Major Article
Infectious disease in pediatric out-of-home child care

https://doi.org/10.1016/j.ajic.2004.11.007Get rights and content

Provision of some form of child care outside of the home is certainly not a new phenomenon. In the past, most out-of-home care was provided by a relative, a friend, or someone who had a specific relationship with the family of the child. The frequency of utilization of child care centers for out-of-home care and the different formats of out-of-home care services has increased within recent decades and will vary by geographic location. Also, there is an increased utilization of temporary child care such as “mother's day out” or baby-sitting services provided at churches, grocery stores, and other places. Child care centers represent special risks for transmission of infectious agents because young children exhibit high susceptibility to many community-acquired viruses and bacteria; they lack developmental understanding required for good hygiene; and they frequently receive antibiotics (appropriately and inappropriately). Infections acquired in child care centers can significantly impact the health of the children who acquire the infection and also result in significant economic impacts on the child's family, particularly if 1 or more of the parents has to lose time from work. In the United States, it is estimated that families who have children in child care lose 13 days of work per year for all types of infections. Interventions that have proven valuable for reducing infections within child care centers include the following: (1) formal written policies for infection control within the child care center, (2) formal education of child care center staff concerning infection control practices (needs to be repeated; preferably on a recurring basis), (3) good hand hygiene by both staff and children, (4) appropriate cleaning of contaminated surfaces, (5) separation of food preparation and diaper changing, (6) exclusion of certain ill children, (7) cohorting ill children when exclusion is not possible, (8) ensuring adequate age-appropriate immunization of child care attendees and staff, and (9) optimal ratios of children to staff.

Section snippets

Epidemiology

Numerous factors affect the epidemiology of infections within child care centers. Infections that are brought into the child care center come from the community. Understanding the epidemiology of infectious illnesses within a community, particularly respiratory and gastrointestinal viruses, can assist in predicting transmission within a child care facility. The size of the facility also impacts on the frequency of transmission of infectious diseases. The larger the size of the center, the

Respiratory tract infections

Acute upper and lower respiratory tract infections are the most frequent illnesses occurring in children, irrespective of attendance in a child care center. Children followed at the Frank Porter Graham Day Care Center29 at the University of North Carolina in Chapel Hill experienced an average of 6.5 respiratory illnesses per year. However, the frequency of infections was highly age dependent. The highest rate of infection occurred in the second 6 months of life (7-12 months of age). During this

Infection control measures

Measures designed to reduce transmission of infectious diseases within day care facilities need to be developed in the context of the goals of these facilities. Unlike hospitals, there is a much greater expectation for person-to-person contact within a child care center. This interaction is essential for normal growth and development of these young children. Therefore, restrictions designed to reduce transmission of infectious diseases might hinder efforts to enhance social development.

The

Conclusion

Child care centers provide an essential service to many families around the world. Over the last few decades, the number of children in out-of-home care has increased. This trend is likely to continue in the future. Therefore, providing a safe and healthy environment in a child care facility may have a significant impact on the health and well being of millions of children. Many efforts needed to reduce transmission of infections within a child care facility require only the use of common

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