30.10.2020

Features of flu in children

If the parents have the slightest suspicion that the child is sick with the flu, then he urgently needs a doctor. Of course, sometimes a banal cold may not require any special treatment and go on its own in 5-7 days. In this case, not all mothers call the local doctor’s house, as they are sure that they will cope with the illness themselves. However, flu is a serious disease, especially in childhood. Its danger lies in the fact that it often leads to serious complications, which in some cases cause hospitalization (sometimes even in the intensive care unit).

The first thing a doctor will do when meeting a sick baby is to ask the mother how long the disease began, what worries him, what is the nature of the fever. Flu is characterized by a sharp onset of chills, weakness, and aches in bones, muscles, and joints. Sometimes at the same time, a child has a cough or a dry, non-intense cough. On the first day, the temperature rarely exceeds 38 ° C, but as early as 2-3 days from the onset of the disease it rises significantly (sometimes to 40-41 ° C). At the same time, a rhinitis is almost never the case, which is characteristic of the flu, unlike most other catarrhal diseases.

In addition to the above symptoms, the child is worried about a headache and vomiting is possible at the height of a fever. In babies of the first 2 years of life, the blood circulation is centralized: the hands and feet are cold, and the head and body are very hot. In some cases, even febrile seizures are possible.

What can see the doctor during the examination of a child with the flu

The doctor will definitely examine the child, because any diagnosis begins primarily with this important point. The baby may be pale, but for some, the skin, on the contrary, becomes red. At the height of fever cooling of the extremities is possible. He rushes about in bed, sometimes delirious, sleep is extremely restless, intermittent. On examination of the throat, the doctor sees mild redness of the mucous membranes, sometimes there are pinpoint hemorrhages on it, slight swelling.

Attentive auscultation or listening with the stethoscope of the lungs is important: the appearance of wheezing or local weakening of the breath is an extremely dangerous sign indicating the development of pneumonia. Some babies are worried about how the doctor is palpating the abdomen (most often, pain is noted for influenza type H1N1).

However, the cunning of the flu is that the symptoms of the disease often develop rapidly: the doctor did not notice any warning signs during the morning visit, and already at night the mother calls an ambulance or sometimes even resuscitation. In addition, there is no pathognomonic symptom, that is, one that is characteristic exclusively for the flu. Therefore, in any case, in order to be 100% confident in the correct diagnosis, any doctor needs his laboratory confirmation. Without it, the diagnosis is based solely on the clinical flair and experience of a pediatrician who examines a child with suspected serious illness.

Diagnosis of influenza in Russia

If we are talking about the fact of the disease during a flu epidemic, doctors in our country do not always send a child to additional methods of research. If 15 people from a group in kindergarten became ill with them, then it is very likely that this particular child was overtaken by this fate. In addition, it is not a secret to anyone that in order to defend a queue in the treatment room and donate blood in our clinics, one must be a healthy and strong person, since it often takes several hours. A febrile kid who rushes about in bed and delirious is often not able to undergo this procedure, moreover, it is very likely that he will be rewarded with another portion of respiratory viruses in the polyclinic lineup.

Therefore, a doctor always faces a dilemma: to make a diagnosis empirically (that is, based on inspection data only), or to send a sick baby for further examination, which can worsen his condition. Often, doctors choose the first and take responsibility for all possible complications, in which case the parents will never remember what the pediatrician wanted to do better for the child.

In clinical practice, the following types of diagnosis of influenza in children:
  • The fluorescent antibody (MFA) method is the fastest or so-called “express method” for diagnosing influenza. In this case, a smear is taken from the surface of the mucous membrane of the nasal passages or conjunctiva and sent to the laboratory. However, the main condition for an accurate result is that it is necessary to conduct it when the patient actively secretes viral particles (in the first 3 days from the onset of the disease). Further, it may be uninformative or show a false-negative result. The answer is received in 2-4 hours, that is, it does not need to wait for several days. This allows the doctor to prescribe anti-influenza drugs as quickly as possible (after all, they are also effective if therapy is started in the first 2-3 days from the onset of the disease).
  • ELISA allows to detect the presence of antigens (influenza virus) with the help of special labeled antibodies. This also requires material taken from the nasal mucosa. The answer can be obtained in 3-6 hours.
  • Polymerase chain reaction method. It also requires material obtained from the surface of the nasal mucosa in the first 3 days of the onset of the disease. However, the method of analysis is laborious, time consuming and the doctor often receives the answer even when the patient is on the mend. And, nevertheless, it can be useful from a scientific point of view (for identifying a strain, assessing the epidemic situation) – in real life its use is extremely limited.
  • Serological diagnosis. This diagnostic method involves taking the patient’s blood at the beginning of the disease and for 10-14 days. Determine the change in antibody titer in paired sera, a positive result is the fact of increasing antibodies by 4 or more times. In practical life, it is also inapplicable: a positive result obtained after 2 weeks from the start of treatment is useless in outpatient practice (the patient will most likely recover by this time). However, in rare cases when the patient is in the hospital with complications of the flu, sometimes he is valuable.

Thus, in practical medicine, when the patient is in the doctor’s office, who needs to assign the correct treatment “here and now”, the first two methods can be applied. However, with their help, you can get an answer only after a few hours.

Diagnosis of influenza in children in other countries

Given the fact that the treatment of influenza is specific and today there are drugs that can affect the pathogen itself, foreign manufacturers are actively working to develop express diagnostic methods. They allow you not only to get a result (positive or negative) for already 10 minutes, that is, right during the medical reception, but also to identify the type of virus (A or B).

These are the so-called immunochromatographic rapid tests to determine the presence of influenza virus A or B antigens in smears taken from the surface of the nasal mucosa. Examples are OSOM Influenza A & B Test manufactured in the USA, CITO TEST INFLUENZA A + B made in Germany. The package includes several test strips (25.50), nasal swabs for material intake, a reagent, a positive or negative control, and a tripod. They are stored at room temperature and the study can be carried out directly in the doctor’s office (or at home) without special equipment and even without medical education. In the instructions for use you can find all the necessary information for the qualitative analysis.

It would be ideal if doctors in our office in each room during the epidemic of the flu had such express tests in place. In this case, they could diagnose in a civilized manner (as it happens in European countries and the USA), and not based on their own ideas about the disease, and prescribe etiotropic treatment. However, the cost of packaging with 25 test strips is high and ranges from 15 to 20 thousand rubles. And during a flu epidemic, in one doctor’s appointment, 20–30 patients visit the site, which, hypothetically, may be useful. And that’s not counting the countless calls to the house. Unfortunately, today our clinics can not afford this pleasure.

Therefore, in most cases, the diagnosis of influenza is made by doctors empirically, with the main tools in the diagnosis are their eyes, hands and ears. Unfortunately, this is not always enough. And, nevertheless, in any case, a doctor’s examination should be mandatory at the slightest suspicion of influenza, especially when it comes to a small child.

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