This is our second report on the current swine flu outbreak. Here are the latest recommendations for protecting your children from becoming ill.
· Keep events in perspective. In the U.S., in “mild” flu seasons, about 20,000 children 
under the age of five years are hospitalized with proven flu. Most of these children are under the age of two.
· But don’t minimize the seriousness of this disease. Percentage-wise, more children than adults are stricken during flu outbreaks. And children harbor the virus for longer than adults and become major sources of transmission. Most affected children require medical care. During the 2007-08 season, an “average” flu season, 86 children died from flu-related causes. Many of these children had other health problems.
· Teach children how to minimize passing the virus to others. No hand-shaking, high-
fives or hugs. No sharing cellular telephones and other such objects. Cover mouths and noses with a tissue when coughing and sneezing. If no tissue is available, cough or sneeze into the upper sleeve or the inside of the elbow, not hands; hands spread germs. Dispose of tissues properly, preferably in a receptacle lined with a plastic bag.
· Wash hands frequently. Fingers and hands become contaminated with viruses from contact with infected individuals or inanimate objects. Viruses remain viable (alive) for hours, possibly days, on toys, doorknobs and other objects. Placing contaminated fingers in one’s eyes, nose or mouth completes the infection cycle – virtually as well as inhaling viruses. Effective hand washing takes 20 seconds. Time it with your children; it’s longer than they think. (It takes about ten seconds to sing “Happy Birthday.” Have them sing “Happy Birthday to Me”, twice.) Alcohol-based hand cleaners are also effective.
· Be aware that nasal secretions are loaded with viruses. Young children do not wipe their noses. You have to do it for them. The secretions contaminate clothes, furniture and toys, whatever the secretions touch. Wash or disinfect surfaces and objects. Storing clothes and toys for three days where no one can touch them probably kills most viruses.
· Seek medical care only if your child’s illness requires immediate attention. High profile disease outbreaks overwhelm health care facilities. Such facilities are also places to become ill.
· Avoid close contact with sick children. (The problem with this is that individuals with flu spread the virus for a day or two before they display symptoms.) Stay away from siblings of children who have been ill in previous days. They may be incubating the illness.
· Don’t ignore secondary symptoms. If a child recovering from flu begins to show new symptoms it may be the onset of complications; rarely these may be more serious than the primary illness. Check with your health care provider.
· Open windows. Ventilation helps remove indoor stale air – and the viruses it may contain. Groups of children playing outdoors are less likely to infect each other than children playing indoors.
An unproven theory: had this swine flu virus arrived in temperate climates in colder weather it would have spread more rapidly. In spring, windows tend to be open and more time is spent outdoors. Expect to hear much more about the importance of effective indoor ventilation in hindering the spread of infectious diseases.
· Isolate children with flu-like symptoms. Children should stay home for 7 days after the onset of symptoms, or until 24-48 hours after symptoms resolve, whichever is longer. Children can go outside if they stay away from other people.
· Never use anti-flu drugs on your own. (Some parents obtain medication from friendly health care providers to have on hand.) These 
drugs have contraindications such as lower age limits, side effects, and different dosage schedules for prevention and treatment. It is not clear how often they can be used effectively in extended outbreaks. Using them now may mean you cannot use them later. And using them unnecessarily may promote drug resistance.
· For further information, see: http://www.cdc.gov/flu/swine/recommendations.htm http://www.cdc.gov/flu/swine/index.htm
For travel advisories, see: http://wwwn.cdc.gov/travel/contentSwineFlu.aspx.
