September 2nd, 2009
03:10 PM ET

How to manage H1N1 flu at day care?

By Caleb Hellerman
CNN Medical Senior Producer

We're still waiting on federal guidelines for how day care centers and preschools should handle the H1N1 flu virus. They were promised last week, but the date has slipped amid behind-the-scenes debate over how far the guidance should go: Should they match the advice for K-12 schools, which say that students who are out sick can come back after just 24 hours without a fever? Or should the day care guidance be more restrictive, since young kids are more prone to complications – and tend to transmit more virus?

In the meantime, I’m watching the debate play out in miniature at the pre-school of my 3-year-old daughter and 15-month-old son. As it happens, my wife helps research flu guidance for the CDC, as do two other parents at the preschool. They helped write a preparedness plan for the school, which goes well beyond the CDC's guidance for K-12 schools – and is stronger than the basic advice the federal government is currently considering for daycares.

My wife and her colleagues recommended that students who are sick with respiratory symptoms stay away for at least seven days. One of them, a senior CDC flu scientist, told me that children with H1N1 typically shed virus – i.e., it's in their mucous and other secretions – for five to 10 days. She said that fits with published research on other flu strains, showing that young children often shed virus for seven days or even longer.

But the head of the school is pushing back. She’s OK with a seven-day restriction for toddlers, but wants it at five days for 3- to 6-year olds, and “24-hours fever-free” – the CDC’s K-12 guideline – for elementary-school-age students. More than that would be too hard on parents, she says. My wife and her friends want to include a warning that the rules are not meant to stop the spread of flu.

In the midst of all this, I talked with Dr. D.A. Henderson of the Center for Biosecurity, who oversaw the CDC's response to the global flu pandemic of 1957. He thinks the guidance to date has been too intrusive – that keeping sick students home longer than usual won't stop the spread of H1N1 and would lead to serious disruptions – including a shortage of health care workers staying home with their kids.

No easy answers, and a lot of disagreement, even among medical professionals. Just one more example: Yesterday, Dr. Sanjay Gupta visited a doctor at Children's Healthcare of Atlanta, who reminded us that for most people, even young children, H1N1 is not likely to cause more than passing symptoms. Dr. Jim Fortenberry said that parents should not bring their kids to the ER unless they seem dehydrated, are younger than 12 weeks, have fever for three days or have a fever that returns after being gone for 12-24 hours. That's all well and good, but he didn’t mention CDC guidance – which says that people in high-risk groups (including children younger than 5, as well as pregnant women and people with medical conditions such as asthma) – who have flu-like symptoms (fever higher than 100 PLUS a cough or sore throat) – should take antiviral medication right away, as a precaution. If you’ve got a child with those symptoms, you don’t have to go to the ER, but do call your doctor right away.

The head of my preschool wants to finalize and send out guidelines by tomorrow. As of now, she and the parents on the health committee have to make their decision without official CDC guidance.

Are you a parent? Have you received guidance from your child's day care on what to do if your child becomes ill?

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