Swine flu: the risks for children

The H1N1 virus is back, and the young are most vulnerable. Just how worried should we be – and how can we keep our children safe? Jeremy Laurance gets the answers from Britain's leading paediatrician

In the swirl of speculation about swine flu, one man has been fielding more calls than most. Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, is the sort of expert most parents would choose to have beside them when – if – their child falls ill with the winter lurgy. They have not been slow to seek his advice.

"I spent so much time answering questions from friends, relatives and the media about swine flu, that I decided to write the answers in a book. I approached the publishers who were fantastic in turning the concept around quickly. I wrote it in August at a friend's house in France and delivered it on 26 August. I hope it will save me from taking so many calls and emails."

The result is Swine Flu – What Parents need to Know, 150 pages of sage advice published this month. It is an impressive feat for a man who is the father of teenage children, Lucy and Patrick, head of a medical royal college and, on 1 October, took up a new post as Nuffield Professor of Child Health at University College London, and honorary consultant paediatrician at Great Ormond Street Hospital. If you want something done, ask a busy person.



How dangerous is swine flu?

"No more dangerous than seasonal flu – that is what all the evidence suggests. But there is an important caveat. Swine flu is caused by a novel H1N1 virus to which most people, especially the young, have no immunity. Up to 30 per cent of the world's population could be infected by it.

"If you get a lot more people infected , more will become seriously ill and more will die. Swine flu does not affect children more severely than adults – the percentage being admitted to intensive care and dying is no greater than for other age groups although the death of any child is a tragedy for their family. But more children are getting infected.

"This is like the 1977 "red" flu outbreak, which started in Russia. It almost exclusively affected people under 25. Why are young people more prone to infection? One theory is that we are not all complete bio-virgins so far as this virus is concerned. When you get to 40 or 50 there seems to be some immunity from exposure to other strains.

"The elderly tend to be most vulnerable in seasonal flu outbreaks, which is owing to poorer nutrition, general frailty and chronic conditions. With swine flu they appear less likely to get infected."



Which children are at greatest risk?

"The Government says that all those who have had drug treatment in the past three years for asthma are at increased risk. This is contentious. One in five young children will have had a wheezy episode at some point. I doubt all these are at serious risk from swine flu.

"There is also no evidence for the recommendation that all children who attend hospital with a flu-like illness but are not ill enough to warrant admission should be sent home with a supply of antibiotics. Only children with a suspected bacterial complication of swine flu should be prescribed antibiotics.

"However, those children with chronic conditions, such as lung, heart, kidney, liver or neurological disease or diabetes may be at increased risk."

Should I have my children vaccinated against swine flu?

"I will be having it [as a front line health worker] and I will recommend my children have it. This is not an illness I want to get. I could be quite ill with it, I could be off work with a high, swinging fever for four or five days, diarrhoea and vomiting. I want to avoid that.

"A survey by the magazine Nursing Times found a third of nurses would refuse the vaccine. That presumably reflects their perception that it is not a very serious illness. "This raises a fundamental issue about vaccination. For an individual parent the risk of swine flu to their child is low, so the benefit from vaccination is low. But if you have a virus that affects 30 per cent of the population then a lot of people will fall ill and a lot will die and the best way to prevent that is to have all the population vaccinated.

"The benefit for any one individual is low but the benefit for the population is great. The benefit will be greatest for very young children and those with chronic conditions and the elderly because they are most vulnerable. By accepting vaccination we help to protect them."



Should I give my children Tamiflu?

"At the onset of symptoms no one can say if this will be an average attack of flu and the child will get better in four or five days, or if will it lead to complications like pneumonia. My children have asked me if they should take Tamiflu and I have said 'yes' and I would take it myself. The side effects are minimal and if it prevents complications and shortens the illness by one day that is worth doing. The numbers affected by the virus could be big and any drug that shortens the severity, longevity and spread of the illness is worth having. Some other countries do not have the liberal prescribing policies that we have but that is because we have built up a large stockpile of Tamiflu. We are lucky enough to have it, we have paid our taxes, so let's use it."

How do I get my child to take Tamiflu?

"If a child cannot swallow the capsule it can be opened and the powder sprinkled on food. However, the powder is very bitter and experience has shown that unless it is disguised young children will refuse further doses. The manufacturer of Tamiflu [Roche] recommends a variety of foods to disguise the taste but experience has shown that undiluted blackcurrant drink concentrate such as Ribena or chocolate syrup (the runny kind that is poured or squirted, not chocolate spread) work best. They are universally popular tastes. Even though Ribena labels carry a warning that they are unsuitable for children under three, if the small amount means children accept their doses then it can be used."



Do face masks offer protection against swine flu?

"I am against [ordinary surgical] face masks for the public, such as we saw on the streets of Hong Kong during the Sars outbreak and on some tourists here in July. If you wear one all day it gets soggy and stops working, if you touch it you transmit the virus on your hands and it may spread complacency. There is no evidence that for the public they are of any benefit. However, for doctors or health staff examining a patient they are useful because they offer protection if the patient coughs or sneezes all over you. And health workers are more likely to change them regularly."



Will the NHS be able to cope with swine flu?

"It depends critically on intensive care. That will be the pinch point. Even though swine flu may be no more lethal than seasonal flu, and the vast majority of people suffer only mild illness, it could still overwhelm the NHS. There are 3,636 intensive care beds and a third of those are for specialist treatment such as burns and spinal injuries. Even the Cabinet Office admits the intensive care system might struggle to cope.

"We can cancel routine operations, and open up more beds, provided there are the staff to run them. But in a real pandemic with 30 per cent of the population affected it is hard to imagine any health service in the world could cope. You would need thousands of intensive care beds that for the rest of the year would do nothing. The NHS is as prepared as any health service anywhere."



How bad will swine flu turn out to be?

"No one knows for sure. We will only find out when it comes. It is unlikely to be a complete damp squib and case numbers are rising again each week. We don't know if it will mirror experience in the southern hemisphere where it has not been particularly bad or whether the higher population density in the northern hemisphere could lead to a very serious pandemic. There is a higher population living in temperate zones in the northern hemisphere where people live indoors. In Australia and South Africa people spend more time outdoors even in winter. That could make a difference."



'Swine Flu – What Parents Need To Know', by Professor Terence Stephenson, Jessica Kingsley, £7.99

Is it swine flu? The telltale signs

* Typical symptoms of swine flu are fever, cough and runny nose. These are the same for seasonal flu. But it can be difficult to distinguish from the common cold and other winter viral illnesses. Anti-viral drugs such as Tamiflu are only effective if given early so there are bound to be cases where it is given unnecessarily. But while Tamiflu is not a treatment for a cold, neither will it make it worse.

* Potentially more serious is the child diagnosed with swine flu at home and given Tamiflu who actually has a more serious disease. I have heard of a new case of diabetes (the patient had a headache and abdominal pain) and of meningitis being treated initially with Tamiflu. This is almost inevitable when there are large numbers of cases. The only advice I can give is to ask parents to remain vigilant. If their child deteriorates markedly they should seek further advice.



* If your child has any of the following they should go straight to A&E or call 999:

Severe breathing distress – indrawing of lower ribcage or breast bone, noisy breathing when calm.

Increased breathing rate – more than 40 breaths a minute (50 breaths for the under ones).

Lips and skin appear grey or blue.

Breathing stops intermittently – pauses of over 20 seconds.

Severe dehydration or shock – not drinking and sunken eyes or fontanelle (the soft spot on the head of a baby).

Altered conscious level – strikingly agitated, irritable, having seizures, or generally floppy.

PROMOTED VIDEO
Life and Style
ebookNow available in paperback
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
News
The data shows that the number of “unlawfully” large infant classes has doubled in the last 12 months alone
i100Mike Stuchbery, a teacher in Great Yarmouth, said he received abuse
Arts and Entertainment
The starship in Star Wars: The Force Awakens
filmsThe first glimpse of JJ Abrams' new film has been released online
Sport
Rio Ferdinand returns for QPR
sportRio Ferdinand returns from his three-game suspension today
News
The Speaker of the House will takes his turn as guest editor of the Today programme
arts + ents
News
people

Watch the spoof Thanksgiving segment filmed for Live!
Sport
Billy Twelvetrees will start for England against Australia tomorrow with Owen Farrell dropping to the bench
rugbyEngland need a victory against Australia today
Arts and Entertainment
The cover of The Guest Cat – expect to see it everywhere
books
Sport
Tyson Fury poses outside the Imperial War Museum in south London ahead of his fight against Dereck Chisora
boxingAll British heavyweight clash gets underway on Saturday night
News
i100 Charity collates series of videos that show acts of kindness to animals
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Opilio Recruitment: QA Automation Engineer

    £30k - 38k per year + Benefits: Opilio Recruitment: An award-winning consume...

    Opilio Recruitment: UX & Design Specialist

    £40k - 45k per year + Benefits: Opilio Recruitment: A fantastic opportunity ...

    Opilio Recruitment: Publishing Application Support Analyst

    £30k - 35k per year + Benefits: Opilio Recruitment: We’re currently re...

    Opilio Recruitment: Digital Marketing Manager

    £35k - 45k per year + benefits: Opilio Recruitment: A fantastic opportunity ...

    Day In a Page

    Homeless Veterans Christmas Appeal: ‘We give them hope. They come to us when no one else can help’

    Christmas Appeal

    Meet the charity giving homeless veterans hope – and who they turn to when no one else can help
    Should doctors and patients learn to plan humane, happier endings rather than trying to prolong life?

    Is it always right to try to prolong life?

    Most of us would prefer to die in our own beds, with our families beside us. But, as a GP, Margaret McCartney sees too many end their days in a medicalised battle
    Thomas Cook's outgoing boss Harriet Green got by on four hours sleep a night - is that what it takes for women to get to the top?

    What does it take for women to get to the top?

    Thomas Cook's outgoing boss Harriet Green got by on four hours sleep a night and told women they had to do more if they wanted to get on
    Christmas jumper craze: Inside the UK factory behind this year's multicultural must-have

    Knitting pretty: British Christmas Jumpers

    Simmy Richman visits Jack Masters, the company behind this year's multicultural must-have
    French chefs have launched a campaign to end violence in kitchens - should British restaurants follow suit?

    French chefs campaign against bullying

    A group of top chefs signed a manifesto against violence in kitchens following the sacking of a chef at a Paris restaurant for scalding his kitchen assistant with a white-hot spoon
    Radio 4 to broadcast 10-hour War and Peace on New Year's Day as Controller warns of cuts

    Just what you need on a New Year hangover...

    Radio 4 to broadcast 10-hour adaptation of War and Peace on first day of 2015
    Cuba set to stage its first US musical in 50 years

    Cuba to stage first US musical in 50 years

    Claire Allfree finds out if the new production of Rent will hit the right note in Havana
    Christmas 2014: 10 best educational toys

    Learn and play: 10 best educational toys

    Of course you want them to have fun, but even better if they can learn at the same time
    Paul Scholes column: I like Brendan Rodgers as a manager but Liverpool seem to be going backwards not forwards this season

    Paul Scholes column

    I like Brendan Rodgers as a manager but Liverpool seem to be going backwards not forwards this season
    Lewis Moody column: Stuart Lancaster has made all the right calls – now England must deliver

    Lewis Moody: Lancaster has made all the right calls – now England must deliver

    So what must the red-rose do differently? They have to take the points on offer 
    Cameron, Miliband and Clegg join forces for Homeless Veterans campaign

    Cameron, Miliband and Clegg join forces for Homeless Veterans campaign

    It's in all our interests to look after servicemen and women who fall on hard times, say party leaders
    Millionaire Sol Campbell wades into wealthy backlash against Labour's mansion tax

    Sol Campbell cries foul at Labour's mansion tax

    The former England defender joins Myleene Klass, Griff Rhys Jones and Melvyn Bragg in criticising proposals
    Nicolas Sarkozy returns: The ex-President is preparing to fight for the leadership of France's main opposition party – but will he win big enough?

    Sarkozy returns

    The ex-President is preparing to fight for the leadership of France's main opposition party – but will he win big enough?
    Is the criticism of Ed Miliband a coded form of anti-Semitism?

    Is the criticism of Miliband anti-Semitic?

    Attacks on the Labour leader have coalesced around a sense that he is different, weird, a man apart. But is the criticism more sinister?
    Ouija boards are the must-have gift this Christmas, fuelled by a schlock horror film

    Ouija boards are the must-have festive gift

    Simon Usborne explores the appeal - and mysteries - of a century-old parlour game