-temperature is 100.4 degrees.) Influenza is a respiratory illness, so it generally starts with a headache and then sore throat and cough—unlike a cold, which starts with a runny nose and congestion, says Dr. Jackson.

Flu vs. Covid-19

When it comes to the flu and the novel coronavirus, it’s important to remember while there are similarities, there are also key differences. For example, both cause fever, dry cough, and muscle and body aches. However, a notable distinction between Covid-19 and the flu is that the novel coronavirus infection usually begins with a fever, while the flu tends to start with a cough and then progresses to fever. Another difference: A change in or loss of taste or smell.

Something parents need to watch for in children who develop Covid-19 is that some may also go on to develop inflammation of limbs and organs, like the brain and kidneys, a condition known as multisystem inflammatory syndrome in children (MIS-C). Although a rare syndrome, it’s important for parents to be mindful of this if their child presents other symptoms that go beyond the flu. (Learn more about how multi-system inflammatory syndrome works.)

The tricky part for parents attempting to diagnose flu in children, of course, is that little ones may not be able to articulate which part of their body hurts. Dr. Jackson says to take note if a child refuses to drink or becomes less active, which is more symptomatic of flu than a cold. If you’re achy and feverish you should go see a doctor.

Boy drinking water

Offer lots to eat and drink

For the flu in children, the first plan of attack should be to keep him or her hydrated and nourished, no doubt easier said than done. “Having high fever increases the body’s metabolic demand, so this means children need more energy and hydration than usual, which is difficult when kids are sick and don’t want to eat or drink,” says David Mathison, MD, a regional medical director for PM Pediatrics, and an assistant professor of pediatrics and emergency medicine at George Washington University School of Medicine and Health Sciences, in Washington, D.C. To avoid dehydration, which can lead to hospitalization, Dr. Johns suggests enticing babies under the age of 12 months with electrolyte- and glucose-fortified drinks, such as Pedialyte. The same concept of what foods to eat during the flu applies to older children, but Gatorade or another sports drink may be substituted.

Baby taking medicine
iStock/Anusorn Sutapan

Early treatment can lead to faster recovery

How long does the flu in children last? When the flu strikes, that may be one of your first questions. There is no cure for the flu. But antiviral medications may help lessen the effects and shorten the duration of the flu. The key: Get started on treatment as soon as possible. “Tamiflu is an option to expedite recovery of flu in children,” says Dr. Mathison. “This medication is indicated to reduce the symptom duration of the flu if started within the first 24 to 48 hours.” He cautions neither Tamiflu nor the generic version, oseltamivir, will lead to an instant recovery, though they can shorten the length of the sickness.

You can start using some types of antiviral drugs in children as young as two weeks old, according to the CDC. There are now four different antiviral drugs that can be used to treat children with the flu, although some are only approved for older children (and keep in mind they can have side effects, so they should only be used when the benefits outweigh the risks). Treatment is recommended for children with severe illness or who are at high risk of complications. “Children at high risk of flu-related complications include children younger than five years old (especially those younger than two years) and children of any age with certain chronic health conditions like asthma, diabetes, or heart or lung disease,” the CDC says.

Mother and child

Soothe with a lot of TLC

Because the flu is viral and can’t be cured with medication, Dr. Johns says lots of comfort is important. Use cold compresses to ease fever, lukewarm baths, and massages for the aches. To treat fever, Dr. Jackson encourages parents of babies to check with their doctors for the proper dose of acetaminophen (Tylenol). She also reminds parents never to give decongestants or cough medications to children younger than six. Instead, a humidifier or vaporizer may help ease the discomfort of congestion.

Cleaning surface

Keep your house clean to reduce the risk of an outbreak

The flu is highly contagious—even before symptoms appear. It is most often spread when germ-filled droplets from someone who is infected transfer to another person via coughing, sneezing, or even talking, which can happen when the individuals are as far away as six feet. The same applies to Covid-19 transmission. That makes for a very tricky situation when a virus enters a household. “It is nearly impossible not to spread a very contagious virus like influenza to family members,” says Dr. Johns. Her best suggestion to minimize the risk of flu spreading to siblings or parents is regular hand washing, no sharing of utensils or food, and disinfecting countertops regularly. (Also, check out the coronavirus cleaning guide.)

Parent and child at the doctor's office

When in doubt, consult a doctor

For most children with the flu who receive proper care and rest at home, Dr. Jackson says fever should subside in two to four days with a cough lingering for seven to 10 days. However, in 20 to 40 percent of cases, she says a complication such as an ear infection or pneumonia may develop. That’s why Dr. Mathison says “sooner is always better” when it comes to taking a child who seems to be worsening to the doctor. “As a pediatric emergency physician, I worry when children become weak, confused, lethargic, or have difficulty breathing,” he says. “These are signs that a patient may have inadequate hydration or the virus is negatively affecting their cardio-respiratory system.” Other major red flags that indicate you need to see a doctor immediately: Your child has rapid breathing or a high fever, becomes listless, develops a blue tinge around his mouth, or experiences a seizure.