"The Bureau of the Census reported in 2013 that at any one time, 61 percent of children 0 to 4 years of age are enrolled in regular child care arrangements while parents do something else outside the home."
Many families and some health professionals mistakenly believe that participation of children in early education and child care causes most of their episodes of seasonal illness. Many parents, friends and family members blame their children's out-of-home care for all of the illnesses their children suffer.
A simple Google search - often the first line of medical research for the public - provides supporting evidence as bloggers write about "daycare syndrome."
But being armed with the facts may be the best medicine, says Susan Aronson MD of the Pennsylvania Chapter of the American Academy of Pediatrics, and knowing what you should do as a parent or caregiver will help when viral illness season hits.
Dr. Aronson says it's challenging to keep people well who are from different families and share any type of common space. Close contact and touching of surfaces in any common space spreads infection. Spread occurs in many places in the community including grocery stores, churches, libraries, shared play spaces, restaurants, and on public transportation.
But yet, there's a feeling that child care settings get the most blame ... thus the non-medical term "daycare syndrome."
Possibly that's because the majority of families with young children use some form of non-parental care, and that's where most young children will come into contact with others outside their family.
The Bureau of the Census reported in 2013 that at any one time, 61 percent of children 0 to 4 years of age are enrolled in regular child care arrangements while parents do something else outside the home. In families with employed moms, 88 percent of the young children participate in child care, spending an average of 36 hours per week in child care.
Pennsylvania has 723,438 children age four and younger. Of these, 336,901 children less than six years of age live in two-parent families with both parents in the labor force, and potentially need non-parental care for some part of the day. Another 230,297 live in single-parent families with the parent in the labor force. This totals 567,198 children or 78 percent of children under six years of age who are likely to need child care while their parents work.
So, it's easy to see why child care centers are most often blamed for sick toddlers.
According to Dr. Aronson, who practices in Media, Pa., whenever children first enter group care, whether as infants or toddlers, preschool or school age, they have a more intense exposure to infectious diseases.
"Children in any group setting play and eat close together, easily passing germs to each other," Dr. Aronson, co-author of the book Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, says.
Karen Rizzo, MD, president of the Pennsylvania Medical Society and a practicing otolaryngologist - ears, nose, and throat physician - says many illnesses associated with child care can lead to parents becoming frustrated when the child is in a constant state of sickness. Having treated many patients experiencing ear infections, she knows.
"In today's modern family it's not unusual for both parents to be working, or for a child to be raised by a single parent," says Dr. Rizzo, who practices in Lancaster, Pa., and can be followed on Twitter via @PAMEDPrez. "They rely on child care facilities so they can go to work, but inevitably, the child comes home sick."
Ear infections, hand-foot-and-mouth, croup, pink eye, fevers, colds, and flu are among the list of illnesses that commonly affect young children, as parents know too well. Dr. Aronson said she and her co-author Timothy Shope MD wrote Managing Infectious Diseases in Child Care and Schools to provide health professionals, teachers, and parents with a clear, common set of current information to address care of ill children in group care.
"Sometimes children are too ill to be in their usual child care setting. Families are hard-pressed to take off from work or find alternative care arrangements for their ill child when the child cannot be accommodated in their usual care arrangement," says Dr. Aronson. "They may resent having their child excluded for illness, but usually want other people's ill children excluded to avoid spread of illness to their own child."
As Drs. Aronson and Shope point out in their book, there is a time when a child shouldn't be in child care due to illness, particularly when the child is too ill to participate in the program or when the ill child requires more care than the caregiver can provide without compromising other children.
But, says Dr. Aronson, exclusion of children for symptoms of mild illness is not helpful. Most of the common viral illnesses are most contagious before the child shows any symptoms.
According to Dr. Aronson, when the child can participate and no longer requires more care than the caregivers can easily provide, the child should be able to return to care.
Furthermore, she says, unless the child requires some type of special care, a note from a health professional to return to care after an illness is unnecessary. She adds that a note should be obtained if the child needs to receive medication or adjustment of child care routines.
"Requests for notes (to return to child care) from a health professional are common and often mentioned in obsolete regulations or program policies," Dr. Aronson says.
But child care can be a risk factor for certain illnesses, and it is important to take precautions.
Middle ear infection (acute otitis media) is one of the most common diseases of childhood, accounting for about 15 percent of ambulatory care visits in children under age four, according to Jeffrey Simons, MD, president-elect of the Pennsylvania Academy of Otolaryngology-Head and Neck Surgery and a practicing physician from Pittsburgh. By age three, more than 80 percent of children will have experienced at least one ear infection.
"Attending child care and having a family history of ear infections are among the most common risk factors for recurrent ear infections as a child," says Dr. Simons, explaining that some children with recurrent ear infections may eventually benefit from ear tube surgery, which is one of the most common childhood surgeries in the country. There are more than 600,000 ear tube surgeries performed each year in the United States, accounting for 20 percent of all outpatient surgery in children.
And the spread of illnesses is not limited to the children. Child care providers are known to get sick too, and parents need to pay attention in the home when the child comes home and are around other family members.
According to the website NationalNannies.com, there are 5,415 childcare centers in Pennsylvania. Of those, 288 are nationally accredited. Overall, the group says, there are about 31,570 workers employed within the Pennsylvania childcare industry.
Child Care Aware of America also offers statewide statistics on the child care environment in Pennsylvania. According to this group, Pennsylvania has 4,601 child care centers and 3,100 family child care homes regulated by the Department of Public Welfare. Around 800 licensed private preschools are regulated by the Department of Education. The U.S. Department of Labor, Bureau of Labor statistics reports that, in Pennsylvania, 25,920 child care workers as of May 2013.
Lora Regan, MD, is president of the Pennsylvania Occupational and Environmental Medical Society and a practicing occupational medicine specialist in Lancaster, Pa. Among the recommendations Dr. Regan suggests are having adults and children stay up-to-date with immunizations and washing hands with soap and water whenever contamination with body fluids or infectious material is likely. Also wash hands before eating.
If alcohol-based hand sanitizers are used, they can only be used on visibly clean skin and are not to be used for children less than 2 years of age. Washing with soap and water is preferable. Soap and water hand hygiene should be used after changing soiled diapers or underclothing and after using the rest room.
In addition, Dr. Regan mentions keeping diaper-changing areas and bathrooms clean and disinfected. Preparing and storing all foods properly is important. She also suggests cleaning hard surfaces such as door knobs with sanitary wipes and covering cough and sneezes with your sleeve or tissue.
"It's a lot of work for child care employees and parents," says Dr. Regan, "but, it really benefits everyone."
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