Like other flu viruses, H1N1 infects the respiratory system: the nose, throat and lungs.

The threat of the H1N1 virus to your child is twofold:

1. More people are expected to become infected by H1N1 than is usual with seasonal flu – the chance that your child will be exposed to flu is greater than usual.
2. Children under 5 are at high risk of serious flu-related complications, no matter what type of flu they have.

• How serious is the flu? ^[1]
  
• How does H1N1 spread? ^[2]
  
• How can I protect my child against the flu? ^[3]
• What can I do if my child gets sick? ^[4]
• Are infants at greater risk of catching H1N1 flu? ^[5]
• How can I help my sick child feel better? ^[6]
• What about day care? ^[7]

How serious is the flu?
Influenza (flu) can be very serious, especially for infants, children under five and people of any age who have chronic medical conditions such as asthma other lung problems, diabetes, heart disease or weakened immune systems.

It’s estimated that more than 20,000 children younger than 5 years old are hospitalized due to flu each year in the U.S. Many more have to go to a doctor, an urgent care center or the emergency room because of flu.

Complications from the flu can include pneumonia (when the lungs get infected and inflamed), dehydration (when a child is too sick to drink enough fluids and the body loses too much water), worsening of long-term medical problems like heart disease or asthma, encephalopathy (inflammation of the brain), sinus problems and ear infections.

How does H1N1 spread?
People with the flu are usually contagious (able to spread germs) beginning one day before their symptoms appear and continuing 5-7 days after. This period may be longer with H1N1 and with children.

The virus spreads mostly from person to person –when you inhale germs from the coughs or sneezes of someone who is sick with influenza. You may also get sick by touching something with flu viruses on it and then touching your mouth, nose or eyes.

For children, the best way to prevent the spread of germs is to stay away from others who are sick and keep hands and toys (and anything else that might go in their mouths) clean.

Here are a few things you and your children can do to keep from sharing germs:

• Start a new family policy of not kissing each other on the face.
• Cover your nose and mouth with a tissue when you cough or sneeze; throw used tissue in the trash (or carry a ziplock bag for temporary disposal). If you have no tissue, cough into your sleeve at the elbow (an area less likely to come into contact with other people or children than your wrist or shoulder, and also less likely to come into contact with doorknobs and other frequently touched items).
• Wash your hands often with soap and water or alcohol-based hand cleaners or wipes. When using a gel-type hand sanitizer, rub it on your hands until your hands are dry.
• Avoid touching your eyes, nose and mouth (where germs can get into your respiratory tract).
• Stay at least 6 feet away from anyone you suspect is sick. (Germs won’t travel much farther than that through the air.)
• Keep household items such as bathroom and kitchen counters, sink faucets, doorknobs, banisters, appliance handles, remote controls, toys and other frequently used items clean by wiping them down with a household disinfectant. Research indicates influenza virus can live on hard surfaces like these for 2-8 hours.
• Keep the sick person’s used towels, bed linens and clothes away from others.
• Teach children not to share anything that goes into their mouth or near their face, such as food, toys, towels, toothbrushes or toothpaste.
• Use paper towels and napkins, rather than cloth.
• Avoid crowds whenever possible.

How can I protect my child against the flu?
The first thing you can do for a child with asthma is visit your healthcare provider and update the child’s written asthma action plan. Be sure you are following the recommended medication schedule and ask what you should do if your child develops flu symptoms. Also, update and refill all asthma medications, so you have them available if you need them.

The next thing to do is make sure your child gets both seasonal and H1N1 influenza vaccinations as soon as they are available, and that all family members and caregivers also get flu vaccine.

The Centers for Disease Control and Prevention (CDC) recommends that all children 6 months up to their 5th birthday get a seasonal flu vaccination every fall. This vaccine is specially manufactured each year to match the type of seasonal flu that experts expect will appear in the U.S.

A vaccine against novel H1N1 flu is also being produced this year, scheduled to be available in the fall.

For full protection against influenza, children will need to get both vaccines. This may mean multiple injections, since young children may require two doses of the H1N1 vaccine (along with two doses of seasonal flu vaccine, if this is the child’s first flu vaccination). A nasal spray vaccine (FluMist®) is available for seasonal flu, but it is not recommended for people with asthma, as it has been known to cause bronchospasm.

What can I do if my child gets sick?
Symptoms of seasonal flu and H1N1 are similar: fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some children also may have vomiting and diarrhea.

If your child is younger than 5 and develops flu-like symptoms, CDC recommends you call your healthcare provider or get medical attention as soon as possible.

Influenza is very different from the common cold. Typically, a child who has a fever and no nasal symptoms likely has influenza. A child who has no fever but significant nasal symptoms likely has a cold, not influenza.

Keep your sick child at home and away from other people. Don’t let him go to school or child care until he has been fever-free for 24 hours.

Take your child (of any age) to a doctor or emergency department right away if any one of the following applies:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Child has underlying health conditions such as asthma or other lung disease, diabetes or heart disease) and develops flu-like symptoms, including fever or cough

Are infants at greater risk of catching H1N1 flu?
Yes, infants are thought to be at higher risk for severe illness from H1N1 than older children. And since flu vaccination is not recommended for babies under 6 months of age, parents and caregivers should take extra precautions to prevent exposing babies to flu.

• All family members and caregivers who interact with the baby should get seasonal and H1N1 flu vaccinations as soon as they are available
• Only family members or caregivers who are not sick should take care of infants
• If you are sick and you must care for your baby, wear a facemask (surgical or N95 respirator ^[8])
• Place a clean towel or blanket over your shoulder or lap when carrying or holding the baby
  • The influenza virus is not transmitted through breastmilk, so if you are breastfeeding ^[9], continue to do so; your milk is custom-made to help your baby fight disease. However, if you are sick:
    • Use a breast pump to express your milk, then ask someone who is not sick to give it to the baby in a bottle
    • Wear a facemask or respirator while you breastfeed and place a clean towel or blanket between you and your baby

How can I help my sick child feel better?

• If your child is uncomfortable because of fever, you can give medicine such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Be sure to follow dosage instructions on the label. Do not give aspirin-containing products.
• Cough and cold medications do not help, and should not be used, especially in children under 4 years of age.
• Encourage your child to drink liquids.

• If you are breastfeeding, give your baby many chances to breastfeed throughout the illness. Babies who are sick need more fluids than when they are well. Babies too sick to breastfeed can drink your milk from a cup, bottle, syringe or eye-dropper

• Antiviral medications like Tamiflu® and Relenza® can be used to treat both seasonal and H1N1 flu. They will not cure the illness, but might make patients feel better sooner. Tamiflu is approved for children over 12 months of age. Relenza is not for children under 5 or people with asthma.

What about day care?

• Keep a sick child home and out of day care until the child’s fever has been gone for 24 hours
• Be aware of what’s going on in your area and follow the recommendations of public health authorities. If the virus is causing significant illness in a particular area, authorities may close child care programs and public events.
• Prepare for what to do if schools and child care centers close.
• If the school or child care program closes and your children are healthy, you should still keep them home and out of large groups. 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 six) to minimize the risk of spreading germs.