A child being held by a grownup for a story about Tamiflu and flu in children

With flu activity still high or moderate in 36 states, and the Centers for Disease Control and Prevention reporting late last week that 119 U.S. youngsters have died this season from flu complications, parents want to do everything possible to keep kids safe. But when it comes to prescription antiviral medications such as oseltamivir (Tamiflu and generic), the right move hasn't been so clear.  (See the CDC flu activity map, below.)

That's because there have been some reports of side effects such as delirium, hallucinations, and even suicidal thoughts in children taking antiviral drugs.

study published today in the Annals of Family Medicine, however, concluded that oseltamivir, the most commonly prescribed antiviral, doesn’t appear to increase risk of suicide in children.

More on the Flu

“The findings should be very reassuring for parents if their child comes down with the flu and their pediatrician recommends a course of oseltamivir,” says Flor Munoz, M.D., an associate professor of pediatric infectious disease at the Texas Children’s Hospital in Houston and a member of the American Academy of Pediatrics Committee on Infectious Diseases. “Given the fact that this research indicates no higher suicide risk, providers may become more comfortable using this drug in children.”

But the new study doesn’t mean that every child with the flu should take an antiviral. Here's what to know about Tamiflu for kids.

What the Research Has Shown

In 2006, after having reviewed more than 100 reported cases, mostly in Japan, of side effects such as delirium, hallucinations, and suicidal thoughts, the Food and Drug Administration issued a warning about oseltamivir. 

The FDA cautioned that people with the flu, particularly children, could be at increased risk of self-injury and confusion shortly after taking the drug, and should be closely monitored for signs of unusual behavior.

This led most doctors to be cautious about antivirals such as Tamiflu for kids, although it was unclear whether such side effects were actually due to the drug.

For the new study, researchers looked at data on more than 21,000 youngsters who had attempted suicide during the 2009 to 2013 flu seasons. They compared 251 kids who had taken oseltamivir for the flu within the prior 15 days with 162 youngsters who had the flu but hadn’t taken the drug.

“When we did this, we didn’t find any association between oseltamivir use and suicide,” says study author James Antoon, M.D., Ph.D., assistant professor of clinical pediatrics at the University of Illinois at Chicago.

The study didn’t look at other side effects that have been associated with oseltamivir, such as delirium, hallucinations, confusion, convulsions, and seizures.

We don't yet know definitively that Tamiflu for kids can cause those. It’s possible that oseltamivir has “an excitatory effect” on the nervous system that leads to the side effects above, says William Schaffner, M.D., professor of preventive medicine and an infectious-disease specialist at Vanderbilt University School of Medicine in Nashville. But in reality, he stresses, these negative effects are exceedingly rare (below 1 percent) and fade as soon as youngsters stop taking the drug.

And as for the flood of reports from Japan in 2006, those, according to Munoz, might have actually been related to the encephalitis that some children with the flu developed as a secondary infection, not to the flu itself. 

Should Your Kids Take Tamiflu?

Research shows that when given within 48 hours of the onset of flu symptoms—such as fever, cough, sore throat, body aches, and chills—oseltamivir lessens a child's sick time by about 29 hours. (Some experts consider this only a modest benefit.) Studies suggest it may also reduce the risk of a secondary infection, such as an ear infection.

Certain children should take oseltamivir (Tamiflu and generic), says Munoz. These include:

• Children already hospitalized with the flu. If your child's symptoms are significant enough for her to be admitted to the pediatric intensive care unit (PICU), she’s sick enough to need oseltamivir. “Even if it’s been more than two days since the start of symptoms, there is the possibility that the drug will work, so we want to try it,” explains Munoz. Some research does suggest that antivirals may have some effectiveness outside the 48-hour window. For instance, one 2013 study in The Lancet Infectious Diseases found that children given oseltamivir within five days of getting sick saw their symptoms ease, compared with those who didn’t get it. They were also much less likely to spread the illness to others.

• Any child at high risk for flu complications such as pneumonia or sepsis. This includes those under age 5, and children with underlying health conditions such as asthma, lung disease such as chronic obstructive pulmonary disease or cystic fibrosis, heart disease, kidney or liver disorders, blood disorders such as sickle cell disease, or diabetes, as well as any child who is currently immunosuppressed and kids with neurologic or neurodevelopmental conditions such as epilepsy, cerebral palsy, or intellectual disability.

• Your child is rapidly worsening. While running a fever of up to 103° F isn’t necessarily a cause for concern, if a youngster is feeling so poorly that he is unable to eat or drink, or is having trouble breathing, then oseltamivir is appropriate, outside of that 48-hour window, advises Munoz. (Here are details on when to get emergency help for the flu.)

• An additional scenario. You may also want to consider having your child take oseltamivir if there's an infant under 6 months old in the house, or a child in the house is in close contact with an elderly relative. Since the very young and very old are more likely to experience serious complications from the flu, treating your child could help stop the spread of the virus in your home, Munoz notes.

For kids who don't fall into one of the categories above, there's generally no need for oseltamivir, although according to the CDC, antivirals can be considered for kids with the flu who are not at high risk for complications. The decision may depend in part on how miserable your youngster is.

If Your Doctor Recommends Tamiflu

In all cases, you and your doctor will want to weigh the benefits and risks.

About 14 percent of all children taking oseltamivir experience tummy troubles such as nausea, diarrhea, and vomiting, compared with about 8.5 percent who take a placebo.

“It’s sometimes hard to tell what’s due to the drug and what’s a symptom of the flu, since it’s common for younger children to experience GI symptoms with influenza,” says Schaiffner.

If your child is taking an antiviral, the FDA recommends watching for unusual behavior such as confusion, hallucinations, delirium, or seizures. Contact your healthcare provider immediately if you notice anything worrisome. If your doctor is concerned, you can stop the medication right away and these symptoms should dissipate, says Munoz.

Interactive courtesy of the CDC