Most cases of the seasonal and H1N1 flu virus can be safely handled at home, experts say, but signs of the illness in members of high-risk groups — including children under age 5 — call for extra vigilance.

A spate of children's deaths from the H1N1 flu across the nation in recent weeks has raised alarm about this strain of the illness. In all, 86 children under age 18 have died from H1N1 flu, according to health officials.

Hawaii has had one pediatric death from the H1N1 — or swine flu — virus, said spokeswoman Janice Okubo of the state Department of Health. A child under the age of 5 with no other underlying health conditions died in August and tested positive for H1N1.

Symptoms of H1N1 are similar to those of the seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headaches, chills and fatigue, and sometimes diarrhea and vomiting.

Doctors say there's no way to tell which influenza strain is infecting a patient without laboratory tests, and in most cases there's no real need to find out, since both seasonal and H1N1 influenza generally can be treated at home without antiviral medications.

In most people, typical flu symptoms do not call for a visit to the doctor.

"If you're an otherwise healthy person you should stay out of the emergency room. If you think you have flu-like symptoms, call your primary care physician. Don't even go down to the office," said Dr. Erlaine Bello, infectious disease specialist with The Queen's Medical Center.

"Make some kind of phone or e-mail contact with your doctor, and if you have typical influenza-like symptoms you might not need to be seen by your health care provider."

However, Bello recommends those at most risk of complications from the H1N1 virus consult with their physician when flu symptoms strike. The group includes children younger than 5, people 65 and older, pregnant women, and people with diabetes, asthma and other chronic lung ailments, heart disease, kidney, liver and neuromuscular disorders, and weakened immune systems.

The American College of Emergency Physicians also advises seeking emergency care only when people have the symptoms of a medical emergency.

"If you have concerns about being sick but it's not a medical emergency, first call your personal physician and get their recommendation," said a news release from the group. "If you arrive in the emergency room, let the triage nurse know right away that you have flu symptoms."

Warning signs that may indicate the need for immediate medical care include, in children, fast breathing or breathing trouble, bluish skin color, not drinking enough fluids, not waking up or interacting, extreme irritability, fever with a rash, and flu-like symptoms that improve and return with fever and a worse cough, according to the Centers for Disease Control and Prevention.

In adults, look for difficulty breathing or shortness of breath, pain or pressure in the chest or abdomen, sudden dizziness, confusion, and severe and persistent vomiting.

The Hawaii Medical Service Association is offering members and nonmembers a free consultation with its Online Care service.

"The flu is very contagious, so the Centers for Disease Control and Prevention and the Hawaii state Department of Health recommend people stay home when they are ill," HMSA medical director Dr. Patricia Avila said in a news release. "If people can speak with a doctor without leaving home, we are limiting the likelihood of spreading the disease."

The offer is available through May 31 and is valid for online consultations only. Visit www.hmsa.com and click on "Important Flu Information."