Kindergarten with CF/Pseudomonas

Question

Hello,

I have registered my daughter with CF for kindergarten. Now, the kindergarten possibly does not want to admit her because they cannot supervise the enzyme substitution and guarantee to avoide problematic germs (Pseudomonas). This is not only regarding the toilet but also the usage of watercolours, floating Play-Doh® [in German: Wasserknete], glue (that has to be mixed with water and is used for several days), wading pool, fountain and streamlet in the garden of the kindergarten. Does she really have to dispense with all this?????? What about the two toilets? They do have lids but the toilets are only separated by little dividers. Can it happen that the water "splashes over"???

Answer

Dear mother of a CF patient,

You are not alone with your problems. Almost all CF parents do have the same problems when their children are old enough to be enrolled in school or to start going to kindergarten. Regarding the substitution of enzymes you have to know that educators and teachers in our country [Germany] are not obliged to administer medicaments, but they are not forbidden to do so either. Therefore, you should explain the educators that enzymes are not medicaments so that they do not have to assume acute side effects after taking; in case of overdose or underdose acute problems are not to be expected. Even if healthy children swallow enzymes accidentally – and this is what educators are afraid of – they do not have to assume severe side effects. Therefore, you should talk to the director of the kindergarten again pointing out the harmlessness of enzymes.

The second part of your question is more complicated: As a matter of course the kindergarten cannot guarantee that your daughter does not come into contact with pseudomonas germs at all. But this cannot be guaranteed by the school, the sports club and the parents of your daughter's best friend either. Here starts the risk in "life" that is handled by each person in a different way. Nobody can answer you how high the risk is to come in contact with pseudomonas germs in the kindergarten with regards to the activities described above. Therefore, you have to decide individually between "normal life" and restrictions of life quality caused by fear. To make a long story short: We recommend our pseudomonas negative patients to take throat swaps every month in order to discover a colonization by pseudomonas as early as possible and then to treat it respectively what suceeds in many cases.

Best regards
Dr. E. Rietschel

23.04.2008