Apparently Flu Symptoms Don't Always Include A Fever, So Here's What To Look For

As I learned this past weekend when we took our daughter to the hospital for what we perceived to be influenza, the flu is a tricky bugger. After the doctors assessed her symptoms — lethargy, cold sweats, and vomiting to name a few — and asked us questions, they decided to administer anti-nausea medicine and swab for influenza. The end result was a stomach flu diagnosis, but that didn't stop us from asking all of the questions as we waited to have her treated, like do you have to have a fever with the flu? And what other red flags could we be missing?

"Medicine is not exact, so there is not always a hard yes or no answer," Dr. Jann T. Caison-Sorey, associate medical director at Blue Cross Blue Shield of Michigan, tells Romper in an email interview. "Illnesses have a dynamic course — a beginning, middle, and convalescent end. A fever is really just a symptom. There is a high likelihood those with the flu will have a fever, however, there are outliers to this rule in that the virus does not manifest itself in every person the exact same way."

Caison-Sorey explains that when you are sick, the body is working hard to get rid of the flu pathogen, so it heats itself up as a first line of defense to send the message something is wrong and eradicate the virus. "The faster the onset of symptoms, the more virulent the virus can eventually become," she says.

Dr. Scott Owen, a Cleveland Clinic family medicine physician, agrees with Caison-Sorey, adding that, while not as common as a fever, some individuals may have "atypical presentation of illnesses, such as only having a cough, or only having nasal congestion.

"In general, children tend to have a more typical presentation, which usually begins with the sudden onset of fever," he tells Romper in an email interview. "Fever will accompany influenza in children under the age of 13 about 95 percent of the time. As we age, that percentage decreases. It is not unusual to see geriatric patients who do not develop a fever or any classic symptoms of influenza at all."

In general, however, flu symptoms include fever, sore throat, a non-productive cough, and sometimes vomiting and diarrhea. Caison-Sorey says red flags that may signal a need for a trip to your doctor or the hospital will be a fever that does not go away with analgesics, abnormal behavior, a refusal to eat or drink, a change in your child's cry, inconsolability, respiratory distress, limpness, and even seizures. If you do visit your healthcare provider or a hospital, they will possibly run a number of tests including a nasal swab for influenza, electrolytes in the body, strep, a complete blood count with differential, and chest x-ray.

"A fever is always a symptom that should be taken seriously," she says. "If it goes away, we know the body is doing its job and symptoms will eventually pass. If it doesn’t go away or break with medication, I would suggest seeking medical care for appropriate treatment."

The best way to prevent the flu, Caison-Sorey says, is with the influenza vaccine. "While this year’s flu vaccine only provides between 10 to 30 percent protection, it is, without question, better to receive a flu vaccination to lessen the severe symptoms associated with the flu," she explains.

Dr. Medell Briggs-Malonson, founder and CEO of IPA Healthcare Solutions, agrees, adding that regularly washing your hands with soap and water and/or using hand sanitizer — especially before eating — is crucial to preventing the flu.

"Avoid touching your eyes, nose and mouth, and avoid close contact with people who are sick," she tells Romper in an email interview. "If someone is sick in your house, clean the bathrooms, countertops, and every door knob with a microbial cleaner." Also important? "Get plenty of rest and hydrate well," Briggs-Malonson adds. Which means snuggling up with a good movie on a chilly winter day is most likely in order and who can argue with that?

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