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

Managing flu or flu-like illness at home

The parents we spoke to tried various ways to manage their child’s flu or flu-like illness symptoms at home. Sometimes children did not need to see a doctor or go to hospital and were able to be looked after at home for the whole illness.
 

When her daughter, who has asthma, was a bit younger, Ruth tended to pack a bag ready to go to hospital every time she got a cold

When her daughter, who has asthma, was a bit younger, Ruth tended to pack a bag ready to go to hospital every time she got a cold

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So yeah no one really sleeps and it’s really stressful, it makes you feel sick when she’s, you know when she’s like this because you, we’ve seen, you know we’ve seen how bad it can get and you know we’re always, I mean one of the sad things, I do remember going to see our asthma nurse and saying “I don’t think normal people pack a bag for hospital when their kids have a cold,” you know like ‘cos when she starts getting bad, quite often we’ll do that, we’ll have a bag ready. Not so much this last year but certainly the year before we did, like you know, so and I don’t think that’s entirely normal. You know so, but yeah so they’re the sort of little things that you do just to try and make it easier, you know and , but no, yeah no one’s sleeping.
 

Oliver usually has similar symptoms when he has flu-like illness. Anita treats him at home rather than go to the GP as she knows antibiotics will not be effective in treating his virus.

Oliver usually has similar symptoms when he has flu-like illness. Anita treats him at home rather than go to the GP as she knows antibiotics will not be effective in treating his virus.

Age at interview: 41
Sex: Female
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Do you think all his sort of episodes of sort of flu or flu-like illness are similar? 

Yes. Yeah he gets a temperature. He gets the croup with it. He gets, yeah, very hoarse, very mucusy. Well yeah they’re about the same symptoms every time. And that’s why I think I know what it is every time because it’s. There is no change in it. It’s, it is what it is. 

Ok so it is the same. Yeah. And the fever for how long does it last?

Couple of days, two to three days. He can have Calpol although sometimes it doesn’t, doesn’t change it. It’s just literally a case of stripping him off and letting him cool down.

Ok and regarding his overall condition when he’s ill with this flu-like what do you need to do differently? 

He drinks more because he does get, he’s off his food. So he drinks, he does drink a lot more but sometimes he doesn’t want to drink because I think he gets a really sore throat. And that’s the thing isn’t it, getting fluids in you. 

So regarding when he is ill you don’t tend to go to the doctor’s?

I don’t know. I don’t if he doesn’t need, like I say I’ve been to the doctors with him previously, same symptoms and everything else and it’s just viral. That’s the answer. Everything is viral. It’s viral. It’s a viral infection. That’s all you tend to get and obviously viral infections they don’t prescribe anything for anyway so I don’t tend to go.
Treating flu or flu-like illness symptoms

Generally a temperature of over 37.5C (99F) is considered a fever. Parents treated their child’s fever with paracetamol (aged over two months old) or ibuprofen (aged over three months old). The NHS Choices website has advice about giving paracetamol and ibuprofen to children. Parents are advised to check with their pharmacist that they have the correct dosage and strength for their child and that they follow the dosage instructions carefully. Oscar can only take paracetamol because he is also taking warfarin. Giving medicine in a syringe was easier for younger children. Damien is able to give Matias his medicines and fluids through his percutaneous endoscopic gastrostomy (PEG) feeding tube.
 

Following advice from her GP, Georgina turns up the heating and strips her son of clothes to manage his high temperature.

Following advice from her GP, Georgina turns up the heating and strips her son of clothes to manage his high temperature.

Age at interview: 50
Sex: Female
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I think we have two GPs, one of the GP’s explained the logic of it. No-one ever did, he explained to me, it’s very, very good, okay you’ve got to put him in the room temperature and strip him down.

Raise the heating in the house okay, it’s normally happening in the winter time, raise the heat really high until completely, really warm if you and I just had a t-shirt, strip him down, allow him to cool naturally so body, okay. And that seemed to really work well okay. In the past we’ve followed this instructions and followed them and it cooled him down, open the window and he just shoot up the temperature, even sky high. So and we took him to hospital. So since then bit by bit we’ve learnt and he’s, we’ve managed to get him better.
It is important that children have plenty of fluids when they have flu or flu-like illness. Sometimes parents of younger children said that their child did not want to drink. Louise’s son who has diabetes doesn’t always want to drink or eat when he is sick, which is a problem when he needs to take insulin. Fiona was breastfeeding her daughter so she knew she was getting enough fluids.
 

When Louise’s son has lost his appetite they give him high sugar drinks to raise his sugar levels so that they can give him insulin.

When Louise’s son has lost his appetite they give him high sugar drinks to raise his sugar levels so that they can give him insulin.

Age at interview: 37
Sex: Female
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In terms of actually one thing I probably haven’t mentioned that is quite challenging is [son’s name], when he feels unwell, he has a loss of appetite, which really, really complicates things, because that means I have to be extra cautious when I administer insulin, because if he hasn’t eaten then I don’t know what the impact will be. Will it just bring it down to normal range or will it send him hypo. So I need to really be extra cautious with that. But five years on, I’m more, I’ve kind of got the courage now to kind of give him more insulin than probably, you know, I could send him hypo, if you like [laughs] on purpose, just in order to bring him up with a bit of glucose, and then I can stabilise him that way. There’s different ways in in which I can manage it. 

So we found through experiments, different types of juices, Lucozade, different things that he will consume when he’s sick. So now we know where, you know, we’ve got to know our son and we know what he will take. We tried everything, you know, sugar with water. We tried honey, we tried this. When a person is sick they reject the normal type of foods that they would normally have. So you just have to, identify which are the ones that they’re willing to have. Ribena, full sugar Ribena worked quite well. So it’s finding that right treatment, and once he was willing to accept it that’s when, you know, I could bring the sugar levels up, give him the insulin to remove the ketones. Once he was well, then he could recover from his bug [laughs] so, yeah. It’s a challenge. 
Some parents gave over the counter cough mixtures which they said soothed their children’s sore throats and helped their coughs or made warm lemon and honey drinks.

Parents said they also encouraged their child to rest, and they tried to keep them warm and comfortable. Tristan has a rest from daily physiotherapy. Karen says Alex has ‘boundless energy’ even when he is ill but she tries to make him rest more than normal. Some parents said they put extra pillows on their child’s bed at night to help with congestion. 

A warm, moist atmosphere can ease breathing if children have a blocked nose. Parents said that warm steam baths were effective and some put a few drops of eucalyptus oil or eucalyptus salts in the child’s bath. 

Anita found that cold air helped 2 year old Oliver to breathe better when his nose was blocked.
 

Georgina gives Alessio a warm bath and she sometimes adds eucalyptus salts or a few drops of eucalyptus oil or lavender oil when he has flu-like illness.

Georgina gives Alessio a warm bath and she sometimes adds eucalyptus salts or a few drops of eucalyptus oil or lavender oil when he has flu-like illness.

Age at interview: 50
Sex: Female
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Have you tried any complementary approaches?

I do yes. I have. I used for example I use Olbas for him to help him to breathe easily for his clothes and his pyjamas. And also for baths I sometimes give him some Eucalyptus to help breathe easily as well and I used bath salt, relaxing as well to deal with all those things. And very soothing, I use Lavender, so it’s very soothing for him with a lovely bath, he likes it okay, he loves his lovely bath. And for aches and pains I do a massage sometimes, okay I use a massage oil. 
Some parents of children aged 6 years and over gave decongestant medicines, which they said helped them to feel more comfortable and improve their breathing. Other parents had used decongestant medicines and said they hadn’t made any difference to their children’s symptoms. The NHS Choices website advises that decongestants should not be given to children under six years old and should only be used by children aged 6-12 on the advice of a GP or pharmacist. 

Some parents said they gave their children vitamins or Echinacea (a herbal remedy) during illness to boost their immune system. There is no research evidence to show there are benefits from taking vitamins, such as Vitamin C, or Echinacea during flu-like illness. The NHS Choices website advises that children under 12 years old should not be given Echinacea.
 

Gillian and her husband usually manage Judith’s flu-like illness at home. She likes someone to cuddle her when she is feeling ill.

Gillian and her husband usually manage Judith’s flu-like illness at home. She likes someone to cuddle her when she is feeling ill.

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So you gave Calpol -

Calpol [paracetamol] and Nurofen, [ibuprofen] and chesty cough and sore throat mixtures. And nose drops for the congestion. Lots of blowing her nose. Wrapping her up. Keep giving her a hot water bottle. She likes to have someone sit next to her and cuddle her all the time when she's feeling that miserable. So me or my mother were sitting with her, or my husband was sitting with her on the floor watching children's programmes, and hugging her for a lot of four, five days when she was at home.

What else do you do? Apart from the medications, and the love and care? Anything -

We, we give her - we do give her vitamins, multivitamins and vitamin C. Particularly when she's sick, we give her. And when she's sick she tends to only be able to take it in like an infant liquid form, you know, obviously for various reasons. And we do try and make sure she eats really well, but when she's sick we don't push it for the worst days, we just give her easy things to digest that she likes eating, like scrambled egg, or cheese, nothing scratchy on the throat. Juice - she's started drinking, been willing to drink juice in the last year. Which helped. She had a bit of juice. But up until sort of 11, she wasn't willing to even taste juice [laughing]. So, yeah.

It wasn't her thing, really.

No [laughing].
Eliza has chronic heart failure. She experiences earache usually as a complication of flu or flu-like illness. Her mum says she has been so unwell throughout her life that now when she gets flu-like illness she is very stoic. Paracetamol and fluids are used to relieve her symptoms.

Treatment for the long term medical condition during influenza or flu-like illness

For most parents, management of their child’s underlying condition during flu or flu-like illness was crucial in ensuring they did not become seriously ill.
 

When Louise’s son has lost his appetite they give him high sugar drinks to raise his sugar levels so that they can give him insulin.

When Louise’s son has lost his appetite they give him high sugar drinks to raise his sugar levels so that they can give him insulin.

Age at interview: 37
Sex: Female
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In terms of actually one thing I probably haven’t mentioned that is quite challenging is [son’s name], when he feels unwell, he has a loss of appetite, which really, really complicates things, because that means I have to be extra cautious when I administer insulin, because if he hasn’t eaten then I don’t know what the impact will be. Will it just bring it down to normal range or will it send him hypo. So I need to really be extra cautious with that. But five years on, I’m more, I’ve kind of got the courage now to kind of give him more insulin than probably, you know, I could send him hypo, if you like [laughs] on purpose, just in order to bring him up with a bit of glucose, and then I can stabilise him that way. There’s different ways in in which I can manage it. 

So we found through experiments, different types of juices, Lucozade, different things that he will consume when he’s sick. So now we know where, you know, we’ve got to know our son and we know what he will take. We tried everything, you know, sugar with water. We tried honey, we tried this. When a person is sick they reject the normal type of foods that they would normally have. So you just have to, identify which are the ones that they’re willing to have. Ribena, full sugar Ribena worked quite well. So it’s finding that right treatment, and once he was willing to accept it that’s when, you know, I could bring the sugar levels up, give him the insulin to remove the ketones. Once he was well, then he could recover from his bug [laughs] so, yeah. It’s a challenge. 
Following the advice of the asthma nurse or GP, parents of children with asthma increased their child’s medication, usually at any sign of a cold. This helps to reduce the asthma symptoms if they develop flu or flu-like illness.
 

Karen gives Alex paracetamol or ibuprofen and plenty of fluids when he has flu-like illness. She monitors him closely and takes him to his GP or A&E if his symptoms worsen.

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Karen gives Alex paracetamol or ibuprofen and plenty of fluids when he has flu-like illness. She monitors him closely and takes him to his GP or A&E if his symptoms worsen.

Age at interview: 50
Sex: Female
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When it comes to as soon as he has a cold of course instead of just thinking, “Oh well he’ll be fine in a couple of days.” We’re always wary that, oh no here we go we’re going to start to go downhill. We’re either going to get the asthma or we’re going to get flu-ish things. And so it’s just a question of, of really monitoring and being on top of it. And you, with him you know that he, if he won’t go to sleep it’s normally because he’s got headache or he’s got ear ache, and then that’s probably because he’s got a temperature or he’s got an ear infection coming. And so [huh] I think it’s just without over fussing just trying to be really aware of things and nipping them in the bud and saying, “Right ok we’ll go down to the GP or if need be we’ll go to A&E and we’ll do something about it.” You can’t just let things linger with him and say, “Oh in a couple of days he’ll be better.” Cos you prob-, in a couple of days he’ll probably be worse if you don’t do something about it.

Yeah and for how long does his fever last with the flu?

He’s normally . It’s normally only two or three days as long as obviously he’s medicated for it. And normally Calpol or Neurofen or something like that is enough to sort that out.

Ok. So you. And what else do you do to manage it at home?

If he’s got a flu-like? I tend to just keep him warm, try and keep, he’s not the most calm and relaxed child on the planet so keeping him calm is, is a big, big job cos he wants to be running about and he’s got boundless energy so. Just try and keep a lid on that and just make sure that he’s drinking plenty and we’ll give him Calpol or Neurofen (ibuprofen) and if he’s got a fever or an earache. 

He has multivitamins anyway because of the allergy thing. He was prescribed those by a dietician. He has multivitamins and I try to make sure that his diet. Again I’m lucky he has never met a fruit and veg that he doesn’t like. And partly because of that, partly because of his allergies anyway he has a pretty super diet. He doesn’t eat much processed stuff And he eats a lot of fruit and veg and I try to really make sure that that side of things is, is, is, you know, really up to scratch because I think not only does it help with the allergies out of necessity but I think it can’t hurt the immune system side of things.
Monitoring

Parents said they frequently monitored their child’s symptoms to make sure they were not becoming worse. Most parents had a thermometer to do this. Maria doesn’t use a thermometer but gauges how well her ten year old daughter is by what she says, how hot she feels and if she starts vomiting. Parents of children with diabetes said they frequently monitored their child’s ketones to make sure they were not developing diabetes ketoacidosis.
 

Fiona makes lists and charts to monitor any change in her daughter’s flu-like illness symptoms and if her temperature is not going down she takes her into the children’s ward where she has open access.

Fiona makes lists and charts to monitor any change in her daughter’s flu-like illness symptoms and if her temperature is not going down she takes her into the children’s ward where she has open access.

Age at interview: 39
Sex: Female
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I go into sort of military mode, I’m, I make a lot of lists, I monitor her mood.

Okay

Signs of irritability, breathlessness. Whether she is walking around and playing or whether she is taking more breaks and just lying down on the floor which she does to almost catch her breath. I monitor that. Her temperature, I take her temperature routinely and keep a chart. And then I become very conscious about the food that she’s eating because she’s on an antibiotic I often worry about her tummy and so, I mean I do breastfeed but I don’t always know, especially at 18 months what they’re getting and what they’re not. She’s hydrated, that I know. But I’m sure there’s nutrients over and above that that she requires. So I’m very conscious about what’s going in to her.

Fever, fever is the main one because that means that there’s an infection that she’s fighting.

And what, how, what is high? What is, is there a particular?

There is, there is and a lot of people think that anything over 37.4 is a fever, so for Meg I don’t worry at that point. I don’t worry at 38, when she hits 39 I worry.

Yeah.

If I can get it down with Ibuprofen or Calpol within four hours then I still don’t panic. 

Yeah.

If I can’t get it down within 8 hours then I know that there’s a problem. 

So what would you at this sort of, eight hour point what do you do then?

I phone the hospital, the children’s ward,

And is that regardless of the time?

Regardless of the time.

Yeah, because you’ve got the open access

Open door access.

Yeah.

And I go in.
Through the night, parents would often sleep in the same room as their child so that they could continue to monitor them. Ruth has a child monitor device in her child’s room and her husband sleeps in the same room as her when she is ill. Like some of the other parents we spoke to, Ruth doesn’t sleep much at night when her daughter is ill, she says, “no-one really sleeps and it’s really stressful.” Mirella sleeps on a mattress in her son’s bedroom and sets an alarm every four hours to give him his inhaler through the night.
 

Lyndey sits on her son’s bedroom floor watching him breathing when he has flu-like illness symptoms which are affecting his asthma.

Lyndey sits on her son’s bedroom floor watching him breathing when he has flu-like illness symptoms which are affecting his asthma.

Age at interview: 35
Sex: Female
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Well, it’s the hours and hours and hours of it and when you’ve got a child, who is feverish and so probably not sleeping very well and coughing and struggling, when it comes to a point, I think I phoned the out-of-hours service about four or five am and said, “I’ve got to bring him in.” And they gave me a slot about half five, six o’clock or something. So it was sort of later on in the night that I knew I had to take him. So it’s just, it’s just, you just lie there listening to them don’t you and you keep popping in to make sure they’re alright and end up sitting on the floor of their bedroom just watching them [laughs].

So yeah, that was the most stressful I think because we were a bit worried about him, whereas in other situation, we were more worried about ourselves because we weren’t sleeping [laughs]. Whereas, yeah, but fevers and viruses do affect it hugely, don’t they, because they do, that’s what brings on, I mean a child can be completely fine and have no asthma symptoms during healthy episodes and then you have a virus in the house and suddenly, it becomes quite frightening. My asthma nurse at home, she always says, “Just be alert because it can come on very quickly.” That was one of the most helpful pieces of advice I was given, actually, with regards to my youngest child.
Parents said monitoring got easier when their child was older and they could tell them how they were feeling. Sharon uses a 1-10 scale with her 10 year old son who has asthma to find out how his chest is feeling. Ten year old Jade rests in her parent’s bedroom downstairs during the day when she is ill so that her mum can keep a close eye on her and talk to her about how she is feeling. 

Parents who had experienced several episodes of flu-like illness became more confident in knowing how best to manage their child’s symptoms at home.
 

Henry has asthma. Sharon says she now feels more confident in the way that she manages his flu-like illness at home.

Henry has asthma. Sharon says she now feels more confident in the way that she manages his flu-like illness at home.

Age at interview: 44
Sex: Female
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I think because we learn now how to manage things better.

OK

So, it is much better because we know the minute he has a virus – flu, cold – that we start the blue Ventolin [salbutamol] inhaler, twice a day, so that it then hopefully limits the need for antibiotics for a full-blown chest infection. That’s not a guaranteed remedy but I think because we now know how to manage things a lot better we stop most infections progressing.

Yeah

And, at the end of the day, the aim is to stop antibiotics – you don’t want to take the antibiotics unless you really need to. Because too many antibiotics are obviously not good. So, I think it's managed better yeah.

I think I can say now that I can manage things a lot better in the last sort of three years or so. I think, because I've seen my son have various illnesses, I now feel more confident in the way that we manage things. But that’s only through course of time and having certain viruses and things happen to him. Where maybe we haven’t used the inhalers early enough and he's had to go on antibiotics and maybe the antibiotics haven’t worked and you go onto some more antibiotics.

And it just pans the whole illness out for him and then, as you get older, that’s more time off of school and then the more antibiotics you take the more other infections I find that he then picks up as well – ear infections, throat infections which you sort of go hand in hand. So I think, finally I now know to, with myself and my son, give the inhaler the chance very early on, the minute you start feeling ill with a virusy, chesty kind of thing.

Yeah

And that certainly helps.
Parents worked hard to keep their child at home for as long as possible but sometimes they decided they needed to get medical help.
 

Liam is having treatment for leukemia. If he has a high temperature, his parents can’t give him paracetamol or ibuprofen at home. They need to take him to hospital first in case his blood count is poor.

Liam is having treatment for leukemia. If he has a high temperature, his parents can’t give him paracetamol or ibuprofen at home. They need to take him to hospital first in case his blood count is poor.

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And what would it say about things like getting a cold or a flu or something like that?

Janet: Well, we have to watch out for the temperature first.

Phil: Yeah, if the temperature rises then we know something's wrong.

Janet: And then we'd have to take him in. We're not allowed to give Calpol; you're not allowed to give Ibuprofen cos it masks temperature and interferes with the platelets.

OK, both paracetamol and Ibuprofen?

Janet: Yeah basically. We have to get him within the hour…well, within the hour to hospital so that they can take bloods, then they’ll give him the Calpol to bring it down.

Oh, so they can give it in hospital monitoring him?

Janet: They can give it in hospital as long as they know what the blood counts are. So, sometimes when he's spiked temperature we've gone in, they’ve done blood counts; he's had good counts so they’ve discharged us, we can give paracetamol for forty eight hours.
See ‘Deciding when to get medical help’.
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