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Influenza or ‘flu’ in children

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Influenza, commonly known as the flu, is a highly contagious respiratory illness caused by influenza viruses. For most healthy adults, it is a miserable but temporary inconvenience. However, for children, especially those under the age of five, the flu can be a serious problem that may lead to hospitalisation, the occurrence of significant complications and in some unfortunate cases, even death. Understanding some of the variegated features of this widespread virus disease, its history, symptoms, treatment, and, most importantly, prevention, is crucial for parents and caregivers. This is especially so as there are increasing numbers of influenza cases in the government and private medical institutions at present. This piece is presented as an item of health education for the general public to facilitate proper management of the disease.

While influenza is perhaps a persistent threat today, history shows that it has caused devastating pandemics throughout several centuries. Hippocrates, the ancient Greek physician, affectionately known as the Father of Medicine, described a flu-like illness as far back as 412 BCE. However, our modern understanding of the disease took shape much later. For many years, the cause was mistakenly thought to be a bacterium. It was not until the 1930s that British researchers successfully isolated and identified the influenza virus itself. This breakthrough paved the way for the development of effective vaccines.

The most notorious chapter in influenza history is the 1918 “Spanish Flu” pandemic, caused by a particularly virulent H1N1 strain. It infected an estimated one-third of the world’s population and is believed to have killed between 20 to 50 million people globally, the exact number varying according to several reports. Since then, other pandemic strains have emerged, such as the 1957 “Asian Flu” (H2N2) and the 1968 “Hong Kong Flu” (H3N2), reminding us of the virus’s continuous transformations into many an evolving threat. Modern surveillance and vaccination efforts have significantly reduced the devastation seen in previous centuries, but the seasonal flu remains a major public health concern, especially for vulnerable populations like children.

Influenza in children often differs a little from the presentation in adults. While a common cold usually develops slowly with a stuffy nose and mild cough, the flu tends to strike suddenly and severely. The classic symptoms of the flu in children include high fever, which often reaches 103°F (39.4°C) or higher. It is accompanied by chills with a feeling of being cold, shivering and then by profuse sweating. Many children complain of headaches and rather severe body aches, contributing to the child’s overall misery. Some children feel severely fatigued and sort of run down and tired for a week or more. Many affected children have sore throats, and a dry cough is generally seen in a significant number of affected children. Unlike adults, children are more likely to experience gastrointestinal problems like nausea, vomiting, and diarrhoea with the flu. In infants and toddlers, symptoms may be less specific, and they might just be irritable, fussy, refuse to eat, and have an unexplained high fever.

Flu can turn into a more serious problem with the development of some complications. While most healthy children recover within a week, the flu can lead to serious complications, particularly in those under age two and those with underlying health conditions like asthma, diabetes, heart disease, or neurological disorders.

The most common and dangerous complications include:

*  Pneumonia: A severe lung infection that can be caused either by the influenza virus itself or by a secondary bacterial infection, which often sets in after the flu has weakened the immune system.

*  Ear Infections (Otitis Media) and Sinus Infections.

*  Croup or Bronchiolitis: Inflammation of the larynx and the airways, which can make breathing difficult, especially in young children.

*  Febrile Seizures: Fits triggered by fever in children who have the constitutional tendency to have them, as seen in some young children.

Less common but more severe complications, too, could occur. In those somewhat rare situations, the flu can cause inflammation of the heart (myocarditis) or the brain (encephalitis), or it can trigger Reye’s syndrome, a severe condition causing swelling of the liver and brain, often linked to giving aspirin to children with viral illnesses.

It is crucial to seek urgent medical care if your child exhibits emergency warning signs, such as difficulty in breathing or shortness of breath, blueish or greyish skin colour, refusing to drink fluids leading to dehydration, severe or persistent vomiting, being hard to wake up or interacting little, or having a seizure.

Since the flu is caused by a virus, antibiotics are completely ineffective unless a secondary bacterial infection, like bacterial pneumonia or an ear infection, is diagnosed.

For most children with uncomplicated flu, treatment focuses on relieving symptoms and supporting recovery:

*  Rest: Plenty of rest is essential.

*  Fluids: Encourage frequent intake of clear fluids to prevent dehydration.

*  Fever and Pain Management: Use Paracetamol in a dosage of 10 to 15 mg per kilogram of body weight. This range is given to allow the parents to select the dose appropriate to the severity of the symptoms.

*  The use of NSAIDs like Aspirin, Ibuprofen, Naproxen, Mefenamic acid, and Diclofenac are discouraged, however high the fever goes, as these drugs may trigger some complications.

In certain cases, a doctor may prescribe antiviral medications. These drugs, like oseltamivir, work by attacking the influenza virus and stopping it from multiplying. It can shorten the duration of flu symptoms and reduce the risk of serious flu complications. It is essential to point out that antivirals are most effective when started within 48 hours of the onset of symptoms in cases scientifically proven to be due to the influenza virus. They are typically reserved for children who are hospitalised with the flu or those who are severely ill or progressing rapidly, and children who are at a higher risk for flu complications, even if symptoms started more than 48 hours ago. This includes all children under 2 years of age and those with chronic medical conditions. It must be strongly stated that antiviral drugs should not be used as a blanket treatment for fevers even vaguely suggestive of influenza. Those medications are not a panacea for all ills in flu. Ideally, there must be a definitive diagnosis with laboratory confirmation of the disease before using these drugs. Aimless usage of these drugs haphazardly is one sure way to produce antimicrobial resistance to these drugs.

Yet for all these considerations, the most effective way to protect children from the flu and its complications is through annual vaccination. The flu shot is recommended for all children 6 months of age and older in the affluent Western countries.

Influenza viruses are unique because they constantly change, or ‘drift,’ which means the strains circulating one year may be different from the strains circulating the next year. This constant evolution is why a new flu vaccine must be developed and administered every year. The vaccine is designed to stimulate the immune system to produce antibodies against the specific strains predicted to be most common during the upcoming flu season.

The world has two primary influenza seasons:

*  Northern Hemisphere: Flu season runs roughly from October to May. The World Health Organisation (WHO) and other bodies issue vaccine recommendations for this hemisphere in February/March, based on surveillance data from the previous year and the ongoing global situation.

*  Southern Hemisphere: Flu season runs roughly from May to September. Vaccine recommendations for this hemisphere are issued in September/October.

The two regions require different vaccines because their flu seasons are six months apart. Scientists in the Northern Hemisphere can often look to the flu season that just occurred in the Southern Hemisphere to see which strains were dominant. This is called using the “Southern Hemisphere experience” to help predict and match the strains for the Northern Hemisphere vaccine, and vice versa.

Flu vaccine effectiveness can vary from season to season, but typically ranges from 40% to 60% when the vaccine strains are a good match for the circulating viruses. It is important to understand what this means: the protection is NOT 100%, but getting the vaccine significantly lowers the risk of getting the flu. Even if a vaccinated person still catches the flu, the vaccine is proven to reduce the severity of the illness, decrease the likelihood of complications, and lower the risk of hospitalisation and death. The vaccine essentially gives the child’s immune system a head start in fighting the infection.

Influenza in children is a somewhat serious infection that demands parental vigilance and, ideally, preventative action. Vaccination remains the single most powerful tool we have to protect our children and the wider community from the seasonal flu’s potentially severe consequences. By understanding the symptoms, knowing when to seek help, and making the decision to vaccinate annually, we can all become effective “flu fighters.”

(The assistance provided by Artificial Intelligence (AI) in compiling this article is acknowledged.)

Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paediatrics), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.



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Opinion

‘Outpost of Empire’

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Review

by Colleen Figg, Editor
and Reviewer – Amazon, New Voices Publishing

“Fernando echoes Macbeth with the line, “There is judgment here.” It captures the question running through the novel: can anyone participate in corruption and remain untouched by it? Beneath this satire is a dark story about power and the danger of believing, that someone else will always pay the price.”

Shavindra Fernando’s Outpost of Empire is a political novel set in the fictional country of Lackadasia. At its heart is a strong idea: an exploration of world politics, terrorism and the ways in which powerful countries manipulate smaller ones. Fernando is clearly writing about political issues that matter deeply to him.

The names immediately establish the book’s satirical character. Lackadasia, Burgherbugaria and the various Klowns suggest a world in which the people and places are exaggerated, but the issues beneath the exaggeration are recognisable. The playful language allows Fernando to approach terrorism, religious conflict and political corruption from an unusual angle.

Henry Stockwell is a central character: an ambassador who arrives in Lackadasia presenting himself as a friend of the country. He believes he understands how power works and treats the country, its politicians and its people as pawns on his personal chessboard. In his arrogance, he never doubts that he controls events rather than being controlled by them. This confidence makes him a compelling figure and in him, we explore the workings of political influence and the potential traps contained therein.

As the story develops, Fernando reveals a political world where causes are adopted when they are useful, people are exploited and discarded, and the truth becomes whatever those in power need it to be. Ordinary people suffer the consequences of decisions made far beyond their reach or knowledge, while those making those decisions continue to justify their actions. Even the people who help keep this world running may not be as important or as safe as they imagine.

Stockwell brings this idea into focus. He recognises corruption in others and willingly takes part in it himself, yet he cannot see that he might also suffer its consequences. Ultimately, he thinks his position will keep him safe. He is intelligent enough to understand the game, but not insightful enough to grasp the limits of his place within it. This blindness gives the novel a strong sense of irony.

The satirical approach gives Fernando room to criticise political hypocrisy without turning the novel into a direct political argument. By using fictional countries and exaggerated names, he creates some distance from specific governments and events while still making the larger targets of the book clear. The humour does not take away from the seriousness of the subject; instead, it makes the cruelty and self-interest beneath the political performance stand out more sharply.

Near the end, Fernando echoes Macbeth with the line, “There is judgment here.” It captures the question running through the novel: can anyone participate in corruption and remain untouched by it? Beneath this satire is a dark story about power and the danger of believing that someone else will always pay the price.

I came away feeling that Outpost of Empire is a valuable and thought-provoking book, particularly in today’s political and social climate. It has a distinctive voice, and the questions it raises about power, responsibility and foreign interference remain relevant far beyond the fictional borders of Lackadasia.
About the Author

Shavindra Fernando has worked as a reporter. He read English & Classics at the University of Peradeniya in Sri Lanka, and took International Relations & Ethnic Politics as a Reuter Fellow at the University of Oxford in England. The Vague Poetess (1999)was his first novel.

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Opinion

Speaker’s dilemma

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The Opposition, in its wisdom (or perhaps stupidity), has submitted yet another No-Confidence Motion (NCM) against the Speaker of Parliament. Perhaps it hopes to score some brownie points in the eyes of the public, which is hardly indifferent to such developments. Yet, knowing full well that the motion is unlikely to succeed, the exercise may well prove futile — akin to banging one’s head against a solid rock.

Nevertheless, the nearly fifty allegations levelled against the Speaker, whether justified or mere mudslinging, cannot simply be brushed aside. Such allegations may well have a bearing on the individual concerned, particularly where it matters most — his conscience — and few would dispute that possibility.

From a protocol standpoint, the Speaker occupies one of the highest positions in the country, ranking third in the hierarchy of state. He consequently belongs to the uppermost echelons of public life, with acquaintances and associates extending across a wide spectrum of society, including diplomats and other distinguished personalities. Such a position carries with it not merely prestige and privilege, but also an onerous responsibility to uphold the dignity and integrity of the office.

As the guardian of Parliament, the Speaker is expected to maintain standards of conduct, impartiality and discipline that are beyond reproach.

Whether the allegations are justifiable or not may be of little consequence to members of the ruling party, who will undoubtedly defend their colleague to the hilt. Nevertheless, the stigma arising from such allegations may prove difficult to erase, particularly in the eyes of his family, close associates and, ultimately, the voters who placed their trust in him. Of course, it is common knowledge that politics can be a dirty game and that, as Lord Acton famously observed, “power tends to corrupt, and absolute power corrupts absolutely.”

Yet, nothing could be more devastating than a person losing his own soul in the process. On the one hand, stepping down could be construed as an admission of responsibility for the allegations levelled against him. On the other, allowing the No-Confidence Motion (NCM) to proceed could expose him to further public scrutiny and potentially inflict lasting damage on his character, dignity and reputation. Thus, he finds himself caught between two unenviable choices, each carrying consequences that may extend far beyond the immediate political fallout.

The Speaker is therefore confronted with a classic Hobson’s choice, with neither option likely to be without consequences. After all, in politics, there are no permanent friends or enemies—only permanent interests.

WILLIAM

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Opinion

How long can Sri Lanka remain silent on its demographic crisis?

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I write this with a sense of profound disappointment, rather than as a critic of the government or any individual public official. For several months, I have been drawing public attention to what I consider one of the most serious long-term challenges facing Sri Lanka—the country’s rapidly changing demographic structure, declining fertility, population ageing and the consequent contraction of the working-age population.

I have written several articles on this subject, believing that informed public discussion could encourage policymakers, academics and relevant institutions to examine the issue before its consequences become irreversible. I went a further step by addressing a detailed letter to the President on 28 August 2026, seeking consideration of a National Demographic Action Plan.

That letter was not merely an expression of concern. It contained practical proposals: long-term demographic projections, assessment of the consequences for labour supply and productivity, examination of declining fertility and delayed family formation, reassessment of education and employment policies, consideration of migration, and the establishment of continuous demographic monitoring.

I deliberately addressed the matter to the highest level because demographic change is not the responsibility of one ministry. It cuts across Finance and Planning, Education, Labour, Health, Higher Education, migration, social protection and national human-resource planning.

Yet, after sending that registered letter, I have not even received an acknowledgement.

This is what troubles me most. I fully appreciate that government has numerous urgent problems to address. Economic recovery, disaster management, employment, education and many other immediate concerns understandably demand attention. But demographic change is different. It operates slowly, almost silently, while steadily narrowing the choices available to future governments.

By the time the shortage of workers, accelerated ageing, increased dependency and the economic consequences of very low fertility become impossible to ignore, remedial action may be enormously more difficult and expensive. What is equally disappointing is the apparent silence of the institutions that should be at the centre of this discussion.

The latest Census has provided the country with an invaluable body of demographic evidence. My own published work has attempted to connect those findings with national development, productivity, education, employment and human-resource planning. On the top of these endeavours, I have seen voluminous articles written by Professor Manori Weerathunga, of the Population Department of the Colombo University, President Population Association of Sri Lanka, and Director Centre for Ageing Studies of University of Colombo. Yet I have seen little evidence of a visible national policy response from the relevant planning and statistical authorities.

Given the multiplicity of the roles and the credentials she possesses, I would strongly urge her to take the bull by the horns and formulate a draft national demographic policy with the expertise of the demographic scientists. This task cannot be delegated to the SLAS or Planning panjandrums. The government should seriously think why the thinktanks are abdicating their mandatory responsibilities and playing a passive role when the country is confronted with burning issues. Are there any sinister plans by disgruntled senior officers to derail the development plans is the question that begs an answer? Alternatively, the government should seriously enlist the support of the IMF or the World Bank, before the demographic bomb explodes!

Are we treating the Census merely as a statistical exercise, rather than as an early-warning the system for national planning? This question deserves a public answer.

I went even further by writing on “Educational Delays, Biological Clock and Sri Lanka’s Fertility Crisis.” My purpose was not to blame the education authorities. I sought to draw attention to the possibility that prolonged delays in university education, examinations, admissions and graduation may interact with delayed family formation and the biological realities of childbearing. I had hoped that this would stimulate examination by the Education sector and other relevant stakeholders.

Unfortunately, I have yet to see any meaningful response. My concern is therefore not whether my own articles have been acknowledged. That is completely irrelevant. The issue is whether the substantive national questions raised in those articles are being examined by anyone in authority.

A citizen who spends considerable time studying a national problem, writing about it publicly and then submitting a constructive proposal to Government should not necessarily expect agreement. But surely an acknowledgement—or better still, a response indicating that the matter is being examined—is not too much to expect.

There is also another dimension which I recently highlighted in discussing Sri Lanka’s transition from an “Age of Longevity” towards an “Age of Experience”. Sri Lanka is simultaneously facing a shrinking younger workforce and an expanding reservoir of older citizens possessing decades of professional and institutional experience.

The demographic challenge, therefore, should not be viewed only through the lenses of pensions, healthcare and elderly care. The country must also ask how the accumulated knowledge, expertise and institutional memory of its experienced citizens can be mobilised for national development.

This is precisely why I find the present silence so difficult to understand. I have no personal or political agenda. I have spent decades working in human resources, productivity and management specialist, and I have chosen in the later stage of my professional life to devote my writing to contemporary national issues which I believe deserve national attention.

Perhaps my concerns are misplaced. Perhaps the government already has a comprehensive demographic strategy under preparation. The relevant institutions have already initiated studies that are not yet public.

If that is the case, I would be delighted to be proved wrong. But if no such comprehensive process exists, then I respectfully ask: how much longer can Sri Lanka afford to remain silent?

The demographic clock does not stop while governments deliberate.

My appeal is therefore not for recognition of my efforts. It is for recognition of the problem. I hope the relevant authorities will prove that the silence I have encountered is not indifference, but merely the silence before meaningful action.

Sri Lanka cannot afford to discover, ten or twenty years from now, that the warnings were visible, the evidence was available, the proposals were made—and nobody acted.

The time to respond to the demographic crisis is now, while choices still remain.

Over to you, the President, the Prime Minister, the Minister of Finance and National Planning, Vice Chancellor of Colombo, Director General of Census and Statistics.

Athula Ranasinghe

Productivity Specialist and Management Consultant

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