Kids and Flu: How Common Are Complications, Really?

Laura A. Stokowski, RN, MS

Disclosures

October 03, 2014

In This Article

Influenza in Children

Influenza in children differs in a few essential ways from influenza in adults, starting with the rate of infection from influenza viruses, which is highest in children. The characteristic symptoms—fever, nonproductive cough, sore throat, malaise, and myalgia—are not always present, especially in very young children (aged < 5 years). Children are more likely to exhibit gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) and symptoms of otitis media.[1] The symptoms of influenza can also mimic bacterial sepsis in very young children, with high fevers and febrile seizures. Like adults, children shed influenza virus before and after the onset of illness, but in children, viral shedding can last twice as long (10 or more days) after the onset of symptoms.[1]

Most children with influenza will recover in 1-2 weeks, but children younger than 5 years are most likely to be taken to the emergency department (ED) for care.[1] A small proportion will develop complications, either resulting directly from the viral infection or from a host-related factor, such as an underlying chronic disease. Potential complications from influenza in children include viral pneumonia, secondary bacterial pneumonia or bacteremia, otitis media, respiratory failure, encephalopathy, seizures, prolonged hospitalization, and death. Children with neurologic/neuromuscular disease or cardiac disease are at highest risk of requiring prolonged hospitalization with influenza.[2]

In a systematic review and meta-analysis of observational studies, Mertz and colleagues[3] assessed the risk for poor outcomes of influenza in children, including death, ventilator support, hospital admission, intensive care unit admission, and pneumonia. They found, in contrast to other evidence, that children younger than 5 years were at lower risk for death, hospital admission, and need for ventilator support, but were at higher risk of developing pneumonia. They also found that children younger than 2 years were at significantly lower risk for admission to the hospital or intensive care, and of requiring ventilator support, compared with all other age groups.[3]

Although rare, pediatric deaths from influenza do occur and are not always predictable. Surveillance data for the 2010-2011 season showed that 49% of children who died of influenza had no known high-risk medical conditions.[4] Of interest, more than one third of pediatric deaths from influenza take place outside the hospital or in the ED, and previously healthy children appear to have a shorter interval between symptom onset and death.[5]

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