As parents can tell when bundling up their child before they head out to trick or treat, a chillier season has arrived. And with cold comes the flu season, when more time spent indoors means more opportunities for the virus to spread.
Some pediatricians have had their shipment of flu vaccines for almost two months, and other organizations are pushing influenza prevention through vaccination as well. One of these, Say Boo to the Flu, ties its efforts to Halloween -- having children dress up in costume for a night of games where they and their families can get flu shots.
Fortunately, Halloween doesn't seem to be a major source of flu-related illnesses. Children following typical healthy advice, like like washing their hands before digging into their cornucopias of candy, can expect to avoid any long-lasting effects from what might be their favorite night of the year.
The flu virus may already have reached your neighborhood, but even if your neighbors have it, it isn't likely to be passed on by what they hand out. So, while candy should be checked to make sure it is unopened, don't go overboard by washing candy wrappers.
"It would be a relatively unusual way to get flu," said Dr. Lindsey Grossman, head of pediatrics at Baystate Medical Center in Springfield, Mass. "Usually, someone would have needed to sneeze or cough right on the wrapper."
But because of the season, it probably isn't too soon to start thinking of other ways to help your children avoid the flu. With that in mind, we present 10 ways you can help children avoid catching the flu.
One important thing to note is that anti-virals, which can shorten the length of a flu, can be given to children a year of age or older but must be administered within 48 hours of the start of symptoms. So, as with adults, if these tips don't help, you may be able to minimize the illness by acting quickly.
Given the number of sick children who enter a pediatrician's office, it should come as no surprise that the toys there are laden with viruses.
Dr. Diane Pappas, an associate professor of pediatrics at the University of Virginia, recently looked at the amount of virus RNA (viruses' genetic material) present on toys from a pediatrician's office, both before and after cleaning, and presented her findings at the American Society of Microbiology/Infectious Disease Society of America meeting this week.
Pappas said the study gives parents the message that doctor's office toys should probably be avoided.
"I can't tell them that [their children are going to be sick,] but certainly I can tell them the virus is there," she said.
Pappas noted that wiping down the toys didn't solve the problem.
"It does remove some of it, but it's a very modest effect that the cleaning has on it," she said.
For optimal cleaning, Pappas said, the toys should be washed with soap and water or disinfected using water with a small amount of household bleach, rinsed and then air-dried.
Grossman concurred. "A very low concentration of a bleach solution is an effective way to kill almost any bacteria and viruses," she said, adding that in the last hospital where she worked, toys would be removed from the waiting room twice a day, with new ones brought in while the old ones are cleaned.
She also noted that parents who bring sick children to the doctor can help prevent the spread of the illness to others who come in.
"When your kid's the one with the snotty nose, try to walk around after them and wipe up after them," Grossman said.
Joe Lastinger of Grapevine, Texas, takes some extra steps to keep his home clean of germs and viruses, in part because of his family's personal tragedy: In February 2004, they lost their then 3-year-old daughter Emily to influenza.
Since then he has become a board member of Families Fighting Flu, an organization that educates about the dangers flu can pose to children. According to the Centers for Disease Control and Prevention, roughly 20,000 children are hospitalized with influenza each year, and last season, 86 children died.
Precautions Lastinger takes to keep his home's surfaces free of the flu include a deep cleaning each week of places like light switches and door handles, where germs and viruses tend to congregate.
Some places, he notes, he tries to clean more often.
"There's some places we hit daily," he said.
He also has his three children, Christopher, 12, Andrew, 10, and Anna, 4, try to avoid bringing new germs into the house.
"When the kids enter the house, they always wash their hands," Lastinger said.
He acknowledges that his family probably goes much further than most, but he believes he didn't know enough when Emily was stricken.
"We thought, how come we didn't know about this?" he said.
And so he has tried to make sure other parents do know.
"We never would have thought that influenza was so deadly," Lastinger said. "Influenza is nothing to be messed with."
Unfortunately, children are consistently putting their hands near their faces, which can give them any viruses their hands might have picked up.
Also, sick children can spread their viruses by getting whatever they have on their hands, which invariably are going to touch many other things around them.
There may be no way for children, or even adults, to keep themselves from doing it entirely.
"Generally, at some point, our hand goes to our nose, whether we like it or not, and that can transmit flu viruses from one person to another," St. Louis University pediatrician Ken Haller told ABCNews.com last month.
Because there may not be a way to keep children from touching their faces, keeping their little hands clean may be the best option.
"Unfortunately, you're mostly left with good hand-washing," Virginia's Pappas said.
Parents have long told children to cover their mouths and noses when they cough or sneeze but, unfortunately, that doesn't tell them what to cover it with. Even adults may be unsure of what to do when they feel a sneeze coming on but don't have a tissue handy.
As the CDC spells out on its Web site, a tissue is the ideal thing to cover your mouth and nose with when coughing or sneezing, but a sleeve should be the first substitute.
"If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands," the site advises.
"We try to teach our kids to do things, like when they sneeze, to sneeze into their elbow and not get stuff on their hands," Lastinger of Families Fighting Flu said.
Mary Ann Blade, a registered nurse and chief executive officer of the Minnesota Visiting Nurse Agency, one of the sponsors of Say Boo to the Flu, said, "If you sneeze in your hand and then touch someone else, you're spreading those germs."
Of course, that problem can present itself after blowing your nose with a tissue as well, so there is still one more step to prevent the spread of illness.
But many adults still don't wash their hands when they should, and children are less likely to do so.
"I think you have to make it fun," Blade said. "Where I work here, we do a lot of day care. ... It has to be fun. You do need to kind of connect it with a song."
The Web site for Say Boo to the Flu has a few activities parents can engage in with children to promote washing hands.
Lastinger agrees that stressing the importance of prevention and making it enjoyable is the key to getting children to practice good hygiene.
"Just make it fun for them," Lastinger said. "If they see it's fun and they see why it's important, I think they're more likely to do it."
Lastinger said, "We lost our daughter to influenza in 2004, and in the aftermath, my wife and I really felt if there was anything we could have done that might have saved her life, it would have been to have her vaccinated."
He said that unlike other flu-prevention techniques, the vaccine gives better piece of mind to parents because it does not involve any initiative on the part of the child.
"One of the reasons why vaccination is so important is that those things are good, but it's so hard. ... If you go in a preschool and watch those kids. ... You can't put those kids in a bubble," Lastinger said. "If you vaccinate them, you know as a parent that that vaccine will go wherever they go."
Blade said that people have questioned the flu shot, but the fears parents raise are unfounded.
"People have asked the question, 'Can you get the flu from the flu shot?'" she said. "If people believe that, they're afraid to get the shot."
Additionally, she noted, parents know that all children are recommended to receive the flu vaccine this year, as well as anyone who interacts with them.
"If you can get them immunized, and you can then get ... the people who come in contact with children, we're going to be a healthier society," Blade said.
"Also important is not only getting your kid immunized, but getting yourself immunized as well," Baystate's Grossman said.
Because children consistently pick up bugs, their families can easily catch them. Familywide vaccination is also important because it can help protect newborns, whose immune systems are not fully developed and who cannot receive the flu vaccine until they are 6 months old.
Additionally, the flu vaccine cannot guarantee that you will not catch some strain of the virus, and by having everyone in the household vaccinated, it reduces the chances of a strain that one person catches from being spread throughout the family.
For those reasons, some organizations that promote childhood flu vaccination, including Say Boo to the Flu, promote vaccination for adults in the household as well. At many events, parents can get vaccinated along with their children.
"The bottom line is everyone should get a flu shot," Grossman said.
Keeping your kids out of school when they're sick is less a preventive measure for your children than it is a courtesy to other parents.
"You wouldn't want somebody else coming in and infecting your child," Dr. Jon Abramson, head of the pediatric department of Brenner Children's Hospital of Wake Forest University Baptist Medical Center in Winston-Salem, N.C. , told ABCNews.com earlier this month.
How do you determine when your child is ready to return?
The typical recommendation is to wait 24 hours after any fever has subsided, so that they are healthy without the use of medication. Children can still have some symptoms and not be contagious, and waiting out all symptoms of the flu would take weeks.
Flu viruses typically start to spread in October, and persist into the spring, and no doubt a few of them end up in your doctor's office. So that might not be the best time to bring your child in for their check-up.
"Certainly, coming not in the middle of sick season is not a bad thought," said Pappas.
Pediatricians have long sought ways of keeping the sick patients who visit them from infecting the healthy ones.
Grossman recalls that when she started in pediatrics, many clinics had separate entrances for sick and well children, but over time, she said, they didn't seem to prevent the spread of illnesses in the doctor's office.
She said, however, that she has heard that being the first appointment of the day, when the office is still freshly cleaned, might be a good idea, and said she agreed with that notion.
Unfortunately, it's still unclear that coming in during the summer will definitely keep your child from picking something up at the doctor's office. At the end of summer, however, offices are packed as well.
"Pediatricians' offices are actually busiest in August," said Grossman, attributing that to the number of children who need physicals for school.
So a late spring-early summer appointment might be ideal. By coming in after flu season ends but before the August school-physical rush begins, you may be able to avoid scheduling headaches, and the viruses.
Exercising, getting enough sleep and eating well may all help your child and you fight off the flu.
The connection between exercise and disease resistance has been tenuous, but perhaps because of other benefits, doctors recommend physical activity, along with sleep and a good diet, to keep your immune system boosted.
Grossman explained that by keeping yourself in better shape you can keep your immune system primed. While you may not be able to keep yourself from getting sick, you may be able to recover quicker.
She notes that by keeping yourself in good shape, various markers of your immune system's abilities are improved.
"We know, in general, that if you are well nourished, if you are well rested," Grossman said, "then in general you're in good shape."
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