Physical Health


Influenza, often called the flu, is a contagious disease that infects the nose, throat, and sometimes lungs. It quickly spreads because:

  • People can spread influenza viruses before they know they are ill and after they feel better.
  • The time between exposure and getting the infection is short, usually two or three days.
  • Influenza viruses live for up to 48 hours in the environment, infecting others who touch objects that have the virus on them.

Influenza is more serious than the common cold, and most people with the flu feel very ill. They often have fever, body aches, chills, cough, tiredness, and sometimes nausea, vomiting, and diarrhea.

Children, especially those younger than 2 and those with chronic health conditions, are particularly at risk for complications of influenza that often need hospitalization. But any young child, including those with no prior health conditions, can have complications. These complications include:

  • Pneumonia
  • Difficulty breathing
  • Severe muscle inflammation, including the heart muscle
  • Seizures
  • Encephalitis (brain infection)
  • Changes in mental status (e.g., confusion, disorientation, loss of alertness)
  • Sepsis
  • Death

Influenza is most often seasonal, occurring in the fall and winter. Rarely, a new influenza virus causes a pandemic.

Early childhood programs should take steps to prevent seasonal influenza because:

  • It is a serious illness that puts children and staff at risk for serious complications and hospitalization.
  • Influenza causes caregivers to miss work.
  • Children with influenza miss valuable learning time.
  • Children can spread influenza in the community.
  • Family resources are strained when parents are unable to work.

How Early Childhood Programs Can Control Influenza


By far, the best way to prevent influenza is seasonal vaccination. Children older than 6 months can be immunized against influenza. All children older than 6 months and their caregivers should receive the flu vaccine every year, preferably before the end of October.

Children who receive the flu vaccine are significantly less likely to need hospitalization from flu complications than those don’t get vaccinated. The flu vaccine also dramatically reduces a child’s risk of death from influenza.

Staff should receive a flu vaccine to avoid missing work and infecting others in the community, but also to protect children in their centers who can’t get a flu vaccine, including infants who are younger than 6 months. Parents, other caregivers, and family members of young infants should be immunized against influenza to protect young infants.

Infection Control

In a setting with young children, infection control is not easy because of close contact, developmentally appropriate behaviors such as mouthing toys and eating with hands, and young children’s inability to contain and control their nasal and oral secretions. Here’s how staff can help:

  • Wash hands regularly for 20 seconds using good hand-washing technique. Washing with soap and water is best.
  • Help children with hand-washing. Wash infants’ hands at the sink using soap and water. Help other children with washing, making sure they do it correctly.
  • Prevent contact with nasal secretions and saliva as much as possible. For sneezing and coughing, teach children and staff to cover their noses and mouths with a disposable facial tissue if possible, or with an upper sleeve or elbow if no facial tissue is available in time. Teach everyone to remove any mucus on skin or other surfaces and wash their hands after using facial tissues. Change or cover clothing with mucus on it.
  • Throw away facial tissues after each use.
  • Wash hands after touching any items that have mucus or saliva.

Hand-washing Technique

Washing your hands is easy, and it is one of the most effective ways to prevent the spread of germs. The Centers for Disease Control and Prevention recommends these five steps:

  1. Wet. Wet the hands with clean, running water.
  2. Lather. Apply clean bar soap or liquid soap to the hands. If using bar soap, place the bar on a rack where it can drain before the next hand-washing.
  3. Scrub. Rub the hands together vigorously. Scrub every surface completely, including the backs of hands, between fingers, and under nails. Keep rubbing and scrubbing for 20 seconds to effectively remove the germs.
  4. Rinse. Rinse the hands completely.
  5. Dry. Dry hands using a clean towel or air dryer.
  6. Be sure to follow routine cleaning, sanitizing, and disinfecting protocols.

Exclusion and Readmission

Typically, a child with a fever, cough, or runny nose likely doesn’t have the flu. Instead, they may have another common virus, even during flu season. It’s not feasible for health care workers to test all children who might have influenza. Deciding whether to exclude a child from care is based on the child’s symptoms and behavior and your program’s exclusion policy.

If a child has a fever and needs more care than staff can give (such as needing to be held all the time) or if the child can’t take part in activities, then excluding the child is the right thing to do. During flu season, a child who has been excluded because of suspected influenza should stay excluded until 24 hours after they are fever-free without taking fever-reducing medication. Children are more likely to spread influenza viruses when they have a fever.

Although helpful, exclusion alone is not effective in preventing the spread of influenza, because the virus is present before symptoms occur. This is why immunization is so important.

Tips for Working with Families

To encourage seasonal flu vaccination, consider these steps:

  • Educate families about the seriousness of influenza and the easy ways to get a vaccination. Ideally, a child’s health care provider should have influenza vaccines, but flu vaccines are available in other places if necessary. Use the flu vaccine finder, entering a zip code finds the nearest place to get a flu vaccine.
  • Host a flu clinic at your program for staff, children, and families. Many immunization providers can help set up this kind of clinic on site.
  • Track influenza immunization rates. Sending reminders and checking in with families can increase immunizations rates, which decreases the spread of influenza in your center.

For Your Family Newsletter

Tailor the messages below to include in your family newsletter.

The flu can be dangerous for children. Each year thousands of children younger than 5 are hospitalized because of influenza. The flu vaccine is safe and helps protect children from the flu and its complications.

Everyone should get a flu vaccine. Anyone older than 6 months should get a flu vaccine to   avoid the flu and to avoid spreading the flu to babies who are not old enough to be vaccinated.

Get a flu vaccine during pregnancy. Because flu vaccines can’t be given to infants younger than 6 months, if you’re pregnant, you can protect your unborn child by getting a flu shot. You pass on protection that lasts for several months after your baby is born.

The flu vaccine is safe. The flu vaccine has been used for decades in millions of children. The flu vaccine doesn’t cause the flu. Some people think children can get the flu from the vaccine because some vaccinated children may still get the flu. This is possible particularly if they don’t receive two doses, or if the vaccination is not given early enough before exposure to someone with the flu.

The flu vaccine can prevent flu, reduce hospitalizations from flu, and reduce the risk of death. Many children can avoid getting the flu because of the vaccine. Also, the risk of a child with the flu needing to go to the hospital is reduced by 76% in those who received a flu vaccine. The risk of death from the flu is reduced by at least half in children who received a flu vaccine.

No-cost or low-cost flu vaccines are available at your local health department. Get your flu vaccine before the end of October. (Consider offering specific contact information for the nearest health department vaccine clinics in your newsletter.)

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