they spread so fastand what to do about them
By Dennis Clements, MD, PhD
two-year-old Davids mother brought him to see me for the third
time in as many months, she seemed frustrated. Its a
great day care, but sometimes it seems like a germ factory,
she says. Davids always coming down with a cold or an
ear infection, and every other month we get a note from the director
saying that strep throat or hand-foot-mouth disease is going around.
I just dont know what to do to keep him from getting sick!
mom isnt alone. Most parents today work at least part-time,
either for personal growth or for financial survivalwhich
means their child needs to be cared for by someone else. Typically
this care takes place in an environment that puts their child in
close contact with other children, and hence at increased risk of
parents of young children talk to me about how difficult it is to
deal with the seemingly constant series of illnesses their child
picks up in day care. I find that explaining why this is so helps
them to realize that they are doing nothing wrong, their child is
normal, and that some day this will all go away.
infections spread in day care
To minimize the impact of day care diseases on children--and their
parents--there are several principles that we need to understand.
Most important is that day care centers by their nature cluster
individuals who are susceptible to diseases. At young ages children
have immature and inexperienced immune systems, so they acquire
virtually every virus they are exposed to. As a result, when an
infection is introduced into the day care setting it usually makes
the rounds of the entire room, and can even affect all the children
in the facility (not to mention the adults).
Another significant factor in day care infections is the close physical
contact among the participantsboth children and adults. Infections
that spread by the oral route can easily pass from individual to
individual as different babies teethe on the same toys or as toddlers
suck their thumbs after touching contaminated surfaces. While most
day cares have strict standards for proper hand-washing and diaper-changing
hygiene, situations do occur that can interrupt this preferred technique
and result in cross-contamination.
an infection appears, transmission can be extremely rapid. Studies
have shown that when a marked virus is introduced on a toy in a
day care room of toddlers in the morning, it can be cultured from
80 percent of the children by the end of the day and 50 percent
of the parents by the next morning.
infants and toddlers in day care have a new viral infection about
every three to four weeks and manifest symptoms of illness about
every two months. This repeated acquisition of infections may not
allow the childs normal physiology to return to a steady state,
making some children prone to chronic infections such as ear infections
the frequency of illness and possible secondary bacterial complications
make children in day care much more likely to have had antibiotic
treatment. This raises the likelihood that antibiotic-resistant
organisms will emerge, complicating treatment.
common day care illnesses
While day care may speed up the process, its important to
remember that children will get the vast majority of illnesses that
circulate in day cares at some point in their lives, whether they
are in day care or not. Furthermore, most day care infections are
caused by viruses and are thus self-limited, meaning that they usually
go away on their own.
Typical symptoms of viral illnesses include fever, runny nose, and
cough. Viral illnesses can also cause secondary bacterial ear infections.
These can be treated with antibiotics, but the underlying physical
changes from the viral illness will have to heal on their own.
adenovirus, and parainfluenza virus are common year-round. Some
cause a barky cough or croup and others conjunctivitis. Among the
more serious viral illnesses are respiratory syncytial virus (RSV)
and influenza, both common winter illnesses. In very young children
they can lead to respiratory difficulties and/or high fever. Rotavirus,
another winter illness, is a gastrointestinal disease that can cause
high fever and prolonged diarrhea.
in day care can also be exposed to bacterial, fungal, and protozoal
infections. Strep throat is common and contagious by the oral route.
Also common and easily transmitted are head lice, giardia (intestinal
protozoa), and ringworm (a fungus). Very rarely, a child in day
care comes down with a significant bacterial infection (which can
cause meningitis), but this is so infrequent that the health departments
usually intervene to treat all those exposed.
parents can do
So, what to do? My advice is to choose the smallest day care group
possible to minimize the number of people from whom your child can
acquire infections. Make sure the day care employees practice frequent
hand-washing techniques. When your child is sick, provide lots of
liquids and fever control medications for comfort and encourage
him or her to get as much sleep as possible to aid recovery. If
a fever persists or returns, bring your child to the doctor to see
if a bacterial complication has occurred.
Good luck this winter. And remember--your parents survived this,
and so will you.
Clements, MD, PhD, is interim chair of the Department of Pediatrics
at Duke University Medical Center. For more information, visit www.dukehealth.org