With the new H1N1 flu rolling through schools throughout the United States, many parents are turning to the Web site of the Centers for Disease Control and Prevention for authoritative advice on how to best care for their sick children at home. But some parents and doctors say at least some of those safety tips are over-the-top and tough to carry out at home.
Under the heading "placement of the sick person," for example, the Web site suggests that parents "keep the sick person in a room separate from the common areas of the house. (For example, a spare bedroom with its own bathroom, if that's possible.) Keep the sickroom door closed."
The site goes on to urge parents to "avoid close contact (less than about six feet away) with the sick person as much as possible. If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a face mask (for example, surgical mask) or N95 disposable respirator." There's even a step-by-step audio podcast on how to put on the mask.
"I wondered if the people who wrote it have kids or know what it's like to have kids," says Jen Hodsdon, a health care worker in Portland, Maine, who checked the Web site last week when her 12-year-old daughter, Soleil MacDonald, got sick with swine flu.
Suiting up in a face mask and keeping her distance from Soleil "would have terrified her," Hodsdon says. "It's like that scene in E.T. where the people come in in suits. It's horrifying."
Treating The Flu In Real Life
And that's a big problem, says Dr. Benard Dreyer, a health literacy specialist and pediatrician at New York University School of Medicine.
"People look at this Web site and sort of get overwhelmed," Dreyer says. They wonder, " 'Oh, my God, am I supposed to do this? Am I supposed to do that?' And then they end up not doing anything."
He's been working on a much simpler list for the American Academy of Pediatrics that focuses first on things like teaching children habits like frequent hand washing, use of hand sanitizers and coughing into the sleeve.
But should sick kids and/or their parents be wearing masks? Hodsdon has asthma, which puts her in the group the CDC Web site urges to wear a mask around anyone with swine flu. Hodsdon thinks that's too extreme — her asthma is mild.
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"It's hard to tell a mother to wear a mask with a kid," says Dreyer. "If somebody had mild asthma, I would probably not get too excited about it. If somebody had real chronic lung disease, really bad asthma, chronic bronchitis, I would be more worried about them. And then I would say maybe you should wear a mask."
Sending A Clear Message
Dreyer was so alarmed when he saw the Web advice that he fired off a note to the CDC. Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, says the Web site is a work in progress and is always being revised.
"We're still really trying to find the best ways to get information out to people that's practical," Schuchat says.
So why push hypervigilance at all? Peter Sandman, a New Jersey risk communication consultant to companies and government agencies, says he thinks the problem stems from the CDC's urge to help parents care for their children the way a hospital would.
"And that's not realistic," says Sandman. "It's well-intentioned. It's good-hearted. It's just not smart."
Research shows that public health experts would have better success, he says, if instead of only putting out the very best, most stringent precautions, they gave parents choices: best, good and good enough.
"I suspect," says Sandman, "that if you sat down with the CDC folks who wrote this advice and said, 'All right, in a realistic situation, where a parent can't do all of this, but if they really work hard they can do some of it, which are the things they should sacrifice, and which are the things we should really try to hang on to?' — they'd have answers."
Meanwhile, Dreyer says, he expects the American Academy of Pediatrics to publish online within the next few weeks its own "how-to list" for parents of children sick with pandemic flu.