By John Bonifield
CNN Medical Producer

Elijah Wiertel has been sick with H1N1 flu for several days now. The 8-year-old thinks he's getting well, but would he know what to tell his mom and dad if he suddenly started getting worse? Elijah's pediatrician, Dr. Author Lavin, says parents can empower children who are sick with swine flu to help look for specific warning signs.

"A lot of times kids are actually the ones that come to their parents and say, 'I'm not feeling right. Something's not right. I hurt here. I'm having trouble breathing.' Or, 'Should my fingernails be looking like this?' Or, 'I can't move my neck anymore,'" Lavin says. "It's often the children who blow the whistle and let everyone know something's wrong."

So how can worried moms and dads talk to their sick kids about the flu? Here's how Elijah's doctor talked with him about what he should do as he continues to remain ill:

Dr. Lavin: If you start having trouble breathing, you'd tell your mom and dad, right?
Elijah: (Nods).
Dr. Lavin: If your neck got stiff and you couldn't move anymore, you'd tell your mom and dad about that?
Elijah: It never got stiff but –
Dr. Lavin: But what if it did?
Elijah: I'd tell my mom and dad.
Dr. Lavin: And then if your fingers got blue, you would notice that? You might not notice that...
Elijah: Yeah.
Dr. Lavin: You would notice that?
Elijah: I write a lot, so I have to put my hands on paper.
Dr. Lavin: They're usually pink, but what if they turned blue? What would you do?
Elijah: I'd tell my mom and dad.
Dr. Lavin: And what if something really hurts? Hurts so badly you had to cry? Who would you tell?
Elijah: My mom and dad.

Trouble breathing, a stiff neck, blue fingernails, and continuous pain in one spot are all warning signs that could signal a child's H1N1 flu has crossed the line to become a potentially deadly virus. Lavin says parents shouldn't rely solely on their child's observations to determine whether they're getting worse, but he says kids can be "a very important part of the equation."

For more advice to parents on H1N1 warning signs, be sure to check out Senior Medical Correspondent Elizabeth Cohen's "Empowered Patient" column.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Connie in California:

"My family will be flying for the holidays. Should we be concerned about being in an enclosed space for five hours?"

Answer:

Connie, more than 2 million people are expected to be flying over this holiday weekend and many have the same concern as you. The Centers for Disease Control and Prevention points out there are not many studies about the spread of flu on airplanes, but anytime people are in close quarters the chance for germs spreading is much higher.

If you are sitting next to someone who is coughing excessively or seems ill, that’s when you are most at risk. According to researchers at Purdue University, you’re most likely to get sick from the people sitting in your row or the row behind you. They actually developed an animation showing how germs move around an airplane. If you’re in this situation, there are things you can do to lessen your risk of getting sick. Point the air vent away from yourself and towards the sick person – that may help push the germs back at that person. Also, turn your body away from the person who seems ill and as we’ve been saying – don’t touch your face. Dr. Julie Gerberding, the former director of the Centers for Disease Control and Prevention, adds that you could ask a flight attendant whether a mask could be given to that person or if that person or you could be moved to another part of the plane. Gerberding also points out that the air on planes is circulated through a HEPA filter, so if you are several rows away from a sick person you’re unlikely to catch his or her germs.

Keep in mind, you can go a long way in protecting yourself by taking some simple steps. I know we talk about this all the time, but wash your hands frequently with soap and water. If soap and water aren't available, you can carry those alcohol-based hand sanitizers. Cover your nose and mouth with a tissue while sneezing and encourage people around you to do the same thing and avoid touching your eyes, nose and mouth. We touch our hands to our faces a lot. In addition, some people might consider carrying a disposable mask, especially if you're feeling sick yourself. Finally, the CDC recommends that you get vaccinated, if you can. That’s sometimes harder than it sounds. For more information, check out flu.gov and CNN’s special report on H1N1.  Have a safe trip, Connie

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Elaine in New Jersey:

I attended a clinic this weekend for the H1N1 shots, and they administered the nasal spray to my 14-month-old! According to the CDC website it should NOT be administered to children under 2 years of age! I contacted the pharmacy where the clinic was held, and they took my contact info and said we will get back to me. Can you tell me is my child at risk?? I also have a call into my pediatrician. I also contact the CDC and was told they are not medical professionals.

Answer:

Elaine, it is easy to sense dismay and concern from your e-mail, and as a father I can certainly relate.

The reality is – yes – the nasal spray version of the H1N1 vaccine, which contains a weakened live flu virus, should be given only to people ages 2 to 49. We also know that children with conditions such as asthma may not be eligible for the live flu vaccine.

In order to ease your mind a bit, unless he or she has asthma, chances are very good that your 14-month-old will be fine.

The primary reason children younger than 2 do not get the nasal spray H1N1 vaccine is that it has not been tested in, and therefore is not licensed for, that age group. It is that simple. You need solid data to submit to the Food and Drug Administration before a medication can be approved for use in a particular population – that data do not exist for children younger than 24 months.

To ease your mind a bit more, rare complaints among adults and children taking the nasal spray form of the H1N1 vaccine are runny nose, sore throat, and sometimes fever. These symptoms usually go away within a couple of days. If they do crop up for your 14-month-old, you should not be too concerned, but if the symptoms get worse or your instinct tells you to, do see your pediatrician.

On the bright side of your predicament, your son or daughter is now vaccinated against H1N1. There are many parents who are still waiting to have their children vaccinated, so count yourself among the fortunate. Your child should soon have a second H1N1 vaccine dose – this time with the injectable form of the vaccine. And if you have not yet been vaccinated, you should do so – as the caregiver for your baby, you are eligible for these early doses of vaccine.

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Kali in Florida:

My 4-year-old daughter has egg and peanut allergies. Can she still take the H1N1 vaccine? If not what are her choices. I've been getting conflicting answers.

Answer:

Kali thanks for writing in. We’ve received several questions like yours since the H1N1 vaccine became available. Let me start by saying that if your daughter has a true egg allergy, and not just a sensitivity, then she can not have the H1N1 or the seasonal flu vaccine. The two types of H1N1 vaccine, the shot and the nasal spray, are made with eggs so it is not recommended for people with severe egg allergies.

However, allergists we spoke with said people with mild reactions to eggs can get vaccinated. Keep in mind that the amount of egg protein in a vaccine is often less than you would find in most baked goods. So if your daughter has been able to eat bread or cake, she may have a more mild allergy.

Consider going to an allergist and ask about getting a skin-prick test. The allergist will have a diluted and non-diluted version of the vaccine. Their first step will be to do the skin-prick test with the undiluted version. If your daughter does not break out in hives or have a strong reaction, then she can have a stronger test with a small, diluted injection. If your child doesn’t have a strong reaction to that test, then her allergy may not be severe and your allergist may give her a flu shot.

If your child does have a strong reaction and your doctor believes she shouldn’t get the flu shot, then talk with your health care provider about strategies for keeping her healthy. These steps are basic hygiene, such as washing hands for the count of singing the “Happy Birthday” song twice and staying away from sick friends plus, avoid wiping your eyes and touching your face if possible.

I hope this helps and your daughter has a flu-free season

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Robert in Kansas:

“I heard this week that the H1N1 virus has now turned up in pigs. Does this mean it can get into our food supply and I’ll get sick if I eat it?”

Answer:

Great question. The U.S. Department of Agriculture did recently announce that a commercial herd of pigs tested positive for swine flu. The USDA continues to stress that you will not infected with the HIN1 virus from eating pork. In fact, the infected pigs in Indiana weren’t destroyed. Once they recover from the flu, they will go to slaughter according to the USDA. Officials experimentally infected pigs earlier this year to see whether their blood and meat also became contaminated. They concluded that the H1N1 virus stayed contained in the respiratory tract of infected pigs and the virus did not infect the meat. The World Health Organization and World Organization for Animal Health have also concluded that humans can not be infected with the H1N1 virus from consuming pork. For more information about H1N1 and food safety, click here.

From Cheryl:

“While at my doctor's office, I asked about the H1N1 vaccine. I was told it will be very expensive, like $300. Since I do not have health insurance, the expense of the H1N1 vaccine will factor into whether I get it.”

Answer:

$300 is an excessive amount to pay for a free vaccine! That’s right – it’s free. The federal government has purchased the H1N1 vaccine and is shipping it out to states free of charge. They’re even picking up the tab for the syringes, needles, sharps containers, and alcohol swabs. Centers for Disease Control and Prevention has also stated private clinics may not charge patients a co-pay or other out-of-pocket charges for the vaccine. The only thing you should be paying is perhaps an administrative fee for your office visit but in many cases that fee is being waived as well. I would double check with your doctor again on the price. If the office still attempts to charge you $300, I would decline and instead contact your state’s health department to locate public clinic administering the vaccines near you. You can also track the vaccine’s shipments in your state through the CDC’s Web site. Check it out by clicking here.

By Rebecca Leibowitz
CNN Medical Intern

I had H1N1. It started with a cough, which quickly progressed to a headache, body aches and a 102-degree fever. A rapid flu test came back positive, confirming my diagnosis. Although this nasal swab test for H1N1 is not very reliable, so much so that it is no longer being used, I had all of the symptoms of the flu. H1N1 was pretty much the only strain circulating in late August, so chances are very high that I did indeed have it. I spent the next three days isolated in my apartment, pumping my body with vitamin C and chicken soup. Then I was fine. I felt great and I was no longer contagious; I could go to class, to the grocery store and to the gym without fear of infecting others. To my friends, I was finally “swine-free.”

My decision whether to be vaccinated against H1N1 has been made for me. Since I most likely already had H1N1, and therefore have built up immunity to the virus, I will not be getting a vaccination. However, millions of Americans are facing the decision of whether to vaccinate themselves and their children against the novel influenza A virus.

The Centers for Disease Control recommends the following high-priority groups get vaccinated: pregnant women; people who live with or provide care for infants younger than six months; health workers; people aged six months to 24 years old; and people 25-64 years old with certain pre-existing conditions.

So, when my mom told me that her doctor recommended she not get the H1N1 vaccine, I was confused. As a chronic Lyme disease sufferer (who is well under 64) and a social worker who works with very young children, my mom fits into one of the high-risk groups. Why, then, did her doctor advise her against getting it?

As I later discovered, there are several reasons why people are apprehensive about getting the H1N1 vaccination. My mom’s doctor told her that he did not see the evidence that the H1N1 inoculation protects one from getting the virus, a concern he also raised regarding the seasonal flu vaccine. This contradicts what the CDC has been saying for weeks. CDC Director Dr. Thomas Frieden recently told reporters that the vaccine should work very well because “it is an excellent match with the strains of the virus that are circulating.”

There is also widespread concern about the safety of the vaccine. During the 1976 swine flu epidemic in the United States, those who received the vaccine for that strand of swine flu were proven to have an elevated risk of contracting Guillain-Barré syndrome. Guillain-Barré syndrome is a disorder in which the body’s immune system attacks part of its nervous system. The most common complications from Guillain-Barré syndrome are breathing-related, and patients are often placed on respirators. The majority of people who contract the disorder recover, but it can be fatal.

The CDC says that it expects the H1N1 inoculation to follow a similar safety profile as the seasonal influenza vaccine, which has not been associated with increased risk of Guillain-Barré. Officials also say that this new pandemic vaccine is much “purer” than the 1976 inoculation. The expected side effects from the 2009 H1N1 vaccine are similar to those from the regular flu shot, including soreness or swelling at the point of injection, low-grade fever and body aches. The CDC and the Food and Drug Administration will be closely monitoring the safety of the immunization. The Vaccine Adverse Event Reporting System exists so that health care providers can report vaccine concerns directly.

And then there are those who think natural immunity is better and safer than any vaccine and are suggesting “swine flu parties” are the way to go – get yourself infected with H1N1 and your body will build up immunity. Most doctors and the CDC strongly advise against this method of protection.

What factors have influenced your decision whether or not to get the H1N1 vaccine? What advice has your doctor given you? Have you come to a decision whether to vaccinate you or your children?

As a  feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Shannon:

"I have a 4-month-old infant and I recently had myself and my 6-year-old son vaccinated for H1N1. My question is, will my infant also gain my immunity to H1N1 through my breast milk? I hope so." 

Answer:

This is a great question and a huge concern for many parents whose children are less than 6 months old and therefore too young to get the H1N1 vaccine. Unfortunately, there is no clear answer to your question, Shannon, so the best we can do is spell out what we do know.

We know that any time you breastfeed your 4-month-old, you pass on potent antibodies (proteins that your immune system produces to fend off disease in the body) that protect him or her against a whole range of infections.

We also know a bit about other vaccines and breast milk, for example, the pneumococcal vaccine that protects against things like pneumonia and meningitis. According to the National Institute of Allergy and Infectious Diseases, mothers who received that vaccine produced antibodies that were detectable in their breast milk, and passed them on to their babies. What is not as clear is whether those antibodies actually conferred immunity to their newborns.

The Centers for Disease Control and Prevention guidance about breast milk and the flu vaccine is a tinge more hopeful, albeit far from conclusive: "By breastfeeding, mothers can pass on to the infant the antibodies that their bodies make in response to the flu shots, which can reduce the infant's chances of getting sick with the flu."

While experts wrestle with this question, you have already taken a positive step – and significantly reduced your baby’s chances of getting the H1N1 virus – by getting yourself vaccinated. The next step is to create a "cocoon of protection" around your baby by making sure that other caregivers in the family also get vaccinated.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Miriam Falco
CNN Medical Managing Editor

For all the (legitimate) talk about the new H1N1 influenza virus, it's worth a reminder that this new flu strain is not all we have to worry about as fall turns into winter (except for Colorado, which evidently has winter now).

There's also something called "RSV." As a medical reporter, I've come across this term a few times. As a new mom of a 6-month-old, I've paid a little more attention and did some research. RSV, or respiratory syncytial virus, can cause upper- and lower-respiratory infections.
The symptoms include runny nose, dry cough, low-grade fever, sore throat, mild headache and general discomfort. But in severe cases, it can cause bronchiolitis (infection of the tiny airways in the lungs) and pneumonia. According to the Mayo Clinic, severe symptoms include "high fever, severe cough, wheezing - a high-pitched noise that's usually heard on breathing out (exhaling), difficulty breathing, and bluish color of the skin due to lack of oxygen. "

RSV is so common that virtually every child will be infected before his or her second birthday. Fortunately, only a small percentage of infants develop severe illness. Luckily for my little guy, he's apparently no longer in the highest risk group, since most children hospitalized for RSV infection are younger than 6 months of age, according to the CDC. However, a study published in the New England Journal of Medicine in February suggests that among children 5 and younger, RSV infection is responsible for approximately 1of every 334 hospitalizations, 1 of every 38 visits to an emergency department, and 1 of every 13 visits to a primary care office each year in the United States.

Older people and adults with underlying illness can also be affected, but young children are at highest risk. One way to limit the risk to your child is to require folks to wash their hands before picking up your baby. Kissing can also spread RSV.

On August 30, the CDC stopped counting only H1N1 hospitalizations and deaths and started counting all hospitalizations for H1N1 and pneumonia; the new numbers will probably include cases of RSV too.

Consider this your reminder that in addition to H1N1 or swine flu, there are other viruses that lurk around. So if you or your children or parents get sick, it's not automatically always swine flu.

Have you had an experience with RSV that you can share with others?

By Ann J. Curley
CNN Medical Assignment Manager

Many of our readers are still asking questions about H1N1 and seasonal influenza. Today we’ve got a question from Patty:

I am a 63-year-old health care worker in relatively good health, and I’m caring for a 2-month-old infant (my granddaughter). I have had a reaction to thimerosal in the past. It was used as a preservative in contact lens solution.

Is thimerosal used as a preservative in either seasonal flu vaccine or H1N1 vaccine? Are there available alternatives to these vaccines? How would I access them?

Thanks,
Patty Holly

Patty,

Thank you for your question. It’s important that you make your health care provider aware of your sensitivity to thimerosal, which is a preservative used in many products, including some vaccines, nasal products, and eye solutions.

According to the Centers for Disease Control and Prevention, the 2009 H1N1 influenza vaccines approved by the FDA are being manufactured with and without thimerosal.

Multi-dose vials of flu vaccine need to contain a preservative to prevent bacterial contamination, which can occur when multiple syringes are inserted into the same bottle.  However, some manufacturers also produce single-dose flu shots, which do not require any preservatives.

The nasal flu vaccine – both for seasonal flu and H1N1 – is always thimerosal-free. However, it is recommended only for people ages 2 to 49 who have no underlying health problems. The nasal spray vaccine is made from a weakened live virus and is not recommended for people with autoimmune disorders, pregnant women, and patients with certain chronic health problems, including diabetes, heart disease, asthma, and lung disease. Unfortunately, you can’t take the nasal flu vaccine because you are 63. You can find more information about the live vaccine here.

Ask your doctor for a thimerosal-free flu shot. If he or she doesn’t have one, you can visit the CDC’s H1N1 Web site and check out its “flu shot locator” .  It has links to the Web site of each state’s health department, with specific information about where vaccine can be found.

The Centers for Disease Control and Prevention has a lot of useful information about both seasonal flu and H1N1 flu on its Web site. Also be sure to check out CNN.com’s flu page.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

As a new feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here are two questions for Dr. Gupta.

From Kat in College Park, Maryland:

“Is it possible to get swine flu (or regular flu, for that matter) twice in the same season?”

Answer:
Once you’ve had the flu, your chance of getting it again in the same season is low. Your body builds antibodies to protect against it. This basically means if you contract that same exact strain, your body fights it off naturally, typically before you’d notice any symptoms. There are a couple of concerns, though, and one that we've been talking about almost since the beginning, and that is that the virus can mutate. It can start to change. If it mutated, a couple of things could happen. A person who has already had H1N1, would no longer be protected. But also, the people who get the vaccine being shipped out now, which is designed specifically to protect against this strain of H1N1, also wouldn’t have protection if it mutates. 

From Vanessa in Gholson, Texas:

“My kids are sick with flu-like symptoms. I’m not sure if I should take them to the doctor but would like to confirm if my children have H1N1 or not. Should we go?”

Answer:
Great question and one I’ve been getting a lot from viewers. Should a person with flu-like symptoms go to the doctor? For the vast majority of people reading this right now, the answer is no. You will have a few miserable days but most likely not need any medical attention whatsoever.

There are some high-risk groups that would need medical attention, but, a good rule of thumb is if you think you are sick enough that you would have gone to the doctor a few years ago for flu-like symptoms, then you can go this year as well. But don't treat this differently simply because it has a different name of H1N1.

As far as getting tested, this is really interesting. When we first started reporting on this virus back in the spring, health officials were trying to figure out exactly what the virus was and confirm whether it was H1N1. They were doing a lot of testing then to help investigate what areas of the country it spread to. But now we know this virus is pretty much everywhere. And the CDC isn’t recommending health providers test for it in most cases because they don't need that information anymore.   Also, the patient probably wouldn’t be medically treated any differently from the treatment for seasonal flu.