Influenza ("the flu") is an infection of the lungs and connected areas (respiratory tract) caused by the influenza virus. The virus typically spreads during the winter. When many people get the flu at about the same time, the situation is called a flu epidemic.

The proteins that coat the flu virus constantly change. As a result, new strains of the flu virus circulate every few years. That's why it's important to get a flu shot every year.

What are the signs and symptoms of influenza?

People with flu infections feel as if they have a cold, but the signs and symptoms are usually more severe. Body systems besides the respiratory tract may be affected. Signs and symptoms include weakness, chills, fatigue, muscle aches, headache, fever (101° to 102° F[39.3° to 38.9° C]), sneezing, runny nose, and dry cough.  Signs and symptoms may last for 7-10 days.

The influenza virus is spread mainly through the air. A typical situation is when one person infected with the flu coughs or sneezes when in close contact with another person. Droplets of the virus become suspended in the air, where the other person can breathe them in, becoming a host to the infection. Once the virus has landed on the lining of the nose, throat, or other body areas related to breathing, it invades the cells of its new host and reproduces rapidly.

People who are at risk for the flu include those over age 65, adults or children with chronic illnesses that affect the heart or lungs, all nursing home residents, children or adolescents who have taken aspirin for a long time, health care workers, and anyone who is in frequent contact with someone who is at high risk for the flu.

People who are at risk for the flu should get a flu shot every year, preferably in October or November. Getting an annual flu shot is important because

· different types of flu are present each year, and

· the shot usually protects against the flu for less than a year.

The most common adverse effect of the flu shot is soreness at the injection site.  The flu shot does not cause the flu.  

People who are allergic to eggs should not get the flu shot.  The reason is that the vaccine is made from virus grown in hens' eggs.  Anyone who has a fever higher than 100° F (37.8° C) should wait until his or her temperature returns to normal (about 98.6°F [37°C]) before getting a flu shot.  

How is the flu treated?

 Usually, the flu goes away with rest, drinking plenty of fluids, and taking mild pain medication, such as Tylenol. (Children who may have the flu shouldn't take aspirin; the combination can lead to an illness called Reye's syndrome.)

Your health care provider may prescribe amantadine (brand names: Symadine and Symmetrel) or rimantadine (brand name: Flumadine) for people who are at high risk for flu complications. People who are at high risk or have symptoms that don't improve within 7-10 days, have difficulty breathing, or have persistently high temperatures should consult a health care provider.

34 THE NURSE PRACTITIONER SEPTEMBER 1998 VOL. 23, NO. 9

Give Kids a Safe Harbor This Winter  

            A crisp winter day quickly turned tragic for 5-year-old Jonathan L’Esperance when he ventured out onto a frozen pond near his house in East Wareham, Mass.  Jonathan had been warned to stay away from the ice-covered pond, but the thought of sliding across was simply too inviting.  He fell through the ice into the pond and was submerged for about 20 to 25 minutes before his father found him. 

            Jonathan survived his fall into icy waters, but his recovery has been long and arduous.  His brain was deprived of oxygen for several minutes and, as a result, he suffered brain damage.  He spent seven months in the hospital, during which time he slowly emerged from a coma.  He has endured intense rehabilitation and had to relearn many skills, including walking and talking.

            “Ice covered ponds and lakes pose a huge risk to children during winter, but there are also many other dangers to consider as temperatures drop,” says Heather Paul, Ph.D., executive director of the National SAFE KIDS Campaign.  “Parents and caregivers should watch kids closely and limit outdoor playtime when temperatures are frigid, no matter how much kids may protest.  Making sure children dress appropriately for the weather is also crucial.”

            The National SAFE KIDS Campaign recommends the following suggestions to help keep your children safe:

Winter Drowning

            Most parents associate drowning with summer months, but the increased use of hot tubs and whirlpools as well as the danger of hidden bodies of water or weak ice make winter drownings a risk as well.  To minimize drowning dangers, parents and caregivers should:

• Supervise children in or near a pool, hot tub or any open body of water.
• Beware of children overheating in hot tubs and whirlpools.
• Make sure pools and spas are secure.  If you have a pool or spa, install four-sided isolation fencing that is at least five feet high.  The fence should have a self-closing and self-latching gate.  Do not use the exterior of the house as one side of the fence.
• Allow children to skate only on ponds or lakes that have been approved for skating.

Frostbite

Exposure to cold without adequate protection can result in frostbite.  Parents can protect their children by following these precautions:

• Dress children warmly.  Several thin layers will help keep children dry as well as warm.  Clothing should consist of thermal long johns, turtlenecks, one or two shirts, pants, sweater, coat, warm socks, boots, gloves or mittens, and a hat.
• Set reasonable time limits on outdoor play.  Call children in periodically to warm up with drinks such as hot chocolate.
• When possible, avoid taking infants outdoors when it is colder than 40 degrees Fahrenheit.  Infants lose body heat quickly.

            If a child complains of numbness or pain in the fingers, toes, nose, cheeks or ears while playing in the snow, or if his skin is blistered, hard to the touch or glossy, be alerted to the possibility of frostbite and take the following steps:

• Take the child indoors.
• Call a doctor.
• Tell the child to wiggle the affected body part(s) to increase blood supply to that area.
• Warm the frozen part(s) against the body.  Hold fingers to the chest, for example.
• Immerse frozen part(s) in warm, not hot, water.  Frozen tissue is fragile and can be damaged easily.  Avoid warming with high heat from radiators, fireplaces or stoves, and avoid rubbing or breaking blisters.

Pedestrian Safety

• Slippery driveways and sidewalks can be particularly hazardous in the winter.  Keep them well shoveled, and apply materials such as rock salt or sand to improve traction. 
• Make sure that children under age 10 do not cross streets alone, and make sure children wear appropriate shoes and brightly colored (not white) clothing while walking in snowy conditions.  Use retroreflective clothing or stickers for maximum protection, especially at dawn and dusk.

Winter Sports and Activities

            Parents and caregivers should inspect equipment and the environment for possible hazards before children engage in winter activities such as sledding, ice skating and skiing.  Remind children not to push, shove or roughhouse while engaging in sports, and tell them always to wait their turn.

Ice Skating

            In 1998, more than 15,500 children ages 5 to 14 were treated in emergency rooms for injuries related to ice skating.  But with extra care, even children as young as age 4, as long as they are steady walkers, can enjoy the sport.  Allow children to skate only on approved surfaces.  Check for signs posted by local police or recreation departments, or call your local police department to find out which areas have been approved. Children should be taught to:

• Skate in the same direction as the crowd.
• Avoid darting across the ice.
• Never skate alone.
• Never go out on ice that an adult has not approved.
• Throw away chewing gum or candy before skating onto the ice.

If a child falls through the ice, he should stretch his arms over the ice and kick as if swimming, in an attempt to crawl back onto the solid ice. 

Sledding

            Nearly 8,500 children ages 5 to 14 were treated in emergency rooms in 1998 for injuries related to sledding. Parents and caregivers should remember the following tips:

• Make sure terrain is free of obstacles and far from traffic.  Children should sled on packed snow (not ice) that is free of debris.  Check carefully for snow-covered hazards such as rocks, tree limbs and stumps that could endanger sledders or skiers.
• Use equipment that is sturdy and safely constructed.  Avoid equipment with sharp and jagged edges.
• Look for energy absorbing pads on sled seats.
• Examine handholds on sleds to be sure they are secure.
• Ensure sleds and toboggans have easy steering, non-jamming devices.

Parents should remind children to:

• Sled only on terrain that is free of obstacles.
• Make sure the bottom of the slope is far from streets and traffic.
• Always use a sled with a steering mechanism.  Avoid makeshift sleds.
• Avoid lying flat on the sled while riding down hill.  Always sit up with feet forward — lying flat increases the chance of head and abdominal injuries.
• Never ride in a sled that is being pulled by a motorized vehicle.
• Make sure the number of children riding on the sled does not exceed the manufacturer's recommendations.

Snow Skiing and Snowboarding

            In 1997, more than 13,500 children ages 5 to 14 visited emergency rooms for snow skiing-related injuries and more than 9,000 children were treated for snowboarding-related injuries.  But with a few safety precautions, skiing and snowboarding are sports that even young children can enjoy.  Parents should make sure children follow these suggested precautions:

·                    Enroll in at least one skiing/snowboarding lesson to start off on the right track.

·                    Use caution when entering and exiting the ski lift.

·                    Do not ski out of control or go too fast.

·                    Be aware of other people on the slope.

·                    Wear a ski helmet and eye protection.

·                    Wear sun protection even on cloudy days.

·                    Never ski alone.  Young children should always be supervised by an  adult.

Snowmobiling

            Snowmobiles can weigh up to 600 pounds and travel at speeds in excess of 90 mph.  Head injuries are the leading cause of snowmobile-related deaths.  In 1998, nearly 800 children ages 14 and under were treated in emergency rooms for snowmobile-related injuries.  The American Academy of Pediatrics has stated that operating snowmobiles is inappropriate for children under age 16.  If a child is riding as a passenger on a snowmobile, be sure he is wearing an approved helmet.

            When properly prepared, your child’s winter wonderland can be a safe and fun-filled adventure!