As Maryland's hospitals brace for the worst that the swine flu pandemic could offer, they are making big changes in the way they handle visitors - restricting children, limiting certain adult visitors and issuing face masks at entrances - in an effort to stem the virus' spread.

In a recent poll by the Maryland Hospital Association, 15 of 39 hospitals' representatives said they had already put new policies into place. Almost all of the others said they are considering a policy change but hadn't finalized the details.

Hospitals officials say the new restrictions are necessary for what is expected to be a severe and unpredictable flu season.

Children and young adults are particularly vulnerable to this new flu, succumbing to serious illness and complications at higher rates than adults. With less than ideal hygiene, children are also known to spread the flu fast. Limiting child visitors means keeping hospital staff healthy and shielding patients - both adults and children - from serious medical complications, administrators said.

"Children with asthma, with underlying medical conditions, who contract the H1N1 flu are at greater risk," said Dr. Steven Czinn, chief of pediatrics at the University of Maryland Medical Center, whose 120-bed Hospital for Children is restricting visitors to two adults and no children under 12. "And so, we really need policies in place to do whatever is possible so that children who are in the hospital being treated for other medical conditions are not at risk to visitors to contract the flu."

Administrators will make exceptions in some circumstances, and they realize the changes are difficult for families, Czinn said.

"We're trying to balance the benefits of having family members around with regard to the heeling process with preventing unnecessary potential exposure to flu virus."

Still, some patients are upset about the new guidelines. They say that instead of establishing blanket restrictions on children, hospitals should allow people to use common sense when visiting sick family members.

Kimberly Franklin, who is preparing for her scheduled C-section next week, had envisioned an intimate family moment taking place around her hospital bed: she, her husband and their 3-year-old son Connor welcoming a new baby boy to the family.

But because of a new policy, Connor won't be allowed at his mother's side. The policy at St. Joseph's Medical Center in Towson prevents children age 12 and under - including siblings - from visiting new moms and babies.

"All my hopes were dashed," said Franklin, 35, of Towson. "I was livid. ... I don't know of any parent of an older child who would let their kid come visit them if they have the flu. I just think it makes more sense to have kids tested for symptoms, have them wear a mask and Purell them up."

Franklin considered switching to a doctor she had never even met, hoping that another hospital would allow Connor to visit. But she soon learned hospitals across the Baltimore region were implementing similar policies.

St. Joseph's typically restricts children 12 and younger from the hospital's mother-baby unit during flu season from October through April, said Lisa Scheidelman, infection control practitioner, who works to prevent and monitor infections at the hospital. But this is the first time the hospital has banned young siblings.

The policy went into effect at the end of September and it's unclear when it may end. "Given that we have the H1N1 circulating and it's a ramped up flu season, we can't say when it's ending," she said.

Policies could tighten further
Scheidelman said the start of the new policy may be a "bumpy road" for new mothers eager to have their entire families with them after the birth of a new baby. But the change is necessary to protect the health of infants, their mothers and pregnant women, who are all at greater risk for complications from the virus, she said.

In addition, anyone with flulike symptoms may not visit new mothers or babies in the St. Joseph's unit, she said. Elsewhere in the hospital, fliers alert visitors to practice good hygiene by washing their hands often and sneezing into their sleeves. They also urge people not to visit the hospital if they have a fever along with a sore throat, cough or running nose.

Scheidelman said if the pandemic becomes severe, policies would be made more restrictive. Visitors would be limited to one patient per day. Hospital staff would keep strict logs of visitors and would screen them for fever at the hospital entrance.

In drawing up new restrictions, officials at Greater Baltimore Medical Center took into account guidance from the Centers for Disease Control and Prevention, which advises hospitals to schedule and control visits and screen visitors for respiratory illness.

"Visitors may be offered a gown, gloves, eye protection, and respiratory protection," according to the guidance.