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Part 2: Drooling, Sharing, Playing…. communicable diseases that can plague the preschool ministry

July 22, 2010

Part one of this series covered some basic suggestions for maintaining health, safety, and developmentally appropriate church preschool areas. In this posting, I will briefly review common communicable childhood illnesses, basic signs and symptoms, how these illnesses are passed on to others, and, more importantly, how they can be prevented. This posting is not meant to be medical advice, leave that to the families you serve and their health care provider. Instead, this posting is meant to be more of an informational… ‘what to watch out for and help prevent’. After all, if the church is not foremost in public health, then who will be?

Skin Infections: Two of the most common skin infections in children are Staphylococcus and Streptococcus bacterial infections. Some of the common results of these bacteria in children are impetigo, folliculitis, cellulitis, and abscesses. Often children create their infections by scratching, making tiny micro-cuts in the skin and introducing all of the bacteria on their fingers and under fingernails. Bug bites are common initial culprits for creating ‘itches’, as are runny noses that can cause a break down of skin integrity under the nose. Common symptoms arise from local inflammation and can include redness, warmth, tenderness, and even blisters or open wounds. These are often contained to a single area, but can spread through contact to other open wounds and other children with open wounds.

PREVENTION: HAND WASHING is THE most effective measure for preventing spread or even warding of initial infection. This is particularly important as much of the Staphlococcal bacteria has now become resistant to many common antibiotics (AKA M.R.S.A.).

Acute Pharyngitis (sore throat): Any throat infection is considered to be an upper respiratory tract infection, since the upper airway is involved. Often, in preschool children these infections are viral, but confirmation of this by a health care provider is top priority. The one bacteria that does plague the throat infection world is Group A Streptococcal Pharyngitis, or Strep Throat. Uncommon before the age of 2, this infection of the throat comes on quickly with low grade fever and sore throat, but they may also have an upset stomach, vomiting, lack of interest in food, or even a fine, red, lacy rash. Any child with any of these symptoms should not be allowed into the preschool area (see my previous post on preschool health).

PREVENTION: Having a policy of when to bring and not bring children, hand washing, covering mouths and noses during coughing and sneezing, and preventing children from sharing drinks or snacks will cut down on the direct exposure to Group A Strep. Further, washing toys down with a disinfectant (like a 1:4 solution of white vinegar:water) and letting them air dry cuts down on both viral and bacterial transmission and keeps toxic cleaners to a minimum.

The Common Cold: Most of the bugs that cause a cold are viral with the greatest occurrences fall to spring. Most colds are relativity minor, but RSV and Influenza can manifest early as common colds and turn into much more serious viral illnesses with significant consequences. Prevention is key, but with that being said the average number of colds that a young child has in a year is six. Symptoms of a cold include a slower onset, with often an early sore throat followed by congestion, runny nose, and sometimes cough or low grade fever.

PREVENTION: These viruses are spread by ‘droplet’ contact, meaning that when someone coughs, sneezes, or wipes their nose they can introduce virus into the environment. That is why a combination of prevention of respiratory spread through good manners and covering coughs or sneezes, frequent nose wiping, and frequent hand washing of all is critical. Likewise, as aforementioned, after each preschool class disinfecting the toys is highly suggested.

Gastroenteritis (‘the stomach bugs’): Vomiting and diarrhea can be caused by viruses or bacteria. The concern with these diseases are how easily they are spread and how quickly they can make a small child critically ill. Death from diarrheal illness is a leading cause of childhood death in many countries and the U.S. has its fair share of hospitalizations and death from such illnesses. Dehydration leading to hypovolemic shock is the ultimate culprit in such deaths. The symptoms are self explanatory, but assessing how hydrated a child is should be done through contact with a child’s health care provider. Lack of wet diapers, lack of tears, and listless behavior are the ‘way too late’ warning signs and warrant the need for immediate medical intervention.

PREVENTION: Spread of gastrointestinal diseases often comes through oral-fecal transmission, meaning dirty hands touch something that might go into another person’s mouth, and let’s face it if you are under 3 years old… everything goes into your mouth. Good hand washing by preschool workers and children after toileting or diaper changing is key. I would even suggest limiting lots of costume jewelery and fake finger-nails by preschool staff as all of these can harbor germs, but I understand if you do not want to be too prescriptive. Gloves for diaper changes, maintaining all diaper supplies being in easy reach and at the ready so that staff are not having to open drawers with possibly contaminated hands, keeping diaper garbage and even the garbage cans up out of the reach of crawlers, disinfecting diaper changing areas after each use, and keeping plastic bags to tie off soiled clothing and spare clothing for accidents is recommended.

— Pediculosis (lice): These fun little creatures are passed from person to person most often through close contact and sharing of hats, jackets, brushes, combs, etc… Often, preschool children are not social enough to pass these to friends, but can obtain them from older siblings. Treatment and diagnosis should be undertaken by parents in conjunction with their health care providers. Female lice lay as many as 10 eggs a day and can live for a month. The eggs are the culprit and are firmly attached to the hair shaft and have to be manually removed. Lice like warm dark spots, much like bacteria, and thus they often lay eggs behind ears and at the base of the neck.

PREVENTION: Not sharing hats, brushes, combs, or jackets with hoods. At home keeping linen clean and dried in a dryer, and even blow drying the hair can help (as heat kills the little guys).

— A Word on vaccine preventable diseases: Your preschool personnel or director should be familiar with vaccine preventable diseases that are reported to local health departments, because if they come through your department you may be responsible for notifying all of the parents that their children were exposed. So, be familiar with public health law in your state and county. Further, recent outbreaks of measles, pertussis, and chicken pox make these diseases more common.

Overall, if I could impart any advice it would be to disinfect toys after each class, good hand washing, well laid out diaper changing areas, and working on staff and students to have ‘good manners’ when it comes to coughing and sneezing. Further, good communication with parents about your efforts to keep their kids healthy will go a long way! Pick good nurse partners from your congregation to help you keep your preschool ministry safe and healthy.

References:

Behrman, Kliegman, Jenson (2004). Nelson Textbook of Pediatrics 17th Ed. W.B.Saunders.

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4 Comments leave one →
  1. July 23, 2010 8:09 pm

    This blog post was great! Avoiding touching the T-zone area (the eyes, nose, and mouth) is something Henry the Hand has been promoting for 10 years. It’s great to see someone helping to spread the word – not the germs! 🙂

  2. July 27, 2010 3:13 am

    Great post, Terri! Nursing and church ministry go hand-in-hand…at least in my family! My husband recently became responsible for all student ministries at our church, including preschool and nursery. Even though I have three children of my own, I definitely enjoy adult care more. 🙂 This will be very helpful as we work together to ensure a safe place for children to learn the Word.

    • July 27, 2010 12:52 pm

      Wow Joni, what a responsibility. Yes, after many years volunteering in a preschool area I have learned that I like adolescents and adults a lot :). If you have other topics you think would be interesting, just let me know. Thanks for reading! Hope you are well.

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