"While we think everybody should take the flu seriously, children less than 5 years old are at high risk for complications from the flu," U.S. Secretary of Health and Human Services Kathleen Sebelius said during a morning press conference. "Tragically, children do die, whether it's H1N1 or seasonal flu."

Sebelius noted that the new H1N1 swine flu is "a young people's disease" that can spread quickly in schools and child-care settings. "Children tend to share toys, cough and sneeze and not wash their hands, making early childhood programs a great incubator for these germs to spread rapidly," she noted.

To combat the spread of the swine flu, children in early child-care programs should be at the front of the line to get the H1N1 vaccine when it becomes available in mid-October, Sebelius said. Children should also get a seasonal flu shot, which is available now, she added.

In addition, since children under 6 months of age can't get these vaccines, Sebelius stressed the need for parents, caregivers and daycare staffers to get vaccinated to protect their children and themselves. And, since pregnant women are also at high risk for complications from the H1N1 flu, they should also get their flu shots, she said.

"We believe the vaccines are safe," Sebelius said. "By the time the H1N1 vaccine is ready to go, we will know it is safe. We won't release it until we know the proper dosage and we know it's safe."

If children or daycare staffers get the swine flu, they should stay home and remain there for 24 hours after their fever subsides without using any fever-reducing medications, Sebelius said.

Parents and daycare providers also need to plan now for a swine flu outbreak, Sebelius said. "Parents need to figure out what to do if their child-care center closes. For providers, it is critical to think about staffing and who can step in as temporary staff," she said.

Daycare providers should monitor children and staffers for signs of the flu, Dr. Beth Bell, associate director for science at the National Center for Immunization and Respiratory Diseases, said during the teleconference.

"Program providers should do a daily health check of children and staff looking for signs of illness, so that sick children and staff can be identified, can be separated from well people as soon as possible and, when feasible, sent home," she said.

The CDC guidelines included these recommendations:

• Wash hands often with soap and water; keep hands away from the nose, mouth and eyes; and cover noses and mouths when coughing or sneezing. Use a shirt sleeve or elbow if no tissue is available.
• Clean the environment regularly. Areas and items that are dirty should be cleaned immediately, and all areas should be regularly cleaned, especially toys and play areas.
• Staffers at high risk for flu complications and parents of children under age 5 who become ill with flu-like illness should call their doctor as soon as possible to see if they need antiviral treatment.
• If the swine flu outbreak is severe, consider temporarily closing the daycare center to decrease the spread of infection. This decision should be made locally, in concert with public health officials, and should balance the risks of keeping a program open with the social and economic problems that can come from closing a program.

These guidelines may need to be revisited and revised should the swine flu prove more dangerous this fall and winter, health officials said. Under those conditions:

• Let high-risk staffers stay home.
• Increase the distance between children, and separate children into small groups of six or less.
• Have children stay home if there are others in the household with the swine flu.
• There may also be the need to close the program either as a reaction to the outbreak or as a preventive closure.