CHICAGO - Max Gomez was a bright-eyed 5-year-old happy to have just started kindergarten when he developed sniffles and a fever. His mother figured it was only a cold.
Three days later, the Antioch, Tenn., boy was dead, apparently from swine flu.
At least 76 American children have died from the new virus, and doctors are urging parents to watch for warning signs that the flu has become life-threatening.
Ruth Gomez says Max developed dangerous symptoms - bluish fingers and extreme fatigue after seeming to get better - just one day before he died. She took him to the doctor, but it was too late.
"We were in shock," Gomez said softly, still trying to wrap her mind around her little boy's Aug. 31 death. "There are so many unanswered questions. What happened?"
It's a question on other parents' minds, too: How can they protect their kids from swine flu until the vaccine is widely available?
Swine flu has probably infected hundreds of thousands of youngsters nationwide, but deaths among children are rare. Health officials are keeping track of children's flu deaths, but they say it's impossible to count all flu cases. So they don't know what percentage of children's infections are fatal.
Many experts say the H1N1 virus does not appear to be more dangerous than other flu strains, but kids have been catching it more easily than seasonal flu.
Last week alone, there were 19 new reports of children who died, according to the federal Centers for Disease Control and Prevention. And the 76 swine flu fatalities since April compare with 68 pediatric deaths from seasonal flu since September 2008.
Because kids seem so vulnerable to it, "every medical epidemiologist in the country" is tracking how it affects them, said Dr. Susan Gerber, an associate medical officer for the public health department in Cook County, Ill.
Most children will recover, but "it's still very concerning and needs to be watched very closely" Gerber said.
Dr. Kenneth Alexander, the University of Chicago's pediatric infectious disease chief, said there are common signs to indicate when both kinds of flu turn dangerous.
Flu viruses can damage cilia, the hair-like fibers lining the respiratory tract that move bacteria and mucous "where we can cough them out" of the lungs, he explained.
That can make people susceptible to pneumonia and other bacterial infections - a scenario blamed for many flu deaths in otherwise healthy children and adults, he said. In these cases, flu patients often appear to get better, but then fever and a cough return.
Parents should also seek medical help if flu symptoms develop in children most vulnerable to flu complications: those younger than 5 or with high-risk conditions, including asthma and other lung problems; cerebral palsy, epilepsy and other neurological diseases; heart, kidney or liver problems; and diabetes.
Authorities are walking a fine line between making sure parents are vigilant without raising undue alarm.
Commenting on the recent deaths in his state, New Mexico's health chief, Dr. Alfredo Vigil, told residents not to panic, but to take swine flu seriously.
That means kids should get vaccinations for both ordinary flu and swine flu when the vaccine is available, and stay home from school if they are sick. Parents should stress hand-washing and covering coughs. Mild cases should be treated at home with rest and plenty of fluids, but parents should call their doctor if more serious symptoms develop.
A recent report from the CDC found that one-third of pediatric deaths from the new H1N1 virus were in children like Max, with no known underlying condition that would put them at risk.
In the past couple of weeks, news reports have tallied the deaths of children with no known health problems, including three in New Mexico, a second-grader in Dalton, Ga., and a Baltimore eighth-grader.
"People are pretty concerned, and I think they should be," said Harvin Bullock, coroner in Sumter County, S.C., where 11-year-old Ashlie Pipkin died three weeks ago, two days after developing symptoms.
Authorities are walking a fine line between making sure parents are vigilant without raising undue alarm.
Commenting on the recent deaths in his state, New Mexico's health chief, Dr. Alfredo Vigil, told residents not to panic, but to take swine flu seriously.
That means kids should get vaccinations for both ordinary flu and swine flu when the vaccine is available, and stay home from school if they are sick. Parents should stress hand-washing and covering coughs. Mild cases should be treated at home with rest and plenty of fluids, but parents should call their doctor if more serious symptoms develop.
"We definitely don't want to suggest to someone who has a very sick child that that child should be at home. But at the same time, we don't want lots of children with mild illness showing up" in emergency rooms or doctors' offices, keeping doctors from treating sicker patients, said Dr. Michael Landen, New Mexico's deputy state epidemiologist.
He said it's a tough message for health officials to explain, and is "very challenging for parents to get this right."
Alexander, the Chicago doctor, said he always tells parents, "Trust your instincts." Then, if it goes beyond the typical flu experience, seek help, he said.
In rare cases, swine flu symptoms turn from bad to worse so quickly that by the time of medical attention, it was too late. That can occur with seasonal flu, too, Landen said.
Ruth Gomez says that's what happened with her son. Test results are still pending, and swine flu has not been ruled the official cause of death, but Gomez, who once worked as a medical assistant, says doctors found nothing else.
She plans to get swine flu shots for Max's two younger sisters, and she said other parents need to be aware of the risks. "Our lives have been turned around," she said. "Every day we miss him."
Vanessa LaGrange of Albuquerque said she's gotten the message. The recent deaths in her state mean she hopes to get all flu shots, including H1N1 vaccinations, for herself and her two children. She has skipped flu shots in the past because her family is generally pretty healthy.
LaGrange said she kept her 6-year-old daughter home from school one day last week with a cough and sore throat, and that even her little girl is concerned.
"She did ask me outright if she had the swine flu," LaGrange said. She said her daughter has improved and probably did not have the flu.
In Atlanta, Kristen Chase sent her daughter off to kindergarten this year and is trying to avoid worrying, "but it's hard not to."
Even though swine flu hasn't hit her school yet, Chase puts sanitized hand wipes in her little girl's lunch box every day and tells her, "Wipe your hands off before you eat your lunch."
If any of her three kids show signs of flu, Chase said she plans to "err on the side of caution" and call the doctor.
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