Flu in Kids Can Be Frightening: Lessons Learned From the 2012-2013 Season

Avinash K. Shetty, MD


April 26, 2013

A Child Who Is Not Getting Better: What Is Going On?

Chief symptoms. Fever and cough.

Medical history. On February 7, 2013, a previously healthy 11-year-old boy was admitted because of fever and respiratory distress. He has been apparently well until 4 days earlier, when he was examined by his primary care provider because of fever (temperature, 103° F, nonproductive cough, sore throat, myalgia, and headache. He was diagnosed with viral syndrome and prescribed acetaminophen.

Fever (temperature >101° F) and cough persisted, and the day before admission, the boy's increasingly worried mother took him to a local emergency department, where he was diagnosed with reactive airway disease. After treatment with albuterol nebulization, he was discharged to home.

The following morning, the patient returned to the primary care provider's office with continuing fever up to 102° F and respiratory distress and was referred to our pediatric emergency department for further evaluation.

The patient's medical history was unremarkable. He had received his childhood immunizations but not the seasonal influenza vaccine. One week before the patient was admitted, his younger sibling had developed an upper respiratory tract infection.

Physical examination. On examination, the patient appeared ill. Vital signs were:

  • Temperature: 102.2° F

  • Heart rate: 110 beats/min

  • Respiratory rate: 30 breaths/min

  • Blood pressure: 112/76 mm Hg

  • Oxygen saturation: 91% on room air

Mild subcostal and intercostal retractions were noted. Chest auscultation revealed decreased breath sounds in the left lower lung field, with crackles. The rest of the examination was normal.

Laboratory data. A complete blood count showed leukocytosis (24.6 × 109 cells/L; normal range, 4.5-13.5 × 109 cells/L) with 80% segmented neutrophils, 15% lymphocytes, and 5% monocytes. Hemoglobin and platelet count were normal. A chest radiograph showed left-sided lower-lobe pneumonia with an adjacent small pleural effusion.