Flu season just began and already I have seen 2 cases of children experiencing severe leg pain and temporarily losing their ability to walk. If this has happened in your family, you know how terrifying it can be. In some cases, the muscles become extremely weak and the child struggles to walk or has difficulty gripping objects. In other cases, severe inflammation can settle into a muscle or joint and cause extreme pain.
When this happens, parents rush their child to the emergency department and endure hours of testing. Often times the test results are inconclusive and the diagnosis is inconclusive. The pain is sometimes diagnosed as rheumatoid arthritis, but a more appropriate diagnosis is benign acute myositis.
Regardless of the diagnosis, parents are often sent home with a “watch and wait” treatment plan and a prescription for analgesics to dull the pain while the virus runs its course.
In this article, we’ll review some of the FAQ’s about flu and what to do when flu symptoms get worse.
Why flu happens during the winter season
The reduction in sun exposure may be the primary reason we have a “cold and flu season.” Ultraviolet radiation stimulates production of vitamin D. Vitamin D is a hormone, which means it binds with cells, communicates a message, and that leads to specific actions by the cells. There are vitamin D receptors on nearly every cell in the body. Other hormones only have receptors on specific cells or organs. This tells us how important vitamin D is in the functionality of multiple different organ systems.
When it comes to the immune system, vitamin D plays a critical role. It is an immune modulator, which means it has the ability to activate processes that need activating, and slow down processes that are overreacting. For example, vitamin D modulates the production of T cells, which are responsible for identifying and destroying infected cells or cancer cells. There are about 5 million T cells in one teaspoon of our blood.
Vitamin D and Cytokines
Vitamin D also modulates cytokine production. Cytokines communicate between cells. They can direct cells to multiply. They can also stimulate a cascade of events leading to inflammation that is sometimes necessary for healing. However, if cytokines are not modulated, they can overproduce and lead to abnormal cell replication, like what we see in the formation of cancer tumors. Overproduction can also lead to excess inflammation leading to atherosclerosis, arthritis, depression, and other inflammatory conditions.
“There are vitamin D receptors on nearly every cell in the body”
We are familiar with the common flu symptoms: fever, chills, fatigue, malaise, sore throat, and runny nose. We’re also not surprised when the flu is paired with diarrhea and dizziness. But when our children can’t walk after having the flu, that’s more concerning.
When flu symptoms become more severe, this suggests the immune system needs more support, and was likely jeopardized to begin with. Treating the flu with fever suppressors and pain relievers does not support the immune system. In fact, fever reducers suppress the immune system by preventing the cytokine action. This can prolong the infection and interfere with the healing process.
Is their temperature is too high?
Myth: a child’s fever will keep rising if you don’t treat it.
Fact: the body has a set point at which the fever maxes out. Normal fevers are between 100℉ and 104℉. A fever is part of the healing process and should be allowed to run its course. In fact, treating fever with Tylenol can cause more harm, damaging the liver and the body’s long term ability to fight infection. Read more about that here.
For more myths about fever see this article by Seattle Childrens .
“Fever reducers suppress the immune system by preventing the cytokine action. This can prolong the infection and interfere with the healing process.”
When a child with the flu can’t walk
The condition is called Benign Acute Childhood Myositis, BACM. Benign is a medical term for “not harmful,” acute means it has been occuring recently and for a limited amount of time, “Myo” refers to muscle and “itis” means inflammation. Symptoms of muscle inflammation include tenderness, weakness, and pain. The severity of symptoms depends upon the origin of the myositis. More details can be found in this article.
- Idiopathic inflammatory myopathies: typically painless muscle weakness at the onset, and gradually worsens over time (weeks, months, or years). The progression may affect muscles all over the body, often in the neck, shoulders and hips, called polymyositis. In some cases, dermatomyositis can develop, where symptoms are seen on the skin such as rashes, scaly patches, or discoloration of the eyelids.
- Infectious myositis: muscle aches and weakness are accompanied by flu symptoms of high fever, fatigue, chills, cough, sore throat, and runny nose. If these symptoms are paired with diarrhea, this could suggest parasitic infection.
- Benign acute myositis or viral myositis: sudden trouble walking or complaints of leg pain that prevent them from walking. Pain is often localized to the calf muscles.
- Other types of myositis include myositis ossificans and drug-induced myositis, but they are not seen in conjunction with flu symptoms.
Parents BEWARE
Your child may not be exaggerating when they say they can’t walk. Children don’t always know the words to express what they’re feeling. They might say things like:
“My legs hurt”
“I’m too tired”
“I feel weird”
Does my kid have myositis?
If an investigation is performed, you can expect screening blood work such as a CBC with differential, which is the basic red and white blood cell analysis. The white blood cell count gives a general overview of ratios that suggest whether bacterial or viral infection is present. Other testing may include a urine myoglobin test, which looks for indications of muscle destruction. An article published by The College of Family Physicians of Canada in 2017 noted that “no clear management guidelines exist,” and that our clinical management allows for “rapid diagnosis, without further investigation.”
What is the treatment for myositis?
Because this is believed to be a benign condition, physicians will often recommend rest and analgesics – Tylenol or Motrin. It is considered self-limiting, which means it will run its course and disappear on its own.
Natural treatment for myositis
While it’s true that myositis may be self-limiting, this shouldn’t prevent us from investigating further. The context around the symptoms are suggestive of the condition of the immune system as a whole. An individual who is frequently ill and often develops more severe varieties of symptoms in conjunction with common viral infections has a compromised immune system. A thorough medical history including analysis of their environmental exposures, dietary habits, sleep patterns, and mood fluctuations can point to other body systems that are compromised and may be influencing their immunological resilience.
We must also carefully evaluate their medications, particularly antibiotic use. One course of antibiotics can trigger a significant shift in the gut ecology that does not present with measurable effects until years later.
“One course of antibiotics can trigger a significant shift in the gut ecology”
Can the flu kill?
Yes, the flu can be deadly, but rarely. Typically flu related deaths occur in those who are already severely immunocompromised, or have severely weakened immune systems.
The Center for Disease control keeps track of flu statistics on a weekly basis and posts them here https://www.cdc.gov/flu/weekly/index.htm so you can stay in-the-know. You can even look at the data specifically for your state. Colorado is linked here.
https://www.colorado.gov/pacific/cdphe/influenza
Please keep in mind that number of flu deaths are counted based on individuals who had the flu and it may have been a contributor to their death, but it was not necessarily the primary cause of death.
Natural remedies for flu
Elderberry syrup:
Elderberry has been used as medicine for centuries. Elderberry is safe for children and can be used preventatively during the cold and flu season. I prefer Gaia Herbs.
Preventative dosing recommendations:
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2 tsp once daily children 4+
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1 tsp once daily children 2+
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Age 1-2: 2ml daily
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6+ mos: 1 ml daily
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Under 6 mos: 5 drops daily
Vitamin D
Vitamin D 1,25(OH)2D acts as an immune system modulator, preventing excessive expression of inflammatory cytokines. True, our body absorbs vitamin D from the sun, but then needs to convert it to the active form before it can perform these important duties. Often times, our body is not efficient at converting, and we become deficient, even during summer months when we have frequent sun exposure. Supplementing with vitamin D helps to stimulates the expression of potent anti-microbial properties.
Vitamin D should be administered in a liposomal base in conjunction with K2, which aids absorption. I prefer Orthomolecular.
Dosing recommendations:
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If vitamin D blood levels are below 80, I recommend my patients supplement with 10,000IU daily for 30 days.
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Adult maintenance dose is typically 4,000-6,000 IU daily
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Children maintenance dose is typically 400-1,000 IU daily
Nutrition as cure – the best kind
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Dark leafy greens: contain vitamins A and C, antioxidants, fiber and more
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Mushrooms: reishi is especially good for the immune system
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Hydration with natural electrolytes. Coconut water is a wonderful source.
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Avoid dairy, banana and citrus, as they can contribute to mucus production
