BY JAMIE LOBER
When to Keep a Sick Child Home
The CDC reports Georgia as one of the eleven states in which Swine Flu or H1N1 is WIDESPREAD. Never before has it been so necessary to be alert and still remain calm.
Every parent dreads hearing the words “Mom, I do not feel well.” Several thoughts may go through your mind. You wonder if a little rest will help his body recuperate, if he should take the day off from school, or if a visit to the pediatrician is necessary. The widespread cases of Swine Flu (H1N1 virus) leads to even more questions. Local medical experts and the CDC help answer your questions.
Feeling prepared is half of the battle when it comes to childhood illness. Being in close contact with others in the classroom facilitates the spread of germs. “Strep throat, ear infections and the common cold are really common at the beginning of school,” comments Dr. Jason Smith of Primary Pediatrics in Macon. Although there is always the chance you may be faced with the unexpected, understanding how to manage a few basic ailments can be a confidence booster.
Fever is the number one reason it is advised to stay home. “If your child runs a temperature of one hundred, he should stay home until he has been fever-free for twenty-four hours without fever-reducing medication,” advises Kathryn Shiplett, lead nurse at Houston County Schools. If you use Tylenol or Advil, remember that your child may still have a fever even if it does not read that way on the thermometer.
Stomach viruses come and go quickly. “It could be a twenty-four hour virus. After it is out of your system and you no longer have diarrhea and are not throwing up, you are probably not contagious,” says Shiplett. Children should stay home as long as they experience diarrhea, nausea, vomiting, or fever. The Center for Disease Control recommends that if the severity of flu-like symptoms grows, your child should stay home for at least seven days even if he becomes asymptomatic.
It is worth taking the time to understand how germs spread. “Things like colds are contagious and viruses are replicating themselves while the fever is going on, making it easy to pass on to another child,” says Smith. It is recommended to schedule a visit with the pediatrician if your child has a fever. “The main reason to see us is to make sure there is not a bacterial infection we can treat with an antibiotic,” explains Smith. In most cases, it is a matter of the illness running its course.
Sometimes your child may be contagious before you realize he is sick. “With chicken pox, you are contagious for three to four days before you ever break out. You will be contagious until all the blistered-like, water-filled lesions are dry and have scabbed over, which usually takes fourteen days,” informs Shiplett. A skin infection like MRSA is unusual because everyone carries staph in their system. “Some people are carriers of different diseases and never get sick. They just have the bacteria in their system and can pass it on but are not sick or symptomatic. That is why infection prevention is the key,” reinforces Shiplett.
Your child’s school will send him home if he has an eye infection which can last up to one week. “Pink eye or conjunctive of the eye is when the whites of the eyes become red and irritated-looking and may have drainage, pus, or yellow matter,” describes Smith. In this situation, it is essential to see the pediatrician to make the definitive diagnosis, receive a medication and learn how to cleanse appropriately. Be sure your child washes his hands before and after putting his hands near his eyes.
Anxiety or underlying health conditions may hold your child back from attending school. “Some kids will throw up in the morning because they are nervous, have a bad reflux or have a medical condition,” says Shiplett. The saying moms know best really is true. If the stomachache is debilitating and hinders regular movement, it is recommended to seek immediate medical attention.
Parents everywhere are talking about swine flu. Whether you call it swine flu or H1N1 flu, this virus has been declared pandemic by WHO and is a hot topic in all news media. It’s enough to make the calmest parents a bit uneasy. And well they should be. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of 2009 H1N1 flu was underway.
The Center for Disease Control (CDC) recently reported 9,079 cases with 593 deaths. According to the World Health Organization most cases are not reported for various reasons. It is especially relevant to us because unlike the common flu, H1N1 attacks younger people rather than those age 60 and up. Children under age 2 have a higher risk of complications and hospitalization due to influenza than do older children. Kids of any age who have an underlying medical condition, such as asthma, diabetes, another metabolic disease, chronic kidney disease or sickle-cell disease are at greater risk of complications. Therefore, when the vaccine is released in October, the CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended the H1N1 vaccination for five key groups:
• Pregnant women
• People who live with or care for children younger than 6 months
• Healthcare and emergency-medical-services personnel
• Persons between the ages of 6 months and 24 years
• People ages 25 through 64 who are at higher risk because of chronic health disorders or compromised immune systems
“The symptoms are typical to other flu-like symptoms of fever, cough, nausea, diarrhea, and just feeling kind of achy. If you have those symptoms, you should call your doctor immediately,” advises Dr. Russ Robbins, senior clinical consultant at Mercer. Schools are working hard with the anticipation of the release of a vaccine against swine flu when released. “We are in a task force situation now of preparing to administer swine flu vaccine, shall that become available in the communities. We will be participating in that distribution,” says Sharon Patterson, Bibb County School Superintendent. There is hope that we can tackle this serious health concern in Central Georgia. (The CDC offers advice for parents on protecting their children from H1N1.)
Teach your child healthy practices. “Although sometimes you cannot avoid illnesses, you should instill the importance of washing hands and good hygiene in your kids to reduce the chances that they will pick up a bug,” says Smith. Consider your own wellness and how you may affect other family members. The Center for Disease Control advises that your child stays home from school for five days after someone in your home gets sick because this is the time he is most susceptible to illness. Keep in mind that personal health affects community health which in turn influences school health. “We are a reflection of our community,” concludes Shiplett. Your health decisions really do matter.
FAQ from the CDC about H1N1 Flu (Swine Flu)
Q: What should parents do to protect their children from the swine flu?
• Wash hands often with soap and water, especially after you cough or sneeze.
• Wash hands for 20 seconds, which is about as long as it takes to sing the “Happy Birthday” song twice.
• Alcohol-based hand cleaners also work well.
• Keep in mind that alcohol-based products are toxic if ingested by children. (The amount left on hands after use is not a concern.)
• Cough or sneeze into your elbow.
• Alternatively, cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Avoid touching your eyes, nose or mouth. Germs spread that way.
• Stay at least six feet away from people who are sick. Avoid crowds. This will limit the spread of illness.
• Stay home when sick to keep from spreading illness.
• Children and adults who are sick should stay home at least 24 hours after they are free from fever (100°F) or signs of fever without the use of fever-reducing medications.
• Seek medical care if you are severely ill, such as having trouble breathing. Antiviral medicines may help.
Q: Are face masks necessary?
• Handwashing and avoiding close contact with sick people are more important than wearing face masks to prevent spreading the virus.
• If you are caring for someone who has swine flu, a face mask can be used to help reduce the chance of spreading germs.
• Follow the recommendations of local and state public health authorities.
Q: How do you know whether or not to be concerned about swine flu in your area?
• Cases have been reported in Middle Georgia. Know what the public health authorities in your area are saying.
• Follow their recommendations to reduce your risk of catching the virus.
Q: What’s the most important thing parents should do now, just in case infections are reported in their own area?
• Plan now what you would do if your child’s school or child care center was to be closed.
• Consider what you will need to do to arrange for child care at home for your children.
• Stock up on supplies and non-perishable food at home.
• Have your pediatrician’s contact information handy.
Q: What advice do you have for parents with children in school or child care?
• Parents should not take children out of child care or school unless public health authorities have recommended such a step.
• We do not have to close schools and other gathering places to prevent infection except in those areas where the public health authorities have determined that school closings are necessary.
• If the virus is causing significant illness in a particular area, authorities may close child care programs and public events.
• If the school or child care program closes and your children are healthy, you should still keep them home and not participate in social activities. Working parents may team up with other parents to take turns staying home with children; such groups should be kept to small numbers of children (less than 6) to minimize the risk of spreading germs.
• Parents should remind their children about proper hygiene, including sneezing and coughing into a tissue or sleeve, and frequent handwashing.
• Parents should advise children to go to the school nurse if they start to feel sick during school. Children who are sick should stay home at least 24 hours after their fever is gone.
Q:. How can parents avoid overreacting?
• Be aware of what’s going on in your area and follow the recommendations of public health authorities.
• It is not necessary to withdraw your kids from school or child care, if there are no reported cases.
• Start preparing for what you would do if schools and child care centers do close.
Q: What are the symptoms of swine flu in children?
• Classically, children with influenza have a sudden onset of high fever, chills, and respiratory symptoms.
• Children will develop mild nasal congestion and cough. Older children may complain of headache, scratchy or sore throat, and muscle aches.
• Influenza is very different from the common cold. Typically, a child who has fever and no nasal symptoms likely has influenza. A child who has no fever, but significant nasal symptoms, likely has a cold, not influenza.
Q: What should parents do if their child has flu-like symptoms?
• If your child has mild illness, he or she should stay home from school or child care.
• Any child younger than 3 months who has a fever should see a pediatrician. In a child older than 3 months, how high the fever is, is not as important as how he or she feels and acts.
• Any child with a chronic medical condition (for example, heart or lung problems, weakened immune system, chronic kidney disease, sickle cell disease, asthma, or a severe neurologic disorder), who has even mild flu symptoms should see a pediatrician.
• Signs that warrant a visit to the pediatrician include lethargy, irritability, fast breathing, vomiting and inattention to the environment.
• If your children are uncomfortable because of fever, you can give them medicine such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Do not give aspirin-containing products.
• If they are not eating well, encourage them to drink liquids.
• Call your pediatrician for advice. Your doctor can help you decide whether your child needs to be seen or if they may need to be tested and/or treated for swine influenza.
To help guide parents, the CDC has posted tips on caring for a child with flu-like symptoms:
• Keep your child at home. Don’t let him go to school or child care until he has been fever-free for 24 hours.
• Keep a sick child away from other people as much as possible.
• If your child has underlying health problems, see a doctor when symptoms start.
• If your child is otherwise healthy, call a doctor to see if an appointment is needed.
• When holding a small child who is sick, place the child’s chin on your shoulder so that he or she will not cough in your face.
• If your child has severe symptoms, has been to an area where there have been cases of swine flu, or been directly exposed to a swine flu patient, call your doctor for advice.
• Wash your hands with soap and water often, or use an alcohol-based hand gel if soap is not available.
• Keep surfaces (including toys and bedside table) clean—wipe them down with a household disinfectant.
• Wash bed sheets and towels with laundry detergent in hot water. Avoid “hugging” the dirty laundry on the way to the washing machine, and wash your hands right after handling dirty laundry.
Q: What are the signs that my child with flu-like symptoms is getting worse?
• Trouble breathing or fast breathing
• Not drinking well
• Not urinating as much as usual
• Bluish or gray skin color
• Being irritable even after their fever goes down
• Not waking up normally or interacting normally
• The fever goes down and flu symptoms get better, but then get worse again a day or two later
Q: Are any medicines recommended to help children with swine flu?
• Children with influenza should not get any product that contains aspirin. Tylenol (acetaminophen) Advil and Motrin (ibuprofen) are fine to treat fever and body aches in children.
• Cough and cold medications do not help, and should not be used, especially in young children under 4 years of age.
• Antiviral medications like Tamiflu and Relenza, which are in adequate supply, work against the H1N1 swine influenza virus. It is expected that Tamiflu will be more effective if taken soon after the onset of symptoms, rather than later in the course of the illness. Based on a recent study, Tamiflu may have more side effects in children than in adults; your pediatrician can help you decide if this medication is right for your child. Relenza is not for young children.
• Although recommendations may change, at this time treatment may not be needed for everyone, even if you are proven to have H1N1 infection.
• Your pediatrician will decide when treatment is indicated and which drug is best to treat your child.
• Based on current recommendations, your pediatrician may prescribe Tamiflu or Relenza for members of the family who have been in close contact with a child diagnosed with H1N1 swine flu.
Q: Is flu more dangerous for very young children?
• Children under age 2 have a higher risk of complications and hospitalization due to influenza than older children.
• Children of any age who have an underlying medical condition, such as asthma, diabetes, another metabolic disease, chronic kidney disease, or sickle cell disease are at greater risk of complications.
Q: Is the swine flu worse than the “regular” flu?
We don’t know the answer to this yet. As we learn more about the people who have been affected by the H1N1 virus, recommendations for prevention and treatment may change.