Managing Infectious Diseases, Part III

This is the third and final blog post on managing infectious diseases, based upon a talk given by Dr. Andrew Hashikawa from The University of Michigan’s Department of Emergency Medicine.  Here we will talk about when and why to exclude students from class due to illnesses. In short, I believe Dr. Hashikawa would say we do so far too frequently (see the staggering stats I posted in the first post). “By the time we see the symptoms, kids have already infected everyone,” he started off by saying. He then went on to list five reasons to send a child home/not allow her to come to school:

1.)    Symptoms prevent the child from participating in activities comfortably

2.)    Symptoms prevent a greater need for care than that which can be provided

3.)    Persistent abdominal pain that lasts for more than two hours

4.)    If a child vomits more than twice—he says once isn’t enough to send home unless coupled with another symptom (diarrhea, fever, etc.)

5.)    Diarrhea which contains blood or mucus, or that causes accidents or dehydration

Many providers (I’m including myself in this) have sat with a child, notice he feels warm, takes his temperature to find it is 101.1, and immediately place a call to a family member to pick him up. From a health care professional’s standpoint, he says this isn’t necessary. Once a fever hits, the contagious part of the illness has already occurred. So long as this child isn’t displaying other symptoms (or anything else from the list above) then he ought not to be excluded from activities. We then looked at specific cases and when/why to exclude a child from school

Pink Eye: more than 96% of conjunctivitis cases are caused by a virus (such as a cold). There is no need to exclude a student with pink eye, unless she also has a fever, a change in behavior, and/or is experiencing eyelid swelling & redness

Fever: Exclude a child with a fever only if it is couple with a change in behavior, is accompanied by other symptoms, if the student is under four-months old, or if he can’t participate in activities or can’t be appropriately cared for. The American Academy of Pediatrics recommends not adjusting or adding a degree to kids’ temperatures, just note the method in which the temperature was taken.

Vomit/diarrhea: exclude when blood or mucus is present, for non-toilet trained children it is a “blowout” and for toilet trained children when they have an accident, concerns of dehydration exist, if it is coupled with a fever, or there is severe belly pain

Cough & other respiratory issues: once a child displays respiratory symptoms, the damage has been done. Therefore a child should only be excluded if it comes with a fever, if she can’t participate in “normal” activities, or if the symptoms persist two or more weeks.

Lice: Excuse me while I itch my head for a few minutes. OK, Dr. Hashikawa says once you see the lice the spreading of it has already occurred.  So there really isn’t a reason for a child to be picked-up as soon as a bug has been spotted, or excluded until from group activities. As soon as a child has received the shampoo treatment, then he or she is good to come back. Lice die without humans within three to four hours, so there really is no reason to scrub or treat classrooms.

And the moral of all of this: spreading illness in our environments is inevitable, and while there is much we can do to keep it at bay, we really ought to take a closer look at when and why we exclude students from school.

Finally, thank you so much to Dr. Andrew Hashikawa for his fabulous presentation and wealth of knowledge shared with our community!

Hashikawa, Andrew. (October 2011). Curriculum for Managing Infectious Diseases in Early Education & Child Care presented at ECDA-WCAEYC Joint Luncheon in Ann Arbor, MI.


Managing Infectious Diseases, Part II

In the first post we learned that germs in our settings are unavoidable, but there are some things we can do to prevent the spread of them, which is what we’ll discuss today. Once again, this information is taken from a lecture given by Dr. Andrew Hashikawa from The University of Michigan’s Department of Emergency Medicine.

In this section of the presentation, Dr. Hashikawa was very gracious to early childhood educators, stressing the important role we play in the healthcare of children. As a pediatrician he said, “I don’t know how many times my patients’ families have come to me and said, ‘My child’s teacher noticed that….’.” And frequently pediatricians are able to give better medical attention as a result of our observations.

First of all, we are in a great position to promote the health of students and can do so by:

  • Educating families on the importance of breast feeding & other nutritious habits
  • Promoting healthy sleep (both in our care and outside of it)
  • Giving our students plenty of gross motor time throughout the day (a minimum of one hour of free gross motor play, as well as a minimum of one hour of structured gross motor play)
  • Sharing the importance of immunizations and vaccines
    • The more people who receive immunizations/vaccines (flu, chicken pox, etc.) the less likely it is for that illness to spread
    • Keep track of students’ vaccine records (Michigan is one of a handful of states who uses online vaccine records)

Secondly, the cleaner we can keep our environments, the less likely it is for germs to spread. Less than half of people in the early childhood environment (teachers and students) wash their hands after going to the bathroom (yikes!). Dr. Hashikawa recommends ditching the fancy, expensive soap (all soaps are antibacterial if used correctly), that the best way to get hands sufficiently clean is by using plan old soap and warm water. I got the sense that outside of wearing them when handling blood, Dr. Hashikawa isn’t a big fan of gloves. Why? They give a false sense of security, and after disposing of the gloves, people aren’t as likely to wash their hands. He stressed the importance of hand-washing even if you have worn gloves to change a diaper, wipe a nose, etc. The other tip he offered here was keeping nails short and well-groomed, as they are a perfect place for germs to linger.

Finally, it is very important to have open communication with families. Starting from enrollment, providers ought to make sure that families know their “sick child” policy (something I think we all do). The point that I really appreciated was that providers ought to know what families’ sick child policies are (which parent to call first, how long it will take them, etc.). He also promoted doing a daily health check with each of our students upon their arrival.

And the moral of all of this: spreading illness in our environments is inevitable, but there is much we can do to keep it at bay.


Stay tuned for his interesting ideas on when and why to exclude students form school activities due to illness!

Hashikawa, Andrew. (October 2011). Curriculum for Managing Infectious Diseases in Early Education & Child Care presented at ECDA-WCAEYC Joint Luncheon in Ann Arbor, MI.

ECDA-WCAEYC Joint Luncheon Update

First of all we would like to extend a huge, “Thank you!” to everyone who was able to make it to our joint luncheon yesterday with Early Childhood Directors Association. We were fortunate enough to have Dr. Andrew Hashikawa, from The University of Michigan’s Department of Emergency Medicine present their Curriculum for Managing Infectious Diseases in Early Education & Child Care. Sounds boring and dry? Not at all, I would even venture to say that it was fun! He shared an incredible wealth of information with those in attendance, so I will divide his presentation into three blog posts over the next few days.

Before introducing the main event, Pam Smith from the Child Care Network spoke to the group on the Child Care Program being unveiled in Michigan. The state is changing the way licensing is done, to a star-rating system. On November 4, 2011, providers are being asked to go online to complete a self-assessment as the first step in this process. This assessment will tell centers if they will be able to move beyond a one-star rating (out of five). If your self-assessment indicates that your center will reach a three-star rating or beyond, a “rater” will come to your center to assess it in person. The criteria in the assessment are based off of HighScope’s Program Quality Assessment. Pam stressed that the rating will not become public until this time next year, as there will certainly be kinks in the program. She also stated that there is not much information available, but questions can be directed to Child Care Network or your county’s Regional Resource Center (if you’re not in Washtenaw County, you can find yours here).

Dr. Hashikawa started his presentation by explaining he was here wearing his American Academy of Pediatrics “hat”, where he heads the Michigan Chapter. Their goals are to form partnerships between medicine and early childhood education programs, provide technical health and safety support to these programs, and support on-going health needs to each of us. I felt like I was a part of an Oprah audience when he announced that each of us were to receive a copy of Managing Infections Diseases in Child Care and Schools, a publication which retails at over $40—thank you, Doctor!

The first topic he discussed which I will share in today’s post is understanding how infectious diseases spread. And it is my hope that I can make the information he shared half as interesting as he did! Here are some statistics he shared:

  • 75% of American children are in some sort of child care setting outside of their homes
  • 40% of parental absenteeism from work is due to children’s illnesses
  • Business lose about $40 billion annually due to children’s illnesses
  • Kids do get sick more when enrolled in child care than those who are not
  • Illnesses decrease after one year
  • Once children hit kindergarten, those kids who have been in early childhood programs are more likely to be healthy and less likely to have asthma
  • More good news, 90% of illnesses in early childhood centers are mild and require no treatment (i.e., they are viruses)

Studies have shown that there are four types of “germs” commonly spread in our environments:

  • Viruses (which account for about 90% of day care germs)
  • Bacteria
  • Fungus
  • Parasite

And how these germs spread:

  • Respiratory droplets (a nice way of saying snot and boogers)
  • Fecal to oral
  • Food

For the reasons we can imagine, children are more vulnerable than adults to illness. But Dr. Hashikawa got a good laugh from the audience when he said, “Kids have no sense of personal space, of course they’re going to spread their ick!” Furthermore, kids in our care are learning everything about the world, including how to build their immune systems. What a great way to put it—and a great way to frame it to families! Now to be clear, Dr. Hashikawa never said these words. However, I got the impression throughout his presentation that educators really jump the gun when choosing to exclude students from their programs due to illnesses.

And the moral of all of this is: spreading illness in our environments is inevitable.

Stay tuned for some tips on what we can do to reduce the spread of germs!

Hashikawa, Andrew. (October 2011). Curriculum for Managing Infectious Diseases in Early Education & Child Care presented at ECDA-WCAEYC Joint Luncheon in Ann Arbor, MI.


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