Dr Danielle Esler provides some practical advice for parents and carers to help reduce the spreading of infection among children attending childcare.
Communicable diseases are spread in a number of ways, such as through the air (for example, by someone coughing or sneezing), through hands contaminated by faeces, direct skin-to-skin contact (for example, school sores) or contamination of surfaces.
Therefore it is not surprising that children, who touch everything, put their hands in their mouths and haven’t yet learned various social graces, are prone to catching infections. Additionally, compared to healthy adults, children have reduced immunity to infection, which means once they start childcare they are likely to have more illnesses as they become exposed to a large number of other children. While it is inevitable that a certain amount of cross-infection between children and staff will occur in the childcare setting, many infections are preventable.
There are three major ways staff and parents can work together to reduce the spreading of infection among children attending childcare:
It is important to be aware that children and adults may be infectious to others before showing symptoms of an illness, and in some cases there may be no evident symptoms at all. For this reason, effective hand washing should be an integral part of the daily routine, both at home and at childcare. Unwashed hands can transmit a variety of bacteria and viruses, including those that cause influenza and diarrhoea. Parents should teach their children to wash their hands as they arrive at the centre, after they leave, after going to the toilet and before meals. Good hand washing takes time (ideally 10 to15 seconds). Liquid-soap dispensers are ideal for hand washing, and children should be encouraged to pat their hands dry. Childcare staff have an important role to play by encouraging this routine, and washing their own hands before preparing food, after they go to the toilet and after cleaning up spills such as vomit. Both parents and staff must be mindful to also wash the hands of babies.
Exclusion Of Sick Children And Staff
Working parents are under pressure, and may find it difficult to take time off to care for their sick child. A specific policy of excluding children who are unwell from childcare is therefore essential to help parents and staff make informed decisions that are in the best interests of all those attending and working at the centre. The National Health and Medical Research Council has issued guidelines regarding the amount of time a child should be excluded from childcare or school if they are infected with certain illness.
Vaccination involves giving a small dose of a dead or weak live virus or bacteria. The body responds to this dose by remembering the virus or bacteria and developing an immune response. If, at a later date, the body is exposed to that virus or bacteria again, the immune system is able to mount a fight, preventing the body from becoming unwell. Vaccination is one of the most effective interventions we have available to prevent disease. Despite this, the World Health Organization (WHO) estimated in 2008 that 1.5 million deaths among children under five years were due to diseases that could have been prevented by routine vaccination.
The Australian vaccination schedule vaccinates against 13 potentially serious infections in the pre-school years, including measles, mumps, rubella, diphtheria, polio, hepatitis B, meningococcal C, varicella (chickenpox), haemophilus influenzae type b, tetanus, pertussis (whooping cough), rotavirus and pneumococcus. Older children are offered hepatitis B, varicella, diphtheria, tetanus and pertussis booster vaccines through school programs. Children aged between 12 and 13 are also vaccinated against human papillomavirus.
Additional vaccinations may be warranted for children from special groups. For example, Aboriginal and Torres Strait Islanders living in high-risk areas are eligible for hepatitis A and an additional pneumococcal vaccination. Children with certain pre-existing illness such as heart or lung conditions should be vaccinated annually against influenza. Adverse reactions to vaccination are rare and usually mild. The potential benefits of the vaccinations offered by the Australian vaccination schedule are greater than the risk of an adverse reaction.
Childcare staff should encourage parents to vaccinate their children by providing information and keeping a record of children’s vaccinations. Supervisors of childcare services should report any outbreak of diarrhoea and/or vomiting or vaccine-preventable disease to their local public health unit. In the event of an outbreak of a vaccine-preventable infection in a childcare setting, public-health staff may advise that non-vaccinated children are to be excluded from care.
Danielle Esler is a registered GP, public-health physician and mother of two boys.