Understanding H1N1 and how it can affect your child with asthma

As a concerned parent, you may have questions about how the H1N1 (swine) flu could affect your child, especially if he or she suffers from asthma. As always, your child's doctor is the best resource for information relating to your child and flu viruses. We encourage you to use the questions and answers below to help start a conversation with your child's doctor at his or her next visit.

What is the H1N1 flu, or swine flu?
  • Influenza—also called "the flu"—is a contagious illness caused by a virus, which is a type of germ.1
  • You may see the flu described as "seasonal flu" because, in the United States, people usually get the flu during the fall and winter months.2
  • Flu viruses change as they pass from person to person. Over time, new strains of the flu virus also develop in animals, such as pigs, and these flu viruses are able to cause illness in people. This is what happened recently in Mexico, where the novel strain of the flu was first called "swine flu." Swine flu is now known as "H1N1."2

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Does the H1N1 flu pose a greater risk than other types of the flu to children with asthma?
  • Children with asthma who get the flu are at greater risk of developing complications that can affect breathing, such as pneumonia. The risks of complications from flu are greater in children under 5 years of age.3,4
  • The H1N1 flu poses additional risks because it tends to cause more severe breathing difficulty and lung infections in children under 5 as well as in otherwise-healthy young adults.3

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Why do respiratory infections, such as the common cold or the flu, often trigger symptoms in children with asthma?
  • Inflammation—or swelling—of the lining of the airways is a major cause of asthma symptoms.5 Respiratory infections such as the common cold or the flu also lead to inflammation of the airways. As a result, both the common cold and the flu can cause asthma symptoms to worsen.5 It is also true that airway-related symptoms from respiratory infections, such as cough and shortness of breath, tend to be worse in children who have asthma.
  • For these reasons, it is important to be sure that your child's asthma is well controlled, especially during the flu season. Continue reading to Question 4 to learn tips for handling this time of year.

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Are there special measures that parents of children with asthma should take during flu season?
  • Both asthma and the flu affect a child's airways. Therefore, it is important to make sure your child's asthma is well controlled during flu season.
    • Talk with your child's doctor if your child is using a quick-relief inhaled medication more than twice a week to relieve wheezing or shortness of breath.5
    • If your child is 5 years of age or younger, you can assess if his or her breathing problems are under control by using the new TRACK™ (Test for Respiratory and Asthma Control in Kids) tool.6 The TRACK questionnaire is designed to be filled out by parents or other caregivers of children and interpreted by health care professionals.
    • Now more than ever, it's important to make sure your child's asthma is under good control. Talk to your child's doctor about creating a daily asthma action plan to help prevent and control asthma episodes and, should they arise, about how to respond to the first signs of symptoms.7
    • Refill your child's asthma prescriptions promptly so you don't run out.7
  • Better control of asthma during the flu season may help prevent an asthma attack if your child does catch a cold or the flu.7

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What steps should parents take to decrease the chances that their children will get the flu?
  • All types of the flu are very contagious. The H1N1 flu may be even more contagious than other flu viruses because most people have never been exposed to this type of flu and have less immunity to it.8,9
  • Children with asthma are at higher risk for serious lung complications if they get the H1N1 flu. The United States Centers for Disease Control and Prevention (CDC) offers recommendations for how to protect your children—and yourself—from getting the flu. The CDC recommends that you
    • Arrange for your child to get a flu vaccine. In 2009, children with asthma should be vaccinated to protect against both the regular seasonal flu and the H1N1 flu2,7
    • Make plans to get the flu vaccines yourself, to decrease the chances that you will get the flu and pass it on to your child3
    • Show your children how to cover their nose and mouth when they sneeze or cough4
    • Remind your children to wash their hands with soap and water often, for at least 20 seconds, especially after coughing or sneezing4,7
    • Remind your children to not touch their eyes, nose, or mouth, as germs are spread this way3
    • When possible, try to avoid having your children come in contact with people who may have the flu4
    • If your child has the flu, limit his or her contact with other children (or adults)4

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What type of flu vaccines will my child need this year?
  • The CDC recommends that all children ages 6 months to 19 years receive a seasonal flu vaccination.10
  • The seasonal flu vaccine helps protect against seasonal flu, but not the novel A/H1N1 strain (also known as "swine flu").10* Flu vaccines to help protect against the novel A/H1N1 have been approved by the FDA, and recommendations for their use are currently available.2† However, there must be 30 days between vaccinations for the seasonal flu and H1N1, so it's important that you obtain your seasonal flu vaccine early.
    1. *Centers for Disease Control and Prevention (CDC), Selecting the viruses in the influenza (flu) vaccine. Available at http://www.cdc.gov/flu/professionals/vaccination/virusqa.htm. Accessed July 7, 2009.
    2. †World Health Organization. Vaccines for the new influenza A (H1N1). Available at http://www.who.int/csr/disease/swineflu/frequently_asked_questions/vaccine_preparedness/en/. Accessed July 7, 2009.
  • Children with asthma, especially children under age 5, are at greater risk of complications from the flu, so it is even more important that these children get vaccinated. Talk to your child's doctor to find out when to schedule an appointment for your child to receive the flu vaccine.2,7

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How can I tell if my child under 5 has the H1N1 flu or any other type of flu?
  • Flu symptoms can be mild or severe, but, in general, the symptoms tend to be worse than the common cold. Symptoms of the H1N1 flu are similar to those caused by other flu viruses and include8
    • High fever, headache, muscle aches, extreme tiredness, cough, sore throat, runny or stuffy nose, and stomach-related symptoms such as nausea, vomiting, and diarrhea8
  • In addition to these symptoms, very young children may have other signs of illness, such as
    • Irritability or not wanting to be held
    • Not drinking enough fluids
    • Rapid breathing or difficulty breathing4

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What should I do if I think my child has the flu?
  • There are a number of specific measures to take if you think your child may have the flu.4
    • Contact your child's doctor right away. There are medications available to treat the flu, but they work only when taken within the first two days after becoming ill
    • Have your child drink lots of clear liquids to stay well hydrated. If your child is unable to keep liquids down, call your child's doctor or seek medical treatment
    • If your child has a fever, use fever-reducing medicine based on recommendations from your child's doctor. Aspirin should not be used by children or teenagers who may have the flu, as it can cause a rare but serious illness known as Reye's syndrome
    • Whenever possible, have your child stay in a separate room, away from members of the household who are not sick. Consider having one person care for the child—again, to decrease the risk of spreading the flu within the home4
    • Keep your child at home until at least 24 hours after he or she no longer has a fever (without the need for fever-reducing medicines)
    • The main points to keep in mind about caring for children with asthma during flu season are that
      1. Children with asthma are among the group of patients at greatest risk for developing complications from the flu, especially the H1N1 type of flu
      2. Good asthma control and flu vaccinations are important safety measures
      3. You should contact your child's doctor promptly if you believe your child may have the flu

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Where can I find additional resources?

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H1N1 Flu & Childhood Asthma Tips

H1N1 Flu & Childhood Asthma Tips

Watch a short video from the Allergy & Asthma Network Mothers of Asthmatics on how to help children with asthma avoid the H1N1 flu.

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Assessing Asthma Control in Kids Under 5

A baby getting a check-up

Use the TRACK™ assessment tool to help determine if your child’s breathing problems are under control. Children with asthma not under control may be at increased risk this flu season.

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  1. Kasper DL, Braunwald E, Fauci AS, et al. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw Hill; 2005.
  2. Centers for Disease Control and Prevention. Prevention and Control of Seasonal Influenza with Vaccines. Atlanta, GA: Centers for Disease Control and Prevention; 2009.
  3. Centers for Disease Control and Prevention. Technical Report for State and Local Public Health Officials and Child Care and Early Childhood Providers on CDC Guidance on Helping Child Care and Early Childhood Programs Respond to Influenza During the 2009-2010 Influenza Seasons. Atlanta, GA: Centers for Disease Control and Prevention; 2009.
  4. Centers for Disease Control and Prevention. Action steps for parents of children at high risk for flu complications. http://www.cdc.gov/h1n1flu/schools/toolkit/parentfactsheet3.htm. Accessed August 26, 2009.
  5. National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program: Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. US Department of Health and Human Services; 2007.
  6. Murphy KR, Zeiger RS, Kosinski M, et al. Test for respiratory and asthma control in kids (TRACK): a caregiver-completed questionnaire for preschool-aged children. J Allergy Clin Immunol. 2009;123(4):833-839.
  7. Mosnaim G. Managing your child's asthma during the cold and flu season. http://findarticles.com/p/articles/mi_m0816/is_12_22/ai_n27097709/. Accessed August 16, 2009.
  8. Centers for Disease Control and Prevention. H1N1 flu. http://www.cdc.gov/h1n1flu/qa.htm. Accessed September 8, 2009.
  9. Chowell G, Bertozzi SM, Colchero MA, et al. Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Eng J Med. 2009;361(7):674-679.
  10. Centers for Disease Control and Prevention. Children, the flu, and the flu vaccine. http://www.cdc.gov/FLU/Protect/childrenb.htm. Accessed September 8, 2009.