The Lifespan hospitals have barred children from visiting patients, along with a number of hospitals around the country that have adopted this restriction to prevent the spread of H1N1 swine flu.

Rhode Island Hospital, Hasbro Children’s Hospital, Miriam Hospital and Newport Hospital are the only ones in Rhode Island to take this step. The others, for now, are merely urging visitors to stay home if they are sick and providing hand sanitizer and face masks.

At Women & Infants Hospital –– whose patients include pregnant women and tiny babies, the people most vulnerable to swine flu –– a spokeswoman said the hospital would restrict visitation in the coming weeks but has not yet finalized its plans.

Lifespan’s ban on children visitors applies to anyone under age 18. The hospitals are also prohibiting anyone with flu symptoms, such as fever or cough, from visiting patients.

Mary Reich Cooper, Lifespan’s senior vice president and chief quality officer, said the Lifespan hospitals were among the first in the country to forbid visitation by children. Since the policy went into effect Sept. 21, others have followed suit, including hospitals in Alabama, North Carolina, Virginia and Ohio. All those states have been hit with swine flu earlier and harder than Rhode Island.

Cooper said exceptions can be made for children in special circumstances –– such as when a new sibling is born at Newport Hospital or a terminally ill relative takes a turn for the worse.

Children are a concern because they can be contagious for a day or so before and after they have flu symptoms, Cooper said. “Children seem to shed the virus a little bit longer,” she said. “Even when children look healthy, they may be in the prelude or aftermath.”

Cooper said the restrictions emerged from a group of Lifespan experts in infectious disease that meets weekly. “The group brought as much science into the decision as possible,” she said.

“We’re asking for the support of the community. Please understand we’re doing this for everyone’s safety. We’re asking people not to come to the hospital if they’re sick. … This is not for people coming in to see their doctors. This is for people coming in to see other patients.”

Posters around the hospital tell of the ban on children, and urge people with flu-like symptoms not to visit patients and to wear a mask if they’re coming for a doctor’s visit. “Cough etiquette stations” dispense hand sanitizer and face masks.

Cooper says the restrictions are being enforced, gently, by people at the reception and triage desks, who explain the policy and the reason for it. “We haven’t really had any significant situations where people have been resistant. We’ve had people thank us,” Cooper said. “I think the first several days, people were a little bit more confused about it. Since then, we have had great cooperation among the community.”

Bradley Hospital, a children’s psychiatric hospital, is also part of the Lifespan system, but it requires a different approach. Because they are young, the children at Bradley are at risk for swine-flu infection, but most are not physically weakened. And their recovery often depends on interaction with family members.

“Their guidelines are not as restrictive,” Cooper said. “People are encouraged if they have symptoms to not come in to visit patients or have any kind of close-quarters confinement with people who are hospitalized.”

But if a family member is participating in a therapeutic meeting, the person won’t be banned because of symptoms. Instead, the meeting might move into a location separate from other people.

The other hospitals in Rhode Island have committees discussing swine flu, most on a weekly basis, but have each decided that visitor restrictions are not yet necessary. Instead, they have trained staff and posted signs asking people who are ill not to visit patients.

Westerly Hospital, for example, recently posted on its Web site what spokesman Brian Jordan called “a kind suggestion.” The statement reads, “During this seasonal and H1N1 flu season, the Westerly Hospital kindly requests that you consider NOT visiting Hospital patients if you are sick or not feeling well.”

“We have not seen widespread effects of H1N1 yet,” said Bill Fischer, spokesman for Landmark Medical Center, in Woonsocket. “If we start to see a change, we won’t be asking; we’ll be telling. … We won’t be saying, ‘please don’t.’ We will say, ‘You will not be allowed to visit patient rooms [while sick].’ ”

ffreyer@projo.com