Pediatric Emergency Readiness and Pandemic Influenza H1N1

1. Pediatric Emergency Readinessand Pandemic Influenza H1N1 Thelma and Jack Rubinstein Professor Director, Division of Developmental and Behavioral Pediatrics Director, National Center for School Crisis and Bereavement Cincinnati Children’s Hospital Medical Center david.schonfeld@cchmc.org David J. Schonfeld, MD www.cincinnatichildrens.org/school-crisis 513-803-2222

2. I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial products or services discussed in this CME activity • I do not intend to discuss unapproved/investigative use of commercial product(s)/device(s) in my presentation

3. Inform children • Even young children can sense something is wrong • Virtually all children have overheard something • If we don’t discuss this with children directly, may signify situation is something adults believe they can not handle • Begin by asking what they have heard • Provide basic, relevant information, without unnecessary detail • Concentrate on what is behaviorally relevant

4. Children may have limited understanding • Limited information • Misinformation • Misinterpretations or misconceptions • Can lead to fears and concerns that are difficult to anticipate • Children generalize from familiar condition to related condition for which they have little information

5. Example of over-generalization • Survey 1,000 5th graders • When asked if you could get cancer from someone, only 57% said no • 43% knew you couldn’t get cancer from sharing a cup • Only 3% knew you couldn’t get cancer if blood of someone with cancer were to get into your body • Anticipate that children will generalize from what they are taught about H1N1 to other illnesses

6. Ensure comprehension • Help children understand differences between different conditions • Emphasize most illnesses with fever, cough, or runny nose are not influenza; most cases of H1N1 will not result in death • Individuals can hold two conflicting pieces of information as being true • Try to find out misinformation they believe and what they don’t understand • Invite questions and answer honestly, without false reassurance

7. Children may have different fears than adults • You can’t reassure people if you don’t know what they are afraid of • If children to have realistic worries or concerns, allow them to own it • Help them cope with distressing feelings

8. Children may become more self-centered during disaster • May have range of feelings – not just fear • Children may appear selfish • Children have difficulty attending to needs of others until assured their basic needs are met • Often sign they are having difficulty coping and need adult support

9. It’s not all fear or trauma • Not only concerns about health, but also changes imposed on day-to-day life • If deaths occur, bereavement is likely to be predominant concern • Children experience many deaths of family members, yet outside disaster typically receive little support

10. Avoid using fear-based approaches • Need to feel a degree of risk in order to take preventive actions, but can become counter-productive  • Fatalism • Reactance – introduce concept of relative risk • Reactive risk-taking and counter-phobic behavior • Can reinforce guilt and impair adjustment

11. Messaging in context of disaster • Two main goals for health messages in context of crisis: • Call to action – there is a risk and there is something you can do to decrease or eliminate risk • Reassurance

12. National Commission on Children and Disasters • Independent: Authorized by Congress under the Consolidated Appropriations Act of 2008 (P.L. 110-161) • Bi-partisan:10 members appointed by President Bush, Senate and House leaders • Balanced: Expertise drawn from multiple professions and disciplines: pediatrics, state and local emergency management, non-governmental organizations, and state elected office • Purpose: examine and assess the needs of children (0-18 years of age) in relation to the preparation for, response to and recovery from all-hazards, including major disasters and emergencies • Report specific findings, conclusions and recommendations to the President and Congress.

13. Interim Report Recommendations • Ensure availability and access to pediatric medical countermeasures at the federal, state and local level for chemical, biological, radiological, nuclear and explosive (CBRNE) threats. • Expand medical capabilities of all federally funded response teams through the comprehensive integration of pediatric-specific training, guidance, exercises, supplies and personnel. • Ensure all health care professionals who may treat children during an emergency have adequate pediatric disaster clinical training specific to their role. • Provide funding for a formal regionalized pediatric system of care for disasters. • Ensure access to physical and mental health services for all children during recovery from disaster.

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