Treatment of Flu in Children

Background

While getting an influenza (flu) vaccine each year is recommended by CDC as the first and most important action in protecting against flu, there also are drugs that can treat flu illness. These "flu antiviral drugs" are an important treatment option for children with suspected or confirmed flu.

Flu antivirals

Antiviral drugs for children come in the form of pills, liquid, inhaled powder, or intravenous (IV) solution. They fight flu by keeping influenza viruses from reproducing in the body. Antiviral drugs must be prescribed by a health care provider — they are not available over the counter. For treatment, flu antiviral drugs should ideally be started within two days after becoming sick, but children can still benefit when antiviral treatment is started two or more days after becoming sick. Antiviral drugs are especially important for children who are at increased risk for flu complications or who are hospitalized. If a child is sick with flu, antiviral drugs offer a safe and effective treatment option.

Flu antiviral drugs only work against influenza viruses — they will not help against other viruses that may cause illness symptoms similar to flu.

Benefits from antiviral treatment of influenza

Flu antiviral drugs can make flu symptoms milder and can shorten duration of illness. Antiviral drugs work best if started soon after getting sick (within two days of symptoms starting). Early treatment of flu with antiviral drugs also has been shown to reduce the incidence of ear infections and the need for antibiotic treatment in children between 1 and 12 years old. Treatment with antiviral drugs also may reduce more serious flu-related complications like pneumonia and hospitalization. Studies in both adults and children show that treatment of hospitalized patients can be beneficial in preventing respiratory failure and death.

CDC and the American Academy of Pediatrics (AAP) recommend antiviral drugs to treat confirmed or suspected flu in children with severe, complicated, or progressive illness, or who are hospitalized with confirmed or suspected flu, as early as possible. Prompt initiation of antiviral treatment also is recommended for children who have confirmed or suspected flu and who are at increased risk of serious flu complications. Children at increased risk of flu-related complications include children younger than 5 years old (especially those younger than 2 years old) and children of any age with certain chronic health conditions like asthma, diabetes, or heart or lung disease.

Antiviral drugs approved for use in children

There are four flu antiviral drugs approved by the U.S. Food and Drug Administration (FDA) for use in the United States which are recommended by CDC for use in children this flu season:

• Oseltamivir (available as a generic version or under the trade name Tamiflu®) is approved for treatment of flu in children 14 days old and older. Oral oseltamivir comes in the form of pills and liquid. Although not part of the FDA-approved indications, use of oral oseltamivir for treatment of flu in infants younger than 14 days old, and for chemoprophylaxis in infants 3 months to 1 year, is recommended by the CDC and the American Academy of Pediatrics. If a child is younger than 3 months old, use of oseltamivir for chemoprophylaxis is not recommended unless the situation is judged critical due to limited data in this age group.
• Zanamivir (trade name Relenza®) is approved for treatment of flu in children 7 years and older. It is not recommended for use in children with underlying respiratory disease, including those with asthma and other chronic lung diseases. Inhaled zanamivir is given via a special inhaler (Diskhaler®).
• Peramivir (trade name Rapivab®) is given intravenously and recommended for use in children 6 months and older.
• Baloxavir (trade name Xofluza®) is a pill that is given as a single dose by mouth and is approved for early treatment of flu in children 5 years to younger than 12 years who do not have any chronic medical conditions, and for all children 12 years and older.

Side effects of antiviral drugs

Side effects vary for each medication. The most common side effects for oseltamivir are nausea and vomiting. Zanamivir can cause difficulty breathing in people with underlying lung disease and peramivir can cause diarrhea. Other less common side effects also have been reported. Your health care provider can give you more information about these drugs or you can check the Food and Drug Administration (FDA) website for specific information about antiviral drugs, including the manufacturer's package insert.

If your child gets sick with flu

Your child's health care provider can help decide whether your child should take antiviral drugs if they become sick with flu this season. Flu signs and symptoms include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose and muscle aches. It's important to note that some children with flu will not have a fever.