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It is important that early childhood programs have access to the most authoritative and up-to-date guidance as the H1N1 flu situation develops in order to appropriately respond.  We highly recommend that programs review The American Academy of Pediatrics' paper on responding to the flu outbreak, "Strategies and Resources for Child Care Providers and Out-of-Home Caregivers of Children."

In addition, attention should be paid to the following recommendations of the US Center for Disease Control...

• Sick people (students, faculty, and staff) should stay home unless they need to seek medical care and stay away from schools, regardless of whether schools and childcare facilities are operating normally or have dismissed students or closed, respectively.
• Dismissal of students in a school and closure of child care facilities should be considered in schools with one or more laboratory-confirmed or non-subtypable influenza A cases among students, faculty, or staff in order to decrease the spread of illness in the community.
• Dismissal of students from schools and closure of child care facilities should be considered for a school district or part of a school district (e.g., a feeder school network or a geographic area) if more than 1 school in that district has confirmed or non-subtypable influenza A cases among their students, faculty, or staff. This would include pre-emptively dismissing students from schools in that district, including schools without current laboratory-confirmed cases.
• Neighboring school districts to those that dismiss students should also consider pre-emptively dismissing students from schools without current laboratory-confirmed cases. Issues to consider include geographic proximity and extent of mixing of student populations across district lines.
• If a school dismisses students or a child care facility closes, school or child care related gatherings should also be canceled. Parents and students should be encouraged to avoid congregating in large numbers outside of the school setting.

If a school dismisses students or a child care facility closes, schools and child care facilities should dismiss students for a minimum of 14 days. Schools, in consultation with local and state public health officials, should evaluate daily the need for possible extension of the dismissal/closure based on local influenza surveillance information, and the occurrence of new infections and severity of illness in the community from this virus. This length of time is recommended because children are likely to be infectious for about 7 – 10 days after the onset of illness.

If students are dismissed from schools, they should be encouraged not to re-congregate outside of school in large numbers. If child care facilities close and there is a need for child care, families could plan to work together with two to three other families to supervise and provide care (using the same caregivers each day) for a small and consistent group of infants and young children while their parents are at work (studies suggest that child care group size of five or fewer children may be associated with fewer respiratory infections).

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