Action Steps for Child Care and Early Childhood Program Providers to Prevent the Spread of Flu

February 17, 2009 1:00 PM ET

Take the following steps to help keep children and staff from getting sick with flu. These steps should be followed ALL the time and not only during a flu pandemic.

• Encourage all early childhood program staff to get vaccinated for seasonal flu and 2009 H1N1 flu in accordance with CDC recommendations. Most staff who work in early childhood programs are in a primary target group for vaccination against 2009 H1N1 flu when it becomes available. Information about 2009 H1N1 flu vaccination can be found at: www.cdc.gov/h1n1flu/vaccination. Information about seasonal flu vaccine can be found at: www.cdc.gov/flu/protect/keyfacts.htm.
• Educate and encourage staff and children to cover their mouth and nose with a tissue when they cough or sneeze. Also, provide easy access to tissues and trash cans. Have program staff teach children to cover coughs or sneezes using their elbow instead of their hand when a tissue is not available. Teach children to throw tissues away after use.
• Remind staff and children to practice good hand hygiene and provide the time and supplies for them to wash their hands as often as necessary. Have them help children wash their hands properly and frequently. If soap and water are not available, alcohol-based hand rubs can be used.
• Remind staff to stay home and parents to keep a sick child at home when they have flu-like symptoms. Symptoms of seasonal flu and 2009 H1N1 flu include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and tiredness. Some people may also have vomiting and diarrhea. People may be infected with the flu, including the 2009 H1N1 flu and have respiratory symptoms without a fever. Sick children and staff should stay at home until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius measured by mouth) or signs and symptoms of a fever (has chills, feels very warm to the touch, has a flushed appearance, or is sweating) without the use of fever-reducing medicine.
• Perform a daily health check of children and make sure that contact information for parents is up-to-date so they can be contacted if they need to pick up their sick child. Special attention should be paid to younger children and those with limitations or delays in communication skills since they may not be able to communicate their symptoms.
• Move sick children or staff to a separate, but supervised, space until their parents can take them home. Limit the number of staff who take care of sick people.
• Send sick staff home immediately and advise them not to return until at least 24 hours after they no longer have a fever or signs of a fever (without the use of fever-reducing medicine).
• Routinely clean surfaces and items that children frequently touch with their hands, mouths, and body fluids, such as toys, diaper stations, chairs, or playground equipment. Wipe these surfaces with a household disinfectant that is usually used, following the directions on the product label. Additional disinfection of these surfaces beyond routine cleaning is not recommended.
• Encourage early medical evaluation for children and staff at higher risk of complications from flu. People at higher risk for flu complications include children younger than 5 years (especially children younger than 2 years old), pregnant women and people with chronic medical conditions (such as asthma, heart disease, or diabetes). For more information on people at higher risk for flu complications, visit http://www.cdc.gov/h1n1flu/highrisk.htm.
• Consider temporarily closing the early childhood program if flu transmission is high in the community. Work closely with local public health officials to decide if the program should close temporarily to decrease the spread of flu.

If the flu conditions become MORE severe, early childhood programs should consider adding the following steps.

• Inform sick children and staff that they should stay home for at least 7 days, even if they feel better before then. Those who are still sick after 7 days should continue to stay home until at least 24 hours after symptoms have gone away.
• Allow children and staff at higher risk for flu complications to stay home while there is flu in the community.
• Request that children who live in a household with people who have flu-like illness stay home for 5 days from the day the first household member got sick.
• Find ways to increase social distances (the space between people) in early childhood programs by dividing classes into smaller groups, moving play stations farther apart, and holding classes and activities outdoors.
• Consider temporarily closing the program if the number of staff and children staying home makes it difficult for the early childhood program to operate or if local health officials recommend temporarily closing early childhood programs to decrease the spread of flu in your community. Work closely with your local public health officials to make this decision.

Follow these steps to prepare for the 2009-2010 flu season:

• Review and revise existing pandemic flu and crisis plans.
• Update parent contact information so they can be contacted quickly if they need to pick up their sick child.
• Identify and establish points of contact with the local public health agency.
• Develop a plan to cover key staff positions when staff stay home because they are sick or caring for family members.
• Encourage parents to develop alternate child care plans if the program must close temporarily. Parents should be encouraged to contact family members, or develop buddy arrangements with neighbors, friends, co-workers, or church groups to develop safe backup child care alternatives.
• Help families and communities understand the important roles they can play in reducing the spread of flu in early childhood programs.
• Set up a separate, but supervised, space for care of sick children or staff until they can be sent home.
• Display and distribute educational materials to encourage hand hygiene and respiratory etiquette.

For more information:

• Visit: www.flu.gov
• Contact CDC 24 Hours/Every Day

• 1-800-CDC-INFO (232-4636)
• TTY: (888) 232-6348
• cdcinfo@cdc.gov