About 25 to 30 children a day are coming to the hospital with the hallmarks of flu - fever, cough, sore throat, congestion, and headaches - pushing the total number of emergency patients 40 percent higher than usual for this time of year. Doctors are not testing patients for flu, but they see the rise in visits as a sign of the spreading H1N1 virus.

A week ago, state officials said flu activity in the state had increased and was now widespread, the highest category on the scale of disease spread.

“Normally this time in October we see 170 kids a day, but on Monday, we saw 240,’’ Stack said. “We are assuming everything that looks like flu is probably H1N1.’’

The cases appear to be as mild or milder than seasonal flu, she said. Unless children have underlying health problems or appear to have complications, they do not need to come to a hospital, she said.

If a child has difficulty breathing, is dehydrated - cannot urinate for six to eight hours or cannot drink - has a change in mental status, or has a rash with a high fever, then coming to the emergency room is appropriate, she said.

Otherwise, children can safely be treated at home with Tylenol, fluids, and rest.

If a child under 2 has flu symptoms, parents should call their pediatrician because children so young are considered at higher risk, according to guidelines from the US Centers for Disease Control and Prevention.

If children of any age have the flu and then feel better, only to get sick again, parents should call their pediatrician in case the child is developing a potentially serious bacterial infection.

Elizabeth Cooney can be reached at lizcooney@gmail.com.