Influenza in Children: Why I Typically Do Not Prescribe Tamiflu
I am a pediatric nurse practitioner and this month I have been seeing a LOT of positive flu tests. For the flu, I simply advise parents on how to treat their child’s symptoms and reasons to return to care. I also discuss the option of oseltamivir (Tamiflu) and possible side effects. So far, all but 2 parents have declined the prescription. Read on to understand how to treat the flu in children and the potential side effects of Tamiflu.
What is Influenza (AKA the Flu)?
The flu is a respiratory illness, typically caused by influenza A or B virus. It occurs mainly during the winter months and is usually an uncomplicated disease in healthy children. Children at increased risk of complication from the flu are those less than 2 years old and those that have chronic diseases, such as asthma. The classic symptoms of the flu are fever, headache, body aches, fatigue, cough, sore throat, and runny nose. Those affected may also experience vomiting, diarrhea, and decreased appetite.
How Long Does the Flu Typically Last?
Most healthy children improve over the course of 1 week. Fever usually does not last more than 4 days. Cough is usually the last symptom to resolve and may persist for 2 to 3 weeks.
Potential Complications
- Ear infections: Typically occurs 3 to 4 days after the onset of flu symptoms. Older children can tell us if they have ear pain. For the younger children, signs of an ear infection can include persistent fever, disrupted sleep, pulling at the ears, and increased fussiness.
- Pneumonia: More common in high-risk patients and children less than 2 years old. I tell parents of the younger kids to follow-up in office if the fever lasts more than 4 to 5 days to have their lungs checked. A sign of pneumonia in an older child may include chest pain and persistent cough.
Treatment
I always tell parents that the flu is a virus and therefore, we treat the symptoms that their child is experiencing. For example, for fever and pain, we can give Tylenol or Motrin (for those at least 6 months old).
The most important treatment includes rest and fluids. I expect a kid with the flu to be tired and sleep more than usual. With symptoms of the flu, a child may not want to eat much and that’s ok; our main goal is to keep them hydrated and ensure that they have a wet diaper at least every 6 hours. If a child has not urinated in over 8 hours, I recommend going to the emergency room for intravenous fluids.
Cough medications are typically not helpful and most cannot be used in children less than 6 years old. Warm drinks with honey (for children greater than 1 year old) are a great natural remedy for cough. Running a cool-mist humidifier in their room at night can also help with cough and congestion.
Tamiflu
Oseltamivir (aka Tamiflu) is an antiviral medication that is approved for children greater than 2 weeks old in treatment of the flu. Tamiflu is most effective if started within 48 hours of symptom onset and may decrease the duration of symptoms by 1 to 1.5 days.
Gastrointestinal Side Effects
The most common adverse side effects of Tamiflu are stomach upset, vomiting, and diarrhea. One study involving children aged 2 months to 12 years old, found that 36.1% experienced adverse drug reactions after taking Tamiflu with vomiting and diarrhea being the most common reactions. If a child is already experiencing these symptoms as a result of the flu, I strongly advise against a Tamiflu prescription.
Neuropsychiatric Side Effects
In the same study mentioned above, neuropsychiatric symptoms were observed in less than 13% of children and included insomnia, dizziness/vertigo, and headache.
In 2007, Japan advised against prescribing Tamiflu after two 14 year olds died by suicide while taking the drug. Before this, there had already been at least 100 reports of neuropsychiatric adverse drug reactions, such as delirium and convulsions.
In 2015, the U.S. Food and Drug Administration (FDA) put out a questions and answers article regarding Tamiflu’s adverse events in children. For children less than 16 years old, adverse neurologic and psychiatric events were discussed and included delirium, hallucinations, confusion, abnormal behavior, convulsions, and encephalitis. The majority of these events were in children from Japan. The FDA article provides possible explanations for why these adverse events were primarily in children from Japan, but no explanation is made with 100% certainty.
Takeaway
Receiving a flu diagnosis for your child can feel scary, but most healthy children will fight off the virus without complication in less than 1 week. As a parent, we want to be able to give our child a medication that will make them feel better quickly, but the adverse side effects of Tamiflu typically outweigh the possible benefits.
Sources
Adverse drug reaction profile of oseltamivir in children
