by Robert Needlman, M.D.

What can you do to keep children as healthy as possible all winter long?

DISEASES THAT PASS from person to person increase during the winter season - in part because we all spend more time indoors with our windows closed. Young children have even more problems because they are still building up immunity -- first by getting sick, then by fighting off the illness. (Later, however, they may have fewer infections because the next time that particular infection comes around, their bodies will be ready.)

Children in group settings are particularly susceptible to coughs, colds, flu, and diarrhea. Any wav vou look at it. minor winter infections are unavoidable. Even a healthy preschooler might have six or more colds a year. Here are some things you can do to keep illness to a minimum.

Evaluate your environment. Are your physical surroundings adequately ventilated? Are there separate areas for toileting, changing diapers, and preparing food? Do these areas have their own containers of disinfectant, disposable towels, and covered wastebaskets? Are there plenty of boxes of tissues within children's easy reach, trash cans for disposal, and low sinks where children can wash up? Remember: Frequent, careful hand washing is the single most important infection-control measure for children and staff!

Think about your kitchen area. It is so important to wash counters, cutting boards, and utensils after each use with a disinfecting solution. Make your own by mixing a cup of household bleach with a gallon of water Just remember, this inexpensive solution needs to be made fresh daily. Be careful to store bleach in a clearly marked container and lock it safely away. Children have been known to drink bleach from a white bottle, thinking it was milk.

Pay attention to your own behavior. Do you wash your hands every time you wipe a child's nose? Every time you sneeze? Do you model careful hand-washing techniques? Get into the habit of noticing-and offering positive reinforcement-when children remember to blow their noses, cover their sneezes, and wash their hands afterwards.

Keep track of immunizations. There has been exciting progress in immunization in the last few years. For children who have not had chicken pox, the American Academy of Pediatrics recommends the new varicella vaccine which has a 20-year record of safety in Japan. Let parents know they can check with their child's doctor or an immunization clinic to find out more about varicella. Another new vaccine against rotavirus, a common cause of diarrhea and vomiting in children (and a very common reason for missed days from preschool and daycare), has just been approved by the FDA. You should be hearing more about it in the years to come.

If a child has a chronic illness, particularly asthma, ask parents to consider the influenza vaccine. Since this vaccine is created new each year to combat the current most common and serious of the influenza viruses, children have to be immunized annually. Parents will also want to check with their doctors to find out whether children would benefit from vaccines against hepatitis A, pneumococcus, and meningococcus.

Most important, work with parents and families to ensure that each child is up to date for all the standard immunizations including pertussis (whooping cough), measles, and polio. Children should also be screened for exposure to tuberculosis.

Questions of the Season

What about zinc?

Earlier reports that zinc-containing medication can cure colds or prevent them have not been supported by later, better studies. Though many parents and some doctors swear by herbs for prevention or treatment, research does not substantiate that herbs work. One thing is certain: A child who is well nourished and well rested is better able to fight off minor infections.

When should children stay at home?

Children with illnesses that are highly contagious need to be excluded from group care. Here are general rules for how long to keep children home with some common illnesses: chicken pox - until every last blister has crusted over; strep throat or impetigo -after a full 24 hours of antibiotics; and conjunctivitis -- until seen by a doctor and given the okay. Children with diarrhea or vomiting should stay home until they are free of both. Children who have a fever (100°F for an infant younger than three months; 102°F for older children) must see a doctor - and "no school" until cause and treatment are determined.

How can you stay healthy?

The same environmental conditions and behaviors that keep children healthy will keep you healthy. Good handwashing can't be stressed enough! Also, if you are or might become pregnant, make sure you check with your doctor about infections that can harm a developing fetus without appearing to affect you. There may be special preca tions you'll want to take.

Robert Needlman, M.D., is an assistant professor of pediatrics at Case Western Reserve University in Cleveland, Ohio.