H1N1 (Swine) Flu Virus: Facts for Parents (& Expecting)
Prevention & Treatment
- Pregnant and recently pregnant women are a priority group for the H1N1 flu vaccine. More…
- Vaccinating children is a priority. Flu is more dangerous than the common cold for children. More…
- Antiviral Drugs to Treat H1N1. More…
- Clinicians should consider these facts before prescribing antivirals. More…
- Do not stop breastfeeding if you are sick. Your breast milk is good for the baby. More…
- The symptoms for all flu, including H1N1 flu, are similar. However, be on the lookout for signs of serious illness. More…
- Don’t wait; call your doctor immediately if your child gets sick with flu-like symptoms. More…
- Relieve the symptoms of H1N1 flu with certain over-the-counter medications. More…
- Emergency medical care may become necessary. Know the signs. More…
- Talk to children about H1N1 flu. More…
- Flu during the school year. More…
Vaccinating Children
All people from 6 months through 24 years of age are a priority group for the H1N1 flu vaccine. Getting your child vaccinated as soon as possible is the best method for protecting him or her from the flu. Use our Flu Shot Locator to get vaccinated where you live.
- There are separate vaccines for seasonal flu and H1N1 in the 2009-2010 flu season.
Seasonal Nasal (LAIV)
Seasonal Flu Shot
H1N1 Nasal (LAIV)
Minimum two weeks between vaccinations
May be given in same visit.
H1N1 Flu Shot
May be given in same visit.
May be given in same visit.
- Children should get both vaccinations as soon as possible.
- Flu vaccine will be available in different settings, such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces.
- The 2009 H1N1 influenza vaccine is expected to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines. More information on vaccine safety
- For the 2010-2011 flu season, which begins in the fall of 2010, the seasonal flu vaccine will include protection against the 2009 H1N1 virus. That means that, barring some unforeseen circumstance, this fall, most Americans will be able to return to having one flu vaccine to protect them against the major circulating flu viruses. As is always the case with seasonal vaccine, younger children who have never had a seasonal vaccine will still need two doses.
- The H1N1 vaccine is provided at no cost by the government. Some, but not all, clinics may charge to administer the vaccine. More information on vaccine cost
Certain vaccine lots are being recalled because of potency. The vaccine is safe.
Non-Safety-Related Voluntary Recall of Certain Lots of Sanofi Pasteur H1N1 Pediatric (0.25 mL, for 6-35 month olds) Vaccine in Pre-Filled Syringes Questions & Answers
For more information on priority vaccinations see CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1.
Antiviral Medications for Treatment of H1N1
If your child gets sick, antiviral drugs can make the illness milder and make him or her feel better faster. They may also prevent serious influenza complications. Most people do not need these antiviral drugs to fully recover from the flu.
- Children younger than 5 years old and children with chronic medical conditions, such as asthma and diabetes, might benefit from antiviral medications. Ask the doctor about any special treatment requirements.
- Even if the child is feeling a little better, he or she should continue taking antiviral medication as directed by the doctor.
Mixing Tamiflu® with Sweet Liquids If your doctor prescribes Tamiflu® capsules for your child and your child cannot swallow them, the prescribed capsules may be opened and mixed with a sweet thick liquid. |
Oseltamivir (Tamiflu ®) | Zanamivir (Relenza ®) |
Find more information and recommended dosage of oseltamivir at http://www.cdc.gov/h1n1flu/eua/pdf/tamiflu-patients.pdf |
Find more information and recommended dosage of zanamivir at |
PERAMIVIR IV |
PERAMIVIR and Nursing Mothers |
Considerations for Clinicians: Prescribing Zanamivir and Oseltamivir
Zanamivir (Relenza®) is approved by the U.S. Food and Drug Administration (FDA) for treatment of H1N1 flu patients 7 years of age and older who have had flu symptoms for no more than 2 days, and for the prevention of influenza in patients 5 years of age and older.
Oseltamivir (Tamiflu®)is approved by the FDA to treat and prevent influenza in children 1 year old and older.
Table 1. Antiviral medication dosing recommendations for treatment or chemoprophylaxis of 2009 H1N1 infection.
(Table extracted from IDSA guidelines for seasonal influenza. 
)
Agent, group | Treatment (5 days) | Chemoprophylaxis (10 days) | |
Oseltamivir | |||
Adults | 75-mg capsule twice per day | 75-mg capsule once per day | |
Children ≥ 12 months | 15 kg or less | 60 mg per day divided into 2 doses | 30 mg once per day |
16-23 kg | 90 mg per day divided into 2 doses | 45 mg once per day | |
24-40 kg | 120 mg per day divided into 2 doses | 60 mg once per day | |
more than 40 kg | 150 mg per day divided into 2 doses | 75 mg once per day | |
Zanamivir | |||
Adults | Two 5-mg inhalations (10 mg total) twice per day | Two 5-mg inhalations (10 mg total) once per day | |
Children | Two 5-mg inhalations (10 mg total) twice per day (age, 7 years or older) | Two 5-mg inhalations (10 mg total) once per day (age, 5 years or older) | |
Children Under 1 Year of Age
On October 30th, 2009, FDA issued an amendment to the Emergency Use Authorization for Oseltamivir (Tamiflu ®) [PDF 52 KB]. The emergency authorization includes dosing recommendations based on weight for infants less than 1 year of age.
Oseltamivir (Tamiflu ®) for Oral Suspension is approved for use in treatment and prophylaxis of influenza in pediatric patients 1 year of age and older. In certain cases, FDA has authorized emergency use of Tamiflu in infants less than 1 year of age.
Health care providers should be aware that there are limited data on safety and dosing when considering Oseltamivir (Tamiflu ®) use in seriously ill, young infants with confirmed 2009 H1N1 influenza, or in one that has been exposed to a confirmed 2009 H1N1 influenza case. Infants should be carefully monitored for adverse events when Oseltamivir (Tamiflu ®) is used.
Oseltamivir (Tamiflu ®) should not be routinely used for prophylaxis in infants less than 3 months of age due to extremely limited pharmacokinetic data to guide dosing in this age group. Prophylaxis with Oseltamivir (Tamiflu ®) in infants less than 3 months of age should be reserved for cases in which the exposure is significant and the risk of severe illness is considered high.
The following tables provide treatment (Table 2) and prophylaxis (Table 3) dosing recommendations for the emergency use of Oseltamivir (Tamiflu ®) in Infants less than 1 year of age:
Table 2. Recommended Treatment Dose for Infants Less than 1 year of age Using Oseltamivir (Tamiflu ®) Oral Suspension
Age | Recommended Treatment Dose for 5 days |
Less than 12 months | 3 mg/kg/dose twice a day |
†Weight-based dosing is preferred, however, if weight is not known, dosing by age for treatment of influenza in full-term infants younger than 1 year of age may be necessary (birth-2 months = 12 mg (1 mL) twice daily; 3-5 months = 20 mg (1.6 mL) twice daily, 6-11 months = 25 mg (2 mL) twice daily)
Table 3. Recommended Prophylaxis Dose for Infants Less than 1 year of age Using Oseltamivir (Tamiflu ®) Oral Suspension
Age | Recommended Prophylaxis Dose for 10 days |
3 months to less than 12 months | 3 mg/kg/dose once daily |
Younger than 3 months | Not recommended unless situation judged critical due to limited data on use in this age group |
††Weight-based dosing is preferred, however, if weight is not known, dosing by age for prophylaxis of influenza in full-term infants younger than 1 year of age may be necessary (3-5 months = 20 mg once daily (1.6 mL), 6-11 months = 25 mg (2 mL) once daily).
Current weight-based dosing recommendations are not intended for premature infants. Premature infants may have slower clearance of Oseltamivir (Tamiflu ®) due to immature renal function, and doses recommended for full term infants may lead to very high drug concentrations in this age group. Very limited data from a cohort of premature infants receiving an average dose of 1.7 mg/kg twice daily demonstrated drug concentrations higher than those observed with the recommended treatment dose in term infants (3 mg/kg twice daily). Observed drug concentrations were highly variable among premature infants. These data are insufficient to recommend a specific dose of Oseltamivir (Tamiflu ®) for premature infants.
When dispensing Oseltamivir (Tamiflu ®) oral suspension for infants younger than 1 year of age, the oral dosing dispenser included in the product package should always be removed and replaced with an appropriate measuring device. The pharmacist or other health care provider should provide a 3 ml or 5 ml oral syringe to correctly measure the dose and counsel the caregiver on how to administer the prescribed dose.
Additional Information:
Tamiflu: Consumer Questions and Answers (FDA)
Relenza: Consumer Questions and Answers (FDA)
Children Under 1 Year of Age
On October 30th, 2009, FDA issued an amendment to the Emergency Use Authorization for Oseltamivir (Tamiflu ®) [PDF 52 KB]. The emergency authorization includes dosing recommendations based on weight for infants less than 1 year of age.
Oseltamivir (Tamiflu ®) for Oral Suspension is approved for use in treatment and prophylaxis of influenza in pediatric patients 1 year of age and older. In certain cases, FDA has authorized emergency use of Tamiflu in infants less than 1 year of age.
Health care providers should be aware that there are limited data on safety and dosing when considering Oseltamivir (Tamiflu ®) use in seriously ill, young infants with confirmed 2009 H1N1 influenza, or in one that has been exposed to a confirmed 2009 H1N1 influenza case. Infants should be carefully monitored for adverse events when Oseltamivir (Tamiflu ®) is used.
Oseltamivir (Tamiflu ®) should not be routinely used for prophylaxis in infants less than 3 months of age due to extremely limited pharmacokinetic data to guide dosing in this age group. Prophylaxis with Oseltamivir (Tamiflu ®) in infants less than 3 months of age should be reserved for cases in which the exposure is significant and the risk of severe illness is considered high.
The following tables provide treatment (Table 2) and prophylaxis (Table 3) dosing recommendations for the emergency use of Oseltamivir (Tamiflu ®) in Infants less than 1 year of age:
Table 2. Recommended Treatment Dose for Infants Less than 1 year of age Using Oseltamivir (Tamiflu ®) Oral Suspension
Age | Recommended Treatment Dose for 5 days |
Less than 12 months | 3 mg/kg/dose twice a day |
†Weight-based dosing is preferred, however, if weight is not known, dosing by age for treatment of influenza in full-term infants younger than 1 year of age may be necessary (birth-2 months = 12 mg (1 mL) twice daily; 3-5 months = 20 mg (1.6 mL) twice daily, 6-11 months = 25 mg (2 mL) twice daily)
Table 3. Recommended Prophylaxis Dose for Infants Less than 1 year of age Using Oseltamivir (Tamiflu ®) Oral Suspension
Age | Recommended Prophylaxis Dose for 10 days |
3 months to less than 12 months | 3 mg/kg/dose once daily |
Younger than 3 months | Not recommended unless situation judged critical due to limited data on use in this age group |
††Weight-based dosing is preferred, however, if weight is not known, dosing by age for prophylaxis of influenza in full-term infants younger than 1 year of age may be necessary (3-5 months = 20 mg once daily (1.6 mL), 6-11 months = 25 mg (2 mL) once daily).
Current weight-based dosing recommendations are not intended for premature infants. Premature infants may have slower clearance of Oseltamivir (Tamiflu ®) due to immature renal function, and doses recommended for full term infants may lead to very high drug concentrations in this age group. Very limited data from a cohort of premature infants receiving an average dose of 1.7 mg/kg twice daily demonstrated drug concentrations higher than those observed with the recommended treatment dose in term infants (3 mg/kg twice daily). Observed drug concentrations were highly variable among premature infants. These data are insufficient to recommend a specific dose of Oseltamivir (Tamiflu ®) for premature infants.
When dispensing Oseltamivir (Tamiflu ®) oral suspension for infants younger than 1 year of age, the oral dosing dispenser included in the product package should always be removed and replaced with an appropriate measuring device. The pharmacist or other health care provider should provide a 3 ml or 5 ml oral syringe to correctly measure the dose and counsel the caregiver on how to administer the prescribed dose.
Additional Information:
Tamiflu: Consumer Questions and Answers (FDA)
Relenza: Consumer Questions and Answers (FDA)
Guidance on Breastfeeding
Mothers who are breastfeeding should continue to nurse their babies while being treated for the flu. Breast milk passes on antibodies from the mother to a baby. Antibodies help fight off infection.
- If possible, only adults who are not sick should care for infants, including providing feedings.
- If you are too sick to breastfeed, pump and have someone give your milk to your baby.
- Your doctor might ask you to wear a facemask to keep from spreading this new virus to your baby (See Facemasks and Respirators).
- Be careful not to cough or sneeze in the baby’s face; wash your hands often with soap and water.
Symptoms of H1N1 Flu
It is important to watch for any signs that your child doesn’t feel well and to pay attention to any unusual behavior. Although the symptoms for all flu are similar, infants could have a fever or be lethargic, but may not have a cough or other respiratory symptoms.
Seasonal Flu | H1N1 Flu |
All types of flu can cause:
| Same as seasonal flu, but symptoms may be more severe.
There may be additional symptoms. A number of H1N1 flu cases reported:
|
What to Do If Your Child Gets Sick
Call your doctor right away if your child gets sick. Antiviral medications used to treat H1N1 flu in some patients work best when started within the first 2 days (48 hours) of getting sick.
- The doctor may start your child on antiviral drugs even after 48 hours when symptoms began, especially if the child has been hospitalized or is at high risk for flu-related complications.
- Children younger than 5 years old and children with chronic medical conditions, such as asthma and diabetes, may be at higher risk for complications from flu. Check with your doctor about any special treatment requirements for them.
- Some over-the-counter medicines are approved for children to use to relieve flu symptoms.
- If your child has a fever, use fever-reducing medicines that your doctor recommends based on your child’s age.
- A fever is a temperature taken with a thermometer that is equal to or greater than 100 degrees Fahrenheit (37.8 degrees Celsius). If you are not able to measure a temperature, the child might have a fever if he or she feels warm, has a flushed appearance, or is sweating or shivering.
- Keep your sick child home until at least 24 hours after the child no longer has a fever or signs of a fever (100°F or 37.8°C) (without the use of a fever-reducing medicine, such as Tylenol®). Read detailed information about how long to stay away from others.
- Make sure your child gets plenty of rest and drinks clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants, Pedialyte®) to keep from being dehydrated.
- Keep your sick child in a separate room in the house as much as possible to limit contact with household members who are not sick.
- Consider having just one person be the main caregiver for the sick child.
- You can consider sending your child back to school after at least 24 hours has passed since his or her temperature returned to normal WITHOUT the use of medications.
Over-the-Counter Medication Guidance
Your child or teen will probably feel miserable with body aches, sore throat, and other symptoms of the flu. Taking certain over-the-counter medicines can help relieve their flu symptoms. A doctor will decide if antiviral medications are necessary.
Call the doctor’s office if your child experiences any side effects, such as nausea, vomiting, rash, or unusual behavior. See Medications to Help Lessen Symptoms of the Flu for more details.
Patient Age | DOs | DON’Ts |
Children/teenagers 5 – 18 years old | DO take acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®, Nuprin®), to relieve symptoms. They do not contain aspirin. DO Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin. | DON’T take aspirin or products that contain aspirin (e.g. Pepto-Bismol®). This can cause a rare but serious illness called Reye’s syndrome. |
Children younger than 4 years of age | DO ask your doctor before using over-the-counter medications (e.g. Children’s Tylenol®, Children’s Motrin®). DO follow the doctor’s instructions exactly to avoid dosing errors. | DON’T give children over-the-counter cough and cold drugs containing antihistamines to help them sleep. |
Children younger than 2 years of age | DO use a cool-mist humidifier and a suction bulb to help clear away mucus. DO follow the doctor’s instructions for care. | DON’T give over-the-counter cough and cold drugs to children younger than 2 years old. |
When to Get Emergency Medical Care
If your child has any of these signs, seek emergency medical care right away:
- fast breathing or trouble breathing
- bluish or gray skin color
- not drinking enough fluids
- severe or persistent vomiting
- not urinating or no tears when crying
- not waking up or not interacting
- being so irritable that the child does not want to be held
- flu-like symptoms improve but then return with fever and worse cough
Additional Resources
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Talking To Children About H1N1
Educate yourself first. Know the basic facts about H1N1—the symptoms, how it spreads, and how you can help protect yourself and your child from getting sick. Consider following some of these helpful tips:
- Share information about H1N1 in a calm, reassuring manner. Be careful not to worry children.
- Limit their exposure to media and adult conversations about H1N1.
- If your children are watching television, try to watch with them or make sure you are available to answer questions about H1N1.
- Use their questions as an opportunity to talk about what they can do to avoid getting H1N1 flu.
- Keep activities as consistent and normal as possible even if your normal routine changes (due to daycare or school closures).
- Be a good example. Show children that you wash your hands frequently with soap and water. When you cough or sneeze, cover your mouth or use a tissue then throw the tissue away.
See Talking With Children About Flu for more tips.
View the Sesame Street public service announcements about flu featuring Elmo.
Additional Resources
Also view the Sesame Street public service announcements |
Flu During the 2009-2010 School Year
Before you are faced with a sudden school dismissal or a sick child, or household member discuss leave procedures with your employer.
- If working from home is not possible, plan ahead for child care at home if your child gets sick or their school is dismissed.
- Identify a separate room in the house for the care of sick children or other household members.
- Update emergency contact lists.
- Have workbooks, learning videos, and other materials available at home that support classroom exercises.
- Collect games, books, DVDs and other items to keep your family entertained if anyone must stay home for an extended period of time.
- If school is dismissed, monitor the school’s Web site, local news, and other sources for information about returning to school.
Learn More
- Interim Guidance for Clinicians on the Prevention and Treatment of Novel Influenza A (H1N1) Influenza Virus Infection in Infants and Children
- Antiviral Agents for Seasonal Influenza: Side Effects and Adverse Reactions
- Messages for Pediatricians' Offices and Clinics Caring for Children
This 3.5-minute message available in English and Spanish can be used by health care providers to deliver information to their patient's families when they call the office after hours. The message, developed for recording on the office telephone answering service, includes basic H1N1 flu information, advice on when to seek emergency care, tips on keeping your child healthy, and resources for additional information.
