ROTAVIRUS: An Unwelcome Guest

When you look around your childcare center, it may seem like there are always a few children with upset stomachs, diarrhea and other minor complaints. But during the fall and winter months, this number may increase due to rotavirus.

Rotavirus is one of the most common illnesses in young children. It occurs most often between November and May and frequently causes outbreaks in childcare centers. Here are some facts and tips about rotavirus that will help you prepare as the winter months approach.

What is rotavirus?

Rotavirus is a virus that causes severe, acute diarrhea. In children ages three months to two years, rotavirus is one of the most common causes of gastroenteritis, which is an inflammation or irritation of the stomach or bowels. By age five, nearly every child has been infected with the virus at least once if not a several times.

Sometimes called the "winter diarrhea," this disease is very contagious. As a childcare provider, you should know how to recognize rotavirus symptoms, control its spread, and watch for signs that it is leading toward a potentially dangerous case of dehydration.

Recognizing Rotavirus

Rotavirus illness in children typically begins with a fever and an upset stomach as well as vomiting. While those symptoms disappear after a day or two, the diarrhea that follows may last up to nine days! In older children, the diarrhea will most likely be mild, but severe diarrhea is not uncommon in children less than three years.

Once a case of rotavirus is present in your childcare center, it can spread from child to child and keep you knee-deep in sick children. Why? Rotavirus is spread very easily, even in clean environments.

A child can catch a rotavirus infection if she puts her fingers in her mouth after touching something that has been contaminated by the stool of an infected person. The virus often is transmitted from one infected child to another by contaminated hands or objects.

Because the child may develop fever, vomiting, and uncontrolled diarrhea, your childcare program's policy on exclusion will likely require calling the parents and sending the child home until the diarrhea stops and the fever has been gone for 24 hours.

While this is a helpful precaution, it is not likely to stop the spread of this disease. It can be 48 hours before a child with rotavirus shows any symptoms at all, and children can spread rotavirus both before and after they have the signs of being sick. In addition, some cases of rotavirus are mild enough that the condition may not even be recognized, but it is still contagious.

Prevention

The most important thing you can do to help control the spread of this disease is hand washing! Washing both the big and little hands in your childcare program with soap and water can help reduce its ability to spread. Consider scheduling more frequent hand washing breaks, especially for young toddlers.

The Centers for Disease Control and Prevention (CDC) recommends that children be vaccinated against rotavirus. This vaccine will prevent 74 percent of all rotavirus cases, about 98 percent of severe cases, and about 96 percent of hospitalizations due to rotavirus.

When reviewing each child's immunization records, make sure that rotavirus is one of the diseases that the child is vaccinated for.

Treatment

With rest, fluids, and healthy eating habits, rotavirus usually will disappear from the child's stool in three-nine days. Parents who think their children may have rotavirus infections should call their doctors, particularly when signs of dehydration are present.

Doctors will not prescribe antibiotics for rotavirus because antibiotics have no effect on viruses. In fact, antibiotics might make a child's diarrhea worse.

Rotavirus also can affect the staff in the childcare center, but cases in adults are seldom severe and often have no symptoms at all.

The real rotavirus danger

While many cases of rotavirus infection have mild symptoms or even no symptoms at all, some can be very serious. Rotavirus infections cause more than 55,000-70,000 hospitalizations in the U.S. each year, primarily for treatment of dehydration. In developing countries that do not benefit from the standard of health care and nutrition provided in the U.S., rotavirus is much more serious; cases of shock and even death from dehydration are not uncommon.

Symptoms

Dehydration is a serious concern because diarrhea can impair the body's ability to process and absorb necessary water, salts and nutrients. Signs of dehydration that caregivers should watch for can include:

• Dry lips and tongue.
• Dry skin.
• Sunken eyes.
• Infrequent wet diapers in young children, or infrequent trips to the bathroom by older children to urinate.

If you see any of these signs in the children in your care, have the caregiver contact a doctor immediately. The doctor will provide guidance about what the child should eat and drink to help replace lost body fluids and prevent any serious complications and may recommend special drinks called oral rehydration solutions such as Ceralyte, Pedialyte or Oralyte.

These solutions can be purchased in nearly all drug stores and grocery stores. Some doctors may suggest switching the child to a liquid diet until diarrhea passes, while others might believe that the child will get well quickly by sticking to a normal, healthy diet.

Infants or toddlers who become severely dehydrated may need to be treated in a hospital to bring the body's water level back to normal. It is important that parents follow the recommendations of their child's doctor to relieve symptoms and prevent dehydration from vomiting or diarrhea.

By Scott Allen, Executive Director
Illinois Chapter, American Academy of Pediatrics

Updated January 2008

Internet Resources

Centers for Disease Control and Prevention (CDC),
www.cdc.gov/vaccines/vpd-vac/rotavirus/default.htm

Merck, www.rotavirusinfo.com

Kid's Health, www.kidshealth.org/parent/infections/bacterial_viral/rotavirus.html