Fall is here, which means protecting your family against the flu is a top priority.

If you have a baby 6 months of age or younger, knowing how to prevent the flu from entering your home is key to keeping your little one safe, especially since they are too young to receive the flu vaccine.

Here are some guidelines for identifying, treating, and preventing the flu in babies.

Flu symptoms in babies are similar to those in older children and adults. But symptoms may be more difficult to detect since your infant cannot communicate pain or other ailments verbally (other than crying).

Here is a list of signs and symptoms to be aware of. If you notice any of these symptoms, call your baby’s doctor right away.

  • running a fever of 100.4°F (38°C) taken rectally, via ear, or via forehead — or 99.4°F (37.4°C) when taken under the arm
  • acting tired, cranky, and not feeding well
  • significant or unusual crying (signifying potential body aches or pains)
  • cough
  • vomiting and diarrhea

Symptoms that require a trip to the emergency room include:

  • extreme fussiness
  • bluish color in the face or lips
  • trouble breathing
  • seizures
  • not waking up or not being alert
  • severe vomiting that does not stop
  • dehydration
  • fever above 104°F (40°C) in older babies and children, or fever in baby younger than 12 weeks

If flu is confirmed by a flu test or is highly suspected, Florencia Segura, MD, FAAP, a pediatrician at Einstein Pediatrics, says antiviral therapy (like Tamiflu) should be started as soon as possible.

“This is especially true for babies under the age of 6 months who are at higher risk of complications,” she says. Starting antiviral therapy within 48 hours of symptoms can help lessen the severity and length of symptoms.

According to the American Academy of Pediatrics (AAP), antivirals work best if started within the first one to two days of showing signs and symptoms of the flu. Call the pediatrician within 24 hours of symptoms if your infant is younger than 6 months old.

While antivirals are important in controlling influenza, they are not a substitute for the flu shot in children over 6 months of age.

The other treatments are focused on keeping your baby comfortable to continue breastfeeding or bottle-feeding to prevent complications such as dehydration.

For babies 6 months of age and younger presenting with fever and irritability, Segura recommends Tylenol. But she says you should always ask your pediatrician for the proper dose based on age and weight.

If your baby has a runny nose and cough, she recommends running a cool-mist humidifier throughout the night and suctioning your baby’s nose with nasal saline drops 4 to 6 times daily to help your baby sleep and continue feeding.

Make sure to stay in touch with your baby’s doctor even after you’ve started treatment.

If your child’s fever is not going down, the symptoms are getting worse, their diapers are not wet, or they’re having trouble breathing, call the doctor right away. They may recommend you go to the emergency room if symptoms are severe.

Taking steps to prevent the flu in children is critical. But it’s even more critical in babies 6 months and younger who cannot receive a flu vaccination.

That’s why the first line of defense is for infants and children over 6 months to get a flu shot each year. Additionally, all eligible family members and caregivers should get a flu shot.

Your pediatrician or child’s doctor will advise you on the timeline for receiving the vaccination. In general, it takes about 2 weeks after receiving the flu shot for antibodies to develop in your body and start protecting your child against the flu.

Your child may need two doses of the vaccination, which requires an initial dose and then a waiting period of 4 weeks for the second dose. Your pediatrician will advise you on the correct dosage amount.

Make sure to get the vaccine early enough to allow enough time before the flu virus begins spreading in your community. While the timing can change year-to-year, most flu seasons run from the fall until the spring or October to April.

Beyond the flu vaccination, the Centers for Disease Control and Prevention (CDC) recommends the following tips:

  • Keep your unvaccinated baby and vaccinated children away from people who are sick.
  • Practice basic hygiene: Cover your mouth and nose when you cough or sneeze, wash your hands often with soap and water, use hand sanitizer, discard used tissues immediately.
  • Clean and disinfect surfaces in your home.
  • Call your pediatrician or primary doctor if your baby is showing signs of the flu.

Other than being able to identify the symptoms, parents should know how serious the flu is for babies.

According to the CDC, all children under the age of 5 are at high risk for flu, with the highest risk of severe flu complications in kids younger than 2, and the highest hospitalization and death rates occurring in infants younger than 6 months old.

Unfortunately, the group with the highest risk is also the group that cannot get the flu vaccine. Infants 6 months and under are not approved for receiving the flu vaccine, which makes a parent’s job of protecting them from the flu that much more critical.

How it spreads

Influenza is highly contagious and typically spreads by droplets from people who have the flu. The droplets can spread when infected people cough, sneeze, or talk, and are then inhaled or land in the mouths or noses of people nearby.

While not as common, you can also get the flu if you touch a contaminated surface or object and then touch your mouth, nose, or eyes. If you have the flu, you can infect others as early as one day before you have symptoms and up to five to seven days after you get sick.

Breastfeeding when you have the flu

You may wonder if it is safe to continue breastfeeding if you have the flu. The good news? Yes, it is safe and recommended since breast milk contains antibodies and other immunological factors that can protect your infant from the flu, according to the CDC.

If a mother is hospitalized for the flu or too sick to breastfeed, assistance from a lactation consultant or pediatrician may help. They can assist with pumping and bottle-feeding breast milk to the baby or advising about other feeding methods.

The symptoms related to the 2019 coronavirus leave many parents wondering how to tell the difference between the flu and COVID-19.

Both flu and COVID-19 present varying degrees of symptoms in babies. Some individuals have asymptomatic presentation (no symptoms) while others have severe symptoms.

When it comes to the influenza virus infection, symptoms vary with the child’s age. “Classic influenza infection in older children is characterized by sudden onset of fever, chills, and muscle aches followed by upper respiratory tract symptoms such as runny nose, cough, and sore throat,” says Segura.

However, she does point out that young infants are less likely to present with this “classic” flu-like illness. “Infants with the flu will often present with fever and irritability and some to minimal respiratory findings (runny nose and cough),” explains Segura.

Symptoms of COVID-19 in children also vary widely, says Segura, with fever and cough being the most common presenting symptoms in older children.

“Infants with COVID-19 are more likely to have irritability, fever, lethargy, and poor feeding rather than respiratory symptoms like cough and runny nose,” she says. Also, gastrointestinal symptoms such as diarrhea and vomiting are more prominent in older children infected with COVID-19.

What complicates matters more, says Segura, is that both flu viruses and COVID-19 will likely be spreading this fall.

“Because the symptoms of the flu and COVID-19 can be varied and quite similar, it will be critical to test for both simultaneously to help confirm the diagnosis,” she says.

Flu in babies, especially under 6 months of age, should not go untreated. If you suspect your infant has the flu, call your doctor immediately.

As COVID-19 and flu season converge, parents need to be even more diligent in their observations and efforts to keep kids safe and healthy.