Watch the following TED-Ed video and answer the questions one by one below. https://www.youtube.com/watch?v=yxonJTWhBJQ&t=2s

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Chapter 11. Managing Infectious Diseases

Science and experience tell us that infectious disease, especially gastrointestinal disease, which means vomiting and diarrhea, and respiratory disease, including coughs, colds, sore throats, and runny noses, are increased among children who are cared for in out-of-home group settings. In addition, such children may be at increased risk for certain other infections that may be transmitted by insects or by body fluids. It's also true that children who are cared for in group out-of-home settings are more likely to experience infectious illnesses that are more severe and more prolonged (although 90% of those infections are mild and self-limited, requiring no special treatment).

But there's good news, too. Infectious illnesses such as pneumonia and influenza, which together were the leading causes of death among U.S. children in the early 20th century, have declined 99.7 percent. Common childhood illnesses such as diphtheria, whooping cough, measles, mumps, and rubella are rare except in communities where immunization rates are low, and polio is unheard of in our country today.

Although younger children are more susceptible to infectious illness because their immune systems are immature, as they grow older, the incidents of infectious disease decreases as their immune systems mature. Furthermore, children who experience more infectious disease at an early age in group out-of-home care have a decreasing incidence of infectious disease as they grow older. In fact, they have less infectious illnesses in kindergarten than children who were taken care of exclusively at home. Illness also decreases with years of attendance in out-of-home early care and education settings.

Figure 11.1. As children get older, they get sick less often. Image by College of the Canyons ZTC Team is based on image from Managing Infectious Disease in Head Start Webinar by Head Start Early Childhood Learning & Knowledge Center, which is in the public domain

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There are negative consequences of childhood illness, including: ● It’s unpleasant to be sick (for children or the adults that may also become infected). ● Illnesses that are minor in children can be much more serious for adults and pregnant

women. ● Some illnesses have severe effects (and can even be life-threatening). ● There are short-term medical costs. ● There may also be additional child care costs or lost wages for parents/caregivers of

children that must be excluded from group care. ● Overuse of antibiotics in an effort to get children well contributes to antibiotic resistance

among common bacteria.

To prevent illness we need to understand the different ways illness is spread, how immunizations protect children, and what universal precautions early care and education program staff can take to prevent the spread of illness.

Learning Objectives

At the end of this chapter, you should be able to: ● Describe each of the ways illness is transmitted. ● Identify symptoms of infectious disease that is common during early childhood. ● Explain how immunization prevents illness. ● Identify standard precautions to prevent illness. ● Outline criteria for exclusion from care for ill children and staff. ● Recall licensing requirements for handling medication in early care and education

programs. ● Explain the communication about illness that should happen between families and early

care and education programs.

How Illnesses are Transmitted

Bacteria, viruses, fungi, and parasites that cause illness can be transmitted in five ways, including through:

1. the respiratory route 2. the fecal-oral route 3. the direct contact route 4. the bodily fluid route (including blood, urine, vomit, and saliva) 5. the vector-borne route

Respiratory Transmission

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Most respiratory germs stay in the nose, sinuses, mouth and throat, or possibly the middle ear. Upper respiratory illnesses (colds) are the most common and the most likely to be transmitted in early care and education settings.

The more common respiratory illnesses include: ● Sinusitis ● Sore throat ● Common cold ● Recurrent middle ear infection ● Strep throat ● RSV ● Pneumonia ● Bronchitis

Pneumonia and bronchitis are rarely the result of an infection picked up in an early education setting. We also have immunizations for many respiratory diseases that are rarely transmitted in early care and education settings today, including:

● Mumps ● Measles ● Bacterial meningitis ● Chicken pox ● Diphtheria ● Pertussis ● Pneumonia ● Seasonal flu

If we could actually see what comes out of a child’s mouth along with a cough or a sneeze, we might appreciate the respiratory route of infectious disease transmission more.

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Figure 11.2. What it might look like if we could see what a child coughs or sneezes. Image from Managing Infectious Disease in Head Start Webinar by Head Start Early Childhood Learning & Knowledge Center is in the public domain.

The germs that are in this contaminated cloud of exhalation can wind up on surfaces and hands and be transmitted to others. Staff and children who are able to are encouraged to cough into their sleeves. Covering your mouth with your hand only transfers these germs to your hand. This will be addressed more in depth later in the chapter.

Fecal-Oral Transmission

When organisms that live in our intestines get into our mouths they can cause illness. Usually, this happens via someone’s hands, usually our own. Fecal-oral routes diseases include:

● Hepatitis A ● diarrhea ● hand, foot, and mouth disease ● pinworms ● rotavirus ● norovirus ● giardia ● shigella ● cryptosporidiosis

That is why it is so important that everyone wash hands after using the bathroom, changing diapers, when preparing food, and before eating.

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Direct Contact Transmission

Direct contact with another person’s skin (or hair) puts infants and children at risk of illnesses such as:

● cold sores ● conjunctivitis ● pink eye ● impetigo ● lice ● scabies ● ringworm (a fungus, not a worm).

Bodily Fluid Transmission

Bodily fluids, including saliva, urine, vomit, and blood, can cause illness, such as: ● Dental caries (by saliva) ● Cytomegalovirus or CMV (by urine) ● Hepatitis B (preventable by vaccine) ● Hepatitis C (rare in children) ● HIV (no cases of transmission in an early education setting)

Vector-Borne Transmission

A vector is a living thing that can transmit disease. We know, for example, that ticks can transmit Lyme disease and Rocky Mountain spotted fever. Fleas are known to transmit Bubonic plague and typhus. Mosquitoes can infect people with St. Louis encephalitis (SLE), dengue fever, Zika virus, and West Nile disease. Rats and mice can transmit leptospirosis, trichinosis, hantavirus, and bacterial food poisoning. Raccoons can spread raccoon roundworm.

While these illnesses are relatively uncommon, the risk reminds us of the importance of ● utilizing integrated pest management techniques to keep insects and rodents out of

buildings (covered later in this chapter) ● using insect repellant specifically recommended for children during outdoor activities ● removing standing water in which mosquitoes can lay their eggs

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● checking for and removing ticks in centers when children come back in after playing in or near heavily wooded areas.1

Universal Precautions to Prevent the Spread of Illness There are some standard practices that prevent, or reduce the risk of, the spread of illness in early care and education programs. These are modeled after practices in health care, where everyone is treated as being potentially infected with something that is contagious. Many illnesses are actually contagious before the infected person is symptomatic, so waiting until you see signs of illness is an ineffective way of preventing its spread. Child care providers can practice these four things to help control the spread of illness:

1. Hand washing 2. Use of disposable nonporous gloves when working with bodily fluids 3. Disinfecting potentially contaminated surfaces 4. Proper disposal of potentially contaminated waste2

Handwashing Regular handwashing is an important step to minimizing the spread of germs. Hands pick up germs from all of the things they touch and then spread them from one place to another. Germs that are on hands can also enter the body when a person eats or when they touch their eyes, nose, mouth, or any area on the body where the skin is broken (because of a cut, rash, etc.). All that is needed for handwashing is soap and clean, running water. Handwashing with soap and water removes visible dirt and hidden germs. Studies have demonstrated that handwashing reduced the number of diarrheal illnesses by 31 percent and respiratory illnesses by 21 percent. Hands should be washed:

● before eating, feeding, or preparing food. This prevents germs from getting into the mouth from hands.

● after touching saliva (after feeding or eating), mucus (wiping a nose, using a tissue), bodily fluids (toileting, diapering), food, or animals

● when visibly dirty, after touching garbage, or after cleaning

The Center for Disease Control recommends the following handwashing steps: 1. “Wet your hands with clean, running water (warm or cold) and apply soap.” 2. “Rub your hands together to make a lather and scrub your hands well; be sure to scrub

the backs of your hands, between your fingers, and under your nails.”

2 California Child Care Health Program. (2011). Health and Safety in the Child Care Setting: Prevention of Infectious Disease. University of California San Francisco.

1 Managing Infectious Disease in Head Start Webinar (Transcript) by Head Start Early Childhood Learning & Knowledge Center is in the public domain.

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3. “Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.”

4. “Rinse your hands well under running water.” 5. “Dry your hands using a clean towel or air dry them.”

Figure 11.3. Illustrations of the 5 steps of handwashing. Stop Germs! Wash Your Hands by the Centers for Disease Control and Prevention is in the public domain

Infants and young children will need help with handwashing. Caring for Our Children recommends that caregivers:

● Safely cradle an infant in one arm to wash their hands at a sink. ● Provide assistance with handwashing for young children that cannot yet wash their

hands independently. ● Offer a stepping stool to young children so they may safely reach the sink.3

Wearing Disposable Gloves Teachers and caregivers should wear gloves when they anticipate coming into contact with any of the following (on a child’s body or a contaminated surface)

● Blood or bodily substances (i.e., fluids or solids) ● Mucous membranes (e.g., nasal, oral, genital area) ● Non-intact skin (e.g., rashes or cuts and scrapes)4

Once the gloves are soiled, it’s important to remove them carefully. 1. Using a gloved hand, grasp the palm area of the other gloved hand and peel off the first

glove. 2. Hold the removed glove in the gloved hand. 3. Slide fingers of the ungloved hand under the remaining glove at the wrist and peel off the

second glove over the first glove. 4. Discard the gloves in a waste container.5

5 Sequence for Putting On Personal Protective Equipment (PPE) by the Centers for Disease Control and Prevention is in the public domain.

4 The Basics of Standard Precautions by Karen Jones, Linda R. Greene, and Lona Mody is in the public domain.

3 Health Tips for Home Visitors to Prevent the Spread of Illness by Head Start National Center on Health is in the public domain.

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Figure 11.4. Safe glove removal. Image by the Centers for Disease Control and Prevention is in the public domain

After you remove your gloves you should wash your hands. “Do not reuse the gloves: this can spread germs from one child to another…Gloves provide added protection from communicable disease only if used correctly. If you use gloves incorrectly, you actually risk spreading more germs than if you don’t use gloves at all. Pay attention to your gloving technique so that you do not develop a false sense of security (and carelessness) when wearing gloves.”6

Cleaning and Disinfecting Washing Surfaces Germs spread onto surfaces from hands and objects (tissues or mouthed toys) or from a sneeze or cough. It is important to clean all surfaces well, including toys and any surface that a young child puts in his mouth, because germs cannot be seen and it is easy to overlook surfaces that do not look soiled or dirty.

Toileting and diapering involve germs from bodily fluids and fecal material. These germs spread easily in a bathroom onto hands, flushers, and faucets. Routinely washing bathroom surfaces removes most germs and prevents them from spreading. The kitchen is another area of the home where it is important to clean surfaces well.

The terms “cleaning,” “sanitizing,” and “disinfecting” deserve close attention.

Cleaning removes visible soil, dirt, and germs. Soap and water will clean most surfaces.

Sanitizing reduces, but does not totally get rid of, germs to a level that is unlikely to cause disease. Sanitizers may be appropriate to use on surfaces where you eat (such as a table or high chair tray) and with toys that children place in their mouths. It is important to follow the instructions on the label, which may also include rinsing surfaces after using the sanitizing product.

6 California Child Care Health Program. (2011). Health and Safety in the Child Care Setting: Prevention of Infectious Disease. University of California San Francisco.

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Disinfecting destroys or inactivates infectious germs on surfaces. Disinfectants may be used on diaper-changing tables, toilets, and countertops.7

Early care and education programs can create a bleach and water solution of one tablespoon household bleach to one quart water for surfaces that need to be sanitized or disinfected. To use effectively, the surface must be wetted with the solution and allowed to air dry. A fresh bleach solution should be made each day to maintain effectiveness, and stored in a clearly labeled spray bottle out of children’s reach. Research shows that other chemicals (e.g. ammonia, vinegar, baking soda, Borax) are not effective against some bacteria.8 “Items that can be washed in a dishwasher or hot cycle of a washing machine do not have to be disinfected because these machines use water that is hot enough for a long enough period of time to kill most germs.”9

Cleaning and disinfecting are essential. Studies have shown that some germs, including influenza virus, can survive on surfaces for two to eight hours; rotavirus can survive up to 10 days.10

Surface/Item Clean Disinfect Frequency

Countertops and Tabletops X X Daily and when soiled

Food prep and service areas X X Before and after use; between prep of raw and cooked food

Floors X X Daily and when soiled

Door and cabinet handles X X Daily and when soiled

Carpets and large rugs X Vacuum daily; clean monthly for infants, every 3 months for other ages and when soiled

Small rugs X Shake or vacuum daily; launder weekly

Utensils, surfaces, and toys that go in the mouth or have been in contact with bodily fluids

X X After each child’s use

Toys not contaminated with bodily fluids X Weekly

Dress up clothes not worn on the head X Weekly

10 California Preschool Curriculum Framework (Volume 2) by the California Department of Education is used with permission.

9 California Child Care Health Program. (2011). Health and Safety in the Child Care Setting: Prevention of Infectious Disease. University of California San Francisco.

8 California Preschool Curriculum Framework (Volume 2) by the California Department of Education is used with permission.

7 Health Tips for Home Visitors to Prevent the Spread of Illness by Head Start National Center on Health is in the public domain.

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Hats X After each child’s use

Sheets and pillowcases X Weekly and when visibly soiled

Blankets and sleeping bags X Monthly and when visibly soiled

Cubbies X Weekly

Cribs X Weekly

Handwashing sinks including faucet, soap dispenser, and surrounding area X X Daily or when soiled

Toilet seats, handles, door knobs or handles in toileting area, floors X X Daily and immediately is soiled

Toilet bowls X X Daily

Changing tables X X After each child’s use

Potty chairs (discouraged in child care because of contamination risks) X X After each child’s use

Any surface contaminated with bodily fluids (saliva, mucus, vomit, urine, stool, or blood) X X Immediately

Water containers X X Daily

Table 11.1. Schedule for Cleaning and Disinfecting. Source: Table 8.2. Paris, J. Chapter 8. Prevention of Illness. Safety, Health, and Nutrition in Early Childhood Education. College of the Canyons. V1.0; 2020. CC BY 4.0

Disposal of Waste Proper disposal and storage of garbage waste prevent the spread of disease, odors, and problems with pests. Disposable items (diapers, gloves, paper towels, and facial tissues) should be thrown away immediately in an appropriate container. Make sure the container is water and rodent-proof, operated with a foot pedal, is lined with a plastic bag, within reach of diaper changing area, handwashing sink, and food preparation areas, out-of-reach of and unable to be knocked over by infants and toddlers. The containers should be emptied, cleaned, and sanitized daily.11

Diaper Changing

11 California Child Care Health Program. (2011). Health and Safety in the Child Care Setting: Prevention of Infectious Disease. University of California San Francisco.

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Diaper changing areas should be smooth and nonporous (such as a plastic-covered pad), have a raised edge to prevent children from falling, be near a sink, be out of reach from children, and away from food preparation areas.12

The following diaper changing procedure should be posted in the changing area and followed to protect the health and safety of children and staff:

1. Before bringing the child to the diaper changing area, perform hand hygiene (including putting on gloves, if using) and bring supplies to the diaper changing area, and place a disposable liner on the changing area.

2. Carry/bring the child to the changing table/surface, keeping soiled clothing away from you and any surfaces you cannot easily clean and sanitize after the change. Always keep a hand on the child.

3. Remove the soiled diaper and clothing without contaminating any surface not already in contact with stool or urine. Put soiled diaper in covered waste container. Put any soiled clothing in a plastic bag that is securely closed to give to family.

4. SClean the child’s diaper area with disposable wipes and place soiled wipes into a covered waste container.

5. Remove the disposable liner and gloves and place in waste container 6. Use facial tissue to apply any creams or ointments. Slide clean diaper under the child

and fasten it and dress the child. 7. Wash the child’s hands and return the child to a supervised area. 8. Clean and disinfect the diaper-changing surface and any equipment or supplies that

were touched (and any other area child soiled before changed). 9. Perform hand hygiene and record the diaper change, diaper contents, and/or any

problems.

Caregivers/teachers should never leave a child unattended on a table or countertop. A safety strap or harness should not be used on the diaper changing table/surface.13

If Using Potty Chairs

Due to being hard to clean and disinfect, potty chairs are not ideal in a child care environment. If they are used, they should be used in the bathroom only. After each use:

● Empty contents immediately into the toilet ● Rinse with water and dump water into the toilet ● Wash with soap and water (with a paper towel) and empty soapy water into the toilet ● Rinse again and empty into the toilet ● Spray with bleach solution ● Air dry ● Wash and disinfect sink

13 Diaper Changing Procedure by Head Start Early Childhood Learning & Knowledge Center is in the public domain.

12 California Child Care Health Program. (2011). Health and Safety in the Child Care Setting: Prevention of Infectious Disease. University of California San Francisco.

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● Wash hands (child and adult)14

Immunizations

Prevention of infectious disease starts with immunizations (or vaccines). Immunizations are considered the number one public health intervention of the 20th century and one of the top 10 interventions of the first decade of the 21st century.15

On-time vaccination throughout childhood is essential because it helps provide immunity before children are exposed to potentially life-threatening diseases. Vaccines are tested to ensure that they are safe and effective for children to receive at the recommended ages.16

Fully vaccinated children in the U.S. are protected against sixteen potentially harmful diseases. Vaccine-preventable diseases can be very serious, may require hospitalization, or even be deadly — especially in infants and young children.17

To view current immunizations requirements, visit the CDC Immunization Schedule website.

How Vaccines Work

The immune system helps the human body fight germs by producing substances to combat them. Once it does, the immune system “remembers” the germ and can fight it again. Vaccines contain germs that have been killed or weakened. When given to a healthy person, the vaccine triggers the immune system to respond and thus build immunity.

Before vaccines, people became immune only by actually getting a disease and surviving it. Immunizations are an easier and less risky way to become immune.

Vaccines are the best defense we have against serious, preventable, and sometimes deadly contagious diseases. Vaccines are some of the safest medical products available, but like any other medical product, there may be risks. Accurate information about the value of vaccines as well as their possible side effects helps people to make informed decisions about vaccination.

17 Vaccines for Your Children: Protect Your Child at Every Age by the CDC is in the public domain

16 For Parents: Vaccines for Your Children by the CDC is in the public domain

15 Managing Infectious Disease in Head Start Webinar (Transcript) by Head Start Early Childhood Learning & Knowledge Center is in the public domain

14 California Child Care Health Program. (2011). Health and Safety in the Child Care Setting: Prevention of Infectious Disease. University of California San Francisco.

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Potential Side Effects

Vaccines, like all medical products, may cause side effects in some people. Most of these side effects are minor, such as redness or swelling at the injection site. Read further to learn about possible side effects of vaccines.

Any vaccine can cause side effects. For the most part, these are minor (for example, a sore arm or low-grade fever) and go away within a few days.18 Serious side effects after vaccination, such as severe allergic reaction, are very rare.19

Remember, vaccines are continually monitored for safety, and like any medication, vaccines can cause side effects. However, a decision not to immunize a child also involves risk and could put the child and others who come into contact with him or her at risk of contracting a potentially deadly disease.

How Well Do Vaccines Work?

Vaccines work really well. No medicine is perfect, of course, but most childhood vaccines produce immunity about 90–100% of the time.

What about the argument made by some people that vaccines don’t work that well and that diseases would be going away on their own because of better hygiene or sanitation, even if there were no vaccines?

That simply isn’t true. Certainly better hygiene and sanitation can help prevent the spread of disease, but the germs that cause disease will still be around, and as long as they are they will continue to make people sick.

All vaccines must be licensed (approved) by the Food and Drug Administration (FDA) before being used in the United States, and a vaccine must go through extensive testing to show that it works and that it is safe before the FDA will approve it. Among these tests are clinical trials, which compare groups of people who get a vaccine with groups of people who get a control. A vaccine is approved only if the FDA makes the determination that it is safe and effective for its intended use.

If you look at the history of any vaccine-preventable disease, you will virtually always see that the number of cases of disease starts to drop when a vaccine is licensed. Vaccines are the most effective tool we have to prevent infectious diseases.

19 Making the Vaccine Decision by the CDC is in the public domain.

18 Disease Prevention and Healthy Lifestyles references Contemporary Health Issues by Judy Baker, Ph.D., licensed under CC BY-SA 4.0

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Illness in Early Care and Education Programs The most frequent infectious disease symptoms that are reported by early care and education settings are sore throat, runny nose, shortness of breath or cough, fever, vomiting and diarrhea (gastroenteritis), earaches, and rashes.

Figure 11.5. Respiratory symptoms are by far the most common for children in care. Image by College of the Canyons ZTC Team is based on image from Managing Infectious Disease in Head Start Webinar by Head Start Early Childhood Learning & Knowledge Center, which is in the public domain.

However, these are not the symptoms that necessarily lead to absences. In fact, although respiratory symptoms are most common, it’s rashes and gastrointestinal disease that more often keep children from attending their early education programs. This is more a reflection of exclusion policies than real risk of serious illness.20

20 Infectious Diseases: Prevention and Management by Head Start Early Childhood Learning & Knowledge Center is in the public domain.

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Figure 11.6. Rashes, vomiting, and diarrhea results in the most absences from care. Image by College of the Canyons ZTC Team is based on image from Managing Infectious Disease in Head Start Webinar by Head Start Early Childhood Learning & Knowledge Center, which is in the public domain.

It’s important for early childhood programs to identify illness accurately and respond in ways that protect all children and staff health (whether it be to allow them to stay in care or to exclude them from care).

Identifying Infectious Diseases

When you are familiar with different infectious diseases, it’s easier to identify them in children and know whether or not children (and staff) who are affected should be excluded from the early care and education program.

Bronchitis (Chest Cold) A chest cold occurs when the airways of the lungs swell and produce mucus in the lungs. That’s what produces the cough. A chest cold, often called acute bronchitis, lasts less than 3 weeks and is the most common type of bronchitis.

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Figure 11.7. Swelling of airways in the lungs produces mucus in the lungs and makes you cough. Image by the National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion is in the public domain.

Acute bronchitis is usually caused by a virus and often occurs after an upper respiratory infection. Bacteria can sometimes cause acute bronchitis, but even in these cases, antibiotics are NOT recommended and will not help an infected person get better.

Symptoms of acute bronchitis last less than 3 weeks and can include: ● Coughing with or without mucus ● Soreness in the chest ● Feeling tired (fatigue) ● Mild headache ● Mild body aches ● Sore throat21

Most chest colds will get better on their own within one week and are not cause for exclusion from child care.

Chickenpox Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It can cause an itchy, blister-like rash. The rash first appears on the chest, back, and face, and then spreads over the entire body, causing between 250 and 500 itchy blisters. Chickenpox can be serious, especially in babies, adolescents, adults, pregnant women, and people with a weakened immune system. The best way to prevent chickenpox is to get the chickenpox vaccine.22

22 About Chickenpox by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

21 Chest Cold (Acute Bronchitis) by the National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion is in the public domain.

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The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn into scabs. The rash may first show up on the chest, back, and face, and then spread over the entire body, including inside the mouth, eyelids, or genital area. It usually takes about one week for all of the blisters to become scabs.

Figure 11.8. An unvaccinated child with chickenpox. Image by the Public Health Image Library (PHIL) is in the public domain

Other typical symptoms that may begin to appear 1-2 days before rash include: · fever · tiredness · loss of appetite · headache23

The virus spreads mainly through close contact with someone who has chickenpox (or shingles). It takes about 2 weeks (from 10 to 21 days) after exposure to a person with chickenpox or shingles for someone to develop chickenpox. A person with chickenpox is contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted (scabbed).24

“Children/staff with chickenpox should be excluded for six days after the rash first appears or until all blisters are crusted over and dry.”25

25 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Chickenpox. University of

California San Francisco.

24 Chickenpox (Varicella): Transmission by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

23 Chickenpox (Varicella): Signs and Symptoms by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

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Common Cold

A child is sneezing and has a stuffy, runny nose. It’s quite likely that they have a common cold. As presented in Chapter 10, children get sick many times a year, probably between 4 and 12 times, depending on age and amount of time in child care. Many of these are likely due to the common cold. More than 200 viruses can cause a cold, but rhinoviruses are the most common type.

Figure11.9. When you have a cold, mucus fills your nose and could cause post-nasal drip, headache, and a sore throat. Image by the Centers for Disease Control and Prevention is in the public domain.

Symptoms of a cold usually peak within 2 to 3 days and can include: ● Sneezing ● Stuffy nose ● Runny nose ● Sore throat ● Coughing ● Mucus dripping down your throat (post-nasal drip) ● Watery eyes ● Fever (although most people with colds do not have fever)

When viruses that cause colds first infect the nose and air-filled pockets in the face (sinuses), the nose makes clear mucus. This helps wash the viruses from the nose and sinuses. After 2 or 3 days, mucus may change to a white, yellow, or green color. This is normal and does not mean an antibiotic is needed. Some symptoms, particularly runny nose, stuffy nose, and cough, can last for up to 10 to 14 days, but those symptoms should be improving during that time.

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There is no cure for a cold. It will get better on its own—without antibiotics. When a child with a cold is feeling well enough to participate and staff are able to provide adequate care for them and all of the other children, the child does not need to be excluded from care. Because colds can have similar symptoms to flu, it can be difficult to tell the difference between the two illnesses based on symptoms alone. Flu and the common cold are both respiratory illnesses, but they are caused by different viruses.26

Conjunctivitis (Pink Eye) Pink eye, or conjunctivitis, is one of the most common and treatable eye conditions in the world. It can affect both children and adults. It is an inflammation of the thin, clear tissue that lines the inside of the eyelid (conjunctiva) and the white part of the eyeball. This inflammation makes blood vessels more visible and gives the eye a pink or reddish color.

Figure 11.10. A healthy eye compared to one infected with conjunctivitis. Image by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

The symptoms may vary, but usually include: ● Redness or swelling of the white of the eye or inside the eyelids ● Increased amount of tears ● Eye discharge which may be clear, yellow, white, or green ● Itchy, irritated, and/or burning eyes ● Gritty feeling in the eye ● Crusting of the eyelids or lashes ● Contact lenses that feel uncomfortable and/or do not stay in place on the eye

There are four main causes of pink eye: ● Viruses ● Bacteria ● Allergens (like pet dander or dust mites)

26 Common Cold by the Centers for Disease Control and Prevention is in the public domain.

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● Irritants (like smog or swimming pool chlorine) that infect or irritate the eye and eyelid lining

It can be difficult to determine the exact cause of pink eye because some signs and symptoms may be the same no matter the cause. When pink eye is caused by a virus or bacteria, it is very contagious. It can spread easily and quickly from person to person (through contact with the discharge from the infected eye). Pink eye caused by allergens or irritants is not contagious.27

If a child has discharge from the eye, they should be excluded from care until they have been examined and cleared for re-admission by a health care provider “with or without treatment as determined by the health provider…They do not need to be sent home in the middle of the day. Children with conjunctivitis caused by allergies need not be excluded.”28

Ear Infections

There are different types of ear infections. Middle ear infection (acute otitis media) is an infection in the middle ear.

Another condition that affects the middle ear is called otitis media with effusion. It occurs when fluid builds up in the middle ear without being infected and without causing fever, ear pain, or pus build-up in the middle ear.

When the outer ear canal is infected, the condition is called swimmer’s ear, which is different from a middle ear infection.

28 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Conjunctivitis (Pink Eye).

University of California San Francisco.

27 Conjunctivitis (Pink Eye): Treatment by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

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Figure 11.11. A healthy ear and an infected ear, including outer, middle, and inner ear, showing inflammation and fluid in the ear. Image by the Centers for Disease Control and Prevention is in the public domain.

Middle Ear Infection

A middle ear infection may be caused by: ● Bacteria, like Streptococcus pneumoniaeand Haemophilus influenza (nontypeable) – the

two most common bacterial causes ● Viruses, like those that cause colds or flu

Common symptoms of middle ear infection in children can include: ● Ear pain ● Fever ● Fussiness or irritability ● Rubbing or tugging at an ear ● Difficulty sleeping

A can make the diagnosis of a middle ear infection by looking inside the child’s ear to examine the eardrum and see if there is pus in the middle ear. Antibiotics are often not needed for middle ear infections because the body’s immune system can fight off the infection on its own. However, sometimes antibiotics, such as amoxicillin, are needed to treat severe cases right away or cases that last longer than 2–3 days.29

Swimmer’s Ear Ear infections can be caused by leaving contaminated water in the ear after swimming. This infection, known as “swimmer’s ear” or otitis externa, is not the same as the common childhood middle ear infection. The infection occurs in the outer ear canal and can cause pain and discomfort for swimmers of all ages.

Symptoms of swimmer’s ear usually appear within a few days of swimming and include: ● Itchiness inside the ear. ● Redness and swelling of the ear. ● Pain when the infected ear is tugged or when pressure is placed on the ear. ● Pus draining from the infected ear.

29 Ear Infection by the Centers for Disease Control and Prevention is in the public domain.

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Although all age groups are affected by swimmer’s ear, it is more common in children and can be extremely painful. If a swimmer's ear is suspected, a healthcare provider should be consulted. Swimmer’s ear can be treated with antibiotic ear drops.30

Fifth Disease (Slapped Cheek) Fifth disease is a mild rash illness caused by parvovirus B19. It is more common in children than adults. A person usually gets sick with fifth disease within 14 days after getting infected with parvovirus B19.

The symptoms of fifth disease are usually mild and may include ● fever ● runny nose ● headache ● rash (on face and body)

Figure 11.12. Slapped cheek rash from fifth disease. Image by Medline Plus is in the public domain.

Parvovirus B19—which causes fifth disease—spreads through respiratory secretions, such as saliva, sputum, or nasal mucus, when an infected person coughs or sneezes. You are most contagious when it seems like you have “just a fever and/or cold” and before you get the rash or joint pain and swelling. After you get the rash you are not likely to be contagious. Fifth disease is usually mild and will go away on its own. Children and adults who are otherwise healthy usually recover completely.31 “A child who has been diagnosed with fifth disease need not be excluded from child care.”32

32 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Fifth Disease (Slapped Cheek Disease). University of California San Francisco.

31 Fifth Disease by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain

30 Healthy Swimming: Ear Infections by the Centers for Disease Control and Prevention is in the public domain

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Hand, Foot and Mouth Disease Hand-foot-mouth disease is a common viral infection that most often begins in the throat. Hand-foot-mouth disease (HFMD) is most commonly caused by a virus called coxsackievirus A16. Children under age 10 are most often affected.

Symptoms of HFMD include: ● Fever ● Headache ● Loss of appetite ● Rash with very small blisters on the hands, feet, and diaper area that may be tender or

painful when pressed ● Sore throat ● Ulcers in the throat (including tonsils), mouth, and tongue

Figure 11.13. Blisters on the hand and ulcers in the mouth. Image by Medline Plus is in the public domain. Image by Medline Plus is in the public domain.

The virus can spread from person-to-person through tiny, air droplets that are released when the sick person sneezes, coughs, or blows their nose. You can catch hand-foot-mouth disease if:

● A person with the infection sneezes, coughs, or blows their nose near you. ● You touch your nose, eyes, or mouth after you have touched something contaminated by

the virus, such as a toy or doorknob. ● You touch stools or fluid from the blisters of an infected person.

The virus is most easily spread the first week a person has the disease. The time between contact with the virus and the start of symptoms is about 3 to 7 days.33

“Children with hand-foot-and-mouth disease do not need to stay home as long as they are feeling well enough to participate…Children with hand-foot-and-mouth disease usually do not need treatment and will get better on their own within a week.”34

34 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Hand-Foot-and-Mouth Disease (Coxsackie Virus A16). University of California San Francisco.

33 Hand-Foot-Mouth Disease by MedlinePlus is in the public domain.

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Head Lice

Head lice are parasitic insects that live on the head. They survive by feeding on human blood. Lice infestations are spread most commonly by close person-to-person contact. Lice move by crawling; they cannot hop or fly.

Adult head lice are 2–3 mm in length. Head lice infest the head and neck and attach their eggs to the base of the hair shaft. Lice move by crawling; they cannot hop or fly.35

Figure 11.14. Adult head louse. Image by the Centers for Disease Control and Prevention is in the public domain.

Symptoms of a head lice infestation include: ● Tickling feeling of something moving in the hair. ● Itching, caused by an allergic reaction to the bites of the head louse. ● Irritability and difficulty sleeping; head lice are most active in the dark. ● Sores on the head caused by scratching. These sores can sometimes become infected

with bacteria found on the person’s skin.

Head-to-head contact with a person who already has an infestation is the most common way to get head lice. Head-to-head contact is common during play at school, at home, and elsewhere (sports activities, playground, slumber parties, camp).

Although uncommon, head lice can be spread by sharing clothing or belongings. This happens when lice crawl, or the nits that are attached to shed hair hatch, and get on the shared clothing or belongings. Examples include:

35 Parasites – Lice by the Centers for Disease Control and Prevention is in the public domain.

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● Sharing clothing (hats, scarves, coats, sports uniforms) or articles (hair ribbons, barrettes, combs, brushes, towels, stuffed animals) recently worn or used by a person with an infestation;

● Or lying on a bed, couch, pillow, or carpet that has recently been in contact with a person with an infestation.

Dogs, cats, and other pets do not play a role in the spread of head lice.

The diagnosis of a head lice infestation is best made by finding a live nymph or adult louse on the scalp or hair of a person. Because nymphs and adult lice are very small, move quickly, and avoid light, they can be difficult to find. Use of a magnifying lens and a fine-toothed comb may be helpful to find live lice.

If crawling lice are not seen, finding nits firmly attached within a ¼ inch of base of the hair shafts strongly suggests, but does not confirm, that a person is infested and should be treated. Nits that are attached more than ¼ inch from the base of the hair shaft are almost always dead or already hatched. Nits are often confused with other things found in the hair such as dandruff, hair spray droplets, and dirt particles. If no live nymphs or adult lice are seen, and the only nits found are more than ¼-inch from the scalp, the infestation is probably old and no longer active and does not need to be treated.36

Figure 11.15. Louse as a nit (egg), nymph (juvenile), and adult compared to a penny. Image by the Centers for Disease Control and Prevention is in the public domain.

Treatment for head lice is recommended for persons diagnosed with an active infestation. All household members and other close contacts should be checked; those persons with evidence of an active infestation should be treated with an over-the-counter or prescription medication (following the provided instructions).

Hats, scarves, pillow cases, bedding, clothing, and towels worn or used by the person with the infestation in the 2-day period just before treatment is started can be machine washed and dried

36 Head Lice: FAQ by the Centers for Disease Control and Prevention is in the public domain.

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using the hot water and hot air cycles because lice and eggs are killed by exposure for 5 minutes to temperatures greater than 128.3°F. Items that cannot be laundered may be dry-cleaned or sealed in a plastic bag for two weeks. Items such as hats, grooming aids, and towels that come in contact with the hair of a person with an infestation should not be shared. Vacuuming furniture and floors can remove hairs that might have viable nits attached. Head lice do not survive long if they fall off a person and cannot feed. After treatment, it’s important to check the hair and comb with a nit comb to remove nits and lice every 2–3 days which will decrease the chance of self–reinfestation. Checking for 2–3 weeks will ensure that all lice and nits are gone.37

Hepatitis A Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. It can range from a mild illness lasting a few weeks to a severe illness lasting several months. Although rare, hepatitis A can cause death in some people.

Most children younger than age 6 do not have symptoms when they have hepatitis A. Older children and adults typically have symptoms. If symptoms develop, they usually start appearing 4 weeks after exposure, but can occur as early as 2 and as late as 7 weeks after exposure. Symptoms usually develop over a period of several days and can include:

● Fever ● Fatigue ● Loss of appetite ● Nausea ● Vomiting ● Abdominal pain ● Dark urine ● Diarrhea ● Clay-colored stools ● Joint pain ● Jaundice (yellowing of the skin and eyes)

Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. A person can transmit the virus to others up to 2 weeks before symptoms appear.38

A child diagnosed with hepatitis A should be excluded from care until one week after the onset of symptoms.39

39 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Hepatitis A. University of California San Francisco.

38 Hepatitis A Questions and Answers for the Public by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention is in the public domain.

37 Head Lice: Treatment by the Centers for Disease Control and Prevention is in the public domain.

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Impetigo Impetigo is a common contagious skin infection that may be caused by two germs—Streptococcus pyogenes and Staphylococcus aureus. Recommended treatment depends on which germs are causing impetigo. With the right treatment, impetigo usually goes away within two to three weeks.

The signs of impetigo include red sores that pop easily and leave a yellow crust, fluid-filled blisters, itchy rash, skin lesions, and swollen lymph nodes. The sores can be uncomfortable and painful.

Figure 11.16. Blisters from impetigo. Image by MedlinePlus is in the public domain

Impetigo is typically spread through skin-to-skin contact with an individual who has impetigo, but it can also be spread by contact with objects someone with impetigo has touched (for example, towels, blankets, and toys).

It is recommended that children with impetigo be excluded from care until 24 hours after treatment is started.40

Influenza (Flu)

In general, flu is worse than a cold, and symptoms are more intense. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations. Flu can have very serious associated complications.41

41 Common Cold by the Centers for Disease Control and Prevention is in the public domain.

40 Impetigo by Head Start Early Childhood Learning & Knowledge Center is in the public domain.

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Figure 11.17. Flu symptoms. Symptoms of Influenza by Mikael Häggström is in the public domain.

Flu can cause mild to severe illness, and at times can lead to death. Flu usually comes on suddenly. People who have flu often feel some or all of these symptoms:

● Fever (common, but not always) or feeling feverish/chills ● cough ● sore throat ● runny or stuffy nose ● muscle or body aches ● headaches ● fatigue (tiredness) ● some people may have vomiting and diarrhea, though this is more common in children

than adults.

Most people who get flu will recover in a few days to less than two weeks, but some people will develop complications (such as pneumonia) as a result of flu, some of which can be life-threatening and result in death.

Sinus and ear infections are examples of moderate complications from flu, while pneumonia is a serious flu complication that can result from either influenza virus infection alone or from co-infection of flu virus and bacteria. Other possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis) tissues, and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection. Flu also can make chronic medical problems worse. For example, people with asthma may experience asthma attacks while they have the flu.42

42 Flu Symptoms & Complications by the Centers for Disease Control and Prevention is in the public domain.

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A yearly flu vaccine is the first and most important step in protecting against influenza and its potentially serious complications for everyone 6 months and older. While there are many different flu viruses, flu vaccines protect against the 3 or 4 viruses that research suggests will be most common. Flu vaccination can reduce flu illnesses, doctors’ visits, missed school due to flu, prevent flu-related hospitalizations, and reduce the risk of dying from influenza. Also, there are data to suggest that even if someone gets sick after vaccination, their illness may be milder.43

Once a person has the flu, their health care provider may recommend antiviral drugs. When used for treatment, antiviral drugs can lessen symptoms and shorten the length of sickness by 1 or 2 days. They also can prevent serious flu complications, like pneumonia. For people at high risk of serious flu complications (including children), treatment with antiviral drugs can mean the difference between milder or more serious illness, possibly resulting in a hospital stay. CDC recommends prompt treatment for people who have influenza infection or suspected influenza infection and who are at high risk of serious flu complications.44

As with a cold, a child with the flu does not need to be excluded if staff can care for them and all of the other children and they feel well enough to participate.

Measles Measles is a serious illness caused by a virus. The virus can last for one to two weeks. It is rare today because most children are immunized against it. However, the number of diagnosed cases has grown across the country. This increase is related to children not being vaccinated.

Measles starts with a fever that can get very high. Some of the other symptoms that may occur are:

● Fatigue ● Cough, runny nose, and red, watery eyes ● Rash of tiny, red spots that usually lasts five to six days, (the rash begins at the hairline,

moves to the face and upper neck, and proceeds down the body) ● Diarrhea ● Ear infection

44 Flu Treatment by the Centers for Disease Control and Prevention is in the public domain

43 Influenza (Flu) Preventive Steps by the Centers for Disease Control and Prevention is in the public domain.

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Figure 11.18. Child with measles. Image by the Public Health Image Library is in the public domain.

Measles spreads when a person infected with the measles virus breathes, coughs, or sneezes. It is very contagious from five days before until four days after the start of the rash. After exposure, it can take one to two weeks for the person to get sick.

Measles can spread by being in a room with a person with measles and up to two hours after that person is gone. It can also spread from an infected person even before they have a measles rash. Almost everyone who has not had the measles vaccine will get measles if they are exposed to the measles virus. People who have had measles or were immunized usually can’t catch it again.

Children diagnosed with measles should remain out of the center until a doctor determines the child is no longer infectious. Any unimmunized children or staff should be excluded from the program for two weeks after the rash appears in the last case of measles at the facility.45

Meningitis Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord, called the meninges. There are several types of meningitis. The most common is viral meningitis. You get it when a virus enters the body through the nose or mouth and travels to the brain. Bacterial meningitis is rare, but can be deadly. It usually starts with bacteria that cause a cold-like infection. It can cause stroke, hearing loss, and brain damage. It can also harm other organs. Pneumococcal infections and meningococcal infections are the most common causes of bacterial meningitis.

Other rare forms of meningitis include, fungal meningitis, parasitic meningitis, amebic meningitis, and non-infectious meningitis.46

46 Meningitis by the National Center for Immunization and Respiratory Diseases is in the public domain.

45 Measles by Head Start Early Childhood Learning & Knowledge Center is in the public domain.

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“Children with meningitis generally feel too ill to attend child care. They can return when they feel better with no fever, or when the health care provider determines the disease is no longer contagious.”47

Molluscum Contagiosum Molluscum contagiosum is an infection caused by a poxvirus (molluscum contagiosum virus). The result of the infection is usually a benign, mild skin disease characterized by lesions (growths) that may appear anywhere on the body. Within 6-12 months, Molluscum contagiosum typically resolves without scarring but may take as long as 4 years.

The lesions, known as Mollusca, are small, raised, and usually white, pink, or flesh-colored with a dimple or pit in the center. They often have a pearly appearance. They’re usually smooth and firm. In most people, the lesions range from about the size of a pinhead to as large as a pencil eraser (2 to 5 millimeters in diameter). They may become itchy, sore, red, and/or swollen.

Figure 11.19. These are classical appearing Molluscum. The large lesion in the center is one that has been picked and scratched and shows evidence of low-grade inflammation. Molluscum Contagiosum - Close-Up of the Chest by Medline Plus is in the public domain.

Mollusca may occur anywhere on the body including the face, neck, arms, legs, abdomen, and genital area, alone or in groups. The lesions are rarely found on the palms of the hands or the soles of the feet.48

“Children with this rash should not be excluded from ECE settings. Molluscum is a nuisance, not a serious health problem.”49

Mumps

49 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Molluscum Contagiosum. University of California San Francisco.

48 Molluscum Contagiosum by the National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology is in the public domain.

47 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Meningitis. University of California San Francisco.

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Mumps is best known for the puffy cheeks and tender, swollen jaw that it causes. It is one of the diseases that is vaccine preventable. This is a result of swollen salivary glands under the ears on one or both sides, often referred to as parotitis.

Figure 11.20. This photo of a young child with mumps shows the characteristic jaw swelling. Image by the Public Health Image Library (PHIL) is in the public domain.

Other symptoms that might begin a few days before parotitis include: ● Fever ● Headache ● Muscle aches ● Tiredness ● Loss of appetite

Symptoms typically appear 16-18 days after infection, but this period can range from 12–25 days after infection.

Some people who get mumps have very mild symptoms (like a cold), or no symptoms at all and may not know they have the disease.

In rare cases, mumps can cause more severe complications.

Most people with mumps recover completely within two weeks.50

Mumps is a contagious disease caused by a virus. It spreads through direct contact with saliva or respiratory droplets from the mouth, nose, or throat. An infected person can likely spread mumps from a few days before their salivary glands begin to swell to up to five days after the

50 Signs & Symptoms of Mumps by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in

the public domain.

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swelling begins. A person with mumps should limit their contact with others during this time. For example, stay home from school and do not attend social events.51

Norovirus Norovirus is the most common cause of vomiting and diarrhea, and foodborne illness.

The most common symptoms of norovirus are: ● diarrhea ● vomiting ● nausea ● stomach pain

Other symptoms include fever, headache, and body aches.

Norovirus causes inflammation of the stomach or intestines. This is called acute gastroenteritis. A person usually develops symptoms 12 to 48 hours after being exposed to norovirus. Most people with norovirus illness get better within 1 to 3 days.

If you have norovirus illness, you can feel extremely ill, and vomit or have diarrhea many times a day. This can lead to dehydration, especially in young children, older adults, and people with other illnesses.52

You can get norovirus by accidentally getting tiny particles of feces or vomit from an infected person in your mouth. This can happen through contaminated food and water, touching contaminated surfaces and then putting your fingers in the mouth, and having direct contact with someone that is infected with norovirus.

If you get norovirus illness, you can shed billions of norovirus particles that you can’t see without a microscope. Only a few norovirus particles can make other people sick. You are most contagious

● when you have symptoms of norovirus illness, especially vomiting, and ● during the first few days after you recover from norovirus illness.

However, studies have shown that you can still spread norovirus for two weeks or more after you feel better.53 Children that are infected with norovirus should be excluded for 48 hours after becoming symptom free.54

54 Thunder Bay District Health Unit. (2017). Common childhood infections - A guide for principals, teachers and child care providers. Thunder Bay District Health Unit.

53 How Norovirus Spreads by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

52 The Symptoms of Norovirus by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

51 Transmission of Mumps by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

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Pertussis Pertussis is a vaccine preventable respiratory illness commonly known as whooping cough. It is a very contagious disease caused by a type of bacteria called Bordetella pertussis. These bacteria attach to the cilia (tiny, hair-like extensions) that line part of the upper respiratory system. The bacteria release toxins (poisons), which damage the cilia and cause airways to swell.55

It can cause serious illness in babies, children, teens, and adults. Symptoms of pertussis usually develop within 5 to 10 days after you are exposed. Sometimes pertussis symptoms do not develop for as long as 3 weeks.

The disease usually starts with cold-like symptoms and maybe a mild cough or fever. In babies, the cough can be minimal or not even there. Babies may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. About half of babies younger than 1 year who get the disease need care in the hospital.

Early symptoms can last for 1 to 2 weeks and usually include: ● Runny nose ● Low-grade fever (generally minimal throughout the course of the disease) ● Mild, occasional cough ● Apnea – a pause in breathing (in babies)

Pertussis in its early stages appears to be nothing more than the common cold. Therefore, healthcare professionals often do not suspect or diagnose it until the more severe symptoms appear.

After 1 to 2 weeks and as the disease progresses, the traditional symptoms of pertussis may appear and include:

● Paroxysms (fits) of many, rapid coughs followed by a high-pitched “whoop” sound (babies with pertussis may not cough at all)

● Vomiting (throwing up) during or after coughing fits ● Exhaustion (very tired) after coughing fits

55 Pertussis (Whooping Cough): Causes and Transmission by the National Center for Immunization and Respiratory Diseases,

Division of Bacterial Diseases is in the public domain.

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Figure 11.21. This baby with pertussis needed ECMO to take over the work of her heart and lungs and dialysis to keep her kidneys working. Image by the National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases is in the public domain.

Figure 11.22. This child with pertussis has broken blood vessels in his eyes and bruising on his face from coughing. Image by the CDC is in the public domain.

Pertussis can cause violent and rapid coughing, over and over, until the air is gone from your lungs. When there is no more air in the lungs, you are forced to inhale with a loud “whooping” sound. This extreme coughing can cause you to throw up and be very tired. Although you are often exhausted after a coughing fit, you usually appear fairly well in-between. Coughing fits generally become more common and bad as the illness continues, and can occur more often at night. The coughing fits can go on for up to 10 weeks or more. Recovery from pertussis can happen slowly. The cough becomes milder and less common. However, coughing fits can return with other respiratory infections for many months after the pertussis infection started.56

56 Pertussis (Whooping Cough): Signs and Symptoms by the National Center for Immunization and Respiratory Diseases, Division

of Bacterial Diseases is in the public domain.

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Children who receive antibiotics should be excluded for 5 days of treatment. Children who do not receive treatment, should stay home for 21 days from the onset of symptoms.57

Pinworms A pinworm (“threadworm”) is a small, thin, white roundworm (nematode) called Enterobius vermicularis that sometimes lives in the colon and rectum of humans. Pinworms are about the length of a staple. While an infected person sleeps, female pinworms leave the intestine through the anus and deposit their eggs on the surrounding skin.

Figure 11.23. A pinworm and pinworm eggs. Image by DPDx - Laboratory Identification of Parasites of Public Health Concern and the Public Health Image Library (PHIL) is in the public domain.

Pinworm infection (called enterobiasis or oxyuriasis) causes itching around the anus which can lead to difficulty sleeping and restlessness. Symptoms are caused by the female pinworm laying her eggs. Symptoms of pinworm infection usually are mild and some infected people have no symptoms.

Pinworm infection often occurs in more than one person in household and institutional settings. Child care centers often are the site of cases of pinworm infection.

People become infected, usually unknowingly, by swallowing (ingesting) infective pinworm eggs that are on fingers, under fingernails, or on clothing, bedding, and other contaminated objects and surfaces. Because of their small size, pinworm eggs sometimes can become airborne and ingested while breathing.58 Children and adults with a pinworm infection should be excluded only until their initial dose of treatment has begun.59

RSV Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. In fact, RSV is the most common cause of

59 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Pinworms. University of California San Francisco.

58 Pinworm Infection FAQs by CDC Global Health, Division of Parasitic Diseases is in the public domain.

57 Thunder Bay District Health Unit. (2017). Common childhood infections - A guide for principals, teachers and child care providers.

Thunder Bay District Health Unit.

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bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States. It is also a significant cause of respiratory illness in older adults.60

Symptoms of RSV infection usually include ● Runny nose ● Decrease in appetite ● Coughing ● Sneezing ● Fever ● Wheezing

These symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties.

RSV can also cause more severe infections such as bronchiolitis, an inflammation of the small airways in the lung, and pneumonia, an infection of the lungs. It is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age. Almost all children will have had an RSV infection by their second birthday. People infected with RSV usually show symptoms within 4 to 6 days after getting infected. Most RSV infections go away on their own in a week or two.61

RSV can spread when an infected person coughs or sneezes. You can get infected if you get droplets from the cough or sneeze in your eyes, nose, or mouth, or if you touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands. Additionally, it can spread through direct contact with the virus, like kissing the face of a child with RSV.

People infected with RSV are usually contagious for 3 to 8 days. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks. Children are often exposed to and infected with RSV outside the home, such as in school or child-care centers. They can then transmit the virus to other members of the family.

RSV can survive for many hours on hard surfaces such as tables and crib rails. It typically lives on soft surfaces such as tissues and hands for shorter amounts of time.62

62 RSV Transmission by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

61 Respiratory Syncytial Virus Infection (RSV): Symptoms and Care by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

60 Respiratory Syncytial Virus Infection (RSV) by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain

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“Frequently, a child is infectious before symptoms appear. Therefore, an infected child does not need to be excluded from child care unless he or she is not well enough to participate in usual activities.”63

Ringworm Ringworm is a common skin infection that is caused by a fungus. It’s called “ringworm” because it can cause a circular rash (shaped like a ring) that is usually red and itchy. Anyone can get ringworm. The fungi that cause this infection can live on skin, surfaces, and on household items such as clothing, towels, and bedding.

Ringworm goes by many names. The medical terms are “tinea” or “dermatophytosis.” Other names for ringworm are based on its location on the body – for example, ringworm on the feet is also called “athlete’s foot.”64

Figure 11.24. Ringworm rashes. Images by the National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases is in the public domain.

Ringworm can affect skin on almost any part of the body as well as fingernails and toenails. The symptoms of ringworm often depend on which part of the body is infected, but they generally include:

● Itchy skin ● Ring-shaped rash ● Red, scaly, cracked skin ● Hair loss

Symptoms typically appear between 4 and 14 days after the skin comes in contact with the fungi that cause ringworm.65

65 Symptoms of Ringworm Infections by the National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases is in the public domain.

64 Ringworm by the National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases is in the public domain.

63 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Respiratory Syncytial Virus (RSV) in the Child Care Setting. University of California San Francisco.

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The fungi that cause ringworm can live on skin and in the environment. There are three main ways that ringworm can spread:

1. From a person who has ringworm 2. From an animal that has ringworm. 3. From the environment.66

“There is no need to exclude children/staff with these common, mild infections once treatment has been started. Refer persons with a suspicious rash to their health care providers for appropriate diagnosis and treatment and allow them to return as soon as treatment has begun.”67

Roseola Roseola is a viral infection that commonly affects infants and young children. It involves a pinkish-red skin rash and high fever. It is common in children ages 3 months to 4 years, and most common in those ages 6 months to 1 year.

It is caused by a virus called human herpesvirus 6 (HHV-6), although similar syndromes are possible with other viruses.

The time between becoming infected and the beginning of symptoms (incubation period) is 5 to 15 days.

The first symptoms include: ● Eye redness ● Irritability ● Runny nose ● Sore throat ● High fever, that comes on quickly and may be as high as 105°F (40.5°C) and can last 3

to 7 days

About 2 to 4 days after becoming sick, the child's fever lowers and a rash appears. This rash most often:

· Starts on the middle of the body and spreads to the arms, legs, neck, and face · Is pink or rose-colored · Has small sores that are slightly raised

The rash lasts from a few hours to 2 to 3 days. It usually does not itch.

67 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Ringworm (Tinea). University of California San Francisco.

66 Sources of Infection by the National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases is in the public domain.

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Figure 11.25. An infant with the rash characteristic of roseola. Image by MedlinePlus is in the public domain.

There is no specific treatment for roseola. The disease most often gets better on its own without complications.68 “A child with fever and rash should be excluded from child care until seen by a health care provider. After the fever breaks, a child may return to care while the rash is still present, provided that the child feels well and is able to participate fully in all activities.”69

Rotavirus Rotavirus is most common in your infants and young children. Children, even those who are vaccinated, may get infected and sick from rotavirus more than once. That is because neither natural infection with rotavirus nor vaccination provides full protection from future infections. Children who are not vaccinated usually have more severe symptoms the first time they get rotavirus disease. Vaccinated children are less likely to get sick from rotavirus.70

Symptoms usually start about 2 days after a person is exposed to rotavirus. Vomiting and watery diarrhea can last 3 to 8 days. Additional symptoms may include loss of appetite and dehydration (loss of body fluids), which can be especially dangerous for infants and young children.

Symptoms of dehydration include: ● decreased urination ● dry mouth and throat ● feeling dizzy when standing up ● crying with few or no tears and

70 Rotavirus: Transmission by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

69 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Roseola (Sixth Disease). University of California San Francisco.

68 Roseola by MedlinePlus is in the public domain.

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● unusual sleepiness or fussiness.71

People who are infected with rotavirus shed the virus in their stool (poop). This is how the virus gets into the environment and can infect other people (through contaminated food, surfaces, or unwashed hands). People shed rotavirus the most, and are more likely to infect others, when they have symptoms and during the first 3 days after they recover. People with rotavirus can also infect others before they have symptoms.72

“Children with rotavirus should be excluded from child care if the stool cannot be contained by diapers or toilet use.”73

Rubella (German Measles) Rubella is a vaccine preventable disease that is also called German measles, but it is caused by a different virus than measles.74 It is usually mild with fever and a rash. About half of the people who get rubella do not have symptoms. If you do get them, symptoms may include

● A rash that starts on the face and spreads to the body ● Mild fever ● Aching joints, especially in young women ● Swollen glands

Figure 11.26. This is the rash of rubella on a child’s back. Image by the Public Health Image Library (PHIL) is in the public domain.

74 Rubella (German Measles) Vaccination by the National Center for Immunization and Respiratory Diseases is in the public domain.

73 California Childcare Health Program. (2009). What Child Care Providers Should Know About…Rotavirus Infections. University of California San Francisco.

72 Rotavirus: Transmission by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

71 Rotavirus: Symptoms by the National Center for Immunization and Respiratory Diseases, Division of Viral Diseases is in the public domain.

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Rubella spreads when an infected person coughs or sneezes. People without symptoms can still spread it. There is no treatment, but the measles-mumps-rubella (MMR) vaccine can prevent it.75

Sinusitis (Sinus Infection)

Sinus infections happen when fluid builds up in the air-filled pockets in the face (sinuses), which allows germs to grow. Viruses cause most sinus infections, but bacteria can cause some sinus infections.

Figure 11.27. When you have a sinus infection, one or more of your sinuses becomes inflamed and fluid builds up, causing congestion and runny nose. Image by the Centers for Disease Control and Prevention is in the public domain.

Common symptoms of sinus infections include: ● Runny nose ● Stuffy nose ● Facial pain or pressure ● Headache ● Mucus dripping down the throat (post-nasal drip) ● Sore throat

75 Rubella by MedlinePlus is in the public domain.

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● Cough ● Bad breath

Most sinus infections usually get better on their own without antibiotics.76 As with colds and flu, a child does not need to be automatically excluded from care for a sinus infection.

Shigella Shigellosis is a very contagious diarrheal disease caused by bacteria called Shigella. Shigella causes about 500,000 cases of diarrhea in the United States annually.

Symptoms of the Shigella infection typically start one to two days after exposure and include: ● Diarrhea (sometimes bloody) ● Fever ● Abdominal pain ● A painful sensation of needing to pass stools even when bowels are empty

Shigella spreads when people put something in their mouths or swallow something that has come into contact with stool of a person infected with Shigella.

Exclusion is required for all diapered children whose stool is not contained in the diaper and toilet-trained children if the diarrhea is causing soiled clothing. Re-admission after diarrhea can occur when diapered children have their stool contained by the diaper (even if the stools remain loose) and when toilet-trained children are continent.77

Sore Throat

A sore throat can make it painful to swallow. A sore throat can also feel dry and scratchy. Sore throat can be a symptom of the common cold, allergies, strep throat, or other upper respiratory tract illness. Strep throat is an infection in the throat and tonsils caused by bacteria called group A Streptococcus (also called Streptococcus pyogenes).

Infections from viruses are the most common cause of sore throats. The following symptoms suggest a virus is the cause of the illness instead of the bacteria called group A strep:

● Cough ● Runny nose ● Hoarseness (changes in your voice that makes it sound breathy, raspy, or strained) ● Conjunctivitis (also called pink eye)

The most common symptoms of strep throat include:

77 Shigella by Head Start Early Childhood Learning & Knowledge Center is in the public domain.

76 Sinus Infection (Sinusitis) by the Centers for Disease Control and Preventionis in the public domain.

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● Sore throat that can start very quickly ● Pain when swallowing ● Fever ● Red and swollen tonsils, sometimes with white patches or streaks of pus ● Tiny red spots on the roof of the mouth ● Swollen lymph nodes in the front of the neck

A doctor can determine the likely cause of a sore throat. If a sore throat is caused by a virus, antibiotics will not help. Most sore throats will get better on their own within one week and are not cause for exclusion from child care. Since bacteria cause strep throat, antibiotics are needed to treat the infection and prevent rheumatic fever and other complications. A doctor cannot tell if someone has strep throat just by looking in the throat. If a doctor suspects strep throat, they may test to confirm diagnosis. A child with strep throat should be excluded from care until they no longer have fever AND have taken antibiotics for at least 24 hours.78

Tuberculosis Tuberculosis (TB) is a contagious disease, caused by the bacteria Mycobacterium tuberculosis. The bacteria usually attack the lungs, but can attack any organ in the body. Recommended treatment depends on whether a person has:

● Latent TB infection–has no symptoms and can't spread the TB bacteria to others; has potential to develop active TB disease if not treated

● Active TB disease–has symptoms such as a fever, cough, or weight loss; these persons may be able to spread the germ to others. Needs treatment to cure the disease.

TB is spread in the air when a person with active TB disease of the lung or throat coughs, sneezes, or speaks. The germs can be inhaled by someone else and they can become infected. TB is often spread between people who spend time together every day. TB in children usually comes from being around adults with active TB disease.

Children and staff with active TB disease should be excluded from the Head Start or child care center until treatment is started, and the doctor determines the child or staff member is no longer infectious. All children and staff should be tested for TB infection if there has been an exposure to a person with active TB disease within the center or at home.79

Reportable Diseases

79 Tuberculosis by Head Start Early Childhood Learning & Knowledge Center is in the public domain.

78 Sore Throat by the Centers for Disease Control and Prevention is in the public domain.

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Some diseases are enough of a threat to the community that it is required that diagnosed cases are reported to the local health department.

How to Report Disease

Report immediately by phone

Anthrax Avian Influenza (human) Botulism (infant, foodborne or wound) Brucellosis Cholera Ciguatera Fish Poisoning Dengue Diarrhea of the Newborn (outbreak) Diphtheria Domoic Acid Poisoning (Amnestic Shellfish Poisoning) Escherichia coli: shiga toxin producing (STEC) including E.coli 0157 Hantavirus infections Hemolytic Uremic Syndrome Meningococcal infections Paralytic shellfish poisoning Plague (human or animal) Rabies (human or animal) Scombroid fish poisoning Severe Acute Respiratory Syndrome (SARS) Shia toxin (detected in feces) Smallpox (Variola) Tularemia Viral hemorrhagic Fever (e.g. Crimean-Congo, Ebola, Lassa and Marburg Viruses) Yellow Fever Two or more cases or suspected cases of foodborne disease from separate households are suspected to have the same source of illness Occurrence of any unusual disease Outbreaks of any disease (Including diseases not listed here)

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Report by fax, telephone, or mail within one (1) working day of identification

Amebiasis Babesiosis Campylobacteriosis Chickenpox (only hospitalizations and deaths) Colorado Tick Fever Conjunctivitis, Acute Infectious of the Newborn Cryptosporidiosis Encephalitis—viral, bacterial, fungal, or parasitic Foodborne Disease Haemophilus influenzae invasive disease (report an incident less than 15 years of age) Hepatitis A Listeriosis Malaria Measles (Rubeola) Meningitis—viral, bacterial, fungal, parasitic Pertussis (whooping cough) Poliomyelitis, paralytic Psittacosis Q fever Relapsing Fever Salmonellosis Shigellosis Staphylococcus aureus infection (outbreaks of any type and individual cases in food handlers and dairy workers only) Syphilis Trichinosis Tuberculosis Typhoid Fever (cases and carriers) Vibrio infections Water-Associated Disease(e.g., Swimmer's Itch or Hot Tub Rash) West Nile Virus (WNV) Infection Yersiniosis

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Report by fax, telephone, or mail within seven (7) calendar days of identification

Chancroid Chlamydial Infections (including Lymphogranulom Venereum (LGV)) Coccidioidomycosis Creutzfeldt-Jakob Disease (CJD) and other Transmissible Spongiform Encephalopathies (TSE) Cysticercosis or Taeniasis Ehrlichiosis Giardiasis Gonococcal infections Hepatitis, viral Hepatitis B (specify acute case or chronic) Hepatitis C (specify acute case or chronic) Hepatitis D (Delta) Hepatitis, other, acute Human Immunodeficiency Virus (HIV) Influenza deaths (report an incident of less than 18 years of age) Kawasaki Syndrome (Mucocutaneous Lymph Node Syndrome) Legionellosis Leprosy (Hansen’s disease) Leptospirosis Lyme disease Mumps Pelvic Inflammatory Disease (PID) Rheumatic Fever, acute Rocky Mountain Spotted Fever Rubella (German Measles) Rubella Syndrome, Congenital Tetanus Toxic Shock Syndrome Toxoplasmosis Typhus Fever

Table 11.2. Diseases Reportable to Local Health Department required by Licensing in California. Source: Child Care Center General Licensing Requirements: Article 6. Continuing Requirements by the California Department of Social Services is in the public domain.

Exclusion Policies

Most children with mild illnesses can safely attend child care. “Many health policies concerning the care of ill children [including exclusion policies] have been based upon common misunderstandings about contagion, risks to ill children, and risks to other children and staff. Current research clearly shows that certain ill children do not pose a health threat. Also, the research shows that keeping certain other mildly ill children at home or isolated at the child care setting will not prevent other children from becoming ill.”80

But there are times when exclusion is the right answer. Licensing states that a child may be too sick to attend if:

● The child does not feel well enough to participate comfortably in the program’s activities. ● The staff cannot adequately care for the sick child without compromising the care of the

other children.

80 California Childcare Health Program. (2018). Preventive Health and Safety in the Child Care Setting: A Curriculum for the Training of Child Care Providers (3rd ed.). University of California, San Francisco.

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● The child has any of the following symptoms unless a health provider determines that the child is well enough to attend and that the illness is not contagious:

● Fever (above 100° F. axillary or above 101° F. orally) accompanied by behavior change and other signs or symptoms of illness (i.e., the child looks and acts sick)

● Signs or symptoms of possibly severe illness (e.g., persistent crying, extreme irritability, uncontrolled coughing, difficulty breathing, wheezing, lethargy)

● Diarrhea: Changes from the child’s usual stool pattern–increased frequency of stools, looser/watery stools, stool runs out of the diaper, or child can’t get to the bathroom in time.

● Vomiting more than once in the previous 24 hours ● Mouth sores with drooling ● Rash with a fever or behavior change

The child has any of the following diagnoses from a health provider (until treated and/or no longer contagious):

● Infectious conjunctivitis/pink-eye (with eye discharge)-until 24 hours after treatment started

● Scabies, head lice, or other infestation-until 24 hours after treatment and free of nits ● Impetigo-until 24 hours after treatment started ● Strep throat, scarlet fever, or other strep infection-until 24 hours after treatment started

and the child is free of fever ● Pertussis-until five days after treatment started ● Tuberculosis (TB)-until a health care provider determines that the disease is not

contagious ● Chicken pox-until six days after start of rash or all sores have crusted over ● Mumps-until nine days after start of symptoms (swelling of “cheeks”) ● Hepatitis A-until seven days after start of symptoms (e.g., jaundice) ● Measles-until six days after start of rash ● Rubella (German measles)-until six days after start of rash ● Oral herpes (if child is drooling or lesions cannot be covered)-until lesions heal ● Shingles (if lesions cannot be covered)-until lesions are dry81

If there is an outbreak of any reportable illness (See Table 11.2), a child or staff member who meets the following criteria as determined by the local health department or a health care provider to be:

● contributing to transmission of the illness ● not adequately immunized when the disease is vaccine-preventable

81 When a Child Is Too Sick to Attend by U.S. Dept. of Health and Human Services is in the public domain.

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● at increased risk due to the pathogens being circulated.

They can be readmitted when the health department official or that health care provider decides that the risk of transmission is no longer present.82

What to Do When a Child Requires Exclusion

When a child becomes ill enough to be excluded, they should be immediately isolated from other children. Early care and education programs are required to be equipped to isolate and care for any child who becomes ill during the day. The isolation area shall be located to afford easy supervision of children by center staff and equipped with a mat, cot, couch or bed for each ill child (or a crib if caring for infants).

The child’s authorized representative shall be notified immediately when the child becomes ill enough to require isolation, and shall be asked to have the child picked up from the center as soon as possible.83

Caring for Mildly Ill Children Because young children in early care and education programs have high incidence of illness and may have conditions (such as eczema and asthmas), providers should be prepared to care for mildly ill children, at least temporarily. And since we know that excluding most mildly ill children doesn’t prevent the spread of illness and can have negative effects on families, programs should consider whether they can care for children with mild symptoms (not meeting the exclusion policy). The California Childcare Health Program poses the following questions to consider:

● Are there sufficient staff (including volunteers) to provide minor modifications that a child might need (such as quiet activities or extra fluids)?

● Are staff willing and able to care for the child’s symptoms (such as wiping a runny nose and checking a fever) without neglecting the care of other children in the group?

● Is there a space where the mildly ill child can rest if needed? ● Are families able or willing to pay extra for sick care if other resources are not available,

so that you can hire extra staff as needed? ● Have families made alternative arrangements for someone to pick up and care for their ill

children if they cannot?”

It’s important that programs recognize that families have to weigh many things when trying to decide whether or not to send a child to child care. They must consider how the child feels

83 Child Care Center General Licensing Requirements: Immunizations by the California Department of Social Services is in the public domain.

82 Infectious Disease Outbreak Control by Head Start Early Childhood Learning & Knowledge Center is in the public domain.

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(physically and emotionally), whether or not the program can provide care for the specific needs of the child, what alternative care arrangements are available, as well as the income they may lose if they have to stay home.84

Administering Medicine

Some children in your early care and education setting may need to take medications during the hours you provide care for them. It’s important that early care and education programs have a written policy for the use of prescription and nonprescription medication.85

According to licensing, programs that choose to handle medications must abide by the following:

● All prescription and nonprescription medications shall be centrally stored in a safe place inaccessible to children, with an unaltered label, and labeled with the child’s name and date

● A refrigerator shall be used to store any medication that requires refrigeration. ● Prescription medications may be administered with written permission by the child’s

authorized representatives in accordance with the label instructions by the physician ● Nonprescription medications may be administered without approval or instructions from

the child’s physician with written approval and instructions from the child’s authorized representative and when administered in accordance with the product label directions.

Figure 11.28. Medication must be given according to the label. Close-up of a woman pours a spoon of medicinal mixture by Marco Verch is licensed under CC BY 2.0

Valid reasons for an early care and education program to consider administering medication.

85 California Childcare Health Program. (2018). Preventive Health and Safety in the Child Care Setting: A Curriculum for the Training of Child Care Providers (3rd ed.). University of California, San Francisco.

84 California Childcare Health Program. (2018). Preventive Health and Safety in the Child Care Setting: A Curriculum for the Training of Child Care Providers (3rd ed.). University of California, San Francisco.

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● Some medication dosing cannot be adjusted to be taken before and after care (and keeping them out of care when otherwise well enough to attend, would be a hardship for families.

● Some children may have chronic conditions that may require urgent administration of medication (such as asthma and diabetes).86

Engaging with Families

Teachers can use the following strategies to help families to develop their children’s health habits:

● Provide families with concise, accurate information about ways to promote and develop good health habits in children; information should be presented in English and the families’ home languages. Capture their interest by addressing topics related to their children’s age and development, as well as topics related to common health risks for children, such as childhood obesity, asthma, and dental caries. Injury prevention and first-aid topics, such as treating burns, bleeding, and choking, are also relevant. Provide written informational materials that are brief and easy to read.

● Provide individualized information, as well as general health information, to all families through daily contact, workshops, and parent meetings. All information should be presented in English and in the families’ home languages. Accommodate family schedules by providing workshops and meetings at various times (e.g., morning, afternoon, evening), and arrange for child care during meetings.

● Show family members what the children are learning by sending home examples of work, encouraging families to visit the preschool and observe children in action, and sharing children’s portfolios during home visits. Reinforce children’s learning about health habits through take-home activities, lending libraries of read-aloud books in the languages of the families in the group, and displays of children’s work.

● As you introduce health routines (e.g., handwashing, tooth brushing), invite family members to participate and model. Encourage families to contribute ideas or materials to interest areas that reflect diverse health habits at home.

● Identify community resources related to health habits (e.g., handwashing, tooth brushing) and invite community personnel to participate in and bring resources to family workshops or parent meetings. Emphasize the role of home and family members in helping children to develop health habits, and inform all parents of the availability of free and low-cost community resources.

● Be sensitive to and respectful of different values or beliefs, as well as varying levels of access to health products and services. Gather information on available and accessible resources in the community, including those for children with special needs, and provide this information to all families, translated into their home languages.

86 California Childcare Health Program. (2018). Preventive Health and Safety in the Child Care Setting: A Curriculum for the Training of Child Care Providers (3rd ed.). University of California, San Francisco.

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When children are excluded from care, it’s important to provide documentation for families of how the child meets the guidelines in your exclusion policy and what needs to happen before the child can return to care. See Appendix G for a possible form that programs could use. Programs are also required to inform families when children are exposed to a communicable disease. See Appendix H for an example of a notice of exposure form you can provide to families so they know what signs of illness to watch for and to seek medical advice when necessary.

Appendices ● Appendix G. Exclusion Form ● Appendix H. Notice of Exposure to Contagious Disease

Attributions

● Paris, J. Chapter 8. Prevention of Illness. Safety, Health, and Nutrition in Early Childhood Education. College of the Canyons. V1.0; 2020. CC BY 4.0

● Paris, J. Chapter 9. Supportive Healthcare. Safety, Health, and Nutrition in Early Childhood Education. College of the Canyons. V1.0; 2020. CC BY 4.0