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DSS Urges Providers to Prevent Flu in Child Care Centers

Sick children and employees should be sent home, centers closed if flu cases confirmed

Department of Children & Family Services (DSS) Secretary Kristy Nichols said today that child care centers should take appropriate steps to prevent the spread of flu by sending sick children home and temporarily closing child care centers if a H1N1 (Swine Flu) flu case is confirmed or if there is a link to a confirmed H1N1 flu case.

"We must be especially cautious to protect the health and safety of children in child care settings as health officials continue to monitor this new strain of H1N1 virus, also known as swine flu," said DSS Secretary Kristy Nichols. "If a child or employee becomes ill with flu-like symptoms, they should be sent home immediately and tested by their physician to determine if they have the H1N1 virus.  Child care centers should strongly consider a temporary closure if the flu virus is confirmed."

In addition, Nichols said that in the event of a school or day care closure due to a confirmed case of the H1N1 flu, parents should not seek an alternate child care facility for their children, but instead, children should be kept at home.  Likewise, child care centers should not accept a child whose school or daycare has been temporarily closed due to a confirmed case of H1N1 flu.

According to new guidelines released today by the U.S. Centers for Disease Control and Prevention (CDC), if a childcare facility closes due to a confirmed case of H1N1 flu or a suspected link to a confirmed H1N1 flu case, they should dismiss students for a minimum of 14 days.  This length of time is recommended because children are likely to be infectious for about 7 - 10 days after the onset of illness.

"The purpose of school closures is to contain the potential spread of the H1N1 flu virus, and sending a child to a child care center when their school or daycare is closed would be counterproductive and could put other children at risk of infection," Nichols said.

Secretary Nichols also recommends that if parents of children at a child care center choose to travel to Mexico or another area where there is a confirmed H1N1 virus outbreak, they should consider isolating themselves from contact with others for four days or longer upon return. It is up to the child care center if they will let the child return to the center following the trip.

According to the CDC, symptoms of flu include fever, cough, sore throat, body aches, headache, chills, fatigue, and, in some cases diarrhea.  Parents should consult their family's health care provider to determine whether influenza testing is needed and when a child can return to child care.

People exposed to the H1N1 virus infection may be contagious before symptoms begin.  Once an infection is confirmed, people are considered potentially contagious as long as symptoms are present and possibly 7-10 days following the onset of the illness. Children, especially younger children, potentially may be contagious for longer periods.

Flu viruses are thought to spread mainly from person to person through coughing or sneezing. People also may become infected by touching something with flu viruses on it and then touching their mouth or nose. DSS encourages parents and child care providers to take these simple steps with children to prevent the spread of flu as recommended by the CDC:

Remind children and care providers to wash their hands or use alcohol-based hand cleaners, and make sure that supplies are available to prevent the spread of germs.
  • Encourage care providers and children to use soap and water to wash hands when hands are visibly soiled, or an alcohol-based hand cleaner when soap and water are not available and hands are not visibly soiled.
  • Encourage care providers to wash their hands to the extent possible between contacts with infants and children, such as before meals or feedings, after wiping the child's nose or mouth, after touching objects such as tissues or surfaces soiled with saliva or nose drainage, after diaper changes, and after assisting a child with toileting.
  • Encourage care providers to wash the hands of infants and toddlers when the hands become soiled.
  • Encourage children to wash hands when their hands have become soiled. Teach children to wash hands for 15-20 seconds (long enough for children to sing the "Happy Birthday" song twice).
  • Oversee the use of alcohol-based hand cleaner by children and avoid using these on the sensitive skin of infants and toddlers.
  • Rub hands thoroughly until the alcohol has dried, when using alcohol-based hand cleaner.
  • Keep alcohol-based hand cleaner out of the reach of children to prevent unsupervised use.
  • Ensure that sink locations and restrooms are stocked with soap, paper towels or working hand dryers.
  • Ensure that each child care room and diaper changing area is supplied with alcohol-based hand cleaner when sinks for washing hands are not readily accessible. Alcohol-based hand cleaner is not recommended when hands are visibly soiled.
Keep the child care environment clean and make sure that supplies are available.
  • Clean frequently touched surfaces, toys, and commonly shared items at least daily and when visibly soiled.
  • Use an Environmental Protection Agency (EPA)-registered household disinfectant labeled for activity against bacteria and viruses, an EPA-registered hospital disinfectant, or EPA-registered chlorine bleach/hypochlorite solution. Always follow label instructions when using any EPA-registered disinfectant. If EPA-registered chlorine bleach is not available and a generic (i.e., store brand) chlorine bleach is used, mix ¼ cup chlorine bleach with 1 gallon of cool water.
  • Keep disinfectants out of the reach of children.
Remind children and care providers to cover their noses and mouths when sneezing or coughing.
  • Advise children and care providers to cover their noses and mouths with a tissue when sneezing or coughing, and to put their used tissue in a waste basket.
  • Make sure that tissues are available in all nurseries, child care rooms, and common areas such as reading rooms, classrooms, and rooms where meals are provided.
  • Encourage care providers and children to wash their hands or use an alcohol-based hand rub as soon as possible, if they have sneezed or coughed on their hands.
In addition, CDC recommends that if a child or care provider becomes ill and experiences any of the following warning signs, emergency medical care should be sought.

In children, warning signs that need urgent medical attention include:
  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
  • Fever with a rash
In adults, warning signs that need urgent medical attention include:
  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
DSS advises all child care providers and parents to continue to monitor the Department of Health and Hospitals (DHH) Web site for the most up to date and relevant information related not only to your personal health but also to the operation of your child care facility.  The Department of Children & Family Services follows the recommendations of DHH regarding community health issues.  A special Web site regarding the H1N1 virus has been set up by DHH at