Flu or Flu-like illness in chronically ill or disabled children

Flu or flu-like illness symptoms

Flu, also called Influenza, is particularly common in the winter months. A high temperature of 37.5°C (99.5°F), a dry chesty cough, a headache, fatigue and weakness, chills, aching muscles, a runny or blocked nose, sore throat and loss of appetite are all common symptoms of flu (Influenza) in children. However, other types of infections may cause similar symptoms in children who are referred to as having ‘flu’. The term ‘flu-like illness’ includes all children who have these symptoms, whether or not they were caused by flu. However, some people still describe children as having ‘flu’ even if the exact cause of their symptoms has not been confirmed.

Parents we interviewed were well aware of the difference between a cold and flu, although sometimes initial symptoms such as a runny nose, a high temperature, or a cough were similar. When their child was getting flu or flu-like illness the parents noticed that they deteriorated quickly – sometimes within a few hours. Their knowledge of what was normal for their child alerted them that it was a more serious illness than a mere ‘sniffle’. Unusual factors included loss of appetite in a child who usually ate well, paper white skin in a child with ‘English rose’ colouring, the disappearance of the ‘sparkle’ from a child’s eye, a different smell, uncharacteristic sleepiness in the day time, a lack of interest in activities that were normally engaged in with enthusiasm, or a child who was usually noisy and mobile being ‘too quiet’ or too still.
Lethargy (a lack of energy and tiredness), sometimes described as the child being ‘floppy’, was common. Matias’s dad said that Matias, “just wanted to sleep all the time, just shattered, absolutely shattered.” Jade was normally active even when she was unwell but when she had flu-like illness, she didn’t want to move. Maria said her daughter’s high temperature lasted for two or three days and “You couldn’t get even near her. She was on fire.”
Eliza’s mother said that despite an underlying heart condition her daughter’s experience of flu-like illness was pretty normal, and like her own. However, children’s health problems sometimes meant that they did not have ‘normal flu’, or caused complications because of the nature of the health problem. Loss of appetite was a particular problem for children with diabetes who need to eat when they take insulin.
Children with lung disease or asthma tended to have very laboured breathing, which could be clearly heard and seen in the chest movements. Some parents said that they noticed a change in the sound of a cough, for example, from chesty to ‘incessant and dry’, or even a change in the child’s laughter, which Ruth said became more ‘shuddery’. 

Flu or flu-like illness symptoms could develop rapidly in children with a long term medical condition or disability, sometimes leading to complications which required medical treatment. Daniel has asthma and Nia is aware “that the one day he could have just a runny nose and a cold, and be blowing his nose, and the next day he could be coughing up green sputum…. a sign it has progressed to a chest infection.” Karen said, “You can’t just let things linger with him and say, “Oh in a couple of days he’ll be better.” Because in a couple of days he’ll probably be worse if you don’t do something about it.”
Parents said they were aware of the signs when their child’s symptoms was deteriorating and they needed to seek medical help. A sign for Lyndey that her youngest child’s flu-like illness was deteriorating was when he developed ‘an incessant cough.’ When her son’s breathing is affected Hyacinth knows that it’s more than a normal cold. Matias is ten years old and is non-verbal. He doesn’t cry for attention, so his parents know that if he is crying he is feeling very unwell. Arthur, who has Down’s Syndrome, is also non-verbal and his parents realised he was touching his ear a lot, which was obviously causing him pain. 

Parents also sometimes just knew or described a gut feeling when the illness was more serious than a cold. Nia explained that for her it was ‘just experience and knowing your child’ and Georgina said, ‘I am very sensitive to my son. I know when he is not well, I see the colour of his face change.’

Because parents were very sensitive to any changes in their child’s health they felt they knew when their child needed care and really appreciated doctors who knew this and responded quickly. Those parents who had other children sometimes felt more confident in recognising that an infant was particularly unwell, while a 17 year old mother of a 3 month old baby with Down’s Syndrome said she had initially had her concerns about her infant dismissed as a ‘sniffle’ by the GP (the baby developed pneumonia).

See ‘Complications of flu or flu-like illness’.

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