Daycare: Impact and Implications for Our Patients and Families for Our Patients and Families D O N N A G G R I G S B Y M D D O N N A G . G R I G S B Y , M . D . A S S O CI A T E P R O F E S S O R O F P E D I A T R I CS K E N T U CK Y CH I L D R E N ’S H O S P I T A L
Background At present, 60% to 70% of children younger than 6 years regularlyattend some type of out of home child care or regularlyattend some type of out-of-home child care or early childhood program. The arrangements families make for their children can vary dramatically, including care by relatives; center- d ti ll i l di b l ti t based care, including preschool early education programs; family child care provided in the caregiver’s home; and care provided in the child’s home by nannies home; and care provided in the child s home by nannies or babysitters. How a family chooses this care is influenced by family values affordability and availability values, affordability, and availability. For many families, high-quality child care is not affordable, which results in compromises.
Indicators of High Quality in a Child Care C Center t State licensing and program accreditation The requirements for licensing generally ensure basic health and safety of a program but not necessarily high quality; state licensing requirements can be found online at http:/ / nrc.uchsc.edu Staff-to-child ratio and group size For centers Birth to 12 mo 1:3 with groups 6 g p 13–30 mo 1:4 with groups 8 31–35 mo 1:5 with groups 10 3 y 1:7 with groups 14 4 and 5 y 1:8 with groups 16 Family child care If there are no children <2 y: 1 adult/ 6 children; when there is 1 child <2 y: 1 adult/ 4 children; and when there are 2 children <2 y (the maximum), no other children are recommended hild d d
Indicators of High Quality in a Child Care Center Director and staff experience and College degrees in early childhood training education Child development associate’s Child development associate s credential Ongoing inservice training Parent’s first-hand observations of care L Low turnover rate t t Infection Control Hand-washing with soap and running water after diapering, before handling food, and when contaminated by body , y y fluids Children wash hands after toileting and before eating Routinely cleaned facilities toys Routinely cleaned facilities, toys, equipment Up-to-date immunizations of staff and children
Indicators of High Quality in a Child Care Center Emergency procedures Written policies All t ff All staff and children familiar with d hild f ili ith procedures Up-to-date parent contact lists Injury prevention j y p Play equipment safe, including proper y q p , g p p shock-absorbing materials under climbing toys Universal Back-to-Sleep practices Developmentally appropriate toys and Developmentally appropriate toys and equipment Toxins out of reach Safe administration of medicines
Injuries in the Child Care Setting Boys slightly more likely overall than girls to have y g y y g injuries Probably related to behavioral differences in boys and girls. Boys more aggressive and higher activity level Boys more aggressive and higher activity level Incidence of moderate to severe injuries significantly higher in boys higher in boys Younger children ( 2-3.5 years) higher mean and median rate of injury compared to older j y p children(3.6-6 years)
Characteristics of injuries Smaller centers had higher mean and median g injuries rates compared with larger centers Of all injuries, 87% were minor, 12% moderate, only 1% were severe Minor injuries- scrapes or superficial cuts 36.5%, bumps or bruises 34.5% b b i % Moderate to severe injuries-deep cuts 5.8%, crush injuries 2 8% multiple cuts 0 3% burns 0 4% injuries 2.8%, multiple cuts 0.3%, burns 0.4%, chipped teeth 0.4%
Characteristics of injuries Body parts injured Face, eyes, nose, mouth 31% Head or neck 17% Arms hands or shoulders Arms, hands or shoulders 27% 27% Location where injury occurs Playground 74% Classroom 17% Field trips Field trips 4% 4% Entry Hall 3% Bathroom 1%
Characteristics of Injuries 81% of injuries occur during free play j g p y 11% transition times Peak time of day- 11 am to 12 y
Characteristics of Injuries Child factors alone (falls, another child)- 58.9% ( , ) 5 9 Environmental factors- 1.8% Both- 39.3% 39 3 Types of contributing factors For minor injuries- child only For moderate to severe- child only or combination of child factor and environmental
Infections in Day Care Attendees Increased rate of infectious diseases Increased rate of acquiring antimicrobial resistant organisms Centers with infants and toddlers have higher risk because of diapering and need for assistance with toileting, oral contact with the environment, poor t il ti l t t ith th i t control over their secretions and excretions, have immunity to fewer common pathogens These immunity to fewer common pathogens. These centers should emphasize infection-control measures.
Prevention and Control of Infection Caregiver’s practice of personal hygiene and immunization status Environmental sanitation Food handling procedures d h dl d Ages and immunization status of children Ratio of children to caregivers R ti f hild t i Physical space and quality of facilities Frequency of use of antibiotics in children in child care Frequency of use of antibiotics in children in child care Adherence to standard precautions for infection control
Management and Prevention of Illness Risk of introducing and agent into a child care group g g g p is related directly to the prevalence of that agent in the population and to the number of susceptible children in that group hild i th t Transmission of an agent within a group depends on the following: the following: Characteristics of the organism Mode of spread, infective dose, survival in the environment Frequency of asymptomatic infection or carrier state Immunity to the pathogen
Management and Prevention of Illness Children infected in a child care environment can transmit organisms within the group and within their households and the community Appropriate hand hygiene is the most important factor for decreasing transmission of disease in a child care setting child care setting
Management of ill or infected children in child care and for reducing transmission of pathogens: Antimicrobial treatment or prophylaxis when A ti i bi l t t t h l i h appropriate Immunization when appropriate Immunization when appropriate Exclusion of ill or infected children from facility Provision of alternative care at a separate site Provision of alternative care at a separate site Cohorting to provide care Limiting new admissions Limiting new admissions Closing the facility( rarely used)
Infection-control procedures Periodic review of center-maintained child and employee health records, including immunization records Hygienic and sanitary procedures for toilet use, toilet t training and diaper changing i i d di h i Review and reinforcement of hand hygiene Environmental sanitation Environmental sanitation Personal hygiene for children and staff Sanitary preparation and handling of food Sanitary preparation and handling of food Communicable disease surveillance and reporting Appropriate handling of pets pp p g p
Recommendations for Inclusion or Exclusion Most children will not need to be excluded from their regular care for mild respiratory illnesses because transmission likely occurred before symptoms d developed. l d Exclusion of sick children and adults is recommended when exclusion could decrease recommended when exclusion could decrease likelihood of secondary cases.
Illnesses that do not constitute a reason to Illnesses that do not constitute a reason to exclude a child from child care Non-pustular rash without fever or behavioral change Parvovirus B19 in an immunocompetent host Cytomegalovirus infection Cytomegalovirus infection Chronic Hepatitis B virus infection* Conjunctivitis without fever and without behavioral j change. (unless, if 2 or more children are infected) Human Immunodeficiency virus infection* Known MRSA carriers or children with colonization of K MRSA i hild ith l i ti f MRSA but without an illness that would require exclusion
Epidemiology and Control Enteric Infections Enteric pathogens transmitted by the person-to- person route have been principle organisms implicated in o tbreaks implicated in outbreaks Rotaviruses, enteric adenoviruses, astroviruses, norviruses, Hepatits A virus, Shigella species, E. coli O157:H7, Giardia p g p intestinalis , Cryptosporidium species Salm onella species, Clostridium difficile , and Cam pylobacter species have infrequently associated with Cam pylobacter species have infrequently associated with outbreaks in child care centers.
Recommend
More recommend
