Is Tamiflu Right For Your Child?

I have seen a lot of fear and misinformation circulating these days regarding Tamiflu, so I decided to put some evidenced-based information together for parents to have at their fingertips. The flu, or more accurately, influenza, is a serious illness, and it can be scary to watch your child go through it. Add to this the confusion and contradictory anecdotes mixed with strong opinions regarding Tamiflu, and what is a parent to do? Here are a few basics that is essentials about Tamiflu for every parent to know.

What is Tamiflu?

First things first. What exactly is Tamiflu? Tamiflu, or more accurately oseltamivir, is an antiviral medication used to SHORTEN the duration of the flu. In certain cases, it can be given to try to prevent the flu for at-risk children and adults that have been exposed to influenza. Tamiflu is available as a liquid or a pill, and the liquid should always be kept in the refrigerator.

Antibiotics can be given at any point during a bacterial infection and still be highly effective. Antivirals like Tamiflu, however, are different. They must be started within the first 48 hours to have much effect. This has to do with how the virus replicates within the body.

Why does Tamiflu only work in the first 48 hours?

When someone with influenza sneezes or coughs, droplets of saliva or mucus containing the virus can get into the nose or mouth of another person. The influenza virus then enters this person’s body and actually goes into the very cells that make up our body, especially the cells of our nose, throat, and lungs. Once they are inside these cells, they replicate, meaning they make more of themselves.

The influenza virus is a terrible guest, and it wreaks havoc in the cells that host it, making it hard for the cells to do their important jobs. Then, the infected cell releases capsules containing the essential elements of the virus. This is called a virion, and these virions are what enter the blood stream and go on to enter other healthy cells where the process is repeated over and over and over again, until more and more of our cells are busy making virions or “virus babies” instead of what they are supposed to be doing. The immune system kicks in trying to get rid of these foreign invaders, and we start feeling the classic fevers, aches, and chills.

Tamiflu works by stopping the virions (virus babies) from being released into the blood stream. It does not help the cells already infected, and it does not kill the actual virus. Our bodies’ immune systems still have to do that. Tamiflu’s purpose is to stop the virus from being able to infect more cells. This is why Tamiflu works best in the beginning of the infection. Taking it after our cells are already infected doesn’t do us as much good.

Studies are showing that taking Tamiflu within the first 48 hours can take off a day to a day and a half of symptoms. This might not sound like much, but for a young child or someone immunocompromised, this can make all the difference. For a healthy person, however, it is simply a day.

Clearly, Tamiflu is no substitute for the flu vaccine. The best way to protect you and your loved ones from the flu is the flu vaccine. On top of preventing the flu in many cases, the flu vaccine is also known to decrease the severity of symptoms of the flu if your child does contract it. Prevention is always better than treatment, and the flu vaccine is the best way to protect you and your loved ones.

Who should take Tamiflu?

The American Academy of Pediatrics recommends that if your child falls into one of the following groups, that he or she should receive Tamiflu as soon as possible:

1. If your child is in the hospital for influenza, it is highly recommended for him to receive Tamiflu as soon as possible. When a child is sick enough to be hospitalized, it is a clear sign that their immune system is having trouble keeping up. Tamiflu, while not a cure, might stop the spread of the virus throughout their body just enough for them to fight it off. At this point, you will want to give Tamiflu regardless of what day of the infection it is. It is extremely important to listen to the advice of your medical providers in the hospital to determine which medications and treatments may help your child recover the fastest and decrease the chances of symptoms getting worse.
2. If your child has what medical providers classify as a SEVERE infection of influenza, he should get Tamiflu as soon as possible. It might be hard for parents to truly gauge how sick their child is. Classifying the infection as severe needs to be done by a medical provider. Basically, it means that your child’s immune system is not being able to stop the virus and needs some help. Once again, while Tamiflu is not a cure, it can give your child a fighting chance.
3. If your child is at high risk of complications from influenza, he should receive Tamiflu, even if the symptoms do not look too bad. This determination also needs to be made by a medical provider, but examples of people at high risk are:
   • Children under 2 years of age
   • Immunocompromised individuals
   • Anyone with a chronic illness such as asthma, kidney disease, cerebral palsy, etc. that can put them at higher risk for complications
   • Pregnant mothers, or mothers who have given birth in the last 2 weeks
   • Adults over 65

Now we get into the gray area. If your child fits into the categories above, it is not a gray area, and it is recommended that they be treated with Tamiflu. However, there are times when it is not so clear.

Who should maybe take Tamiflu?

1. If your otherwise healthy child (over 2 years of age) has been diagnosed with influenza within 48 hours of the onset of symptoms, your provider MAY prescribe Tamiflu. Like we discussed earlier, that 48-hour window is crucial, and an otherwise healthy child receiving Tamiflu outside the 48-hour window is probably not going to do much good. At that point, the potential side effects of Tamiflu may not be worth it.
   
   If your child falls within the 48-hour window, it is best to discuss the situation with your pediatric provider. If your provider is saying that the decision is “up to you,” I would encourage you to ask for his or her recommendation based on your child’s medical history and how severe of symptoms your child has. Whether or not your child had the influenza vaccine will also play a role in the decision making. The influenza vaccine can decrease the severity of flu symptoms and help prevent severe infection, and being unvaccinated may be part of the reason to give Tamiflu. This is one of those cases where information about other people’s children and how they did on Tamiflu is not particularly helpful. Every child is affected by the flu differently, and a professional assessment and recommendation is important.
2. Another reason an otherwise healthy child may receive Tamiflu is when they have siblings or close contact with children under 6 months of age or with a person that is at a high-risk of complications from influenza, especially those that have not been vaccinated for the flu. This means, if you have a 1-month old baby at home and your 6-year-old gets influenza, it is a good idea to talk to your medical provider about Tamiflu. Another example is if your child’s immunocompromised grandmother is living with you, this might be enough to warrant Tamiflu.  

Who should NOT take Tamiflu?

1. Any child who has had a serious allergic reaction to Tamiflu, should not take it. A true allergic reaction is not a mild rash or some vomiting or diarrhea. A true allergic reaction will be clearer than that, and it should be assessed by your pediatric provider.
2. If your child has a virus other than the flu, Tamiflu is completely ineffective against it. It will not treat colds no matter how bad the cold is and it does nothing against gastroenteritis (stomach flu).  It also will not treat a bacterial infection such as pneumonia or ear infections.
3. If your child has received the live attenuated influenza vaccine within the last two weeks, Tamiflu could interfere in the vaccine’s effectiveness.

Potential Tamiflu Side Effects

Now it is time to talk about the potential side effects of Tamiflu. Some of you may have heard anecdotal reports of some scary side effects, and I would like to address that. No medication is without side effects, and it is always a case of weighing risk vs benefit.

Also, no medication should be taken lightly. We do not want to overuse Tamiflu as that can cause the influenza virus to develop resistance to this antiviral. We also do not want to subject children to any unnecessary medication. However, there has also been an overemphasis lately on the side-effects, and they have been blown largely out of proportion.

It is also important to remember the complications of the flu.  The flu itself can lead to hospitalizations, pneumonia, and even death.

The most common side effect of Tamiflu is nausea, vomiting, and stomach pain. Giving food at the same time your child takes Tamiflu can help decrease this side effect. There has also been some diarrhea reported.

The second most common side effects reported are rashes, including diaper rashes. It is important to note that, apart from a diaper rash, some rashes can simply be a side-effect whereas others are a symptom of a hypersensitivity (allergic) reaction.

If your child is having a significant rash or is having severe vomiting or diarrhea, make sure to call your pediatric provider. It is possible to have an allergic reaction, and this would be an important reason to stop giving Tamiflu.

After Tamiflu was released, some concern developed about neurological problems following people taking Tamiflu including seizures, hallucinations, behavioral changes, and self-harming behaviors. This has received a lot of attention, and there is some discussion over whether this is being caused by Tamiflu or if it’s a symptom of the flu, which Tamiflu is given to treat. Studies have been done to determine if there is a causal relationship. One study, in particular, was conducted in 2018 over the concern that Tamiflu may cause suicide, and it clearly showed that there was no relationship between Tamiflu and suicide. Studies will continue to be conducted to evaluate the safety of this life-saving medication, and your pediatric provider can answer questions or concerns you may have about what research is currently being done.

It is worth noting that influenza itself can cause neurological problems, including febrile seizures and encephalopathy. Encephalopathy is swelling of the brain that can cause seizures, hallucinations, and behavioral changes. Any study that looks at the side effects of Tamiflu will have the difficult task of differentiating between the side effects of the medication and the symptoms and complications of the disease itself. This is easier said than done.

If your child develops ANY severe symptoms whether neurological or otherwise after starting Tamiflu, call your child’s medical provider immediately.

Risks vs Benefits

Like we discussed previously, no medication is without side effects and should never be given lightly. We need to weigh the benefits against the risk for each situation and determine what is best for the individual child. Following guidelines helps in that determination.

If your child is under 2 years of age, falls into the high-risk category, has severe influenza, or is hospitalized for the flu, the benefits outweigh the risks. Influenza can be a very severe illness. In fact, the Center for Disease Control estimates that over 14,000 people have died from the flu this season (and this number may even be closer to 36,000 deaths), and the flu season is not over yet.

For children who do not fall into the above categories, there needs to be a conversation between you and your child’s doctor about the best course of action. Tamiflu is not a magic cure.

As a medical provider, I cannot pass up this opportunity to, once again, bring up the the flu vaccine. The flu vaccine is the BEST way to protect your child and loved ones, and it carries very minimal risk.

Flu Prevention With Tamiflu

Some of you have probably heard that Tamiflu can be used in an attempt to prevent the flu in certain cases. Just like with antibiotics, we have to be careful to not create resistance to Tamiflu by using it too much. Also, we do have to balance side effects with how effective the prevention will be. No medication is 100% effective. The dose used to prevent the flu is lower than the dose that would be used to treat the flu. If your child is on a prevention dose of Tamiflu, it is important to watch for symptoms of the flu, because the dose would need to be changed.

The American Academy of Pediatrics recommends using Tamiflu as a preventative for the flu in a few cases:

1. Children who are at a high risk for complications from the flu who have NOT or more importantly CANNOT receive the flu vaccine. Sometimes Tamiflu can be given to high-risk children for the two weeks between the time when the vaccine is given and when the vaccine will be fully effective.
2. Your pediatric provider may also give Tamiflu as a preventative if someone within the family has influenza. This is especially important if other children in the family are immunocompromised or at high risk.

Taking Tamiflu as a preventative is going to be up to your child’s medical provider. If they prescribe Tamiflu, it is usually for a good reason, but always question if you do not understand why it’s been prescribed or the care instructions.

Tamiflu should always be used judiciously, but there are some very legitimate reasons to give it. Like any medication, it can have side effects and may only take away about a day to a day and a half of symptoms. For some kids, however, this day and a half is what they need to fight off the infection, so don’t be afraid to give it when their pediatric provider recommends it.

Once again, as a vaccine advocate, I have to say that Tamiflu is no substitute for the flu vaccine. Please, please always vaccinate your child. (And wash those hands!) I wish all of you a healthy, flu-free home.

Author: Dani Stringer, MSN, CPNP, PMHS – founder of KidNurse and MomNurse Academy