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Preventing the Spread of Influenza (the Flu) in Child Care Settings: Guidance for Administrators, Care Providers, and Other Staff


Symptoms of flu include fever (usually high), headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Nausea, vomiting, and diarrhea also can occur, but are much more common in children than adults.

Spread of the Flu

Flu viruses are thought to spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. People with influenza can potentially infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

Preventing Spread of the Flu in Child Care Settings

Yearly flu vaccination is the first and most important step in protecting against this serious disease. Two kinds of flu vaccine are available in the United States:

Yearly flu vaccination should begin as soon as vaccine is available and continue throughout the influenza season, into December, January, and beyond. While influenza outbreaks can happen as early as October, influenza activity peaks most often in February.

About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body. Vaccination, along with other measures, also may help to decrease the spread of influenza among children in the child care setting and among care providers.

Recommend influenza vaccination for children and care providers in child care settings.

Vaccination is the best method for preventing flu and its potentially severe complications in children.

CDC recommends that all children aged 6 months up to their 19th birthday get a flu vaccine.

Certain groups of children are at increased risk for flu complications. For more information about children at greater risk of serious flu-related complications visit Children and the Flu Vaccine.

CDC also recommends that people in contact with certain groups of children get a flu vaccine in order to protect children from the flu.

For more information about those recommended for vaccination visit Persons for Whom Annual Vaccination is Recommended.

Children 6 months up to 9 years of age getting a flu vaccine for the first time will need two doses of vaccine the first year they are vaccinated. If possible, the first dose should be given as soon as vaccine becomes available. The second dose should be given 28 or more days after the first dose. The first dose "primes" the immune system; the second dose provides immune protection. Children who only get one dose but who need two doses can have reduced or no protection from a single dose of flu vaccine. Two doses are necessary to protect these children. It usually takes about two weeks after the second dose for protection to begin. For more information see CDC's Childhood Immunization Schedule.

Remind children and care providers to wash their hands or use alcohol-based hand cleaners, and make sure that supplies are available to prevent the spread of germs.
Keep the child care environment clean and make sure that supplies are available.
Remind children and care providers to cover their noses and mouths when sneezing or coughing.
Observe all children for symptoms of respiratory illness

Observe closely all infants and children for symptoms of respiratory illness. Notify the parent if a child develops a fever (100˚F. or higher under the arm, 101˚F. orally, or 102˚F. rectally) or chills, cough, sore throat, headache, or muscle aches. For children 4 months or younger, the lower rectal temperature of 101˚F or under the arm of 100˚F is considered a fever threshold. Send the child home, if possible, and advise the parent to contact the child’s doctor.

Encourage parents of sick children to keep their children home. Encourage sick care providers to stay home.
Consult your local health department when increases in respiratory illness occur in the child care setting.


The following resources provide information about flu that may be adapted for use in the child care setting:

CDC Resources
State and Local Health Departments
Other Resources

* "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.

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