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Talking with Kids about health

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What Parents Need to Know About Swine Flu (H1N1 Influenza)


An interview on May 1, 2009 with Dr. Henry Bernstein, from The Parent's Journal with Bobbi Conner (heard nationwide on public radio stations):

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Total length: 11:51

Dr. Henry Bernstein, a pediatrician and professor of pediatrics at Dartmouth Medical School, is a member of the American Academy of Pediatrics Committee on Infectious Diseases.

Interview Transcript

Program Host, Bobbi Conner: Dr. Bernstein, what would you most like parents to know about swine flu?

Dr. Henry Bernstein: I'd like to say that first, there really, at this point, is no need to panic. We know that infectious diseases can spread from person to person, and there are everyday steps that all of us can take to stay healthy. Some of those include, you know, washing our hands often with soap and water, especially after we cough or sneeze. We should have alcohol-based hand cleansers available because they're remarkably effective. We really should try to cover our nose and mouth with a tissue when we cough or sneeze. And of course, throw the tissue in the trash—don't just leave it on the table or the counter in the home. We should do our best not to touch our eyes, nose, and mouth, because certainly, germs can spread that way. And we also should keep away from people who are sick because this will help limit the spread of illness.

Q. Now, what about children in particular? I'm thinking about toddlers and preschoolers, even elementary age kids that are out there playing and sharing toys and maybe cups and drinks and all that sort of thing. Any extra precautions parents should be taking now?

A. Well, again, emphasizing, for example, coughing into their elbow, as we say. That's certainly important. It's kind of hard to get kids to not to share toys or not to play with one another. We oftentimes want them playing well together. But certainly, if somebody has a cold or cough or a fever, those are the kind of children that actually should be kept home from school or daycare, as opposed to still coming and playing routinely with the other kids. There should be less sharing of drinks and foods; I mean, that's a great way to spread infectious diseases, so I would certainly avoid doing that.

Q. Dr. Bernstein, some parents are calling their family physicians or their pediatricians asking about the antiviral medicine when they don't have a child who is sick at home. What can you tell us about that situation?

A. We don't have enough of the antiviral medicines to be able to just give it to everyone in the United States to have at home. We need to distribute it around the country and make sure that it's available in various geographic areas when it's needed, under specific recommendation. So no, they should not be calling their doctor, asking to have the medicine in the medicine cabinet at home, should they need it down the line.

Q. So it sounds as though there's not a different approach at this point in time if the child has just mild flu symptoms.

A. Correct. That is exactly right. It's really only those few that may have been exposed to somebody who they, within six feet, a close contact, of somebody who is known to have swine flu. Then they might be managed differently based on the recommendation from the Centers for Disease Control and Prevention. Otherwise, all of us should just stay calm and then just treat them as having a mild respiratory illness, separating them from those who are well and doing all of those good hand hygiene and cough etiquette that I mentioned earlier.

Q. Dr. Bernstein, parents seem like they're quite worried, and I'm wondering what words of wisdom you can say just about the worry factor for moms and dads.

A. Well, certainly, people are understandably worried. Any time they hear about the flu, that's something that sort of gets people a little bit concerned, and depending upon what's going on nationally and, in this case, internationally, that can raise people's level of concern. We should know that seasonal flu happens every year, and that there's no question that it causes 36,000 deaths a year in all ages and around 100 pediatric deaths a year, and so there's no question that it's an appropriate concern about trying to keep our kids healthy. Generally, the recommendation is for children to get vaccinated each year against the flu, and those children that perhaps have a medical condition that puts them at higher risk should they get the flu, those are the ones that should touch base with their doctor when they get a respiratory illness. But most healthy children can weather the storm and do well during a mild influenza experience such as we're having right at the moment. There is no question, though, when you talk about the age group that you mentioned—the two-, three-, four-year-olds—those are the great transmitters. Those are the ones that spread the flu. They may themselves not necessarily have difficulty handling the illness, but there's question that they're the ones that don't use the greatest hand washing, because developmentally you wouldn't expect them to, and they're the ones who need care, are in closer contact with parents, family members, caretakers, and that's how the flu spreads to others...

Q. Now, I'm wondering, because the media is having a lot in the way of reporting on swine flu, and kids often hear and see that stuff, what should we be doing as parents to sort of buffer or protect our kids from, you know, all of the news, so that they don't become terribly alarmed?

A. Well, we certainly—we want parents to help their kids to feel safe despite, you know, the scary news that's out there. One of the first things that we, as parents, should do, is to have our own facts straight, because that will help us to stay calm and explain in a calm way what's going on for their children or in their family or in their communities. Sometimes if people don't have the facts straight, then things tend to spiral in the wrong direction and raise people's fears unnecessarily. I think it's important for people to understand the kids of all ages now; younger children—we need to keep the questions quite straight forward and our answers quite simple. We might talk with our kids and ask them, you know, in a discussion or have a quick conversation with them, you know, what do they know about the flu, or what have they heard. What does that mean to them? What might they do to keep themselves healthy? And we want to make sure that, as parents, that we are very comforting, and we reassure our kids of all ages that we will do everything that we can to keep them safe—you know: we're there; we're going to do these things . . . and this might be a teachable moment for emphasizing how to cough into the elbow or to use tissues and throw them into the trash, etc. It's a great opportunity to engage in a conversation at the appropriate developmental stage of their child, but to be immensely reassuring, and then take steps as a family to keep everyone in the family as healthy as they can be. You recognize that we are trying to prevent everyone from being ill. Some people will still get respiratory illnesses; we just want to do whatever we can for them to recover from their respiratory illness.

Q. Now, what about the flu shot? A lot of parents have taken their children to the doctor to get a general flu shot earlier in the season, maybe last fall. Is that going to provide any protection?

A. Well, first of all, I want to say that it's fantastic that the children got their flu shot, and I hope the parents and the other family members did as well, because the more people in our country that get a flu shot each year or a flu vaccine, the better, because there's no question that the flu vaccine is quite effective in preventing most seasonal flu, especially this season. It's been very mild in that regard. We do not have the information yet to know whether the seasonal flu vaccine that millions of people received this year, whether or not that's going to protect against this new strain of swine flu. It may indeed turn out that it gives some, perhaps, cross protection. We just don't have that information one way or the other.

Q. And the last question: Now, should parents avoid pork products? Does that have any legitimacy?

A. Uh, no, not at all. You can't get the swine flu from eating pork or pork products. The one last thing is that this is rapidly evolving, and that parents really should be keeping in touch with their providers, and also the CDC websites provide the new information as it becomes available.

Q. And that CDC website is cdc.gov, and they do have information for consumers and parents, rather than just healthcare professionals.

A. Yes. And I would probably add one other thing. People should understand that this is a shared responsibility of all of us, so with something like this swine flu outbreak, people, individuals, communities, and all parts of the government—you know, local, state, national—all of us need to work closely together during this serious time.

Q. And part of that means doing our part, staying home or keeping our kids home if they get sick or we get sick.

A. That's exactly right. So it being that it's a shared responsibility, so therefore, if somebody is ill with a respiratory illness, we should be thinking about—each parent or each family—what would you do if there's an outbreak in your area and you or your child gets sick?

Q. In other words, stay home from work, have plans, have a back up for child care.

A. Contingency plan. Absolutely.

This interview was excerpted from The Parent's Journal public radio program.

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