health, safety, and nutrition for the young child, 8th...

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Health, Safety, and Nutrition for the Young Child

Eighth Edition

Lynn R. Marotz, RN, Ph.D.

University of Kansas

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Health, Safety, and Nutrition for the Young Child, Eighth EditionLynn R. Marotz

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136

Communicable and Acute

Illness: Identification and

Management

�� NAEYC Standards Chapter Links

� #1 a, b, and c: Promoting child development and learning

� #2 a, b, and c: Building family and community relationships

� #3 a, c, and d: Observing, documenting, and assessing to support young children and families

�� Learning Objectives

After studying this chapter, you should be able to:

� Discuss why it is important for teachers to be knowledgeable about children’s communicable

and acute illnesses.

� Explain how communicable illnesses such as chickenpox, pinkeye, impetigo, and giardia are

spread and identify appropriate control measures.

� Describe the teachers’ role in addressing common acute childhood illnesses.

B

ecause young children are especially vulnerable to a variety of communicable and acute ill-

nesses, classroom teachers must be prepared to identify and implement policies and practices

designed to limit their spread. Teachers can best prepare themselves for this role by becoming

familiar with the signs and symptoms of common childhood illnesses and the precautionary

measures appropriate for each. This knowledge can be useful for establishing program guidelines,

creating meaningful lessons for children, and communicating important health information with

families.

CHAPTER

6

symptoms – changes in the body or its functions that are experienced by the affected individual.



Chapter 6 Communicable and Acute Illness: Identification and Management 137

�� Communicable Childhood IllnessesProtecting children’s health in group settings requires teachers to have a sound understanding of

common communicable illnesses—what causes them, how they are transmitted, and how they can

be controlled. Their knowledge of childhood illnesses and ability to implement infection control

procedures, including hand washing and disinfection, are important management skills. Table 6–1

provides brief descriptions of communicable illnesses that young children commonly experience.

Teachers should also be familiar with local public health policies that specify which communi-

cable illnesses must be reported. Notifying health officials of existing cases enables them to moni-

tor communities for potential outbreaks. They may also be able to provide additional information

about an illness that teachers can share with families.

Reflective Thoughts

Teachers recognize the importance of addressing issues of diversity in their programs. How-ever, little is often understood about how individuals from various backgrounds—cultures, recent immigrants, homeless families—view the concepts of health, illness, and traditional Western medicine. Notable differences between mainstream values, beliefs, and practices and those held by a particular group are common. Thus, teachers must make an effort to learn more about individual families and their unique beliefs and priorities in order to best serve children’s health needs. Excellent resources are available on the National Center for Cultural Competence website (http://www11.georgetown.edu/research/gucchd/nccc). Take time to explore the information and self-assessment tools provided.

��Teachers should be able to identify the early signs of childhood illnesses.

© h

ttp:

//ph

il.cd

c.go

v/ph

il



138 UNIT 1 Promoting Children’s Health: Healthy Lifestyles and Health Concerns

Co

mm

un

icab

le

Illn

ess

Sig

ns

an

d

Sy

mp

tom

sIn

fec

tio

us

Ag

ent

Me

tho

ds

of

Tra

nsm

issi

on

Incu

ba

tio

n

Per

iod

Len

gth

of

Co

mm

un

icab

ilit

yC

on

tro

l Mea

sure

s

Air

bo

rne

Tra

nsm

itte

d I

lln

esse

s

Chi

cken

pox

Slig

ht f

ever

, ir

rita

bilit

y, c

old

-lik

e sy

mpt

oms.

R

ed r

ash

that

de

velo

ps b

liste

r-lik

e he

ad, s

cabs

late

r. M

ost a

bund

ant

on c

over

ed p

arts

of

bod

y, e

.g.,

ches

t, ba

ck, n

eck,

fo

rear

ms.

Vir

usA

irbo

rne

thro

ugh

co

ntac

t wit

h

secr

etio

ns

from

the

resp

irat

ory

trac

t. Tr

ansm

issi

on

from

con

tact

w

ith

blis

ters

less

co

mm

on.

2–3

wee

ks

afte

r ex

posu

re2–

3 da

ys p

rior

to

the

onse

t of

sym

ptom

s un

til

5–6

days

aft

er f

irst

er

upti

ons.

Sca

bs

are

not c

onta

gio

us.

Spe

cifi

c co

ntro

l m

easu

res:

(1)

Exc

lusi

on

of s

ick

child

ren.

(2)

P

ract

ice

good

per

sona

l hy

gie

ne, e

spec

ially

ca

refu

l han

d w

ashi

ng.

Chi

ldre

n c

an r

etur

n to

gr

oup

car

e w

hen

all

blis

ters

hav

e fo

rmed

a

dry

scab

(ap

prox

imat

ely

1 w

eek)

. Im

mun

izat

ion

is

now

ava

ilabl

e.

Com

mon

Col

dH

ighl

y co

ntag

ious

in

fect

ion

of t

he

uppe

r re

spir

ator

y tr

act a

ccom

pani

ed

by s

light

fev

er,

chill

s, r

unny

no

se, f

atig

ue,

mus

cle

ache

and

he

adac

hes.

Ons

et

may

be

sudd

en.

Vir

usA

irbo

rne

thro

ugh

co

ntac

t wit

h

secr

etio

ns f

rom

th

e re

spir

ator

y tr

act,

e.g.

, co

ughs

, sne

ezes

, ea

ting

ute

nsils

, et

c.

12–7

2 ho

urs

Abo

ut 1

day

bef

ore

onse

t of s

ympt

oms

to 2

–3 d

ays

afte

r ac

ute

illne

ss.

Pre

vent

ion

thro

ugh

ed

ucat

ion

and

goo

d

pers

onal

hyg

iene

. A

void

exp

osur

e.

Exc

lude

fir

st d

ay o

r tw

o. A

ntib

ioti

cs n

ot

effe

ctiv

e ag

ains

t vir

uses

. A

void

asp

irin

pro

duct

s (p

ossi

ble

link

to R

eye’

s sy

ndro

me)

. Obs

erve

fo

r co

mpl

icat

ions

, e.g

., ea

rach

es, b

ronc

hiti

s,

crou

p, p

neum

onia

.

Fift

h d

isea

seA

ppea

ranc

e of

br

ight

red

ras

h o

n

face

, esp

ecia

lly

chee

ks.

Vir

usA

irbo

rne

cont

act

wit

h s

ecre

tion

s fr

om th

e no

se/

mou

th o

f inf

ecte

d

pers

on.

4–14

day

sP

rior

to

appe

aran

ce o

f ra

sh; p

roba

bly

not

cont

agio

us a

fter

ra

sh d

evel

ops.

Chi

ldre

n d

on’t

nee

d

to b

e ex

clud

ed o

nce

rash

app

ears

. Fre

quen

t ha

nd w

ashi

ng; f

requ

ent

was

hing

/dis

infe

ctin

g o

f to

ys/s

urfa

ces.

Use

car

e w

hen

han

dlin

g t

issu

es/

nasa

l sec

reti

ons.

Ta

ble

6–1

C

om

mo

n C

om

mu

nic

able

Ch

ild

ho

od

Ill

nes

ses




Hae

mop

hilu

s i

nflu

enza

Typ

e b

(H

ib)

An

acu

te

resp

irat

ory

infe

ctio

n;

freq

uent

ly c

ause

s m

enin

git

is. O

ther

co

mpl

icat

ions

in

clud

e pn

eum

onia

, ep

iglo

ttit

is,

arth

riti

s, in

fect

ions

of

the

bloo

dstr

eam

, an

d c

onju

ncti

viti

s.

Bac

teri

aA

irbo

rne

via

secr

etio

ns o

f the

re

spir

ator

y tr

act

(nos

e, th

roat

).

Som

e ch

ildre

n

are

carr

iers

and

m

ay/m

ay n

ot h

ave

sym

ptom

s.

2–4

days

Thr

ough

out a

cute

ph

ase;

as

long

as

org

anis

m

is p

rese

nt.

Non

com

mun

icab

le

36–4

8 ho

urs

afte

r tr

eatm

ent w

ith

an

tibi

otic

s.

Iden

tify

and

exc

lude

sic

k ch

ildre

n. Tr

eatm

ent w

ith

antib

ioti

cs 3

–4 d

ays

befo

re

retu

rnin

g to

gro

up c

are.

N

otif

y fa

mili

es o

f exp

osed

ch

ildre

n to

con

tact

thei

r ph

ysic

ian.

Imm

uniz

e ch

ildre

n. P

ract

ice

good

ha

nd w

ashi

ng te

chni

ques

; sa

niti

ze c

onta

min

ated

ob

ject

s.

Mea

sles

(

Rub

eola

)Fe

ver,

coug

h, r

unny

no

se, e

yes

sens

itiv

e to

ligh

t. D

ark

red

bl

otch

y ra

sh th

at

ofte

n b

egin

s on

the

face

and

nec

k, th

en

spre

ads

over

the

enti

re b

ody.

Hig

hly

com

mun

icab

le.

Vir

usA

irbo

rne

thro

ugh

co

ughs

, sne

ezes

, an

d c

onta

ct w

ith

co

ntam

inat

ed

arti

cles

.

8–13

day

s;

rash

dev

elop

s ap

prox

imat

ely

14 d

ays

afte

r ex

posu

re

From

beg

inni

ng

of s

ympt

oms

unti

l 4

days

aft

er r

ash

ap

pear

s.

Mos

t eff

ecti

ve c

ontr

ol

met

hod

is im

mun

izat

ion.

G

ood

per

sona

l hyg

iene

, es

peci

ally

han

d w

ashi

ng

and

cov

erin

g c

ough

s.

Exc

lude

chi

ld fo

r at

le

ast 4

day

s af

ter

rash

ap

pear

s.

Men

ing

itis

Sud

den

ons

et

of f

ever

, sti

ff

neck

, hea

dach

e,

irri

tabi

lity,

an

d v

omit

ing

; gr

adua

l los

s of

co

nsci

ousn

ess,

se

izur

es, a

nd d

eath

.

Bac

teri

aA

irbo

rne

thro

ugh

co

ughs

, nas

al

secr

etio

ns;

dire

ct c

onta

ct

wit

h s

aliv

a/na

sal

disc

harg

es.

Var

ies

wit

h

the

infe

ctin

g

org

anis

m; 2

–4

days

ave

rag

e

Thr

ough

out

acut

e ph

ase;

no

ncom

mun

icab

le

afte

r an

tibi

otic

tr

eatm

ent.

Enc

oura

ge

imm

uniz

atio

n.

Exc

lude

chi

ld fr

om s

choo

l un

til m

edic

al tr

eatm

ent

is c

ompl

eted

. Use

un

iver

sal p

reca

utio

ns

whe

n h

andl

ing

sal

iva/

nasa

l sec

reti

ons,

fr

eque

nt h

and

was

hing

, an

d d

isin

fect

ing

of t

oys/

surf

aces

.

Mon

onuc

leos

isC

hara

cter

isti

c sy

mpt

oms

incl

ude

sore

thro

at,

inte

rmit

tent

feve

r, fa

tigue

, and

enl

arge

d

lym

ph g

land

s in

th

e ne

ck. M

ay a

lso

be

acc

ompa

nied

by

hea

dach

e an

d

enla

rged

live

r or

sple

en.

Vir

usA

irbo

rne;

als

o

dire

ct c

onta

ct

wit

h s

aliv

a of

an

in

fect

ed p

erso

n.

2–4

wee

ks

for

child

ren

; 4–

6 w

eeks

for

adul

ts

Unk

now

n.

Org

anis

ms

may

be

pre

sent

in o

ral

secr

etio

ns fo

r as

long

as

1 ye

ar

follo

win

g il

lnes

s.

Non

e kn

own.

Chi

ld

shou

ld b

e ke

pt h

ome

unti

l ove

r th

e ac

ute

phas

e (6

–10

days

). U

se

freq

uent

han

d w

ashi

ng

and

car

eful

dis

posa

l of

tiss

ues

afte

r co

ughi

ng o

r bl

owin

g n

ose.

(con

tinu

ed)




Mum

psS

udde

n o

nset

of

feve

r w

ith

sw

ellin

g

of th

e sa

livar

y g

land

s.

Vir

usA

irbo

rne

thro

ugh

co

ughs

and

sn

eeze

s; d

irec

t co

ntac

t wit

h o

ral

secr

etio

ns o

f in

fect

ed p

erso

ns.

12–2

6 da

ys6–

7 da

ys p

rior

to

the

onse

t of

sym

ptom

s un

til

swel

ling

in th

e sa

livar

y g

land

s is

go

ne (

7–9

days

).

Imm

uniz

atio

n p

rovi

des

perm

anen

t pro

tect

ion.

P

eak

inci

denc

e is

in

win

ter

and

spr

ing.

E

xclu

de c

hild

ren

fro

m

scho

ol o

r gr

oup

set

ting

s un

til a

ll sy

mpt

oms

have

di

sapp

eare

d.

Ros

eola

Infa

ntum

(

6–24

mos

.)M

ost c

omm

on in

th

e sp

ring

and

fal

l. Fe

ver

rise

s ab

rupt

ly

(102

°–10

5°F

) an

d

last

s 3–

4 da

ys;

loss

of a

ppet

ite,

lis

tles

snes

s, r

unny

no

se, r

ash

on

trun

k,

arm

s, a

nd n

eck

last

ing

1–2

day

s.

Vir

usP

erso

n to

per

son

; m

etho

d u

nkno

wn.

10–1

5 da

ys1–

2 da

ys b

efor

e on

set t

o s

ever

al

days

follo

win

g

fadi

ng o

f the

ras

h.

Exc

lude

fro

m s

choo

l or

grou

p c

are

unti

l ras

h a

nd

feve

r ar

e go

ne.

Rub

ella

(G

erm

an

Mea

sles

)M

ild f

ever

; ras

h

beg

ins

on f

ace

and

nec

k an

d

rare

ly la

sts

mor

e th

an 3

day

s. M

ay

have

art

hrit

is-l

ike

disc

omfo

rt a

nd

swel

ling

in jo

ints

.

Vir

usA

irbo

rne

thro

ugh

co

ntac

t wit

h

resp

irat

ory

secr

etio

ns, e

.g.,

coug

hs, s

neez

es.

4–21

day

sFr

om o

ne w

eek

prio

r to

5 d

ays

follo

win

g o

nset

of

the

rash

.

Imm

uniz

atio

n o

ffer

s pe

rman

ent p

rote

ctio

n.

Chi

ldre

n m

ust b

e ex

clud

ed f

rom

sch

ool

for

at le

ast 7

day

s af

ter

appe

aran

ce o

f ras

h.

Str

epto

cocc

al

Inf

ecti

ons

(st

rep

th

roat

, s

carl

atin

a,

rhe

umat

ic f

ever

)

Sud

den

ons

et. H

igh

fe

ver

acco

mpa

nied

by

sor

e, r

ed th

roat

; m

ay a

lso

hav

e na

usea

, vom

itin

g,

head

ache

,

Bac

teri

aA

irbo

rne

via

drop

lets

from

co

ughs

or

snee

zes.

May

als

o

be tr

ansm

itte

d by

fo

od a

nd r

aw m

ilk.

1–4

days

Thr

ough

out t

he

illne

ss a

nd fo

r ap

prox

imat

ely

10

days

aft

erw

ard,

un

less

trea

ted

wit

h

anti

biot

ics.

Exc

lude

chi

ld w

ith

sy

mpt

oms.

Ant

ibio

tic

trea

tmen

t is

esse

ntia

l. A

void

cro

wdi

ng in

cl

assr

oom

s. P

ract

ice

freq

uent

han

d w

ashi

ng,

Ta

ble

6–1

C

om

mo

n C

om

mu

nic

able

Ch

ild

ho

od

Ill

nes

ses

(con

tinu

ed)

Co

mm

un

icab

le

Illn

ess

Sig

ns

an

d

Sy

mp

tom

sIn

fec

tio

us

Ag

ent

Me

tho

ds

of

Tra

nsm

issi

on

Incu

ba

tio

n

Per

iod

Len

gth

of

Co

mm

un

icab

ilit

yC

on

tro

l Mea

sure

s

Air

bo

rne

Tra

nsm

itte

d I

lln

esse

s (c

onti

nued

)




whi

te p

atch

es

on to

nsils

, and

en

larg

ed g

land

s.

Dev

elop

men

t of

a ra

sh d

epen

ds

on th

e in

fect

ious

or

gan

ism

.

Med

ical

trea

tmen

t el

imin

ates

co

mm

unic

abili

ty

wit

hin

36

hour

s.

Can

dev

elop

rh

eum

atic

fev

er o

r be

com

e a

carr

ier

if

not t

reat

ed.

educ

atin

g c

hild

ren,

and

ca

refu

l sup

ervi

sion

of

food

han

dler

s.

Tube

rcul

osis

Man

y pe

ople

hav

e no

sym

ptom

s.

Act

ive

dise

ase

caus

es p

rodu

ctiv

e co

ugh,

wei

ght

loss

, fat

igue

, los

s of

app

etit

e, c

hills

, ni

ght s

wea

ts.

Bac

teri

aA

irbo

rne

via

coug

hs o

r sn

eeze

s.

2–3

mon

ths

As

long

as

dise

ase

is

untr

eate

d; u

sual

ly

nonc

onta

gio

us

afte

r 2–

3 w

eeks

on

m

edic

atio

n.

TB

ski

n te

stin

g,

espe

cial

ly b

abie

s an

d

youn

g ch

ildre

n if

ther

e ha

s be

en c

onta

ct w

ith

an

infe

cted

per

son.

See

k pr

ompt

dia

gnos

is a

nd

trea

tmen

t if e

xper

ienc

ing

sy

mpt

oms;

com

plet

e dr

ug th

erap

y. C

over

co

ughs

/sne

ezes

. Pra

ctic

e go

od h

and

was

hing

.

Blo

od

-Bo

rne

Tra

nsm

itte

d I

lln

esse

s

Acq

uire

d

Im

mun

o-

def

icie

ncy

Syn

drom

e (

AID

S)

Flu

-lik

e sy

mpt

oms,

in

clud

ing

fat

igue

, w

eigh

t los

s,

enla

rged

lym

ph

gla

nds,

per

sist

ent

coug

h, f

ever

, and

di

arrh

ea.

Vir

usC

hild

ren

acq

uire

vi

rus

whe

n

born

to in

fect

ed

mot

hers

, fro

m

cont

amin

ated

bl

ood

tr

ansf

usio

ns,

and

pos

sibl

y fr

om b

reas

t m

ilk o

f inf

ecte

d

mot

hers

. Adu

lts

acqu

ire

the

viru

s vi

a se

xual

tr

ansm

issi

on,

cont

amin

ated

dr

ug n

eedl

es,

and

blo

od

tran

sfus

ions

.

6 w

eeks

to 8

ye

ars

Lif

etim

eE

xclu

de c

hild

ren

0–5

yr

s. if

they

hav

e op

en

lesi

ons,

unc

ontr

olla

ble

nose

blee

ds, b

lood

y di

arrh

ea, o

r ar

e at

hig

h

risk

for

expo

sing

oth

ers

to b

lood

-con

tam

inat

edbo

dy f

luid

s. U

se u

nive

rsal

pr

ecau

tion

s w

hen

ha

ndlin

g bo

dy f

luid

s,

incl

udin

g go

od h

and

w

ashi

ng te

chni

ques

. Sea

l co

ntam

inat

ed it

ems,

e.g

., di

aper

s, p

aper

tow

els

in

plas

tic

bags

. Dis

infe

ct

surf

aces

wit

h bl

each

/w

ater

sol

utio

n (1

:10)

or

othe

r di

sinf

ecta

nt.

(con

tinu

ed)




Hep

atit

is B

Slo

w o

nset

; los

s of

ap

peti

te, n

ause

a,

vom

itin

g, a

bdom

inal

pa

in, a

nd ja

undi

ce.

May

als

o b

e a

sym

pto

ma

tic.

Vir

usT

hrou

gh c

onta

ct

wit

h b

lood

/bod

y fl

uids

con

tain

ing

bl

ood.

45–1

80 d

ays;

av

erag

e 60

–80

days

Var

ies;

som

e pe

rson

s ar

e lif

etim

e ca

rrie

rs.

Imm

uniz

atio

n is

pr

efer

able

. Use

uni

vers

al

prec

auti

ons

whe

n

hand

ling

any

blo

od/b

ody

flui

ds; u

se f

requ

ent h

and

w

ashi

ng.

Co

nta

ct

(Dir

ect

an

d I

nd

irec

t) T

ran

smit

ted

Ill

nes

ses

Con

junc

tivi

tis

(P

inke

ye)

Red

ness

of t

he

whi

te p

orti

on

(con

junc

tiva

) of

the

eye

and

inne

r ey

elid

, sw

ellin

g o

f the

lids

, ye

llow

dis

char

ge

from

eye

s, a

nd

itch

ing.

Bac

teri

a or

vi

rus

Dire

ct c

onta

ct

with

dis

char

ge

from

eye

s or

upp

er

resp

irato

ry tr

act

of a

n in

fect

ed

pers

on; t

hrou

gh

cont

amin

ated

fin

gers

and

ob

ject

s,

e.g.

, tis

sues

, w

ashc

loth

s, to

wel

s.

1–3

days

Thr

ough

out a

ctiv

e in

fect

ion

; sev

eral

da

ys u

p to

2–3

w

eeks

.

Ant

ibio

tic

trea

tmen

t. E

xclu

de c

hild

for

24

hour

s af

ter

med

icat

ion

is

sta

rted

. Fre

quen

t han

d

was

hing

and

dis

infe

ctio

n

of to

ys/s

urfa

ces

is

nece

ssar

y.

Cyt

omeg

alov

irus

(

CM

V)

Oft

en n

o s

ympt

oms

in c

hild

ren

und

er

2 yr

s.; s

ore

thro

at,

feve

r, fa

tigu

e in

ol

der

child

ren.

Hig

h

risk

of f

etal

dam

age

if m

othe

r is

infe

cted

du

ring

pre

gnan

cy.

Vir

usP

erso

n to

per

son

co

ntac

t wit

h b

ody

flui

ds, e

.g.,

saliv

a,

bloo

d, u

rine

, br

east

milk

, in

ut

ero.

Unk

now

n;

may

be

4–8

wee

ks

Vir

us p

rese

nt (

in

saliv

a, u

rine

) fo

r m

onth

s fo

llow

ing

in

fect

ion.

No

nee

d to

exc

lude

ch

ildre

n. A

lway

s w

ash

ha

nds

afte

r ch

ang

ing

di

aper

s or

con

tact

wit

h

saliv

a. A

void

kis

sing

ch

ildre

n’s

mou

ths

or

shar

ing

eat

ing

ute

nsils

. P

ract

ice

care

ful h

and

w

ashi

ng w

ith

chi

ldre

n;

was

h/d

isin

fect

toys

and

su

rfac

es f

requ

entl

y.

Han

d, F

oot,

and

M

outh

Dis

ease

Aff

ects

chi

ldre

n

unde

r 10

yrs

. Ons

et

of f

ever

, fol

low

ed b

y bl

iste

red

sor

es in

Vir

usP

erso

n to

per

son

th

roug

h d

irec

t co

ntac

t wit

h

saliv

a, n

asal

3–6

days

7–10

day

sE

xclu

de s

ick

child

ren

for

seve

ral d

ays.

Pra

ctic

e fr

eque

nt h

and

was

hing

, es

peci

ally

aft

er c

hang

ing

Co

mm

un

icab

le

Illn

ess

Sig

ns

an

d

Sy

mp

tom

sIn

fec

tio

us

Ag

ent

Me

tho

ds

of

Tra

nsm

issi

on

Incu

ba

tio

n

Per

iod

Len

gth

of

Co

mm

un

icab

ilit

yC

on

tro

l Mea

sure

s

Blo

od

Bo

rne

Tra

nsm

itte

d I

lln

esse

s (c

onti

nued

)

Ta

ble

6–1

C

om

mo

n C

om

mu

nic

able

Ch

ild

ho

od

Ill

nes

ses

(con

tinu

ed)

asym

ptom

atic

– h

av

ing

no

sy

mp

tom

s.




the

mou

th/c

heek

s;

1–2

days

late

r ra

ised

ras

h a

ppea

rs

on p

alm

s of

han

ds

and

sol

es o

f fee

t.

disc

harg

e, o

r fe

ces.

diap

ers.

Cle

an/d

isin

fect

su

rfac

es.

Her

pes

sim

plex

(

cold

sor

es)

Cle

ar b

liste

rs

deve

lop

on fa

ce, l

ips,

an

d ot

her b

ody

part

s th

at c

rust

and

hea

l w

ithin

a fe

w d

ays.

Vir

usD

irec

t con

tact

w

ith

sal

iva,

on

ha

nds,

or

sexu

al

cont

act.

Up

to 2

wee

ksV

irus

rem

ains

in

sal

iva

for

as

long

as

7 w

eeks

fo

llow

ing

rec

over

y.

No

spe

cifi

c co

ntro

l. Fr

eque

nt h

and

was

hing

. C

hild

doe

s no

t hav

e to

be

excl

uded

fro

m s

choo

l.

Impe

tigo

Infe

ctio

n of

the

skin

fo

rmin

g cr

usty

, moi

st

lesi

ons

usua

lly o

n th

e fa

ce, e

ars,

and

aro

und

th

e no

se. H

ighl

y co

ntag

ious

. Com

mon

am

ong

child

ren.

Bac

teri

aD

irect

con

tact

with

di

scha

rge

from

so

res;

indi

rect

co

ntac

t with

co

ntam

inat

ed

artic

les

of c

loth

ing,

tis

sues

, etc

.

2–5

days

; may

be

as

long

as

10 d

ays

Unt

il tr

eate

d w

ith

an

tibi

otic

s an

d a

ll le

sion

s ar

e he

aled

.

Exc

lude

fro

m g

roup

se

ttin

gs u

ntil

lesi

ons

have

bee

n tr

eate

d w

ith

an

tibi

otic

s fo

r 24

–48

hour

s. C

over

are

as w

ith

ba

ndag

e un

til t

reat

ed.

Lic

e (h

ead

)L

ice

are

seld

om

visi

ble

to th

e na

ked

ey

e. W

hite

nit

s (e

ggs)

are

vis

ible

on

hai

r sh

afts

. T

he m

ost o

bvio

us

sym

ptom

is it

chin

g

of th

e sc

alp,

es

peci

ally

beh

ind

th

e ea

rs a

nd a

t the

ba

se o

f the

nec

k.

Hea

d lo

use

Dir

ect c

onta

ct

wit

h in

fect

ed

pers

ons

or w

ith

th

eir

pers

onal

ar

ticl

es, e

.g.,

hats

, hai

r br

ushe

s, c

ombs

, or

clo

thin

g. L

ice

can

sur

vive

for

2–3

wee

ks o

n

bedd

ing,

car

pet,

furn

itur

e, c

ar

seat

s, c

loth

ing,

et

c.

Nit

s ha

tch

in

1 w

eek

and

rea

ch

mat

urit

y w

ithi

n 8

–10

days

Whi

le li

ce r

emai

n

aliv

e on

infe

sted

pe

rson

s or

cl

othi

ng; u

ntil

nits

hav

e be

en

dest

roye

d.

Infe

sted

chi

ldre

n sh

ould

be

exc

lude

d fr

om g

roup

se

ttin

gs u

ntil

trea

ted.

H

air s

houl

d be

was

hed

w

ith

a sp

ecia

l med

icat

ed

sham

poo

and

rins

ed w

ith

a

vine

gar/

wat

er s

olut

ion

(a

ny c

once

ntra

tion

will

w

ork)

to e

ase

rem

oval

of

all

nits

(usi

ng a

fine

-to

othe

d co

mb)

. Hea

t fr

om a

hai

r dry

er a

lso

he

lps

to d

estr

oy e

ggs.

All

frie

nds

and

fam

ily s

houl

d

be c

aref

ully

che

cked

. T

horo

ughl

y cl

ean

child

’s

envi

ronm

ent;

vacu

um

carp

ets/

upho

lste

ry, w

ash/

dry

or d

ry c

lean

bed

ding

, cl

othi

ng, h

airb

rush

es.

Sea

l non

was

habl

e it

ems

in p

last

ic b

ag fo

r 2 w

eeks

.

(con

tinu

ed)




Rin

gwor

mA

n in

fect

ion

of

the

scal

p, s

kin,

or

nails

. Cau

ses

flat

, sp

read

ing,

ova

l-sh

aped

lesi

ons

that

m

ay b

ecom

e dr

y an

d s

caly

or

moi

st

and

cru

sted

. Whe

n

it is

pre

sent

on

the

feet

it is

com

mon

ly

calle

d a

thle

te’s

fo

ot. I

nfec

ted

na

ils m

ay b

ecom

e di

scol

ored

, bri

ttle

, or

cha

lky

or th

ey

may

dis

inte

grat

e.

Fun

gus

Dir

ect o

r in

dire

ct

cont

act w

ith

in

fect

ed p

erso

ns,

thei

r pe

rson

al

item

s, s

how

ers,

sw

imm

ing

poo

ls,

thea

ter

seat

s,

etc.

Dog

s an

d

cats

may

als

o

be in

fect

ed

and

tran

smit

it

to c

hild

ren

or

adul

ts.

4–10

day

s (u

nkno

wn

for

athl

ete’

s fo

ot)

As

long

as

lesi

ons

are

pres

ent.

Exc

lude

chi

ldre

n f

rom

gy

ms,

poo

ls, o

r ac

tivi

ties

w

here

they

are

like

ly

to e

xpos

e ot

hers

. May

re

turn

to g

roup

car

e fo

llow

ing

trea

tmen

t wit

h

a fu

ngic

idal

oin

tmen

t. A

ll sh

ared

are

as, s

uch

as

poo

ls a

nd s

how

ers,

sh

ould

be

thor

ough

ly

clea

nsed

wit

h a

fu

ngic

ide.

Roc

ky M

ount

ain

S

pott

ed F

ever

Ons

et u

sual

ly

abru

pt; f

ever

(1

01°–

104°

F);

join

t an

d m

uscl

e pa

in,

seve

re n

ause

a an

d

vom

itin

g, a

nd w

hite

co

atin

g o

n to

ngue

. R

ash

app

ears

on

2n

d to

5th

day

ove

r fo

rehe

ad, w

rist

, and

an

kles

; lat

er c

over

s en

tire

bod

y. C

an b

e fa

tal i

f unt

reat

ed.

Bac

teri

aIn

dire

ct

tran

smis

sion

: tic

k bi

te.

2–14

day

s;

aver

age

7 da

ys

Not

con

tag

ious

fr

om p

erso

n to

pe

rson

.

Pro

mpt

rem

oval

of

tick

s; n

ot a

ll ti

cks

caus

e ill

ness

. Adm

inis

trat

ion

of

ant

ibio

tics

. Use

inse

ct

repe

llent

on

clo

thes

w

hen

out

door

s.

Co

mm

un

icab

le

Illn

ess

Sig

ns

an

d

Sy

mp

tom

sIn

fec

tio

us

Ag

ent

Me

tho

ds

of

Tra

nsm

issi

on

Incu

ba

tio

n

Per

iod

Len

gth

of

Co

mm

un

icab

ilit

yC

on

tro

l Mea

sure

s

Co

nta

ct

(Dir

ect

An

d I

nd

irec

t) T

ran

smit

ted

Ill

nes

ses

(con

tinu

ed)

Ta

ble

6–1

C

om

mo

n C

om

mu

nic

able

Ch

ild

ho

od

Ill

nes

ses

(con

tinu

ed)




Sca

bies

Cha

ract

eris

tic

burr

ows

or li

near

tu

nnel

s un

der

the

skin

, esp

ecia

lly

betw

een

the

fing

ers

and

aro

und

the

wri

sts,

elb

ows,

w

aist

, thi

ghs,

and

bu

ttoc

ks. C

ause

s in

tens

e it

chin

g.

Par

asit

eD

irec

t con

tact

w

ith

an

infe

cted

pe

rson

.

Sev

eral

day

s to

2–4

wee

ksU

ntil

all m

ites

an

d e

ggs

are

dest

roye

d.

Chi

ldre

n s

houl

d b

e ex

clud

ed f

rom

sch

ool o

r gr

oup

car

e un

til t

reat

ed.

Aff

ecte

d p

erso

ns s

houl

d

bath

e w

ith

pre

scri

bed

so

ap a

nd c

aref

ully

la

unde

r al

l bed

ding

and

cl

othi

ng. A

ll co

ntac

ts

of th

e in

fect

ed p

erso

n

shou

ld b

e no

tifi

ed.

Teta

nus

Mus

cle

spas

ms

and

st

iffn

ess,

esp

ecia

lly

in th

e m

uscl

es

arou

nd th

e ne

ck

and

mou

th. C

an

lead

to c

onvu

lsio

ns,

inab

ility

to b

reat

he,

and

dea

th.

Bac

teri

aIn

dire

ct:

org

anis

ms

live

in s

oil a

nd d

ust;

en

ter

body

th

roug

h w

ound

s,

espe

cial

ly

punc

ture

-typ

e in

juri

es, b

urns

, an

d u

nnot

iced

cu

ts.

4 da

ys to

2

wee

ksN

ot c

onta

gio

us.

Imm

uniz

atio

n e

very

8–1

0 ye

ars

affo

rds

com

plet

e pr

otec

tion

.

Fec

al/

Ora

l Tra

nsm

itte

d I

lln

esse

s

Dys

ente

ry

(S

hig

ello

sis)

Sud

den

onse

t of

vom

itin

g; d

iarr

hea,

m

ay b

e ac

com

pani

ed

by h

igh

feve

r, he

adac

he, a

bdom

inal

pa

in. S

tool

s m

ay

cont

ain

bloo

d, p

us,

or m

ucus

. Can

be

fata

l in

youn

g

child

ren.

Bac

teri

aFe

cal-

oral

tr

ansm

issi

on v

ia

cont

amin

ated

ob

ject

s or

in

dire

ctly

thro

ugh

in

ges

tion

of

cont

amin

ated

fo

od o

r w

ater

and

vi

a fl

ies.

1–7

days

Var

iabl

e; m

ay

last

up

to 4

wee

ks

or lo

nger

in th

e ca

rrie

r st

ate.

Exc

lude

chi

ld d

urin

g

acut

e ill

ness

. Car

eful

ha

nd w

ashi

ng a

fter

bo

wel

mov

emen

ts.

Pro

per

disp

osal

of

hum

an f

eces

; con

trol

of

flie

s. S

tric

t adh

eren

ce to

sa

nita

ry p

roce

dure

s fo

r fo

od p

repa

rati

on.

E. c

oli

Dia

rrhe

a, o

ften

bl

oody

.B

acte

ria

Spr

ead

thro

ugh

co

ntam

inat

ed

food

, dir

ty h

ands

.

3–4

days

; can

be

as

long

as

10 d

ays

For

dura

tion

of

diar

rhea

; usu

ally

se

vera

l day

s.

Exc

lude

infe

cted

chi

ldre

n

unti

l no

dia

rrhe

a;

prac

tice

fre

quen

t han

d

was

hing

, esp

ecia

lly a

fter

to

ileti

ng a

nd b

efor

e pr

epar

ing

food

. (con

tinu

ed)




Enc

epha

litis

Sud

den

onse

t of

head

ache

, hig

h fe

ver,

conv

ulsi

ons,

vom

iting

, co

nfus

ion,

nec

k an

d ba

ck s

tiffn

ess,

tr

emor

s, a

nd c

oma.

Vir

usIn

dire

ct s

prea

d

by b

ites

fro

m

dise

ase-

carr

ying

m

osqu

itoe

s;

in s

ome

area

s tr

ansm

itte

d b

y ti

ck b

ites

.

5–15

day

sN

ot c

onta

gio

us.

Spr

ayin

g o

f mos

quit

o

bree

ding

are

as a

nd u

se

of in

sect

rep

elle

nts;

pu

blic

edu

cati

on.

Gia

rdia

sis

Man

y pe

rson

s ar

e as

ympt

omat

ic.

Typi

cal s

ympt

oms

incl

ude

chro

nic

diar

rhea

, abd

omin

al

cram

ping

, blo

atin

g,

pale

and

foul

-sm

ellin

g s

tool

s,

wei

ght l

oss,

and

fa

tigu

e.

Par

asit

e (p

roto

zoa)

Feca

l-ora

l tra

ns-

mis

sion

; thr

ough

co

ntac

t with

in

fect

ed s

tool

(e.g

., di

aper

cha

nges

, he

lpin

g ch

ild w

ith

soile

d un

derw

ear)

, po

or h

and

was

hing

, pa

ssed

from

han

ds

to m

outh

(toy

s,

food

). A

lso

tr

ansm

itted

th

roug

h

cont

amin

ated

w

ater

sou

rces

.

7–10

day

s av

erag

e; c

an

be a

s lo

ng a

s 5–

25 d

ays

As

long

as

para

site

is p

rese

nt

in th

e st

ool.

Exc

lude

chi

ldre

n

unti

l dia

rrhe

a en

ds.

Scr

upul

ous

hand

w

ashi

ng b

efor

e ea

ting

, pr

epar

ing

food

, and

aft

er

usin

g th

e ba

thro

om.

Mai

ntai

n s

anit

ary

cond

itio

ns in

bat

hroo

m

area

s.

Hep

atit

is

(In

fect

ious

; T

ype

A)

Feve

r, fa

tigu

e,

loss

of a

ppet

ite,

na

usea

, abd

omin

al

pain

(in

reg

ion

of

liver

). Il

lnes

s m

ay

be a

ccom

pani

ed

by y

ello

win

g o

f the

sk

in a

nd e

yeba

lls

(jau

ndic

e) in

adu

lts,

bu

t not

alw

ays

in

child

ren.

Acu

te

onse

t.

Vir

usFe

cal-

oral

rou

te.

Als

o s

prea

d v

ia

cont

amin

ated

fo

od, w

ater

, milk

, an

d o

bjec

ts.

10–5

0 da

ys

(ave

rag

e ra

nge

25–3

0 da

ys)

7–10

day

s pr

ior

to

onse

t of s

ympt

oms

to n

ot m

ore

than

7

days

aft

er o

nset

of

jaun

dice

.

Excl

ude

from

gro

up

sett

ings

a m

inim

um o

f 1

wee

k fo

llow

ing

onse

t. S

peci

al a

tten

tion

to

care

ful h

and

was

hing

af

ter

goin

g to

the

bath

room

and

bef

ore

eati

ng is

cri

tica

l fol

low

ing

an

out

brea

k. R

epor

t di

seas

e in

cide

nts

to

publ

ic h

ealt

h au

thor

itie

s.

Imm

unog

lobu

lin (

IG)

reco

mm

ende

d fo

r pr

otec

tion

of c

lose

co

ntac

ts.

Co

mm

un

icab

le

Illn

ess

Sig

ns

an

d

Sy

mp

tom

sIn

fec

tio

us

Ag

ent

Me

tho

ds

of

Tra

nsm

issi

on

Incu

ba

tio

n

Per

iod

Len

gth

of

Co

mm

un

icab

ilit

yC

on

tro

l Mea

sure

s

Fec

al/

Ora

l Tra

nsm

itte

d I

lln

esse

s (c

onti

nued

)

Ta

ble

6–1

C

om

mo

n C

om

mu

nic

able

Ch

ild

ho

od

Ill

nes

ses

(con

tinu

ed)




Pin

wor

ms

Irri

tabi

lity,

and

it

chin

g o

f the

rec

tal

area

. Com

mon

am

ong

you

ng

child

ren.

Som

e ch

ildre

n h

ave

no

sym

ptom

s.

Par

asit

e;

not

cont

agio

us

from

an

imal

s.

Infe

ctio

us e

ggs

are

tran

sfer

red

fr

om p

erso

n

to p

erso

n b

y co

ntam

inat

ed

hand

s (o

ral-

feca

l rou

te).

In

dire

ctly

spr

ead

by

con

tam

inat

ed

bedd

ing,

food

, cl

othi

ng,

swim

min

g p

ool.

Lif

e cy

cle

of

the

wor

m is

3–

6 w

eeks

; pe

rson

s ca

n

also

re-

infe

ct

them

selv

es.

2–8

wee

ks o

r as

lo

ng a

s a

sour

ce o

f in

fect

ion

rem

ains

pr

esen

t.

Infe

cted

chi

ldre

n m

ust

be e

xclu

ded

fro

m

scho

ol u

ntil

trea

ted

w

ith

med

icat

ion

; may

re

turn

aft

er in

itia

l dos

e.

All

infe

cted

and

non

-in

fect

ed f

amily

mem

bers

m

ust b

e tr

eate

d a

t one

ti

me.

Fre

quen

t han

d

was

hing

is e

ssen

tial

; di

scou

rag

e na

il bi

ting

or

suck

ing

of f

ing

ers.

Dai

ly b

aths

and

cha

nge

of li

nen

are

nec

essa

ry.

Dis

infe

ct s

choo

l toi

let

seat

s an

d s

ink

hand

les

at le

ast o

nce

a da

y.

Vac

uum

car

pete

d a

reas

da

ily. E

ggs

are

also

de

stro

yed

whe

n e

xpos

ed

to t

empe

ratu

res

over

13

2°F.

Edu

cati

on a

nd

good

per

sona

l hyg

iene

ar

e vi

tal t

o c

ontr

ol.

Sal

mon

ello

sis

Abd

omin

al p

ain

an

d c

ram

ping

, su

dden

fev

er,

seve

re d

iarr

hea

(may

con

tain

bl

ood

), n

ause

a an

d

vom

itin

g la

sts

5–7

days

.

Bac

teri

aFe

cal-

oral

tr

ansm

issi

on: v

ia

dirt

y ha

nds.

Als

o

cont

amin

ated

fo

od (

espe

cial

ly

impr

oper

ly

cook

ed p

oult

ry,

milk

, egg

s), w

ater

su

pplie

s, a

nd

infe

cted

ani

mal

s.

12–3

6 ho

urs

Thr

ough

out a

cute

ill

ness

; may

re

mai

n a

car

rier

for

mon

ths.

Att

empt

to id

enti

fy

sour

ce. E

xclu

de c

hild

ren

/ad

ults

wit

h d

iarr

hea;

may

re

turn

whe

n s

ympt

oms

end.

Car

rier

s sh

ould

no

t han

dle

or p

repa

re

food

unt

il st

ool c

ultu

res

are

neg

ativ

e. P

ract

ice

good

han

d w

ashi

ng a

nd

sani

tizi

ng p

roce

dure

s.




�� Common Acute Childhood IllnessesChildren experience many forms of acute illness; however, not all of these are contagious (Bour-

geois et al., 2009; Bradley, 2003). Teachers must be able to distinguish conditions that are conta-

gious from those that are limited to an individual child. However, teachers must never attempt to

diagnose children’s health problems. Their primary responsibilities include identifying children

who are ill, making them comfortable until parents arrive, and advising the family to contact their

health care provider. The remainder of this chapter is devoted to several common childhood ill-

nesses and acute health conditions.

ColdsChildren may experience as many as seven to eight colds during a typical year. This number tends

to decrease as children mature and their respiratory passageways increase in size, their immune

systems become more effective at warding off illness, and they begin to develop healthy habits. Cold

symptoms can range from frequent sneezing and runny nose to fever, sore throat, cough, headache,

and muscle aches (Pappas et al., 2008).

Cause Most colds are caused by a viral infection, primarily rhinoviruses and coronoviruses.

They spread rapidly and have a short incubation stage of 1 to 2 days.

Management Because colds are highly contagious during the first day or two, it is best to exclude

children from group settings. Rest, and increased fluid intake (water, fruit juices, soups) are recom-

mended. Non-aspirin, fever-reducing medication may help children feel more comfortable and is

usually adequate treatment for a cold. (Note: Schools must obtain a physician’s approval before

administering any medication.)

Antibiotics are not effective against most viruses and are therefore of limited value for treating

simple colds. However, a physician may prescribe antibiotics to treat complications or secondary

infections, such as fever, red throat, white patches on their tonsils (one indication of strep throat),

extreme fatigue, or yellow nasal drainage. Toddlers and preschool-age children are often more

prone to these conditions and should be observed closely. Families should also be advised to seek

immediate medical attention for children who do not improve after 4 to 5 days or if they develop

any of these secondary complications.

Some children who have special needs, such as Down syndrome, leukemia, or allergies, may

exhibit chronic cold-like symptoms including runny nose and a productive cough. It isn’t necessary

for these children to be excluded from school unless they develop signs of a secondary infection.

Diaper Rash (Diaper Dermatitis)Diaper rash is an irritation of the skin in and around the buttocks and genital area. Infants who

have sensitive skin or are formula-fed versus breastfed are more likely to experience periodic out-

breaks of diaper rash (Hockenberry & Wilson, 2009).

Cause Prolonged contact with ammonia in urine and organic acids in stools can burn baby’s skin,

causing patches of red, raised areas or tiny pimples. In severe cases, open, weeping areas of the skin

may become infected with yeast or bacteria. Reactions to fabric softeners, soaps, lotions, powders,

antibiotics, foods, and certain brands of disposable diapers may also cause some infants and tod-

dlers to develop diaper rash.

infection – a condition that results when a pathogen invades and establishes itself within a susceptible host.




Management Prompt changing of wet and/or soiled diapers followed by a thorough cleansing of

the skin is often sufficient to prevent and treat diaper rash. Baby products, such as powders and

lotions, should be avoided because they can encourage bacterial growth when combined with urine

and feces. In addition, infants are apt to inhale fine powder particles and many of these products con-

tain phthalates which may have harmful effects on children’s development and reproductive systems

(Sathyanarayana et al., 2008). A thin layer of petroleum jelly or zinc oxide ointment can be applied

to irritated areas to protect the skin. Allowing the infant to go without diapers (when at home) and

exposing irritated skin to the air may also help speed the healing process. If the diaper rash does not

improve in 2 or 3 days, parents should be encouraged to contact their health care provider.

DiarrheaThe term diarrhea refers to frequent watery or very soft bowel movements. They may be foul-smell-

ing and also contain particles of blood or mucus. Young children’s digestive systems tend to be

more sensitive to foods and medications so that it is not uncommon for them to experience several

episodes of diarrhea throughout the year.

Cause Diarrhea can either be infectious or noninfectious. Infectious forms of diarrhea include:

� viral or bacterial infections, such as rotavirus, hepatitis A, or salmonellosis

� parasitic, such as giardia

Causes of noninfectious diarrhea can include:

� fruit juices containing sorbitol (Orenstein, 2006)

� antibiotic therapy

� recent dietary changes

� food allergies, such as lactose or gluten intolerance

� food poisoning

� illnesses, such as earaches, colds, strep throat, or cystic fibrosis

Children typically experience many colds during the year.

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Until new vaccines became available in 2006, approximately 55,000 -70,000 children were hospital-

ized each year for severe diarrhea caused by rotavirus (Cortese & Parashar, 2009). Because children

under age three are the most frequent victims of this illness, infants are now being immunized at 2-,

4- and 6-months of age. Consequently, the numbers of children who experience rotavirus infections

and hospitalizations have declined significantly.

Frequent or prolonged diarrhea can result in dehydration, especially in infants and toddlers.

Dehydration involves a loss of body water and can occur quickly in young children due to their

poor fluid regulation and small body size. Because excessive dehydration can be fatal in infants and

young children, they should be observed closely for:

� dryness of the mouth

� listlessness � sunken eyes

� absence of tears

� decreased or no urinary output

� rapid, weak pulse

� skin loses elasticity; dough-like

Management It is important to monitor and record the frequency (number) and amount (small,

large) of bowel movements. The color, consistency, and presence of any blood, mucus, or pus should

also be noted. Be sure to check the child’s temperature and observe for any signs of discomfort.

Prompt medical advice should be sought if diarrhea is severe or prolonged, or the child becomes

lethargic or drowsy. Adults and children should practice meticulous hand washing to avoid infect-

ing themselves and others.

Most cases of diarrhea can be treated by temporarily replacing solid foods in the child’s diet

with a commercially prepared electrolyte solution. This solution supplies important fluids and

salts lost through diarrhea and helps to restore normal function. Liquids and soft foods can gradu-

ally be added back into the child’s diet once the diarrhea has ended. Any complaint of pain that is

continuous or located in the lower right side of the abdomen should be reported promptly to the

child’s family and checked by a physician.

Children who have experienced diarrhea during the past 24 hours should be excluded from

group settings. Exceptions to this policy would include children whose diarrhea resulted from non-

contagious conditions such as food allergies, changes in diet, or recent treatment with antibiotics.

However, even these children may not feel well enough to attend school and participate in the day’s

activities. The problem and inconvenience of frequent accidental soiling may also be too time-

consuming for teachers to manage.

Diarrhea lasting longer than a week should be cause for concern, especially if it is accom-

panied by bloating, change of appetite, or weight loss. The child should remain at home until

a cause is determined, and conditions such as giardia, dysentery, or hepatitis A have been

ruled out.

dehydration – a state in which there is an excessive loss of body fluids or extremely limited fluid intake. Symptoms may include

loss of skin tone, sunken eyes, and mental confusion.

listlessness – a state characterized by a lack of energy and/or interest in one’s affairs.

abdomen – the portion of the body located between the diaphragm (located at the base of the lungs) and the pelvic or hip

bones.




DizzinessIt is not unusual for children to complain of momentary dizziness or a spinning sensation after vigor-

ous play. However, repeated complaints of dizziness should be noted and reported to the child’s family.

They should be advised to contact the child’s physician to determine a possible underlying cause.

Cause Dizziness can be a symptom of other health conditions, including:

� ear infections

� fever

� headaches

� head injuries

� anemia

� nasal congestion and sinus infections

� brain tumor (rare)

Management Temporary episodes of dizziness usually respond to simple first aid measures.

Have the child lie down quietly or sit with head resting on or between the knees until the sensation

has passed. Quiet play can be resumed when the child no longer feels dizzy. Inform the child’s fam-

ily of this experience so they can continue to monitor the condition at home.

Each year, seasonal flu and cold-like symptoms begin to make their appearance as the winter months approach. For the most part, these are relatively mild respiratory illnesses that affect 5 to 20 percent of the population annually. Only a small number of victims who are either very young, elderly, or have compromised immune systems die from the infection or develop serious compli-cations that require hospitalization. However, recent events have drawn attention to the fact that communicable illnesses of pandemic proportions are not a thing of the past. Outbreaks of avian flu and SARS (severe acute respiratory syndrome) have raised international concerns about the potential for massive infection and significant numbers of deaths (Zimmer & Burke, 2009). Dense living conditions and modern travel methods have encouraged the rapid spread of newly emerging diseases, such as the H1N1 flu, to large numbers of people throughout the world. Children seem to be at particularly high risk for contracting the H1N1 flu and often experience a more severe form of the disease. Consequently, health care workers, employers, schools, and families have had to revisit their policies, practices, and understanding of communicable illness and containment methods (Child Health Alert, 2009; McFadden & Frelick, 2009). Many excellent planning resources and response guidelines are available online for families, schools, communities, health care organizations, businesses, and other professional groups: CDC (http://www.cdc.gov/h1n1flu); U.S. Department of Health & Human Services (www.flu.gov); and Public Health Agency of Canada (http://www.phac-aspc.gc.ca).

� What are the symptoms of H1N1 flu? How is it spread?

� What factors in your setting would increase children’s risk of exposure?

� What community resources are available to help prepare your school or early childhood program in the event of an epidemic?

� What immediate precautionary measures could your program implement?

� Is H1N1 a reportable illness?

Seasonal and H1N1 FluIssues To Consider




If dizziness is accompanied by any loss of balance or coordination, parents should be encour-

aged to check with the child’s physician at once. Dizziness that results from an underlying health

problem will usually not respond to most first aid measures.

EarachesEaraches and ear infections are frequently a problem during the first 3 or so years of a child’s life,

affecting boys more often than girls (Bradley, 2003). More than half of all infants, especially those

who are formula-fed versus breastfed, experience an ear infection before their first birthday (Het-

zner et al., 2009). However, by age five, children usually begin to have fewer ear infections as struc-

tures in the ear, nose, and throat increase in size and resistance to infection (antibody formation)

improves. Children of Native American and Eskimo ethnicity are known to experience a higher rate

of ear infections, possibly related to structural differences in the ear canal (Singleton et al., 2009).

Exposure to second-hand smoke has also been identified as a contributing factor. Additionally,

studies have shown that children in group care tend to have a higher incidence of ear infections and

of otitis media than those who stay at home (American Academy of Otolaryngology, 2009).

Cause A number of conditions can cause earache in children, including:

� upper respiratory infections, such as a cold

� allergies

� dental cavities and eruption of new teeth

� excessive ear wax

� foreign objects, such as plastic beads, food, small toy pieces, or stones

� bacterial infections, such as “swimmer’s ear” or otitis media

� feeding infants in a reclining position

Earaches caused by an acute bacterial infection of the middle ear are known as otitis media. Children

who have some forms of developmental disabilities, such as Williams syndrome, Turner’s syndrome,

Down syndrome, fragile X, autism, and cleft palate are at higher risk for developing this condition

(Schieve et al., 2009). Otitis media causes an inflammation of the eustachian tube (passageway con-

necting the ear, nose, and throat), which can lead to a backup of fluid in the middle ear and result in

pain, fever, and temporary or chronic hearing loss (Hockenberry & Wilson, 2009). Often, only one ear

will be affected at a time, and the infection may or may not be accompanied by fluid accumulation

behind the eardrum. Placing infants on their backs to sleep has been shown to be effective in decreas-

ing the incidence of ear infection (Hunt et al., 2003). Children, especially infants and toddlers with

limited language, should be observed carefully for signs of a possible ear infection, including:

� nausea, vomiting, and/or diarrhea

� tugging or rubbing of the affected ear

� refusal to eat or swallow

� redness of the outer ear

Reflective Thoughts

Sometimes families knowingly or unknowingly bring sick children to school or child care. Examine your feelings about being exposed to children’s communicable illnesses. Do you feel differently depending on the illness? What steps can teachers take to improve their resis-tance to communicable illness? How would you respond to families who repeatedly ignore a program’s exclusion policies? How might cultural differences influence what parents view as illness? What could you do to help families understand and respect a program’s policies?

��




� fever

� dizziness or unsteady balance

� irritability

� discharge from the ear canal

� difficulty hearing

� crying when placed in a reclining position

� difficulty sleeping

Management Children who develop otitis media do not need to be excluded from group settings

unless they are too ill to participate in daily activities or have other symptoms that are contagious.

Teachers may be able to provide temporary relief from earache pain by having the child lie down

with the affected ear on a soft blanket; the warmth helps to soothe discomfort. A small, dry cotton

ball placed in the outer ear may also help reduce pain by keeping air out of the ear canal. If excess

wax or a foreign object is causing the child’s ear pain, it must be removed only by a physician.

Persistent complaints of ear pain or earache should not be ignored and need to be checked

by the child’s health care provider if symptoms last longer than 2 or 3 days. In most cases the fluid

will clear up without treatment. However, chronic otitis media with fluid can interfere with chil-

dren’s speech and language development and may therefore require medical treatment (Proops &

Archarya, 2009; Vernon-Feagons & Manlove, 2005).

Physicians now use several approaches to treat acute bacterial ear infections. Current guide-

lines recommend taking a wait-and-see approach and limiting the use of antibiotics to reduce the

potential of drug resistance. If children are placed

on oral antibiotics, it is important that all medica-

tion be taken; failure to finish medication can result

in a recurrence of the infection. When children have

taken all of the prescribed medication, they should

be re-checked by a physician to make certain the

infection is gone. In some cases, a second round of

medication may be needed. Surgical insertion of

small plastic tubes into the eardrum is sometimes

recommended for children who have repeated infec-

tions and chronic fluid buildup to lessen the risk

of permanent hearing loss (Singleton et al., 2009).

Teachers should be alert to any children with tubes

in their ears. Special precautions must be taken to

avoid getting water in the outer ear canal during

activities that involve water play, such as swimming,

bathing, or playing in pools or sprinklers. Ear plugs

or a special plastic putty are commonly used for this

purpose.

FaintingFainting, a momentary loss of consciousness, occurs

when blood supply to the brain is temporarily

reduced.

Cause Possible causes for this condition in young

children include:

� anemia

� breath-holding

The frequency of ear infections decreases as children get older.

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� hyperventilation � extreme stress, excitement, or hysteria

� drug reactions

� illness, infection, or extreme pain

� poisoning

Management Children may initially complain of feeling dizzy or weak. Their skin may appear

pale, cool, and moist, and the child may collapse. If this occurs, lay the child down, elevate the legs

8 to 10 inches on a pillow or similar object, and observe breathing and pulse frequently. A light

blanket can be placed over the child for extra warmth. Breathing is made easier if clothing is loos-

ened from around the neck and waist. No attempt should be made to give the child anything to eat

or drink until consciousness is regained. The child’s family should be notified and encouraged to

consult with their physician.

FeverActivity, age, eating, sleeping, and the time of day cause normal fluctuations in children’s tempera-

tures. However, a persistent elevated temperature is usually an indication of illness or infection,

especially if the child also complains of headache, coughing, nausea, or sore throat.

Cause Common causes of fever in children include:

� viral and bacterial illnesses, such as ear, skin, and upper respiratory infections

� urinary tract infections

� heat stroke and overheating

Changes in children’s appearance and behavior may be an early indication of fever. Other indica-

tions may include:

� flushed or reddened face

� listlessness or desire to sleep

� “glassy” eyes

� loss of appetite

� complaints of not feeling well

� chills

� warm, dry skin; older children may have increased perspiration

Management Children’s temperature should be checked if there is reason to believe that they

may have a fever. Only digital and infrared tympanic thermometers are recommended for use in

schools and group-care settings because of safety and liability concerns (Table 6–2). These ther-

mometers are quick and efficient to use, especially with children who may be fussy or uncoopera-

tive, and they provide readings that are reasonably accurate (Table 6–3) (Devrim et al., 2007; Sganga

et al., 2000). Infrared forehead thermometers are currently being marketed but studies have shown

them to be unreliable. Glass mercury thermometers are considered unsafe to use with young chil-

dren and also pose hazardous environmental concerns.

hyperventilation – rapid breathing often with forced inhalation; can lead to sensations of dizziness, lightheadedness, and

weakness.

temperature – a measurement of body heat; varies with the time of day, activity, and method of measurement.

fever – an elevation of body temperature above normal; a temperature over 99.4°F or 37.4°C orally is usually considered a fever.

tympanic – referring to the ear canal.




infants and toddlers axillary

2–5 years old tympanicaxillary

oral

5 years and older oraltympanic

axillary

Table 6–2 Preferred Methods for Checking Children’s Temperature in Group Settings (in Rank Order)

Children with an axillary temperature over 99.1°F (37.4°C) or a tympanic reading over 100.4°F

(38°C) should be observed carefully for other symptoms of illness. Unless a program’s exclusion

policies require children with fevers to be sent home, they can be moved to a separate room or

quiet area in the classroom and monitored. If there are no immediate indications of acute illness,

children should be encouraged to rest. Lowering the room temperature, removing warm clothing,

and offering extra fluids can also help make a child feel more comfortable. Fever-reducing medica-

tions should be administered only with a physician’s approval. Families should also be notified so

they can decide whether to take the child home or wait to see if any further symptoms develop.

HeadachesHeadaches are not a common complaint of young children, but when they do occur they are usu-

ally a symptom of some other condition. Repeated complaints of headache should be brought to

families’ attention.

Cause Children may experience headaches as the result of several conditions, including:

� bacterial or viral infections

� allergies

� head injuries

� emotional tension or stress

� reaction to medication

� lead poisoning

� hunger

� eye strain

� nasal congestion

� brain tumor (rare)

� constipation

� carbon monoxide poisoning

Management In the absence of any fever, rash, vomiting, or disorientation, children who expe-

rience headaches can remain in care but should continue to be observed for other indications of

illness or injury. Frequently, their headaches will disappear with rest. However, patterns of repeated

or intense headaches should be noted and families encouraged to discuss the problem with the

child’s physician.

disorientation – lack of awareness or ability to recognize familiar persons or objects.




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Heat RashHeat rash is most commonly seen in infants and toddlers.

Cause Heat rash is caused by a blockage in the sweat glands and occurs more commonly during

the summer months, although it may also develop when an infant or child is dressed too warmly.

Some children have sensitive skin and may develop heat rash from clothing made of synthetic

fabrics.

Management Heat rash is not contagious. However, several measures can be taken to make

a child more comfortable. Affected areas can be washed with cool water, dried thoroughly, and

dusted sparingly with cornstarch.

Lyme DiseaseLyme disease is a tick-borne infection most prevalent along the East Coast, although it has been

identified in nearly every U.S. state and many provinces of Canada (Anderson & Chaney, 2009;

Sockett & Artsob, 2009). The number of cases continues to increase. There were over 29,000 con-

firmed cases and 6200 probable cases reported in 2008, with children ages birth to 14 being the

most common victims (CDC, 2009b).

Cause This bacterial illness is caused by the bite of a tiny, infected deer tick; however, not all deer

ticks are infected, nor will everyone who is bitten develop Lyme disease. Many species of the deer

tick are commonly found in grassy and wooded areas during the summer and fall months.

Management The most effective way to prevent Lyme disease is to take preventive measures

whenever children will be spending time outdoors, especially in grassy or wooded areas (Table 6–4).

Because deer ticks are exceptionally small, they are easily overlooked. Development of any

unusual symptoms following a tick bite should be reported immediately to a physician. Early

symptoms of Lyme disease may be easily mistaken for other illnesses, which sometimes makes the

condition difficult to diagnose. In the early weeks following a bite, a small red, flat, or raised area

may develop at the site, followed by a localized rash that gradually disappears. Flu-like symptoms,

Lyme disease – bacterial illness caused by the bite of infected deer ticks found in grassy or wooded areas.

Table 6–4 Measures to Prevent Tick Bites

• Encourage children to wear long pants, a long-sleeved shirt, socks, shoes, and a hat; light-colored clothing makes it easier to spot small deer ticks.

• Apply insect/tick repellent containing DEET to clothing and exposed areas of the skin (Hansmann, 2009; Katz, Miller, & Hebert, 2008). Be sure to follow manufacturer’s directions and avoid aerosol sprays that children might inhale.

• Discourage children from rolling in the grass or sitting on fallen logs.• Remove clothing as soon as children come indoors and check all areas of the body (under arms,

around waist, behind knees, in the groin, on neck) and hair.• Bathe or shower to remove any ticks.• Wash clothing in soapy water and dry in dryer. (Heat will destroy ticks.)

• Continue to check children for any sign of ticks that may have been overlooked on a previous inspection.

• Promptly remove any tick discovered on the skin and wash the area carefully. (See Chapter 9).




including fever, chills, fatigue, headache, and joint pain, may also be experienced during this stage.

If the bacterial infection is not diagnosed early and treated with antibiotics, complications, includ-

ing arthritis, heart, and/or neurological problems can develop within 2 years of the initial bite. A

blood test is available for early detection.

Sore ThroatSore throats are a relatively common complaint among young children, especially during the fall

and winter seasons. Teachers must often rely on their observations to determine when infants and

toddlers may be experiencing a sore throat because children of this age are unlikely to verbalize

their discomfort. Fussiness, lack of interest in food or refusal to eat, difficulty swallowing, enlarged

lymph glands, fever, and fatigue may be early indications that the child is not feeling well.

Cause Most sore throats are caused by a viral or bacterial infection. However, some children may

experience a scratchy throat as the result of sinus drainage, mouth breathing, or allergies.

Management It is extremely important not to ignore a child’s complaint of sore throat. A small

percentage of sore throats are caused by a highly contagious streptococcal infection (Table 6–1).

Although most children are quite ill with these infections, some may experience only mild symp-

toms, such as headache or stomachache and fever, or none at all. Unknowingly, they may become

carriers of the infection and capable of spreading it to others. A routine throat culture is necessary

to determine if a strep infection is present and which antibiotic will provide the most effective

treatment. If left untreated, strep throat can lead to serious complications, including rheumatic

fever, heart valve damage, and kidney disease (Hockenberry & Wilson, 2009).

Sore throats resulting from viral infections are not usually harmful, but they may cause the

child considerable discomfort. Cool beverages (and popsicles) can soothe an irritated throat. Anti-

biotics are not effective against most viral infections and, therefore, seldom prescribed.

StomachachesMost children experience an occasional stomachache from time to time. However, children may

use this term to describe a range of discomforts, from hunger or a full bladder to actual nausea,

cramping, or emotional upset. Teachers can use their observation and questioning skills to deter-

mine a probable cause.

Cause Children’s stomachaches are often a symptom of some other condition. There are many

possible causes, including:

� food allergies or intolerance

� appendicitis

� intestinal infections, e.g., giardiasis, salmonella, E. coli

� urinary tract infections

� gas or constipation

� side effect to medication, especially antibiotics

� change in diet

� emotional stress or desire for attention

� hunger

� diarrhea and/or vomiting

� strep throat

intestinal – pertaining to the intestinal tract or bowel.




Management There are several ways to determine whether or not a child’s stomach pain is seri-

ous. Is the discomfort continuous or a cramping-type pain that comes and goes? Does the child

have a fever? Is the child able to continue playing? If no fever is present, the stomachache is prob-

ably not serious. Encourage the child to use the bathroom and see if urination or having a bowel

movement relieves the pain. Have the child rest quietly to see if the discomfort goes away. Check

with families to determine if the child is taking any new medication or has had a change of diet.

Stomach pain or stomachaches should be considered serious if they:

� disrupt a child’s activity, such as running, playing, eating, sleeping

� cause tenderness of the abdomen

� are accompanied by diarrhea, vomiting, or severe cramping

� last longer than 3 to 4 hours

� result in stools that are bloody or contain mucus

If any of these conditions occur while the child is attending school or group care, families should be

notified and advised to seek prompt medical attention for the child.

Sudden Infant Death Syndrome (SIDS)Sudden infant death syndrome (SIDS) refers to the unexplainable death of a seemingly healthy infant

under 12 months of age. It is a leading cause of infant death, which tends to peak between the sec-

ond and fourth months (National SIDS Resource Center, 2009). Deaths are more likely to occur dur-

ing sleep (nighttime and naps), and especially during the fall and winter months. Despite aggressive

awareness campaigns, approximately 2,000–3,000 infants continue to die each year (CDC, 2009a).

Cause Although no one single cause has yet been identified, several factors seem to place some

babies at higher risk of dying from SIDS, including:

� premature birth

� weighing less than 3.5 pounds at birth

� being a male child

� being of African American or American Indian/Alaska Native ethnicity (MacDorman &

Mathews, 2009)

� having a sibling who also died of SIDS

� family poverty

� prenatal exposure to alcohol and/or illicit drugs, such as cocaine, heroin, or methadone

� maternal smoking (during and after pregnancy) (Richardson, Walker, & Horne, 2009a)

� being born to a teenage mother

Children born into families with limited education and financial resources seem to experience the

highest rate of SIDS deaths. Many of their mothers failed to obtain prenatal care or they engaged

in unhealthy practices during and after their pregnancy. Infants who die of SIDS often experience

repeated interruptions of breathing called apnea. Researchers continue to investigate possible

connections between this breathing disturbance and other factors, including:

� toxic mattress fumes

� immunizations

� use of pacifiers

� air pollution

� bed sharing or co-sleeping with parents (Hauck et al., 2008)

� respiratory infections (such as colds and flu)

� swaddling (Richardson, Walker, & Horne, 2009b)

urination – the act of emptying the bladder of urine.

apnea – momentary absence of breathing.




To date there has been no scientific evidence linking toxic mattress fumes or immunizations to

SIDS. In fact, babies who are immunized are less likely to die from SIDS (First Candle/SIDS Alliance,

2009). Evidence regarding bed-sharing practices as a risk factor remains controversial although

most authorities encourage parents to place infants in their own crib (near parents) to sleep

(Shapiro-Mendoza et al., 2009).

Recent studies have established a connection between low production of serotonin, a hormone

that regulates breathing, and SIDS (Duncan et al., 2010). Other studies have identified a positive rela-

tionship between SIDS and air pollution (Richardson, Walker, & Horne, 2009a). These findings have

led to recommendations that families avoid exposing babies to second-hand smoke and other forms

of concentrated air pollution. The use of pacifiers has actually been shown to reduce SIDS deaths

although questions remain about why this practice is beneficial (Mitchell, 2009; Sexton & Natale, 2009).

Management An infant’s sleeping position has proven to be the strongest link to preventing SIDS

(Kinney & Thach, 2009). This discovery led to a nationwide “Back to Sleep” campaign, which has

been ongoing and credited with significantly reducing SIDS deaths (NICHD, 2009). Multiple child

and maternal government and private agencies continue to educate parents about proper sleep

positioning for infants—that babies must always be placed on their backs for sleeping— and

have extended their efforts to include early childhood teachers and caregivers. Although fewer than

16 percent of SIDS fatalities occur in early childhood programs, teachers must take steps to avoid

any preventable death (AAP, 2009; Moon, Calabrese, & Aird, 2008). Despite ongoing educational

efforts, researchers have found that nearly one-quarter of early childhood teachers continue to

place infants in unsafe conditions and sleeping positions. As a result, many states now address

infant sleep position in their child care licensing regulations so that programs will no longer be able

to ignore this critical safety measure.

Initial fears that babies would be more likely to choke when placed on their back for sleep-

ing have not proven true. It isn’t clear whether back-sleeping improves infants’ oxygen intake or

reduces their breathing in of carbon dioxide. However, the SIDS death rate has decreased by nearly

50 percent since this practice was initially recommended (CDC, 2009a).

Babies should not share a crib with another infant nor sleep in a bed with adults; both of these

practices have been found to increase the risk of SIDS. However, researchers have found that plac-

ing an infant’s crib in the same room with their parents can decrease this risk (Fu et al., 2008).

Additional guidelines for reducing the risk of SIDS are outlined in Table 6–5.

Because infants spend many hours sleeping, it is important to change their position often

during times when they are awake so they are not always on their backs. Weak neck muscles make

Table 6–5 Teacher Checklist: Practices to Reduce the Risk of Sudden Infant Death Syndrome (SIDS)

• Always put infants to sleep on their back unless a health condition prevents this.• Use a firm mattress that fits snugly in a safety-approved crib. Never place infants on a waterbed,

sheepskin, comforter, soft sofa cushions, or other soft bedding material.• Remove pillows, thick or fluffy blankets, and soft toys from an infant’s bed.• Cover infants with a thin blanket, tucking the bottom half under the mattress (Figure 6–1).• Dress infants in light sleepwear and do not raise room temperature to avoid overheating.• Offer a pacifier to infants who use them.• Avoid exposing infants to second-hand smoke, car exhaust, wood smoke, and other air pollutants.• Limit infants’ exposure to persons who have colds or other respiratory infections.• Encourage mothers to obtain professional prenatal care for themselves and recommended well-child

checkups for their infant.• Encourage and support breastfeeding; this may help to protect infants against SIDS.• Know how to respond to medical emergencies.




it difficult for infants to turn their head from side to side; flat spots

may develop when they remain in the same position for extended

periods. These can be prevented by changing infants’ position and

placing them on their tummies for brief periods while they are

awake. Alternating an infant’s position in the crib is also benefi-

cial—one day the head should be placed at the head of the crib, the

following day the head should be placed at the foot of the bed. This

prevents the infant from consistently laying on the same side of his

or her head every day.

Because there is often no identifiable cause for SIDS, families

tend to blame themselves for having been negligent or using poor

judgment. They may believe that somehow they could have pre-

vented this tragedy. Consequently, families who have experienced

the unexpected death of an infant from SIDS require special emo-

tional support and counseling. Siblings may also be affected by

an infant’s death and should be included in counseling therapy.

Local chapters of several national SIDS organizations offer infor-

mation and support groups to help families cope with their grief,

including:

� First Candle/SIDS Alliance (http://www.sidsalliance.org)

� National SIDS Resource Center (http://www.sidscenter.org)

� Association of SIDS and Infant Mortality Programs (http://

www.asip1.org)

� Canadian Foundation for the Study of Infant Deaths (http://

www.SIDSCanada.org)

TeethingTeething is a natural process. Infants usually begin getting their first teeth around 4 to 7 months of

age. Older children will begin the process of losing and replacing their baby teeth with a permanent

set about the time they reach their fifth or sixth birthday.

Cause New teeth erupting through gum tissue can cause some children mild discomfort. How-

ever, most children move through this stage with relatively few problems.

Management An increase in drooling and chewing activity for several days or weeks may be the

only indication that an infant is teething. Some infants become a bit more fussy, run a low-grade

fever (under 100°F), and may not be interested in eating. However, high fevers, diarrhea, and vomit-

ing are usually not caused by teething, but may be an indication of illness. Chilled teething rings

and firm objects for children to chew often provide comfort and relief to swollen gums.

ToothacheYoung children do not typically experience toothaches. Untreated oral health problems can cause

pain and suffering, interfere with speech and language development, make eating difficult, affect

school performance, and lead to early tooth loss. Preventive oral health care is an important com-

ponent of wellness, and children should not have to forgo necessary dental treatment because of

limited family income (Vargas & Arevalo, 2009; Malik-Kotru, Kirchner, & Kisby, 2009). Low-cost

insurance (CHIP), Medicaid, and community resources, such as clinics and dental schools, are

available to help families obtain essential dental care for children (National Maternal & Child Oral

Health Resource Center, 2009).

Figure 6–1 Putting infants to sleep on their backs significantly reduces the risk of SIDS.




Some infants and toddlers may expe-

rience temporary discomfort while teeth-

ing. Older children may have similar

discomfort when they begin losing baby

teeth and their permanent teeth erupt.

Cause Although tooth decay is the most

common cause of toothache, gum disease

and injury can also be painful. Children

may complain of a throbbing discomfort

that sometimes radiates into the ear. Red-

ness and swelling may also be observed

around the gumline of the affected tooth.

Foods that are hot or very sweet may

intensify pain.

Management Complaints of toothache

require prompt attention from the child’s

dentist. In the meantime, an icepack applied to the cheek on the affected side may make the child

feel more comfortable. Aspirin-free products can also be administered by the child’s family for pain

relief. However, prevention, including proper brushing after eating and reduction of dietary sugars,

is always the preferred approach for limiting tooth decay.

VomitingVomiting can be a frightening and unpleasant experience for children. True vomiting is different

from a baby who simply spits up after eating. Vomiting is a symptom often associated with an acute

illness or other health problem (Hockenberry & Wilson 2009).

Cause A number of conditions can cause children to vomit, including:

� emotional upset

� viral or bacterial infection, such as stomach flu or strep throat

� drug reactions

� ear infections

� meningitis

� salmonellosis � indigestion

� severe coughing

� head injury

� poisoning

Management The frequency, amount, and composition of vomited material is important to

observe and record. Dehydration and disturbances of the body’s chemical balance can occur with

prolonged or excessive vomiting, especially in infants and toddlers. Children should be observed

carefully for:

� high fever

� abdominal pain

salmonellosis – a bacterial infection that is spread through contaminated drinking water, food, or milk or contact with other

infected persons. Symptoms include diarrhea, fever, nausea, and vomiting.

Brushing teeth after eating helps to promote good oral health.

© C

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� signs of dehydration

� headache

� excessive drowsiness

� difficulty breathing

� sore throat

� exhaustion

Children who continue to vomit and show signs of a sore throat, fever, or stomach pains should be

sent home as soon as possible. The teacher should also advise the child’s family to contact their

physician for further advice.

In the absence of any other symptoms, a single episode of vomiting may simply be due to an

emotional upset, dislike of a particular food, excess mucus, or reaction to medication. Usually

the child feels better immediately after vomiting and should be encouraged to rest quietly while

remaining at school.

In addition to not feeling well, some children are upset by the act of vomiting itself. Extra reas-

surance and comforting can help make the experience less traumatic. Infants should be positioned

on their stomachs, with their hips and legs slightly raised to allow vomited material to flow out of

the mouth and prevent choking. Older children should also be watched closely so they don’t choke

or inhale vomitus.

West Nile VirusHumans have long considered mosquitoes to simply be annoying insects that buzz in the ear, feast

on exposed skin, and leave an itchy raised welt as their calling card. However, they are also capable

of transmitting disease. The Centers for Disease Control and Protection (CDC) reported 1356 West

Nile virus cases in the United States during 2008 (CDC, 2009c); a total of 2215 cases were reported

in Canada for 2007 (Public Health Agency of Canada, 2008).

A majority of persons infected with the West Nile virus will have no symptoms of the illness.

Some people will experience mild flu-like symptoms; a small percent will develop more serious

symptoms, such as high fever, muscle weakness, rash, stiff neck, tremors, disorientation, coma,

and even death. Young children and the elderly are at the greatest risk for developing the West

Nile virus.

Cause West Nile virus is caused by the bite of an infected mosquito. The incidence is highest dur-

ing the summer and fall seasons. However, there have also been limited reports of transmission via

blood transfusion and the breast milk of an infected mother.

Management Prevention is the most important and effective strategy for avoiding this infec-

tious illness (LaBeaud et al., 2009). Eliminating standing water found in flower pots, water

fountains, bird baths, buckets, tire swings, small pools, and similar sources removes mosquito

breeding sites. A number of products containing natural chemicals and bacteria are available

to spray or to use in ponds that cannot be drained. Additional precautionary measures include

applying mosquito repellents containing DEET whenever going outdoors, wearing protective

clothing (long sleeves, long pants), staying indoors during early morning and evening hours when

mosquitoes are at their peak activity, and making sure that screen doors and windows are in

good repair. In most cases, persons with mild symptoms will recover without medical treatment.

However, prompt medical attention should be sought for prolonged illness or if any serious com-

plications develop.

Finally, rely on your intuition. Don’t hesitate to call the doctor if you are unsure about the

symptoms your child may be experiencing. Most physicians would rather be notified of a child’s

condition than to be called only when there is a crisis.




When to Call the Doctor

Frequent bouts of illness are not uncommon among young children. With time, their bodies mature, they begin to build up resistance (immunity) to many illnesses, and their immunizations will have been completed. In the meantime, families often face the difficult task of deciding at what point their child is sick enough to warrant a call to the doctor. Although each child’s symptoms and needs are dif-ferent, there are guidelines that may be helpful in making this decision. Call the physician if your child:

� Experiences serious injury, bleeding that cannot be stopped, or excessive or prolonged pain.

� Is less than one month old and develops a fever, or is between 1 and 3 months of age and has a rectal temperature over 100.4°F.

� Has difficult, rapid, or noisy breathing.

� Experiences any loss of consciousness, including a seizure.

� Complains of unusual pain in an arm or leg. X-rays may be necessary to rule out a fracture.

� Has repeated episodes of vomiting or diarrhea and is unable to keep down liquids. Symptoms of dehydration include urination fewer than three times per day, dry lips or tongue, headache, lack of tears, and excessive drowsiness. A sunken fontanel (soft spot) is an additional symptom in infants. Young children can become dehydrated quickly.

� Develops an unusual skin rash, especially one that spreads.

� Has blood in his/her vomit, urine, or stool.

� Suffers an eye injury or develops an eye discharge. Children who have sustained an eye injury should always be seen by a physician.

� Develops stomach pain that is prolonged or interferes with appetite or activity.

� Becomes excessively sleepy and difficult to arouse.

Focus On Families

Gear up for health...

Concept: Physical activity is important for staying healthy. (Grades 3–5; National Health Education Standards 1.5.1 and 6.5.1)

Learning Objectives

� Children will learn the importance of moving to stay healthy.

� Children will improve their aerobic condition.

Supplies

� worksheet for recording activities

� kick balls

(continued)

Teacher ActivitiesClassroom Corner




Teacher Activities (continued)Classroom Corner

� pedometers

� charts or graph paper

� Mylar balloons

� masking tape

Learning Activities

� Read and discuss any of the following books:

• Anna Banana: 101 Jump-Rope Rhymes by Joanna Cole• Norma Jean, Jumping Bean by Joanna Cole• Song and Dance Man by Karen Ackerman• Snow Dance by Lezlie Evans

� As a group, discuss the benefits of physical activity in terms of improving the body’s immune system to fight off germs and protect against illness. Encourage the children to brainstorm activities that will increase their respiratory and heart rates (jumping rope, running, riding bikes, going for a walk, playing soccer, etc.).

� Introduce the terms aerobic (activities that increase heart and breathing rates) and anaerobic (activities that improve muscle strength) and explain the differences. Prepare a worksheet with two columns: one headed “aerobic activities,” the other “anaerobic activities.” Have the children list as many activities as they can in each appropriate column. As a group, ask the children to share one activity listed on their sheet and compile a master class list. Challenge the children to engage in at least one of these activities each day.

� Set up a game of kick ball and give each child a pedometer to wear during the activity. At the end of 15 minutes, have each child record the number of steps he or she has taken. As an alternative, set up two cones and have children run laps; each week, increase the distance or number of laps children must run. Older children can graph their data (number of steps) while younger children might simply keep a daily tally. Varying the distance between cones, the number of laps run, or the length of playing time is an effective way to help children grasp the relationship between activity and health benefits. Children can also set weekly goals for themselves and gradually increase the number of steps they want to accumulate on their pedometer.

� Play balloon volleyball (great indoor activity). Group children into small teams, place a tape line on the floor, and instruct children to keep the balloon in motion by batting it back and forth. Have the children compare and describe how they felt before (heart beating slowly, easy to breathe) and after (breathing hard, heart beating fast, sweaty) the activity.

Evaluation

� Children will describe how physical activity improves health.

� Children will improve aerobic capacity by setting goals and recording their progress.

Additional lesson plans for grades PreK–2 are available on this text’s website.




�� Summary � Illness is common among young children in schools and group settings.

� Teachers can utilize multiple strategies to control the spread of illnesses:

• careful observation and early identification of sick children

• implementation of exclusion policies

• thorough hand washing

• environmental sanitation

• ongoing health education

� Teachers should be familiar with the signs/symptoms, method of transmission, and control mea-

sures associated with common communicable and acute childhood illnesses.

�� Chapter ReviewA. By Yourself:

1. Define each of the Terms to Know.

2. Match each of the following signs/symptoms in column I with the correct communicable illness

in column II.

Column I Column II

1. swelling and redness of white portion of the eye a. chickenpox

2. frequent itching of the scalp b. strep throat

3. flat, oval-shaped lesions on the scalp, skin; infected nails c. head lice

become discolored, brittle, and chalky and may

disintegrate

4. high fever; red, sore throat d. shigellosis

5. mild fever and rash that lasts approximately 3 days e. conjunctivitis

6. irritability and itching of the rectal area f. ringworm

7. red rash with blister-like heads; cold-like symptoms g. German measles

8. sudden onset of fever; swelling of salivary glands h. scabies

9. burrows or linear tunnels under the skin; intense itching i. pinworms

10. vomiting, abdominal pain, diarrhea that may be bloody j. mumps

k. Lyme disease

symptoms p. 136

asymptomatic p. 142

infection p. 148

dehydration p. 150

listlessness p. 150

abdomen p. 150

hyperventilation p. 154

temperature p. 154

fever p. 154

tympanic p. 154

disorientation p. 155

Lyme disease p. 157

intestinal p. 158

urination p. 159

apnea p. 159

salmonellosis p. 162

�� Terms to Know




B. As a Group:

1. Discuss what a teacher should do in each of the following situations:

a. You have just finished serving lunch to the children, when Kara begins to vomit.

b. The class is involved in a game of keep-away. Theo suddenly complains of feeling dizzy.

c. During check-in, a parent mentions that his son has been experiencing stomachaches every

morning before coming to school.

d. Lucy wakes up from her afternoon nap crying because her ear hurts.

e. You have just changed a toddler’s diaper for the third time in the last hour because of diarrhea.

f. Christi enters the classroom, sneezing, and blowing his nose.

g. While you are helping Jasmine put on her coat to go outdoors, you notice that her skin feels

very warm.

h. Randy refuses to eat his lunch because it makes his teeth hurt.

i. While you are cleaning up the blocks, Sean tells you that his throat is sore and it hurts to

swallow.

j. You have just taken Monique’s temperature (orally) and it is 102°F.

2. The concepts of illness and pain are often viewed differently by various cultural groups. Select

two or three predominant cultures and research their beliefs about illness and pain. How might

these differences in cultural values and beliefs influence your response in each of the situations

described in Question #1?

�� Case StudyThe teacher noticed that Carrie seemed quite restless today and was having difficulty concentrating on any task that she started. She continuously squirmed, whether in her chair or sitting on the floor. On a number of occasions the teacher also observed Carrie tugging at her underwear and scratching her bottom. She recalled that Carrie’s mother had mentioned something about getting her younger brother tested for pinworms and wondered if this might be what she was observing.

1. What action should the teacher take in this situation?

2. What control measures should be implemented? At school? At home?

3. When can Carrie return to school?

4. If Carrie does have pinworms, for what length of time must the teacher carefully observe the other children for similar problems?

5. What special personal health measures should be emphasized with the other children?

�� Application Activities

1. With a partner, practice taking each other’s axillary, oral, and tympanic temperatures. Follow

steps for correct cleaning of the thermometer between each use.

2. Divide the class into groups of five to six students. Discuss how each member feels about caring

for children who are ill. Could they hold or cuddle a child with a high fever or diarrhea? What

are their feelings about being exposed to children’s contagious illnesses? How might they react




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if an infant just vomited on their new sweater? If they feel uncomfortable around sick children,

what steps could they take to better cope with the situation?

3. Select another student as a partner and observe that person carefully for 20 seconds. Now look

away. Write down everything you can remember about this person, such as eye color, hair color,

scars or moles, approximate weight, height, color of skin, shape of teeth, clothing, and so on.

What can you do to improve your observational skills?

4. Conduct an Internet search to learn more about avian (bird) flu. What is it? What steps are

being taken at the national level to control its spread? What is your community doing?

�� Helpful Web Resources

Center for Disease Control http://www.cdc.gov

Health Canada http://www.hc-sc.gc.ca

Keep Kids Healthy http://www.keepkidshealthy.com

Morbidity & Mortality Weekly http://www.cdc.gov/mmwr

National Initiative for Children’s http://www.nichq.org/

Healthcare Quality (special needs)

National Institutes of Health http://www.nih.gov

Office of Minority Health http://www.omhrc.gov/

You are just a click away from additional health, safety, and nutrition resources! Go to www

.CengageBrain.com to access this text’s Education CourseMate website, where you’ll find:

• glossary flashcards, activities, tutorial quizzes, videos, web links, and more




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