Eleven-year old Grant Powell battles Crohn's, a chronic intestinal disease. Powerful medications keep it in check.
But they also weaken his immune system and raise his risk of infection.
"This is the first time that we've gone into a flu season and he's actually taking immunosuppressants. So I don't really know what to expect," said Grant's mother, Lisa.
Grant is among an estimated 5 million kids in the U.S. on immune suppressing medications. They treat everything from asthma to juvenile arthritis to cancer.
"We've been getting lots of calls from worried parents, many of them asking "do you have the vaccine?" said Dr. Danielle Zerr, infectious disease expert at Seattle Children's Hospital.
Dr. Zerr says H1N1 swine flu shots are the best protection for kids with chronic conditions.
But they shouldn't get the nasal spray because it contains live virus.
"The flu mist is generally indicated for people between the ages of 2 and 49 years, and those people should be generally healthy," she said.
And even though immune suppressing meds raise the risk of infection, kids need them now more than ever.
"Viruses are a trigger for a lot of kids to have asthma exacerbation. So viral season in general is a time when we want to see people taking their regular medications," said Dr. Zerr.
Children with and without underlying conditions have been coming to emergency with suspected swine flu.
Though most kids with flu can be treated at home, Dr. Zerr says there's different advice if your child has a chronic disease.
"Contact your doctor first, because your doctor may want to see you. And that may be accomplished more comfortably and more easily. But the doctor based on the conversation they have with you, they may want you to go straight to the ED," she said.
The antiviral drugs that can reduce complications should be started right away.
Staff at Seattle Children's says they're braced for a second surge of H1N1 swine flu. And the seasonal flu is likely on its way too.
