2017 Tool Kit: CMV in Child Care Awareness

Child care providers should be educated about CMV in child care. If you would like to ask your legislator to pass a law to ensure that they are, the following are some suggested print outs to place in a three ring binder in plastic sheets for your representatives:

1. Flyer for healthcare providers and those who care for toddlers--either their own or professionally: Two-sided flyer includes poster for hanging and content from CT Public Health webpage. CT Dept Public Health CMV flyer/web content.
2. Pamphlet for policy makers/daycare directors: six panel, two page flyer, front and back, for those who want to ensure child care providers learn how to protect their pregnancies: CT Child Care Providers Against CMV
3. Assorted Flyers: National CMV Foundation: Click the following for simple flyers for downloading. The National CMV Foundation allowed the Connecticut Department of Public Health to include its logo in this flyer. 
4. One-Page CMV Fact Sheet for Policy Makers includes cost estimates
5. Recommendations made by the American Academy of Pediatrics or: "Staff Education and Policies on Cytomegalovirus (CMV)," American Academy of Pediatrics (AAP) et al., Caring for Our Children: http://cfoc.nrckids.org/StandardView/7.7.1.1
6. ChildCare Aware of America:  "The Danger of Spreading CMV: How We Can Protect Our Children."
7. Recent survey of child care providers (most have never heard of CMV).  
8. Study showing that diaper wipes do not kill CMV. 
9. Study: "In the past, the hazards facing child care workers have largely been ignored by health and safety professionals, due in part to a lack of awareness of hazards and inconsistencies in state health and safety requirements" (Bright et al., 1999).
10. Rights of child care providers:  Occupational Safety and Health Administration (OSHA) states it is a worker's right to know occupational hazards. 
11. State child care licencing departments: click here. 
12. States with a CMV law: click here. 
13. Study:  "Children cared for at daycare or in preschool education exhibit a two to three times greater risk of acquiring infections...control measures are indispensable to the prevention and control of infectious diseases." (Nesti et al,, 2007). 
14. Child with Congenital CMV in Your Childcare Center? What to tell your staff
15. 15 Reasons to Tell Child Care Providers About CMV (for pdf, click here)
16. Fact sheet from MotherToBaby.org on CMV  includes child care providers. 
17. CMV prevention brochure specifically for child care providers: Utah's brochure for childcare providers.
18. NAEYC: National Association for the Education of Young Children and its "Early Childhood Program Standards and Accreditation Criteria and Guidance for Assessment (10.D.01, p.91)" includes: "a. steps to reduce occupational hazards such as infectious diseases (e.g., exposure of pregnant staff to CMV [cytomegalovirus], chicken pox)..."
19. LOUIS, C. S. (2016, Oct. 24). CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed. The New York Times. Retrieved from http://www.nytimes.com/2016/10/25/health/cmv-cytomegalovirus-pregnancy.html?_r=0
20. H.B. 81 Second Substitute Cytomegalovirus Public Health Initiative. (2013 General Session). Retrieved from Utah State Legislature: http://le.utah.gov/~2013/bills/static/hb0081.html

Connecticut: 

1. Flyers from the Connecticut Department of Public Health website,  Congenital Cytomegalovirus (CMV): http://www.ct.gov/dph/cwp/view.asp?a=3138&q=527824
2. National CMV Foundation flyer: Are You Pregnant? (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/ncmvf_awareness_flyer_ct_dph.pdf
3. About Cytomegalovirus (CMV) FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/about_cmv_obs.pdf
4. About Cytomegalovirus (CMV): TESTING FOR OBSTETRIC HEALTH CARE PROVIDERS. (2017). Retrieved from Connecticut Department of Public Health: http://www.ct.gov/dph/lib/dph/ehdi/cmv_testing_info_obs.pdf
5. H.B. No. 5147. (2014). Retrieved from Connecictut General Assembly : http://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=5147&which_year=2014
6. H.B. No. 5525: An Act Concerning Cytomegalovirus. (2015). Retrieved from Connecticut General Assembly: https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&which_year=2015&bill_num=5525+
7. Lisa's outline and talking points for a presentation on CMV in Child Care (click for pdf)

Yale: Sedative combats CMV--Michael J. Paidas, M.D.; Sara Ornaghi, MD; a...

Child with Congenital CMV in Your Childcare Center? What to tell your staff

Are you a childcare provider being asked to care for a child born with congenital CMV? 

Not sure what to tell your staff? 

Click on the following National CMV Foundation  flyer,  "Should you exclude a child born with CMV?" for an answer to this question and read below for more information. According to the flyer (which also includes prevention tips): "Most children born with congenital CMV (cytomegalovirus) will shed, or release, the virus in their body fluids throughout their toddler and preschool years. However, CMV is a very common childhood virus, affecting 70 percent of healthy children between 1 and 3 years of age... According to the Centers for Disease Control and Prevention (CDC), screening of children for CMV infection is not recommended, and infected children should not be excluded from school or other settings. Children born with congenital CMV pose no threat to their peers and no more of a threat to those at risk for CMV infection (ie. pregnant women) than would any other child." 

If a child is  KNOWN to be excreting the virus, this is what was posted in a newsletter by the Congenital CMV Disease Research Clinic & Registry:

Q. "There are pregnant teachers and other care givers at our school who work closely with children known to have CMV infection. For their safety, should these employees be relieved from their duties in caring for these children?"

A: “Changing the duties of a teacher or care giver from children known to have CMV infection to other children may not reduce their risk of acquiring CMV. It is a common virus in all children. In fact, studies reveal that between 30 and 80% of children between the ages of 1-3 years of age who attend some form of group care are excreting CMV. In this setting transmission of CMV is usually transmitted from child-to-child by direct contact with bodily fluids such as saliva or urine. It also may be transmitted to care givers. Therefore it is wise for care givers in this type of setting to be aware of CMV and consider knowing their CMV antibody status. If results are negative, they are susceptible to catching CMV for the first time and it is a potential risk to the fetus if they are pregnant. On the other hand, if results of a CMV antibody titer (IgG) is positive, they have already acquired CMV at some time in their life and their risk is greatly reduced. Additionally, it is important for all care givers to practice good hygienic measures. This is achieved by hand washing with soap and water, especially after diaper changes and any contact with a child's bodily fluids. Kissing and sharing food or drink also should be avoided.” 

(https://www.bcm.edu/web/pediatrics/documents/cmv2-2-96.pdf)

Childcare staff: 

You need to assume ALL young children are shedding CMV because between 44% to 100% of toddlers were shedding the virus in the study, “Group day care and cytomegaloviral infections of mothers and children.” Toddlers can shed CMV for many months in their saliva, urine and other bodily fluids. 

Pregnant child care givers need to be diligent about sanitizing surfaces used by toddlers and washing their hands after direct contact with bodily fluids. Licensed childcare facilities have hygiene protocols in place. 

The following article by me was written for caregivers and published by ChildCare Aware: 

 "The Danger of Spreading CMV: How We Can Protect Our Children."

If you have any more questions, please let me know.

Lisa Saunders, former licensed daycare provider Parent Rep., Congenital Cytomegalovirus Foundation LisaSaunders42@gmail.com | www.authorlisasaunders.com | http://congenitalcmv.org/ | PO Box 389, Mystic, CT 06355 |

Back to School: Share a Meal--Not the Germs! Free Table-Setting Tool Kit Teaches How

Back to School: Share a Meal--Not the Germs! 

Free Table-Setting Tool Kit Teaches How

Teachers/caregivers of young children are at greater risk for contracting diseases as are the children in their care: "Children cared for at daycare or in preschool education exhibit a two to three times greater risk of acquiring infections...control measures are indispensable to the prevention and control of infectious diseases." (Nesti et al,, 2007). 

Did you know there are many diseases spread through saliva? These include: 

1. Cytomegalovirus (CMV). Pregnant teachers can contract CMV from their students and pass it to their unborn babies. Congenital (present at birth) CMV is the leading viral cause of birth defects. Staff of childbearing age need to know the "importance of hand hygiene measures (especially handwashing and avoiding contact with urine, saliva, and nasal secretions) to lower the risk of CMV " (American Academy of Pediatrics [AAP] et al., Caring for Our Children, 2011). 
2. Cavity-causing germs.
3. Respiratory infections including influenza and croup.
4. Strep throat, tonsillitis, and scarlet fever.
5. Mononucleosis, commonly known as the “kissing disease,” caused by the Epstein-Barr virus.
6. Cold sores, caused by herpes simplex virus-1.
7. Hand, foot, and mouth disease, caused by a strain of Coxsackie virus.

Teach Infection Control! 

Teachers/caregivers can share a meal with their students without sharing the germs! Teach children the importance of handwashing and refraining from sharing cups and utensils with each other by downloading the free program kit created by Lisa Saunders, author of "The Danger of Spreading CMV: How We Can Protect Our Children" published by ChildCare Aware and the "color-me-in" fairytale, Once Upon a Placemat: A Table Setting Tale.  

FREE Teaching Tool Kit includes:

1. Placemat, Side One: Placemat with tableware characters with space for your coloring artist's name (perfect for laminating and using as a table-setting reminder). 
2. Placemat, Side Two: Germ prevention tips and hand-washing instructions.
3. Video: Short introduction of  the tableware characters by Lisa Saunders, the parent representative of the Congenital Cytomegalovirus Foundation. 
4. Educational Coloring Book:  "Grandma" reminds children when and why to wash their hands and speaks for Miss Cup to teach germ prevention. She stresses Mr. Knife's fear of the dish running away with the spoon to teach table-setting. For a free pdf version of Once Upon a Placemat: A Table Setting Tale, contact LisaSaunders42@gmail.com or ask your library to carry a copy for you to borrow (copies also available on Amazon). 

Professional reviews:

"Once Upon a Placement is a clever way to get across an important message about prevention of infectious diseases. As a doctor, I recommend it to my young patients and their families. As a grandmother, I have shared it with my granddaughter." Gail J Demmler Harrison, MD, CMV Registry, CMV Research and CMV Clinic

"The lesson of how to set a table is valuable as this is part of encouraging a family to sit down and eat together—a main intervention in preventing obesity," said Alison Dvorak, MS, RDN, CDN, of Franklin, Connecticut.

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Author's note:  “Once Upon a Placemat” is an expanded version of the fairytale Saunders told in her children’s novel, “Ride a Horse, Not an Elevator,” which is available on Amazon and was featured in the Cornell University 4-H “Horse Book in a Bucket” program.

About the author:.Lisa Saunders is an award-winning writer living in Mystic, Connecticut, with her husband and hound. A graduate of Cornell University, she is the parent representative of the Congenital Cytomegalovirus (CMV) Foundation, and in 2015, was instrumental in helping Connecticut become one of the few states in the country to enact a law combating the leading viral cause of birth defects, congenital CMV.  Saunders said, “CMV is carried by a high percentage of apparently healthy toddlers. It is found in bodily fluids such as saliva and is of concern to women of childbearing age because the virus can lead to complications in their baby's development if they are pregnant while infected.”

Co-author of "Once Upon a Placemat," Jackie Tortora, is a digital strategist living with her husband and their young son in Vienna, Virginia. 

The story was illustrated by Marianne Greiner of Bloomfield, New York.  

For more information, visit www.authorlisasaunders.com or write to LisaSaunders42@gmail.com

The Abigail Phelps Chapter presents: Congenital Cytomegalovirus

My Story with CMV by Lisa Saunders, former licensed daycare provider

“CMV and Licensed Daycare Providers”

By Lisa Saunders

CMV is often found in child care centers. I was unaware that cytomegalovirus (CMV) was an occupational risk for daycare educators when I became a licensed home daycare provider in Maryland in 1987. I didn’t know that CMV could devastate my pregnancy with Elizabeth, who was born severely disabled by congenital CMV in 1989. 

At the time of Elizabeth’s birth, I was operating my licensed home daycare center and volunteering in our church nursery, additionally putting my pregnancy at risk. Elizabeth was born with an abnormally small head, was profoundly mentally impaired, legally blind, and had cerebral palsy. After her birth, I was given information from the Centers and Disease Control Prevention (CDC) informing me 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..." Nowhere in my daycare licensing training was CMV mentioned. CMV prevention measures were not discussed in my prenatal doctor visits.

Though Elizabeth grew into a very cheerful girl who won the "Best Smiling Award" at school, she couldn't hold up her head and lived as a three-month-old for 16 years, requiring several surgeries such as spinal fusion. She developed epilepsy and was gradually losing her hearing by the time she died at 16 during a seizure in 2006 while we were living in New York. I had a bad dream shortly after Elizabeth’s death about new parents wondering why I hadn’t done more to warn them about the precautions to take against CMV. Although I wrote about Elizabeth’s adventurous life with her tomboy sister and a series of dysfunctional pets, including a homeless older dog that joined her on the couch in my memoir, “Anything But a Dog: the perfect pet for a girl with congenital CMV,” congenital CMV still remains largely unknown.

In 2010, my husband and I moved to Connecticut. In 2012, I received an email from a distressed grandmother about her grandson born with congenital CMV in a Connecticut hospital (I am the parent representative of the Congenital Cytomegalovirus Foundation). The mother of her grandson was a high school student interning in a Connecticut daycare center. The young mother, just like me over 20 years earlier, was unaware she was putting her pregnancy at greater risk by working in daycare with young children.  When I visited the family in the hospital, the attending nurse asked me, "Knowing what you do about CMV, why haven’t you launched an awareness campaign?"

I explained to the nurse that CMV parents, scientists and doctors have been trying for years to raise awareness, but the real risk of CMV to pregnancies remains little discussed—a real tragedy for daycare workers given that every year, 8 - 20% of caregivers/teachers contract cytomegalovirus (CMV). The American Academy of Pediatrics recommends counseling caregivers of their increased exposure to CMV, importance of hand-washing, and avoiding contact with urine, saliva, and nasal secretions. Mothers of children in daycare are also at increased risk for CMV (Pass et al., 1986).

I continue to warn daycare providers wherever I can. Please share my article published by ChildCare Aware of America:  The Danger of Spreading CMV: How We Can Protect Our Children.

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ChildCare Aware of America publishes: "The Danger of Spreading CMV: How We Can Protect Our Children."

The book, "Caring for Our Children," co-authored by the American Academy of Pediatrics (AAP) makes it clear child care workers should be educated about CMV, their increased risk for it, and need for meticulous hygiene, but so few caregivers/teachers are told about CMV. I am trying to change that by speaking, blogging, and e-mailing daycare directors and licensing agencies, but it's hard to make any changes to policy. 

I am a former licensed daycare provider who never heard about CMV and my increased risk for it until after my daughter Elizabeth was born severely disabled by congenital CMV. 

ChildCare Aware of America just published my blog post, The Danger of Spreading CMV: How We Can Protect Our Children, where I use "Caring for Our Children," as a source. The post is geared to child care providers, babysitters and church nursery volunteers.  You can access and share it through this link: http://usa.childcareaware.org/2017/06/the-danger-of-spreading-cmv-how-we-we-can-protect-our-children

If you prefer Facebook, ChildCare Aware of America posted the article link on their Facebook page at: https://www.facebook.com/USAChildCare/photos/a.395624597809.177089.11189057809/10154753518262810/?type=3

Do you have any advice on how I can reach child care providers with CMV information? Since so few daycare center directors have even heard of CMV, it is very difficult. Utah passed a law requiring child care providers be informed, but very few states have such a law. I helped get a CMV testing law passed in Connecticut, but the prevention education part didn't pass because of funds (prevention education was estimated to cost Connecticut $40,000 per year). 

Many child care agencies feel they are doing their job because they are teaching hand-washing protocol, but it's important child care workers understand their CMV risk to increase their motivation for following the protocol. 

I just sent out the following newsletter in honor of June as National Congenital CMV Awareness month It includes materials of interest  to those who work in the child care industry including my list, “15 Reasons Why Childcare Providers Need to Know About CMV.” For the newsletter, click on: http://mailchi.mp/0079ebc73a87/how-to-help-cmv-prevention?e=73aaf3ceff

or click on "View this email in your browser."

You may be interested in my TV interview: Child Care and Cytomegalovirus (CMV): Protect Your Pregnancy

I would welcome any advice on how to raise CMV awareness. One way I am trying is through my educational, "color-me-in" fairy tale, Once Upon a Placemat: A Table Setting Tale,” which includes a free, downloadable school/child care teaching tool kit on table-setting and germ prevention, particularly against diseases spread through saliva. The toolkit can be accessed through: http://congenitalcmv.blogspot.com/2017/04/free-cmv-teaching-tool-once-upon.html

If you live or work in my home state of Connecticut, here is a CMV prevention flyer with the Department of Public Health logo: http://www.ct.gov/dph/lib/dph/ehdi/ncmvf_awareness_flyer_ct_dph.pdf