1. 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.
• 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.

2. Are face masks necessary?

• Hand washing and avoiding close contact with sick people are more important than wearing face masks to prevent the spread of the virus.
• If you are caring for a child or other person 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.

3. How do you know whether or not to be concerned about swine flu in your area?

• Know what the public health authorities in your area are saying.
• Follow their recommendations to reduce your risk of catching the virus.

4. 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.

5. 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 (<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 hand washing.
• 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.

6. 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.

7. 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.

8. 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.

9. 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, being so irritable they don't want to be held
• Not waking up normally or interacting normally
• Rash
• The fever goes down and flu symptoms get better, but then get worse again a day or two later

10. 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. 
• 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.

• UPDATE REGARDING TREATMENT WITH ANTIVIRALS (Sept. 22, 2009)

11. 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.

12. 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.

13. Should I use antibacterial soaps and/or alcohol-based hand rub products?

• Washing hands with warm running water and soap (antibacterial soap is fine but not necessary) for at least 20 seconds ( the time it takes to sing the “Happy Birthday” song twice) has been shown to kill the H1N1 virus.
• Alcohol-based rubs can be used when soap and water are not available, such as after hand shaking or touching objects that carry germs. Keep in mind that alcohol-based products are toxic if ingested by children. (The amount left on hands after use is not a concern.) Please keep these products out of the reach of children and supervise their use.

14. Can mothers who have swine flu continue to breastfeed?

• The influenza virus is not transmitted by breast milk.
• Mothers who believe they may be infected should be sure to wash their hands before breastfeeding their baby.
• Be sure to use clean burp cloths, and consider wearing a face mask.

~CDC