When Cayden Smith, age 3, developed a low-grade fever and congestion one Thursday evening in December 2014, her family first thought it was a cold. The following day, they visited an urgent-care center.
“We did let them know that she had been scheduled to get a flu shot a couple weeks before, but she had an ear infection,” Jessica Richman, Cayden’s mom, 41, from Newport News, Virginia, told CIDRAP News. “She had a little fever at the time, so they said we needed to reschedule the flu shot.”
Urgent care staff didn’t test Cayden for influenza; instead, they treated her cold symptoms and advised the family to return if the toddler didn’t improve. “We actually took her back three different times, because she was getting very progressively worse,” Richman recalled.
From lack of concern to a 911 call
Cayden was Richman’s first child, born May 18, 2011. The outgoing, bubbly girl, who never met a person who would remain a stranger, loved the color pink and her 130-pound Bernese Mountain dog. “It was cute to see this tiny, small girl and this big, huge dog,” Richman said. “She had a great personality.”
While Cayden had always received her vaccines, she missed her flu vaccine in 2014 because of that ear infection. At the time, Richman didn’t know how serious flu could be. “I didn’t realize it was super dangerous, so I didn’t urgently reschedule her flu shot,” she said.
Each time the family took Cayden back to urgent care that December, they mentioned she had not received her flu shot. Still, staff never tested her for flu. “They just didn’t seem that concerned that that’s what it was,” Richman said. “I’m not sure why.”
By Friday evening, Cayden’s breathing had become labored. She’d take deep breaths in but still didn’t seem to get much air. Unlike other times when she was sick, Cayden wasn’t playing with her toys and behaved lethargically. Finally, her dad called 911.
“She was not moving, wasn’t asking for anything. She didn’t want to eat or drink,” Richman said. “We had first responders show up to the house. Unfortunately, she had passed at the house.”
The family felt stunned. They had no idea how their previously healthy daughter could simply not be there anymore. While the autopsy provided answers as to how Cayden died, the family struggled to understand.
“When I did get the information that it was influenza A that caused pneumonia, I was like, ‘What?’” Richman said. “At the time, I felt like flu was similar to a cold. In no way did I believe that it would take someone’s life, not a small, healthy child. My child had no immune issues. She didn’t have any medical issues.”
As Richman grappled with the loss of her daughter, she connected with the nonprofit Families Fighting Flu. Being connected to other families whose loved ones grappled with severe flu complications and flu deaths helped her navigate her grief and made her feel less alone.
“It was shocking and eye-opening,” she said. “From my experience with other families who had a similar situation, [death has] been fairly quick, which is surprising. You would think that it wouldn’t be, but they get sick so quickly, and small children, their lungs are just smaller and they can’t fight it off.”
Preventing life-threatening complications
Flu is a seasonal respiratory illness that causes symptoms such as chills, muscle aches, nasal congestion, cough, vomiting, nausea, and diarrhea.
“We describe it as a more severe virus,” Jennifer Duchon, MD, MPH, associate professor in the Division of Newborn Medicine in the Jack and Lucy Department of Pediatrics at the Icahn School of Medicine at Mount Sinai, told CIDRAP News. “It’s not necessarily like a cold, which you can generally feel creeping on. When you get the flu, it almost always happens suddenly.”