Tuesday, April 11, 2017

Have a toddler or care for one? Includes Resources

Image from Surviving Loss: The Woodcutter's Tale, co-authored by Lisa Saunders

"CMV: Protect Your Pregnancy"

by Lisa Saunders

(Lisa is a former licensed daycare provider, church nursery volunteer, and parent representative of the Congenital Cytomegalovirus Foundation.)

Everyone agrees toddlers are cute--and they are! But if you are the mother of a toddler, a nursery volunteer, a child care worker, or have a toddler in group care, you need to know about cytomegalovirus (CMV). 

What is CMV? 
According to the Centers for Disease Control and Prevention (CDC), "Cytomegalovirus (pronounced sy-toe-MEG-a-low-vy-rus), or CMV, is a common virus that infects people of all ages. Over half of adults by age 40 have been infected with CMV...Most people infected with CMV show no signs or symptoms. However, CMV infection can cause serious health problems for people with weakened immune systems, as well as babies infected with the virus before they are born (congenital CMV)."

The Problem
CMV can cause birth defects if a woman contracts the virus when she is pregnant according to the CDC. The CDC states that people who care for or work closely with young children may be at greater risk of CMV infection than other people because CMV infection is common among young children. Toddlers quickly spread infections by putting each other’s toys in their mouths, sharing cups and utensils, and needing adults to wipe their noses, feed them, and change their diapers. 

“Women who are exposed to CMV prior to conception or within the first trimester of pregnancy and seroconvert have increased risk of their infant being infected with CMV”(Thackeray et al., 2016).

What Should You Do?
The American Academy of Pediatrics (AAP) co-authored “Caring for Our Children,” which includes Staff Education and Policies on Cytomegalovirus (CMV), stating that caregivers/teachers should be informed about their increased probability of exposure to CMV and: "Hygiene measures (especially handwashing and avoiding contact with urine, saliva, and nasal secretions) aimed at reducing acquisition of CMV..."

Reduce Transmission of CMV
  1. Wash hands often with soap and water for 15-20 seconds, especially after wiping runny noses, changing diapers, picking up toys, etc. If soap and water are not available, use alcohol-based hand gel.
  2. Use soap and water or a disinfectant to clean hard surfaces that have been contaminated by secretions.
  3. Don’t kiss young children on the lips or share food, drinks, or eating utensils with them.
  4. Pregnant women working in child care facilities should minimize direct exposure to saliva…Hugging is fine and is not a risk factor, (NY Dept. of Health)

CMV Prevention Resources
The Congenital CMV Disease Research Clinic and Registry provides resources to share with women of childbearing age. In addition, the National CMV Foundation features CMV prevention flyers. The book, “Caring for Our Children,” has several articles on sanitizing hands and surfaces in child care centers.  

Why Haven't You Heard of CMV Before?

Less than half (44%) of OB/GYNs warn patients about CMV according to a survey done by the American College of Obstetricians and Gynecologists (ACOG) in 2007.  The following reasons have been cited for this: 

1.     Don’t want to frighten their patients: An OB/GYN was quoted in FitPregnancy magazine (June/July '08): "The list of things we're supposed to talk about during women's first visit could easily take two hours and scare them to death...That's just the reality."
2.     Most CMV infections go undiagnosed—“The virtual absence of a prevention message has been due, in part, to the low profile of congenital CMV. Infection is usually asymptomatic in both mother and infant, and when symptoms do occur, they are non-specific, so most CMV infections go undiagnosed” (Washing our hands of the congenital cytomegalovirus disease epidemic, Cannon and Davis, 2005).
3.     Feel prevention measures are “impractical or burdensome." According to the New York Times article, CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed (2016), “Guidelines from ACOG suggest that pregnant women will find CMV prevention ‘impractical and burdensome,’ especially if they are told not to kiss their toddlers on the mouth — a possible route of transmission.”

Does Prevention Education Work? 
Yes! The above mentioned New York Times article summarized two prevention studies:  “A study in a French hospital found five to 10 minutes of counseling about CMV prevention resulted in fewer women contracting the virus. In another study, pregnant mothers shown a video and offered hygiene tips were much less likely to get CMV (5.9 percent) than those not given information on prevention (41.7 percent).” 

Free Teaching Tool Kit for Homes and Group Care Centers

  • "Grandma" speaks for Miss Cup to teach germ prevention while featuring Mr. Knife's fear of the dish running away with the spoon to teach table-setting in the "color-me-in" fairytale, Once Upon a Placemat: A Table Setting Tale  
FREE Teaching Toolkit includes:

Television Interview Teaches CMV Prevention
You will find a lot of advice on this segment of the Lisa Saunders ShowChild Care and CMV: Protect Your Pregnancy. Hear tips from:

  • Gail J Demmler-Harrison, MD, Professor, Pediatrics, Section Infectious Diseases, Baylor College of Medicine, Attending Physician, Infectious Diseases Service, Texas Children's Hospital, CMV Registry, CMV Research and CMV Clinic.
  • Caroline Bailey, congenital CMV survivor and Master's college student. 
  • Brenda K. Balch, MD, Connecticut’s American Academy of Pediatrics Early Hearing Detection & Intervention Chapter Champion.
  • Lisa Saunders, former child care provider, nursery volunteer, and mother of a toddler.

Author's note: I am the parent representative of the Congenital Cytomegalovirus Foundation, a CMV education consultant, and helped Connecticut become the second state in the U.S. to pass a CMV law. When I was of childbearing age, I was a licensed home daycare provider, church nursery volunteer, and the mother of a toddler. I was never advised that caring for toddlers increased my risk of contracting CMV. Although I washed my hands after every diaper change, I should have been much more diligent about hand-hygiene after picking up toys and wiping runny noses. My daughter Elizabeth (1989-2006) was born severely disabled from congenital CMV.  I am the author of  a memoir about my daughter's life, Anything But a Dog! The perfect pet for a girl with congenital CMV,  and the germ prevention coloring book, Once Upon a Placemat: A Table Setting Tale


Lisa Saunders, parent representative
PO Box 389
Mystic, CT 06355

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