Stephen J. Schueler, M.D.

Influenza Home Care

Home care for all forms of influenza, including swine flu or H1N1 influenza, includes:

Influenza Congestion in Adults

Home treatment measures for congestion in adults with influenza include general measures and medications. Medications include oral decongestants, decongestant nasal sprays and antihistamines.

General Measures

  • Blow your nose gently. Forceful blowing can cause pain and bleeding.
  • Apply petroleum jelly to the nostrils if the skin becomes dry.
  • Drink plenty of liquids.
  • Place a vaporizer or nebulizer in the bedroom at night.
  • Use saline (saltwater) nose spray, such as Ocean Nasal Mist: saline helps to keep the lining of nasal passages moist. Saline may be used to flush the nasal passages:
    • Lie on your back and tilt your head back.
    • Apply 2- 4 drops of saline in one on nostril, then wait 1 minute.
    • Blow your nose.
    • Repeat in the other nostril.

Oral Decongestants
Oral decongestants, such as pseudoephedrine (Sudafed), help to thin the mucus responsible for the congestion. Decongestants are safe for adults and adolescents.

Decongestant precautions:

Decongestant Sprays
Decongestant nasal sprays, such as pseudoephedrine (Afrin) can relieve congestion faster than oral medications.

Examples include:
  • Afrin Nasal Spray
  • Duration Nasal Spray
  • Four-Way Fast Nasal Spray
  • Neo-Synephrine Nasal Spray
  • Vicks Sinex Nasal Spray

Precautions include:
  • Do not use decongestant nasal sprays for longer than 3 days. After three days, the nasal tissues become dependent on the medication. When the medication is stopped, the nasal tissue swells and congestion worsens.

Antihistamines
Antihistamines, such as diphenhydramine (Benadryl) brompheniramine and chlorpheniramine, dry nasal tissue.

Examples include:

Antihistamine precautions:

Influenza Congestion in Children

Home treatment for congestion in children with influenza includes general measures and medications. Medications include oral decongestants, decongestant nasal sprays and antihistamines.

General Measures

  • Ask your child to blow the nose gently. Forceful blowing can cause pain and bleeding.
  • Apply petroleum jelly to the nostrils if the skin becomes dry.
  • Drink plenty of liquids.
  • Place a vaporizer or nebulizer in the bedroom at night.
  • Use saline (saltwater) nose spray, such as Ocean Nasal Mist: saline helps to keep the lining of nasal passages moist.

Oral Decongestants
Oral decongestants, such as pseudoephedrine (Sudafed), help to thin the mucus responsible for the congestion. Decongestants are safe for children more than 6 years old. Talk to your doctor before providing a decongestant to a child less than 6 years old.

Decongestant Sprays
Decongestant nasal sprays, such as pseudoephedrine (Afrin), can relieve congestion faster than oral medications, but should not be used in children less than 12 years old.

Examples include:
  • Afrin Nasal Spray
  • Duration Nasal Spray
  • Four-Way Fast Nasal Spray
  • Neo-Synephrine Nasal Spray
  • Vicks Sinex Nasal Spray

Precautions include:
  • Do not use decongestant nasal sprays for longer than 3 days. After three days, the nasal tissues become dependent on the medication. When the medication is stopped, the nasal tissue swells and congestion worsens.

Antihistamines
Antihistamines, such as diphenhydramine (Benadryl) brompheniramine and chlorpheniramine, dry nasal tissue. Antihistamines are safe for children more than 5 years old. Talk to your doctor before providing an antihistamine to a child less than 5 years old.

Examples include:

Precautions include:

Diphenhydramine Dosing Chart
AgeDoseIntervalMax Daily Dose
2-5 years6.25 mg4-6 hours37.5 mg/day
6-11 years12.5-25 mg4-6 hours150 mg/day
12 and older25-50 mg4-6 hours300 mg/day

Chlorpheniramine Dosing Chart
AgeDoseIntervalMax Daily Dose
Under 6consult your physician
6-11 years2 mg4-6 hours12 mg/day
12 and up4 mg4-6 hours24 mg/day

Influenza Cough in Adults

Home treatment of a cough in adults with influenza includes:

  • Avoid respiratory irritants, such as pollution, pollen, mold, dust and chemical fumes
  • Change A/C and furnace filters regularly.
  • Stop smoking
  • Avoid exposure to secondary smoke
  • Drink warm liquids to relieve coughing spasms.
  • Raise the head of your bed at night and sleep on your left side: this minimizes acid reflux.
  • Use throat lozenges.
  • Place a vaporizer or nebulizer in the bedroom at night.

Cough medications:

Cough medication precautions:

Influenza Cough in Children

Home treatment of a cough in children with influenza includes:

  • Avoid respiratory irritants, such as pollution, pollen, mold, dust and chemical fumes
  • Change A/C and furnace filters regularly.
  • Avoid exposure to secondary smoke.
  • Drink warm liquids to relieve coughing spasms.
  • Use throat lozenges, but do not use them in children under 5 years of age.
  • Place a vaporizer or nebulizer in the bedroom at night.

Cough medicines:

Dosing Dextromethorphan
Childs WeightDextromethorphan Dose
22 lb (10 kg)5 mg every 8 hrs
33 lb (15 kg)7.5 mg every 8 hrs
44 lb (20 kg)10 mg every 8 hrs
55 lb (25 kg)12.5 mg every 8 hrs
66 lb (30 kg)15 mg every 8 hrs
88 lb (40 kg)20 mg every 8 hrs
110 lb (50 kg)25 mg every 8 hrs
132 lb-adult (60 kg)30 mg every 8 hrs

Cough medication precautions:

Influenza Diarrhea in Adults

Home treatment of diarrhea in adults with influenza includes hydration and dietary therapy.

Hydration
Those who are able to drink liquids can restore lost water and salt with oral rehydration therapy (ORT).

ORT fluids are usually used in children, but are also effective for adults. These include:

  • Infalyte
  • Lytren
  • Naturalyte
  • Pedialyte
  • Rehydralyte
  • ReVital
  • Generic drugstore brands

Additional ORT fluids include:
  • Soft drinks without caffeine
  • Sports drinks (Gatorade)
  • Tea
  • Water

Dietary Therapy
ORT is most important if you have vomiting with the diarrhea. Once vomiting and nausea resolves, eat bland foods first. If you tolerate bland food, then you can resume a normal diet.

Foods that may help diarrhea:
  • Applesauce
  • Bananas
  • Bread
  • Cereal
  • Crackers
  • Mashed potatoes
  • Noodles
  • Oatmeal
  • Potatoes
  • Rice
  • Strained carrots
  • Wheat
  • Yogurt

Items that may worsen diarrhea include:
  • Alcohol
  • Caffeine
  • Concentrated fruit juices
  • High-sugar foods (junk food)
  • Cow's milk
  • Spicy foods
  • Sugar substitutes

Influenza Diarrhea in Children

Home treatment of diarrhea in children with influenza includes hydration and dietary therapy.

Hydration
Those who are able to drink liquids can restore lost water and salt with oral rehydration therapy (ORT).

ORT fluids used in children include:

  • Infalyte
  • Lytren
  • Naturalyte
  • Pedialyte
  • Rehydralyte
  • ReVital
  • Generic drugstore brands

Additional ORT fluids for older children include:
  • Soft drinks without caffeine
  • Sports drinks (Gatorade)
  • Tea
  • Water

Strategies for breast-fed infants under 6 months include:
  • Continue breast feeding as much as your baby desires.
  • Provide additional ORT fluids to supplement breast milk.
  • If vomiting occurs, provide small amounts of ORT fluids every 30-60 minutes.
  • Prevent diaper rash by changing diapers frequently and apply Vaseline to the skin.
  • Watch for symptoms of dehydration.

Strategies for bottle-fed infants under 6 months:
  • Give your child normal amounts of formula.
  • Provide as much ORT fluids as your baby desires.
  • If vomiting occurs, provide small amounts of ORT fluids every 30-60 minutes.
  • If vomiting occurs, try a lactose-free formula.
  • Prevent diaper rash by changing diapers frequently and apply Vaseline to the skin.
  • Watch for symptoms of dehydration.

Strategies for children over 6 months:

Dietary Therapy
ORT is most important if you have vomiting with the diarrhea. Once vomiting and nausea resolves, provide bland foods first. If bland foods are tolerated, then you resume a normal diet.

Foods that may help diarrhea:
  • Applesauce
  • Bananas
  • Bread
  • Cereal
  • Crackers
  • Mashed potatoes
  • Noodles
  • Oatmeal
  • Potatoes
  • Rice
  • Strained carrots
  • Wheat
  • Yogurt

Items that may worsen diarrhea include:
  • Alcohol
  • Caffeine
  • Concentrated fruit juices
  • High-sugar foods junk food
  • Cow's milk
  • Spicy foods
  • Sugar substitutes

Influenza Pain and Fever Adults

Medications commonly used to control pain and fever in adults with influenza include:


Acetaminophen
  • Acetaminophen decreases fever and pain, but does not help inflammation.
  • Adult dosing is 2 regular strength (325 mg) every 4 hours or 2 extra-strength (500 mg) every 6 hours.
  • Maximum dose is 4,000 mg per day.
  • Avoid this drug if you have alcoholism, liver disease or an allergy to the drug. See the package instructions.
  • Common brand names include Tylenol, Panadol, and many others.

Aspirin

Ibuprofen

Naproxen

Ketoprofen

NSAID Precautions

Influenza Pain and Fever Children

Common medications used at home for pain and fever in children with influenza include:


Aspirin and most of the other nonsteroidal anti-inflammatory drugs are not used in children except under a doctor's care.

Acetaminophen
  • Acetaminophen decreases fever and pain, but does not help inflammation.
  • Dosing is 10-15 mg per kilogram (5-7 mg per pound) of body weight every 4-6 hours, up to the adult dose.
  • Do not exceed the maximum daily dose.
  • Acetaminophen products come in various strengths. Always follow the package instructions.
  • Avoid this drug in children with liver disease or an allergy to acetaminophen.
  • Common acetaminophen products include Tylenol, Panadol and many others.

Ibuprofen

Naproxen

Influenza Sore Throat

Home care for a sore throat in an adult with influenza includes:

  • Avoid alcohol.
  • Avoid citrus juice.
  • Avoid hot and spicy foods.
  • Do not smoke and avoid exposure to secondary smoke.
  • Drink plenty of fluids.
  • Get plenty of rest.
  • Numb the throat pain with throat spray or lozenges.
  • Perform warm salt water gargles several times a day. Mix 1/2 teaspoon (92.5 ml) salt per cup (240 cc) of water.
  • Place a vaporizer or nebulizer in the bedroom at night.
  • Nonsteroidal anti-inflammatory medications for pain
  • Acetaminophen for pain

Home care for a sore throat in a child includes:
  • Avoid citrus juice.
  • Avoid hot and spicy foods.
  • Avoid exposure to secondary smoke.
  • Drink plenty of fluids.
  • Get plenty of rest.
  • Numb the throat pain with throat spray or lozenges.
  • Perform warm salt water gargles several times a day. Mix 1/2 teaspoon (92.5 ml) salt per cup (240 cc) of water.
  • Place a vaporizer or nebulizer in the bedroom at night.
  • Nonsteroidal anti-inflammatory medications for pain
  • Acetaminophen for pain

Influenza Vomiting in Adults

Home care for vomiting in adults with influenza:

  • Drink clear liquids only, such as water, sports drinks, fruit juice and dilute tea. Sports drinks are best. The absence of food allows the intestines to rest.
  • Drink small quantities of fluids frequently. In general, two tablespoons of fluid every 5 minutes is an effective strategy.
  • Avoid milk and dairy products for 3 days.
  • Avoid liquids that irritate the stomach, such as citrus juice, alcohol and coffee.
  • If nausea or vomiting continues despite the above, consider one of the nonprescription medicines listed below.
  • Once vomiting and nausea resolves, start bland foods first. If you tolerate bland food, then you can resume a normal diet.

Nonprescription medications for vomiting include:

Influenza Vomiting in Children

Home treatment of vomiting in children with influenza includes hydration and dietary therapy. Those who are able to drink liquids can restore lost water and salt with oral rehydration therapy (ORT).

ORT fluids used in infants include:

  • Infalyte
  • Lytren
  • Naturalyte
  • Pedialyte
  • Rehydralyte

ORT fluids used in older children include:
  • Sports drinks (Gatorade)
  • Broth
  • Dilute fruit juices
  • Flat soda
  • Weak tea with sugar

Strategies for breast-fed infants younger than 6 months:
  • If the infant tolerates breast milk, continue breast-feeding in small amounts very frequently.
  • Provide additional ORT fluids to supplement breast milk.
  • Feed very small amounts every 30-60 minutes, or try giving small amounts more frequently, such as:
    • Children up to 5 kg (11 lb): give 5 ml (1 teaspoon) every 5 minutes
    • Children 5-10 kg (11-22 lb): give 10 ml (2 teaspoons) every 5 minutes
  • Watch for dehydration: dry mouth, decreased urination, dark yellow urine and lack of tears.

Strategies for formula-fed infants younger than 6 months:
  • If the infant tolerates formula, continue to provide small amounts very frequently.
  • Provide additional ORT fluids to formula.
  • Try giving small amounts more frequently, such as:
    • Children up to 5 kg (11 lb): give 5 ml (1 teaspoon) every 5 minutes
    • Children 5-10 kg (11-22 lb): give 10 ml (2 teaspoons) every 5 minutes
  • Watch for dehydration: dry mouth, decreased urination, dark yellow urine and lack of tears.

Strategies for children over 6 months:
  • Provide as much ORT fluids as your child desires.
  • If vomiting occurs, provide small amounts of ORT fluids more frequently:
    • Children 10-20 kg (22-44 lb): 15 ml (1 tablespoon) every 5 minutes
    • Children 20-40 kg (44-88 lb): 22 ml (1 and 1/2 tablespoons) every 5 minutes
    • Children 40 kg (88 lb) and over: 30 ml (2 tablespoons) every 5 minutes
  • Watch for dehydration: dry mouth, decreased urination, dark yellow urine and lack of tears.

Dietary Therapy
Most children with vomiting improve in a few hours and symptoms usually resolve in one day. Once vomiting and nausea resolves, provide bland foods first. If bland foods are tolerated, then you resume a normal diet.

Foods that are easiest to tolerate include:
  • Crackers
  • Oatmeal
  • Jell-O
  • Soft foods
  • Yogurt

Foods to avoid include:
  • Concentrated fruit juices
  • Junk foods
  • Milk products
  • Recently introduced foods
  • Spicy foods

Nonprescription medicines for vomiting should only be used under the direction of your doctor.

Influenza Warning Signs

Notify your doctor if you have influenza and any of the following:


Consider closer physician follow-up for individuals at higher risk for serious influenza infection:

Influenza Wheezing

Home care for mild wheezing in those with influenza includes:

  • Avoid exposure to smoke.
  • Avoid cough medicine.
  • Avoid sedative medications.
  • Avoid substances that trigger wheezing.
  • Drink plenty of liquids to remain hydrated.
  • Place a vaporizer or nebulizer in the bedroom at night.

Home care for those who take medication for wheezing includes:
  • Follow asthma home care instructions.
  • Learn to use prescribed inhalers correctly.
  • Use short-acting inhalers every 20 minutes, or as directed by your doctor.
  • Long-acting medications must be used regularly.
  • Learn to use a peak flow meter.
  • Know the peak flow danger zones.
  • Develop a strategy for using your inhaler based on your PEFR reading
  • Stay calm during a wheezing attack.

Peak Flow Zones:
  • Green Zone:
    • A PEFR reading that is 80-100% of personal best represents good control
  • Yellow Zone:
    • A PEFR reading that is 50-80% of personal best represents a moderate attack
  • Red Zone:
    • A PEFR reading that is less than 50% of personal best represents a severe attack and may identify the need for treatment in an emergency department.

Continue to Influenza Prevention

Last Updated: Mar 7, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Influenza References
  1. Centers for Disease Control and Prevention (CDC)
  2. Ebell MH, White LL, Casault T. A systematic review of the history and physical examination to diagnose influenza. J Am Board Fam Pract. 2004 Jan-Feb;17(1):1-5. [15014046]
  3. Flu.gov, HHS Interagency Public Affairs Group on Influenza Preparedness and Response
  4. Jefferson T, Smith S, Demicheli V, Harnden A, Rivetti A, Di Pietrantonj C. Assessment of the efficacy and effectiveness of influenza vaccines in healthy children: systematic review. Lancet. 2005 Feb 26-Mar 4;365(9461):773-80. [15733718]
  5. Montalto NJ. An office-based approach to influenza: clinical diagnosis and laboratory testing. Am Fam Physician. 2003 Jan 1;67(1):111-8. [12537174]
  6. Strategy for Off-Site Rapid Triage(c) (SORT) and Real-time Epidemiological Assessment for Community Health(c) (REACH), Emory University, Principal Investigators: Alexander Isakov, MD, MPH; Arthur Kellermann, MD, MPH, Collaboration with the Emory at Grady Health Literacy Team (Ruth Parker, MD; Kara Jacobson, MPH, CHES; Lorenzo DiFrancesco, MD)
  7. VHA Office of Public Health Surveillance and Research; Influenza Algorithm Work Group
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