Every year millions of people acquire flu disease; many need admission to the hospital and intensive care unit. Unfortunately, some of us will develop severe complications from the flu and even die. Seniors, pregnant women, and women soon after delivery of the baby and children at less than five years of age are especially vulnerable to this disease and its complications.
It is only natural that young parents are anxious about their newborn babies if there is a chance that they were exposed to flu or if they present with symptoms that may be suggestive of current flu disease. In my article, I aim to familiarize you with flu disease in newborn babies and ways of protecting them from it. I will also talk about the symptoms of flu and treating flu in this vulnerable population.
Basic information about the flu.
Each year seasonal influenza in the USA is associated with 4-16 million medical visits, 140 000-700 000 hospitalizations, and 12 000-56 000 deaths. Depending on the season, 10%-40% of children become sick with flu, and 50-300 deaths occur among children (CDC resources).
The influenza viruses cause flu disease. There are three types of influenza viruses: A, B, and C. Influenza viruses type A and B cause significant epidemics each year and are usually included in seasonal influenza vaccines. Influenza type C causes milder disease and is not such a big concern.
Each year, flu viruses undergo small changes in their “antigen make-up” therefore, scientists have to predict which viruses are likely to cause epidemics so they will be included in seasonal vaccines. That explains why, in some years, vaccines provide more protection from the disease than during other years.
Influenza spreads from person to person through air droplets while people cough and sneeze. Another mode of transfer is a direct contact with contaminated surfaces. Touching contaminated surfaces and then touching your face, eyes, nose, or mouth carries a high risk of acquiring the virus.
Incubation time (time between exposure and start of the disease) for influenza is 1 – 4 days, with average being two days. People become infectious usually 1 day before becoming symptomatic, and they will shed virus for 7 days; children may be contagious even for 10 days or longer. Viral shedding is correlated with the severity of fever.
For most individuals, flu symptoms will last 3-7 days. Sometimes, children, even if they were previously completely healthy, will develop complications such as pneumonia, encephalopathy (brain inflammation), seizures, Reye syndrome, and death.
Can the baby catch flu disease?
All humans, whether they are young or old, can get flu disease. Some populations are more vulnerable to it, and newborns with young infants belong in that category. Newborn babies get born with immature immune systems. Their immune system has not been exposed to any natural microbes yet and does not function to its full mature capacity as one of the adults. Newborn babies’ respiratory tract is very short; therefore, any infection attacking upper airways (like flu) may quickly descend into the lungs and lead to a more severe condition such as pneumonia.
The only way newborns can get some immunity is if their mothers get vaccinated for the current flu virus. The vaccination must occur early enough during pregnancy, so the mother develops antibodies against the flu, and the antibodies can pass through the placenta into the baby’s body. The highest amount of antibodies gets passed to the baby during the third trimester (last three months of the pregnancy). If the baby is born prematurely, it may not be able to benefit from the maternal vaccine. Defensive mechanisms acquired from maternal antibodies are called passive immunity.
How can I protect my baby from catching the flu?
The most important way of protecting your newly born baby from flu disease is to make sure that you get the flu vaccine during pregnancy. In addition to that, all other people around your baby should get vaccinated. All household members, including your other children above six months of age who do not have any contraindications, should get the flu vaccine. Finally, baby’s grandparents, nannies, and friends visiting your house should obtain vaccines as well.
If any of the members of your family is sick or was in contact with an ill person, they should follow these recommendations:
- If feasible, avoid contact with the baby
- Wash hands frequently but specifically before and after touching your baby
- Do not cough in the room where the baby is located
- Cover your mouth while coughing
- Obtain the surgical face mask and wear it until respiratory symptoms subside (your pediatrician’s office should be able to provide it to you, or you can purchase it in Walgreens)
- Do not touch your face, eyes, nose, and mouth when you have symptoms of flu (when you do that, and then you touch somebody else or tables and doors, you spread your virus)
- Provide breast milk to your baby (breastmilk has cellular and chemical components that will help your baby fight off the flu disease). Here is my article on the benefits of breastfeeding for the baby.
- Ask your doctor if people who are sick with flu symptoms and are around your baby should be started on chemoprophylaxis (Oseltamivir)
- Ask your pediatrician if your baby after exposure to flu should be started on prophylaxis (Oseltamivir)
Oseltamivir is approved by the FDA for the treatment of flu in newborns starting from 2 weeks of age and for prophylaxis beginning from 3 months of age. Under particular circumstances, a pediatrician may decide that the benefits of using Oseltamivir earlier in your baby significantly outweigh any risks.
What are the symptoms of the flu in a baby?
First of all, call your doctor right away if you think your baby has any symptoms of flu. The first symptom of the flu disease and any other sickness in a newborn will be changed behavior. Baby will appear sleepy, quickly tired, and will not be eating well.
Other symptoms of flu are:
- Elevated body temperature (fever) or abnormally low body temperature
- Body aches, joint, and muscle aches (obviously baby will not tell you that)
- Sore throat
- Sometimes congested and runny nose
- Gastrointestinal symptoms such as vomiting, diarrhea (not in all patients)
I want to emphasize that the above-described symptoms are non-specific. It means that based on the combination of the symptoms, one can not make a diagnosis regarding which infectious agent is causing the disease. A baby with these symptoms may have influenza, RSV infection, or “normal” cold virus. However, if you observe any of those symptoms in a newborn baby, you should always contact your doctor to discuss the next steps in the diagnostic process and treatment. (My article on RSV infections in newborns and children).
How do you treat a newborn baby with the flu?
Treatment of the flu in a newborn baby should be done only by licensed medical professionals. Most newborn babies with confirmed influenza will be admitted to the hospital. Typically, doctors will be monitoring vital signs of the baby, making sure that oxygenation levels are appropriate, and the baby does not have an overwhelming fever.
Providing feedings or IV fluids if the baby is not eating well will ensure appropriate hydration. If the baby has low oxygen levels, supplementary oxygen will be given.
Finally, in most cases, the baby will be receiving an anti-viral medication called Oseltamivir (Tamiflu). The FDA approved Oseltamivir for the treatment of flu disease in children as young as two weeks of age. However, AAP (American Academy of Pediatrics) believes that this medication can be used in premature and full-term newborns starting from birth because benefits outweigh any perceived risks of this therapy.
If the baby is believed to have acquired additional bacterial infection or is affected by pneumonia or brain inflammation, we will treat such patients aggressively with anti-bacterial antibiotics.
Fever in babies can be controlled with cold compresses or Acetaminophen (Tylenol). Under no circumstances, Aspirin can be given to newborn babies with flu disease (there may be rare exceptions from the rule). Aspirin may lead to a complication called Reye syndrome if used in a pediatric patient with flu disease.
If a baby develops seizure, doctors will make sure that fever is well controlled and may consider treating it with anti-convulsant medications.
How long does the flu last for a baby?
Typically, flu disease lasts in children 3-7 days, but it may take longer for the baby to recover. Also, some babies may develop severe complications such as pneumonia, seizures, or brain inflammation. In those cases, hospitalization and recovery may take much longer.
Can a baby die from the flu disease?
Unfortunately, children under two years of age, including newborn babies, are more prone to severe complications, including death. Statistics gathered by the CDC provide information that each year, approximately 50-350 children die from the flu-related disease.
This article is only for general information purposes. It should not be viewed as any medical advice. There is a chance that information here may be inaccurate. It would be best if you always discussed all health-related matters with your doctor before making any decisions that may affect your health or health of your family members.