Children less than 5 years of age are at increased risk of complications from influenza (flu); the risk is greater among children less than 2 years old. Importantly, infants less than 6 months of age represent a particularly vulnerable group because they are too young to receive the seasonal or 2009 H1N1 influenza vaccine; as a result, individuals responsible for caring for these children constitute a high-priority group for early vaccination. Influenza vaccination is the primary means of preventing flu. Additionally, infection control measures are recommended to reduce the spread of flu.
However, early childhood settings present unique challenges for infection control due to the highly vulnerable population, close interpersonal contact, shared toys and other objects, and limited ability of young children to understand or practice good respiratory etiquette and hand hygiene. Thus, parents, early childhood providers, and public health officials should be aware that, even under the best of circumstances, transmission of infectious diseases such as flu cannot be completely prevented in early childhood or other settings. No policy can keep everyone who is potentially infectious out of these settings.
Recommendations for early childhood programs for the 2009–2010 influenza season
Early childhood providers should examine and revise, as necessary, their current crisis or pandemic plans and procedures; develop contingency plans to cover key positions when staff are absent from work; update contact information for families and staff; and share their plans with families, staff, and the community. Early childhood providers should review and revise, if necessary, their sick leave policies to remove barriers to staff staying home while ill or to care for an ill family member. A doctor’s note should not be required for children or staff to validate their illness or to return to the early childhood setting.
Early childhood providers should frequently remind children, their families, and staff about the importance of staying home when ill; early treatment for people at higher risk for flu complications; hand hygiene; and respiratory etiquette. Educational materials (for example, posters) to enhance compliance with recommendations should be visible in the child care setting. Examples of these materials are available at http://www.cdc.gov/h1n1flu/flyers.htm.
Stay home when sick: Children and caregivers with flu-like illness should remain at home and away from others until at least 24 hours after they are free of fever (100° F [37.8° C] or greater when measured orally), or signs of a fever, without the use of fever-reducing medications. To the extent possible, sick individuals should stay at home and avoid contact with others until they have been without fever for 24 hours, except when necessary to seek medical care.
Conduct daily health checks: Early childhood providers conducting daily health checks should observe all children and staff and talk with each child’s parent or guardian and each child. He or she should look for changes in the child’s behavior, a report of illness or recent visit to a health care provider, and any signs or symptoms of illness. During the day, staff also should identify children and other staff who may be ill. Ill children and staff should be further screened by taking their temperature and inquiring about symptoms. An example of how to perform daily health checks can be found at: http://www.bmcc.edu/Headstart/Trngds/Diseases/pg91-108.htm.
Separate ill children and staff: Children and staff who develop symptoms of flu-like illness while at the early childhood program should promptly be separated from others until they can be sent home. While this may be challenging for some home-based providers, they should provide a space where the child can be comfortable and supervised at all times.
Encourage hand hygiene and respiratory etiquette of both people who are well and those who have any symptoms of flu: Wash hands frequently with soap and water when possible; keep hands away from your nose, mouth, and eyes; and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available). For children with emerging self-care skills, parents and caregivers should closely monitor their respiratory etiquette and hand hygiene and remind children not to share cups or eating utensils. Visit: www.cdc.gov/cleanhands for more information on hand hygiene and http://www.cdc.gov/flu/protect/covercough.htm for more information on respiratory etiquette.
Perform routine environmental cleaning: Areas and items that are visibly soiled should be cleaned immediately, and all areas should be regularly cleaned – with a particular focus on items that are more likely to have frequent contact with the hands, mouths, and bodily fluids of young children (for example, toys and play areas).
Consider selective early childhood program closures: If flu transmission is high, some communities or early childhood programs may consider temporary closures with the goal of decreasing the spread of flu among children less than 5 years of age. The decision to selectively close should be made locally in partnership with public health officials and should balance the risks of keeping the children in early childhood programs with the social and economic disruption that can result from closing these programs.
Excerpts are from an article at www.flu.gov. To read the full article: http://www.flu.gov/professional/school/childguidance.html
