the curse of the winter illnesses in pre-school children - myth or reality?
Most of us have experienced the seasonality of colds and flu in both ourselves and in our children – giving rise to sniffles, sneezes and coughs occurring much more frequently in the winter months than at other times of the year. This is unfortunately especially true of pre-school children and children attending any type of day-care facility – we would love to avoid the sniffles, the fevers and other discomforts associated with childhood illnesses but whatever we do they occur with relentless frequency.
In many households, the stay-at-home option is not really an option for both financial and personal reasons. Consequently, more and more parents now seek day or nursery care for their children. Obviously day-care centres, nurseries and pre-schools provide high quality, monitored care and intellectual stimulation from trained professionals, as well as socialization skills through interaction with other children and although the chance of getting infections increases, there are some advantages in getting frequent viral infections whilst young.
A viral illness and even bacterial infections which follow a viral infection, occur more frequently in the winter months. One reason is that the children remain closer to each other or stay indoors, which often results in enclosed, highly populated places where transmission of viral respiratory and gastrointestinal (diarrhoea and vomiting illnesses) is optimal. It also appears that cold dry air, as found in the winter months, seems to prolong the survival of viruses outside the body, so increases the chance of coughs and sneezes spreading quickly.
Children who attend day-care, nursery or pre-schools are therefore more prone to infections and there is a 2- to 3-fold increase in risk for respiratory infections, ear infections and diarrhoeal disease. The increased risk is independent of age, race and social class. Importantly, though, this risk also decreases significantly when there are high standards of hygiene in the nursery, with regular hand-washing, good personal hygiene practises by the staff and children, parents avoiding where possible sending their child into the nursery with a fever or significant symptoms of an illness, and high levels of food-preparation hygiene are used.
What factors lead to an increased risk of infections in day-care? Behavioural habits in day-care centres, such as close interpersonal contact with large numbers of other children and a need for physical contact with adults, increases the risk of diseases that can be spread from person-to-person. This is particularly true of the winter vomiting viruses – also called the Norwalk virus and also the autumnal diarrhoea virus the Rotor virus – for which some countries offer a vaccine, although this is not routinely available in the UK.
Small children lack simple hygienic practices, including hand washing or not putting things in their mouths. In a day-care centre, there needs to be a very high level of awareness amongst the staff of unhygienic habits and efforts made to avoid them where at all possible. For example ensuring toys are washed as they are passed between children can reduce the risk of infections.
Young children have a relatively immature immune system. The presence of an immature immune system that defends poorly against new infections makes small children more prone to new infections to which they have not been exposed.
Some children have age-related physical immaturities (such as an underdeveloped Eustachian tube) that may make them more prone to ear infections. In addition, prior to developing toileting skills so called ‘toilet training’, the need to change nappies, in association with poor hand washing practices in the adults caring for the children is an underlying cause for increased spread of diarrhoeal diseases.
are there some health benefits associated with day-care and pre-school socialising?
The need for a medical report to be submitted prior to starting nursery and ensuring all the children entering nursery have been vaccinated where possible does help some children to receive healthcare and for their carers to be better informed regarding their child’s health needs, that may be inadvertently omitted by families whose children remain at home .
Many childcare facilities offer health education resources that can benefit the entire family and good health and hygiene practices in the nursery or playgroup educate the children.
It is also very interesting to note that children who attend day-care appear to have a lower risk of childhood leukaemia and asthma. The reasons for this are not absolutely clear, but is does seem that exposure to large numbers of infections, i.e. more then the average of 8 per year, does seem to convey an advantage in terms of reduced risk of developing asthma and a small but measurable reduction in the frequency of the common childhood leukaemia in children who attend nursery when compared to children who remain at home until school age.
here are a few simple things you can do at home and you should also ensure that your child’s day centre does as well, to help reduce, but not eliminate the risk of infection:-
Frequent hand washing. Hand washing is not only important for the children, but for the staff and caregivers as well. Studies have shown that proper hand washing is probably the best way to limit the spread of infection in day-care and nurseries. However, keep in mind that doing it the right way is more important than doing it at all. One study showed that taps and toilet handles are one of the most contaminated areas in a day-care centre. One option is the use of automatic taps whose high costs may outweigh the benefits, but they can assist in limiting the spread of disease, although hand washing with soap is the best prevention.
Clean nappy changing facilities and suitable toileting aides. Foot-activated roll-out disposable bins for nappies greatly reduce the transfer of infectious microbes on hands. Use of disposable gloves and good provision of cleaning materials for nappy change areas are also important ways to prevent infections that can cause tummy upsets or diarrhoea.
Proper food storage. Make sure food storage areas are clean and milk and foods that can spoil at room temperature are refrigerated.
Proper food preparation. These points are valid both for the home and the nursery. Porous, cracked or damaged surfaces can provide infection, offering bacteria places to hide. Make sure that food preparation areas can be cleaned thoroughly. Children are advised not to share food, drinks or utensils. Food preparation should not be done near nappy change areas.
We make sure all our staff have been properly trained on hygiene practices for limiting the spread of infections. Simply understanding how diseases are spread and which ones to look out for can work really well in infection prevention.
Follow your centre’s guidelines for children who are ill, or appear to be sickening. Keep your child at home when he or she has a fever, is vomiting, has diarrhoea or has eye discharge (conjunctivitis) as these are all easily caught and spread around the nursery.
