The reason for most sick days for both children and caregivers is infectious disease. Infectious diseases are caused by microorganisms, which are organisms too small to be visible without a microscope (commonly called “germs”). Colds, flu, and diarrhea are common infectious illnesses that can be spread at childcare facilities.

Germs can be spread by touching, eating, drinking, or breathing in germs. This chain of infection starts when a person gets germs in one of these ways, develops the disease, and then spreads the infection to others. Being informed of how illness spreads and taking necessary precautions can help stop the spread of infections in your childcare program.

The Chain of Infection

Here’s how disease-causing germs are spread:

• The germ lives in a person who has the disease. These germs leave the host and travel in droplets during a sneeze or cough, from an open sore or cut, or through urine or stool. Germs can travel through the air or by touching someone or something that is contaminated.
• Next, the germs needs an open door to enter the next human body. Germs may enter through mouth, nose, eyes, or genital; or through an open wound or other break in the skin.
• Once inside the body, the germs set up housekeeping and multiply (incubation period). The incubation period is how long it takes from the time exposed, until disease actually shows up.
• When there are enough living germs in the body, the person will usually show symptoms of the disease.

This new host can spread germs to the next person. Sometimes, germs can be spread during the incubation period, before the person even shows symptoms.

Influenza and Childcare

The flu, or influenza, is a viral disease that spreads mainly through person-to-person contact, often through coughing or sneezing. Children may become infected by touching something with flu viruses on it, such as a toy, and then touching their mouth or nose. The single best way to prevent many illnesses is vaccination, and this is true for flu.

To diagnose an illness, a medical professional should examine the child to see if the illness is caused by a virus or bacteria, the most common causes for a person to get sick. To diagnose the influenza virus, a respiratory specimen generally needs to be collected within the first 4-5 days of illness (when an infected person is most likely to spread the virus).

Children may be carriers of the virus for up to 10 days or longer which makes it possible for other children to catch this virus if the ill child is in the childcare setting. Follow your childcare program’s policy for the exclusion of ill children to insure that other children and staff are not exposed to the flu.

Treatment

If a child in your care gets sick, there are antiviral drugs that can reduce the symptoms and severity of an illness caused by a virus. The symptoms of the flu mainly include fever, lethargy, lack of appetite, and coughing. Some children or adults also have reported runny nose, sore throat, nausea, vomiting, and diarrhea.

Prescription medications such as Tamiflu should only be obtained through a legitimate pharmacy or clinic. Consumers should beware of buying medicines for H1N1 influenza A over the Internet due to the possibility of fake antiviral medications being sold.

Antibiotics are ineffective against the viral diseases such as influenza. However, antibiotics may be prescribed for secondary bacterial illnesses that can occur with the influenza. Only a qualified physician or health care provider can make the diagnosis.

Outbreaks and Epidemics

The recent H1N1 (previously called “swine flu”) outbreak has caused a great deal of concern. H1N1 influenza viruses are not transmitted by eating pork. You cannot get H1N1 flu from eating properly cooked pork or pork products.

Human-to-human transmission of H1N1 flu can occur, which is why it is considered a threat to the nation’s health. It is reported to occur in people the same way as seasonal flu occurs, which is mainly person-to-person transmission through coughing or sneezing. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

In childcare, reminders of good health habits are necessary to help stop the spread of germs and prevent illness. Simple habits like covering your mouth when you cough and frequently washing your hands can effectively reduce the spread of disease.

Prevention of Disease

Vaccines can help prevent infection, and are recommended by medical professionals. Each year, a seasonal flu vaccine is prepared to protect against that season’s particular flu virus. It is recommended that children be vaccinated annually against the seasonal flu. At this time, researchers are working to develop a vaccine for the H1N1 virus.

In addition to vaccines, there are other precautions to prevent the spread of illnesses. The Centers for Disease Control and Prevention (CDC) recommends the following:

• Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick, too. As a caregiver it is important that you stay home when you are sick to prevent the spread of illness to other caregivers and children. Help parents understand how important it is to keep their children home when they are sick.
• Have children cover their mouth and nose with a tissue when coughing or sneezing. It may prevent others from getting sick.
• Avoid touching the eyes, nose, or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
• Wash hands! Keeping hands clean is one of the most important steps adults and children can take to avoid getting sick and spreading germs to others. It is best to have children wash hands with soap and clean, running water for 20 seconds.

Waterless hand sanitizers (such as gels and foams) are effective in killing germs, but do not replace regular hand washing with soap and running water. If hand sanitizers are used, follow manufacturer’s instructions for use and supervise each child’s use of the product. Such products are potentially toxic and must be stored away from children’s reach.

In a childcare setting, children and adults should wash hands before preparing food and after handling uncooked meat and poultry; before eating; after changing diapers; after coughing, sneezing, or blowing noses; and after toileting.

Sanitation is important in the childcare setting. Sanitizing toys and surfaces such as tables and door knobs on a daily basis can help reduce the transmission of illnesses.

Gayle L. Bush, PhD
Associate Professor,
Department of Kinesiology and Health Promotion, Troy University, Troy, AL

Internet Resources

Centers for Disease Control & Prevention, www.cdc.gov/flu/professionals/infectioncontrol/childcaresettings.htm

Minnesota Child Care R & R, www.mnchildcare.org/health/infection_control.php

Central Iowa Childcare, www.centraliowachildcare.org/healthconsulting/tencommandmentschildcare.pdf

U.S. Department of Health & Human Services, www.pandemicflu.gov/plan/school/preschool.html