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Working with clay at day care allowed with CF?


In our daughter’s (3 years old, CF) day care, a corner will be set up where the children can work with clay by themselves. Since clay has to be kept humid, I am now wondering whether this is suited for her. Do you see any objections concerning germ formation, particularly of PA?

Many thanks.
Dear parent of a CF patient,

Humidity and Pseudomonas are indeed a burdensome problem for families which the day care situation certainly will not mitigate. There are a lot of advices, though unfortunately only few of them are reassuring. Since you are not alone with this Pseudomonas issue, let me tell you the following in the hope that it will bring some relief:

* The water bug is traceable everywhere, but I never found any Pseudomonas germs in several random tests – e.g. when a child bit into a toilet brush, or when the water from a rain barrel or a pool was sampled. This means that the germ does not necessarily have to be found everywhere.

Of course, the day care can not guarantee you that their facilities are Pseudomonas-free – but neither can the school, the sports club, or even your daughter’s best friend’s parents. This is where the risk of “life” starts, which everyone deals with differently. Nobody can tell you how high the risk of getting in touch with Pseudomonas is during the day-care activities you mention. There is no certainty when working with clay or play dough. Therefore, you need to carefully weigh individually “normal life” against a limited quality of life caused by fear. To be on the safe side, for instance, children going to kindergarten could have throat swabs tested for Pseudomonas more frequently. The test is not very expensive if done without resistance determination. If Pseudomonas colonization is detected early on, eradication is definitely an option!

* In 2007, Pseudomonas colonization in toddlers was still specified with >30%. In 2010, the evidence was at less than 20%. In large CF centres, the evidence threshold for this age group is currently at about 10%.

The risk is getting lower because people are being more careful.

In my opinion, parents and children should not be overly afraid of working with clay and play dough at kindergarten, if thorough and frequent microbiological monitoring with a paediatrician and at the CF centre is guaranteed.

Dr. E. Rietschel (2008) and Dr. M. Hofer (2010) came to a similar conclusion for ECORN-CF.

Kind regards
Dr. Hans-Eberhard Heuer