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

Complications of flu or flu-like illness

Children can develop complications from flu or flu-like illness including bacterial chest infections and middle ear infection. Children with a long term medical condition or disability can be more at risk of complications from flu or flu-like illness and their long term medical condition may also be affected. They can become seriously ill and hospital treatment may be needed.

Chest infection/bronchitis

Children with asthma and chronic lung disease already have a weakened chest and lungs. Flu or flu-like illness can make them more vulnerable to developing chest infections and bronchitis. Kwame frequently has chest infections if he has flu or flu-like illness and when he was four, he developed pneumonia. Adam’s son used to develop chest infections when he had flu or flu-like illness but they have become less frequent as he has got older. The last time he needed to go to hospital because of a chest infection was when he was four years old.
 

Kwame has chronic lung disease. Since he was a baby he would develop chest infections following a cold or flu-like illness. When he was four years old he had pneumonia.

Kwame has chronic lung disease. Since he was a baby he would develop chest infections following a cold or flu-like illness. When he was four years old he had pneumonia.

Age at interview: 42
Sex: Female
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They was kind of just talking to me about in the winter time a lot of premature babies get really, you know like the common colds and things, just actually can make them really ill, especially if they’ve been long term oxygen dependent.

Right.

So I assumed he’d get really ill like every winter, but there was a few winters, I think maybe two or three winters where he didn’t really get unwell.

Yeah

But now every winter he ends up at, in, probably in the hospital at least once, depending on the virus…

Right

…that’s going around but he will end up in hospital once needing either oxygen or recently like a nebuliser. Yeah really because of the kind of breathing problems as well. So…

Right.

It will start off as a normal cold and then it might move, well it moves to a chest infection and then…

Yeah.

I think when he was about four it turned to pneumonia he had for about five days he was really unwell, really but usually it runs from a cold to a chest infection and then to needing oxygen or hospital support then. 
 

After having flu-like illness, El developed a chest infection and was susceptible to chest infections for a long time afterwards.

After having flu-like illness, El developed a chest infection and was susceptible to chest infections for a long time afterwards.

Age at interview: 44
Sex: Female
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Has she ever had complications due to a flu-like illness?

We said she had a secondary chest infection that, that first time and I think that’s maybe how the diagnosis. It was around the sort of, were all around about that time, you know, when they said that they thought because obviously she was given some antibiotics then but she had been quite unwell with the flu initially and then obviously it wasn’t shifting. I did take her to the GP and that’s when he said, “Oh she had a chest infection which was probably because she’d had the flu. 

Is your child sort of susceptible to flu-related complications would you say or no?

Yeah [cough] yeah I mean like we had a chest infections and feeling very tired for quite a long time afterwards and weak and. Yeah

Ok

Run down.
Sometimes chest infections can worsen and develop into pneumonia. When Henry was four years old, he had a chest infection which developed rapidly into pneumonia and he spent a couple of days in hospital.
 

Daniel developed pneumonia when he was three months old after a flu-like illness.

Daniel developed pneumonia when he was three months old after a flu-like illness.

Age at interview: 27
Sex: Female
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It was the November after, he was born in August, and by the November of 2002 he started just really with the symptoms of a cold, well it would seem like a cold. With a runny nose, sneezing, coughing and that developed into projectile vomiting of his milk. We took him to the GP and initially they, the words of the GP were, “It’s just a little sniffle.”

I remember those words very clearly and he was very, not very concerned at all. He just said, “It’s just a little sniffle, children get ill you know, it’s a virus. Maybe give him Calpol if he has a temperature, it’ll improve.” And three days later he still hadn’t improved and I, you know lacking experience now was you know was looking to my mother for advice, and my mother was of the opinion that he was becoming dehydrated. He wasn’t wetting his nappy as often as we would have liked and it was my mother who took him to the GP on the second occasion because I was at college. 

And the GP that saw him on that occasion was very concerned about him and immediately referred him to the children’s ward at [hospital name] with a direct access. So my mother collected me from college and took me and Daniel and herself off to the hospital where we waited for a paediatrician, and they agreed that he had at least got a chest infection. They sent him for chest x-rays so I remember being taken by a porter from the children’s ward to the x-ray area. Now the x-ray area is full of mainly elderly people, very, very ill people and it’s only at that point when you get to the x-ray area and you’ve got all these ill people around you that you realise actually this could be quite serious. You know my son’s very, he was a small, fairly small baby to start with. He wasn’t, didn’t have a lot of extra weight anyway. 

They then diagnosed the pneumonia he had on the left side quite an extensive patch of pneumonia. And they then put him in a side ward, you know 
 

Several days after having flu-like illness symptoms, Ciaran deteriorated overnight and was rushed to hospital with pneumonia.

Several days after having flu-like illness symptoms, Ciaran deteriorated overnight and was rushed to hospital with pneumonia.

Age at interview: 50
Sex: Female
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So, how did you manage at home?

Well we were just, well we would have stayed at home with him, and we would have slept with him in the same room. We do that. And just kept an eye on him. And then he'd wake every hour, and we would try and get some fluids down him. Which wasn't always easy. And then - but that wasn't too bad. It was just, you know, us sleeping with him because he was distressed and we would sort of try and get as much throughout the night, as much fluids down him. But , you know, it got to the stage where we thought well, you know, he's not getting any better, it's been a couple of days with these sort of symptoms, so we took him to the GP. And the GP didn't seem to be overly worried about it either. So, you know, we just went home again. But then the next day it just - he seemed to deteriorate quite quickly overnight, so we took him urgently to the doctors the following morning. And basically they couldn't find a pulse, they were putting one of those things on his fingers, and they couldn't find - yeah. And they couldn't find any pulse. And basically they called an ambulance straight away. And we were taken then and blue-lighted from the GP's surgery to the general. Where he was taken straight into resus and basically they were - because he wasn't breathing very well, and they were, I think they were going to intubate him, but they managed to avoid that by putting a big mask where - on his face - where it forces oxygen in him. So it was quite, it wasn't very nice to look at because it covered his whole face, you know?

Okay. Okay.

And, but it helped him.

So it blows oxygen.

Did they do tests, like blood tests and x-rays and-?

Yes, they did, yes. At the beginning, they did an x-ray and then I think they might have done it again, I think they might have- did they bring him?- in the two weeks I think we were down in paediatrics HDU, I think they didn’t have an x-ray machine down there, so. I don’t think we had an x-ray while he was there cos we were sort of in the bowels of the hospital, and I don’t think they ever took him out of there for an x-ray, I don’t recall him having an x-ray

Okay, and blood tests, yes?

At the beginning and at the end, blood tests, yes. 

Okay. And what point they told you, they say ‘It’s pneumonia’?

Well, it was not even that, they said it was double pneumonia, it was, it’s what we used to call double pneumonia, pretty much quickly. 
Ear infection

Ear infection is another possible complication. Symptoms may include earaches and thick, yellow fluid coming from the ears. Lyndey explained that her children sometimes get ‘agonising earache’ after flu-like illness which stops them from sleeping. Eliza often develops an ear infection when she has flu-like illness. She gets antibiotic ear drops from the doctors if her ear has become infected and starts to smell.
 

Alessio is immuno-compromised and he tends to develop secondary bacterial chest and ear infections when he has flu-like illness.

Alessio is immuno-compromised and he tends to develop secondary bacterial chest and ear infections when he has flu-like illness.

Age at interview: 50
Sex: Female
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And especially for prolonged period I mean if, if he’s just for example like he got better on Monday and if it hadn’t continued I would not have taken him to the doctor for the antibiotic. It came back again, if I don’t get treatment now it will get, it will get worse.

Yes.

Because it’s a prolonged period and it, I can hear that his breathing is difficult.

Yes.

Last night. And he’s also having a hoarse voice and he’s complaining about his ear ache. So it could be that he’s got ear, nose, throat infection as well. I think that’s possibly secondary. I think he had a viral infection initially…

Yes, yeah.

…and then it prolonged, it’s not been treated and now it’s gone to his ear, nose, throat because he suffers from hay fever. So he’s more inclined to get congested. He’s also got narrow tear ducts.

Yes.

So he cannot excrete, so it’s quite, it’s quite easy to get an infection around eyes.
Effect on long term medical condition or disability

Some parents we interviewed said that their child’s long term medical condition or disability was also affected and as well as recovering from the flu or flu-like illness, their body was coping with additional symptoms. Jack developed shingles because his immune system was so compromised following flu-like illness.

For children who had asthma, flu or flu-like illness could lead to a worsening of their asthma symptoms and sometimes an asthma attack. Sharon said that a viral or flu-like illness was the only time that Henry had an asthma attack.
 

Flu-like illness often develops into chest infections and breathing problems for Kwame.

Flu-like illness often develops into chest infections and breathing problems for Kwame.

Age at interview: 42
Sex: Female
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Well it just kind of would start with a normal cold, kind of sneezing, I dunno coughing, feeling really tired, probably a temperature. And if it’s just going to be a normal cold or a virus after probably two or three days, yeah that’s usually the symptoms are getting better or maybe even gone. But if it actually is going into something else then it will kind of carry on, and what will happen is things will just kind of steadily kind of get worse, so if he’s got a temperature it will go on for longer until maybe Calpol and other stuff is not keeping it down. He’ll feel even yeah even worse really. And his chest, because when he left hospital on oxygen I always check his chest, so I’ll check his kind of neck and chest and if he’s kind of struggling to breathe he’ll start with his chest kind of really sucking in here, so that’s when I know it’s the start…

Okay

…of respiratory distress. And it’s usually like, sometimes he might have wheezing and sometimes he might not, but once he gets to that point where he’s actually struggling to breathe and I can see he’s struggling to breathe we’re usually at the hospital then. A&E.
 

When Rebecca’s son was a baby he experienced wheezing and breathing difficulties after developing flu-like illness. As he got older he was diagnosed with asthma and now every time he has a cold or flu he has an asthma attack.

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When Rebecca’s son was a baby he experienced wheezing and breathing difficulties after developing flu-like illness. As he got older he was diagnosed with asthma and now every time he has a cold or flu he has an asthma attack.

Age at interview: 35
Sex: Female
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When he was actually a baby, probably about, from about six months old he constantly had ear infections first of all. No sign of asthma but permanent sort of green thick gunge coming out of his ears. So, and they kept putting him on antibiotics which didn’t really help that much. So he was put under an ENT consultant who put him on a low dose six month course of antibiotics.

But at the time it followed sort of a flu-like illness, really bad cold, really bad fever, crying, you could tell he was uncomfortable. But then we noticed the recessing in the ribs and struggling to get his breath in, coughing and trying to, really struggling. So that was the first time he got admitted. 

At, at that time they said they were, they couldn’t say what it was, they thought it was some kind of viral induced wheeze brought on by the flu, and then he got admitted again, eight weeks later I think it was, with the same thing. So again they were saying viral induced wheeze which we heard several times over that sort of year.

So the cycle kept continuing, either every time he got a cold or flu like illness, which he seemed to get more often than other children, he would then have an episode, or every eight weeks as well, even if he wasn’t poorly. So you know that would happen anyway. 

Right.

Which was really odd.

So yes it does seem to be that it’s, it’s, it follows a cycle but then if he gets a cold or flu like illness then that, there’s no doubt that he will also then flare up as well.

Every time?

Yeah.
For some children with a long term medical condition or disability, flu-like illness had to be managed very carefully because further complications could make them seriously ill. Loss of appetite could lead to a particular problem for children with Type 1 diabetes who need to eat when they take insulin. With high levels of ketones in the blood, diabetic ketoacidosis could develop, which can be life-threatening. Louise explained she needs to keep her sons blood glucose levels low when he has flu or flu-like illness otherwise, “the body is battling two different things. It’s battling the highs and potentially going into diabetic ketoacidosis, and at the same time has a virus.”
 

Managing her son’s insulin needs when he has flu-like illness is difficult and it takes a while for his body to adjust.

Managing her son’s insulin needs when he has flu-like illness is difficult and it takes a while for his body to adjust.

Age at interview: 37
Sex: Female
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But, yeah, it is quite hard work when he gets ill, because mainly the main drain on the family and it is a drain on the whole family is the night time checks. I have to check him through the night, because to keep those, there’s no chance of him recuperating, unless I can keep those blood sugar levels down and normal, cos then the body is battling two different things. It’s battling the highs and potentially going into diabetic ketoacidosis, and at the same time has a virus. So you don’t, you want to remove one element so to give the body a chance to fight the other, do you understand? So I have to try my very best and insulin needs a requirements can quadruple, you know, they go so high and it is a constant firefighting of kind of increasing the dose finding, you can get advice six day rules from the consultant and really you have to just, you can’t really follow it to the letter, because every child is different. So I need to kind of just take that as a basic template as what how to cope and then experiment. You have to be very aggressive with the insulin and try and bring the blood sugar levels down. 

Now, how long does it take for, for the diabetes to get under control, following a flu or flu-like illness episode?

It really takes a long time. So, we have high blood sugar levels prior to the flu kind of being kind of noticeable. And then we have high blood sugar levels in duration. And when he starts to pick it up his insulin needs drop dramatically and they go back to kind of the normal requirements. So that adjustment, from being on sick day kind of insulin needs to kind of normal needs is, is quite tricky one. And I have sent him to school for instance, after a bug thinking he’s been a week off, he’s fine now and he looks fine. Sent him to school Monday, but him suffering from continuous lows all day, because his body is still kind of, I don’t really understand it and is probably something a consultant can answer. But it’s gone, he’s gone from needing so much insulin to requiring less and the body is still adjusting to that.
Ella is immunocompromised and gets flu or flu-like illness frequently. When she develops flu-like symptoms she usually needs to go to hospital to be checked and to have antibiotics because if she doesn’t drink enough fluids this could have a severe effect on her kidney condition. 
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