Swine flu can take sudden turn for the worse

Swine flu can be as mild as a run-of-the-mill virus - or as serious as a heart attack.

How to spot the difference can keep parents up at night worrying about their children.

The H1N1 virus that causes swine flu initially creates the same symptoms, and appears to be about as deadly, as common seasonal flu, which kills an estimated 36,000 people a year.

But more than 90 percent of deaths from seasonal flu involve people over 65, while H1N1 hits hard at young adults and children.

Most H1N1 victims recover at home. But anecdotes suggest a small number of young patients with H1N1 might start getting better, then can take a sudden turn for the worse three to five days after falling ill. Some develop severe respiratory complications requiring hospitalization, including viral or bacterial pneumonia or a marked worsening of asthma or other underlying lung problems, the World Health Organization reported last week.

Concern over the disease is taking on a renewed urgency, following the deaths of 86 children and teens this year, including a 14-year-old Naperville girl who was found to have an underlying undiagnosed heart condition that contributed to her death. A normal flu season would include 40 to 50 deaths among children or teens.

The vast majority of children with H1N1 have mild symptoms and get better on their own, stressed Dr. Susan Gerber, associate medical director of the Cook County Department of Public Health.

Most of those who do get seriously ill have underlying conditions such as respiratory or heart disease or weak immune systems and need immediate medical attention if they get the flu. But roughly one out of three who become seriously ill do not have underlying conditions.

To assess how ill a child is, the first thing parents should do is take his or her temperature, according to Dr. Michael Koller. A fever of more than 100 degrees and a cough or sore throat are defining characteristics of the flu, said Koller, a doctor of internal medicine at Loyola University Health Systems.

Once parents know a child's temperature, they can report symptoms to a doctor who can make an initial diagnosis about how serious the case is and how closely the patient, even a teen or young adult, needs to be watched.

"I can't give you a blanket, 'Can I go to work or can't I?'" Kohler said. "You need to call your doctor to help figure it out."

Two symptoms that differentiate H1N1 from common flu are vomiting and diarrhea, which occur in about one out of three H1N1 victims.

If a child has the flu, here are additional specific signs to watch out for. If they occur, get medical care right away.

• Fast or troubled breathing

• Bluish skin

• Lack of thirst

• Failure to wake up easily or interact

• Irritability, not wanting to be held

• Improvement of symptoms, then return to a fever and worse cough

• Fever with a rash

• Dizziness

• Chest pain