INFECTIOUS DISEASES IN CHILDCARE SETTINGS Informational Guidelines for Directors, Caregivers, and Parents Second Edition January 2006 D D e e p p a a r r t t m m e e n n t t o o f f H H e e a a l l t t h h a a n n d d S S o o c c i i a a l l S S e e r r v v i i c c e e s s D D e e l l a a w w a a r r e e D D i i v v i i s s i i o o n n o o f f P P u u b b l l i i c c H H e e a a l l t t h h H H e e a a l l t t h h I I n n f f o o r r m m a a t t i i o o n n a a n n d d E E p p i i d d e e m m i i o o l l o o g g y y J J e e s s s s e e C C o o o o p p e e r r B B u u i i l l d d i i n n g g 4 4 1 1 7 7 F F e e d d e e r r a a l l S S t t r r e e e e t t D D o o v v e e r r , , D D e e l l a a w w a a r r e e 1 1 9 9 9 9 0 0 1 1 3 3 0 0 2 2 - - 7 7 4 4 4 4 - - 4 4 5 5 4 4 1 1 8 8 8 8 8 8 - - 2 2 9 9 5 5 - - 5 5 1 1 5 5 6 6 Delaware Childcare Licensing Website: http://www.state.de.us/kids/occl/occl.shtml Childcare Manual 2 T T a a b b l l e e o o f f C C o o n n t t e e n n t t s s P P a a g g e e A A b b o o u u t t t t h h i i s s b b o o o o k k 5 5 C C h h a a p p t t e e r r 1 1 . . I I n n t t r r o o d d u u c c t t i i o o n n : : K K e e e e p p i i n n g g C C h h i i l l d d r r e e n n H H e e a a l l t t h h y y 6 6 C C h h a a p p t t e e r r 2 2 . . H H e e a a l l t t h h H H i i s s t t o o r r y y a a n n d d I I m m m m u u n n i i z z a a t t i i o o n n s s f f o o r r C C h h i i l l d d r r e e n n 7 7 - - 8 8 H H e e a a l l t t h h H H i i s s t t o o r r y y a a n n d d I I m m m m u u n n i i z z a a t t i i o o n n s s f f o o r r C C a a r r e e g g i i v v e e r r s s 9 9 I I m m m m u u n n i i z z a a t t i i o o n n S S c c h h e e d d u u l l e e 1 1 0 0 T T e e n n T T h h i i n n g g s s Y Y o o u u N N e e e e d d t t o o K K n n o o w w a a b b o o u u t t I I m m m m u u n n i i z z a a t t i i o o n n s s 1 1 1 1 - - 1 1 2 2 C C h h a a p p t t e e r r 3 3 . . I I n n f f e e c c t t i i o o n n O O v v e e r r v v i i e e w w : : 1 1 3 3 I I n n f f e e c c t t i i o o n n S S p p r r e e a a d d b b y y D D i i r r e e c c t t C C o o n n t t a a c c t t w w i i t t h h P P e e o o p p l l e e o o r r O O b b j j e e c c t t s s 1 1 3 3 I I n n f f e e c c t t i i o o n n S S p p r r e e a a d d b b y y t t h h e e F F e e c c a a l l - - O O r r a a l l R R o o u u t t e e 1 1 3 3 I I n n f f e e c c t t i i o o n n S S p p r r e e a a d d b b y y t t h h e e R R e e s s p p i i r r a a t t o o r r y y R R o o u u t t e e 1 1 3 3 I I n n f f e e c c t t i i o o n n S S p p r r e e a a d d t t h h r r o o u u g g h h B B l l o o o o d d , , U U r r i i n n e e , , a a n n d d S S a a l l i i v v a a 1 1 4 4 C C h h a a p p t t e e r r 4 4 . . I I n n f f e e c c t t i i o o n n C C o o n n t t r r o o l l M M e e a a s s u u r r e e s s : : S S a a n n i i t t a a t t i i o o n n a a n n d d D D i i s s i i n n f f e e c c t t i i o o n n 1 1 5 5 W W a a s s h h i i n n g g a a n n d d D D i i s s i i n n f f e e c c t t i i n n g g B B a a t t h h r r o o o o m m s s a a n n d d o o t t h h e e r r S S u u r r f f a a c c e e s s 1 1 6 6 W W a a s s h h i i n n g g a a n n d d D D i i s s i i n n f f e e c c t t i i n n g g D D i i a a p p e e r r C C h h a a n n g g i i n n g g A A r r e e a a s s 1 1 6 6 W W a a s s h h i i n n g g P P o o t t t t y y C C h h a a i i r r s s a a n n d d T T o o i i l l e e t t s s 1 1 6 6 - - 1 1 7 7 W W a a s s h h i i n n g g a a n n d d D D i i s s i i n n f f e e c c t t i i n n g g C C l l o o t t h h i i n n g g , , L L i i n n e e n n a a n n d d F F u u r r n n i i s s h h i i n n g g s s 1 1 7 7 W W a a s s h h i i n n g g a a n n d d D D i i s s i i n n f f e e c c t t i i n n g g T T o o y y s s 1 1 7 7 - - 1 1 8 8 C C l l e e a a n n i i n n g g u u p p B B o o d d y y F F l l u u i i d d s s 1 1 8 8 H H a a n n d d W W a a s s h h i i n n g g 1 1 9 9 H H a a n n d d W W a a s s h h i i n n g g S S t t e e p p s s a a n n d d D D i i a a g g r r a a m m 2 2 0 0 - - 2 2 1 1 D D i i a a p p e e r r C C h h a a n n g g i i n n g g S S t t e e p p s s 2 2 2 2 - - 2 2 3 3 F F o o o o d d S S a a f f e e t t y y a a n n d d S S a a n n i i t t a a t t i i o o n n 2 2 4 4 - - 2 2 5 5 B B r r e e a a s s t t M M i i l l k k a a n n d d H H I I V V E E x x p p o o s s u u r r e e 2 2 6 6 P P e e t t s s i i n n t t h h e e C C h h i i l l d d c c a a r r e e S S e e t t t t i i n n g g 2 2 7 7 C C h h a a p p t t e e r r 5 5 . . C C a a r r e e g g i i v v e e r r / / T T e e a a c c h h e e r r H H e e a a l l t t h h 2 2 8 8 H H e e a a l l t t h h A A p p p p r r a a i i s s a a l l s s 2 2 8 8 H H e e a a l l t t h h L L i i m m i i t t a a t t i i o o n n s s o o f f S S t t a a f f f f 2 2 8 8 H H e e a a l l t t h h R R i i s s k k s s f f o o r r P P r r e e g g n n a a n n t t C C h h i i l l d d c c a a r r e e P P r r o o v v i i d d e e r r s s 2 2 9 9 C C h h a a p p t t e e r r 6 6 . . R R e e c c o o g g n n i i z z i i n n g g t t h h e e I I l l l l C C h h i i l l d d : : D D a a i i l l y y H H e e a a l l t t h h A A s s s s e e s s s s m m e e n n t t C C h h e e c c k k 3 3 0 0 W W h h e e n n t t o o g g e e t t I I m m m m e e d d i i a a t t e e M M e e d d i i c c a a l l H H e e l l p p 3 3 0 0 E E x x c c l l u u s s i i o o n n C C r r i i t t e e r r i i a a 3 3 1 1 P P r r o o v v i i d d e e r r E E x x c c l l u u s s i i o o n n / / R R e e - - a a d d m m i i t t t t a a n n c c e e C C r r i i t t e e r r i i a a 3 3 2 2 P P r r e e p p a a r r i i n n g g f f o o r r M M a a n n a a g g i i n n g g I I l l l l n n e e s s s s 3 3 3 3 D D e e l l a a w w a a r r e e R R e e p p o o r r t t a a b b l l e e D D i i s s e e a a s s e e s s 3 3 4 4 C C h h a a p p t t e e r r 7 7 . . O O r r a a l l H H e e a a l l t t h h D D i i s s e e a a s s e e s s : : E E a a r r l l y y C C h h i i l l d d h h o o o o d d C C a a r r i i e e s s ( ( E E C C C C ) ) 3 3 5 5 A A c c u u t t e e H H e e r r p p e e t t i i c c G G i i n n g g i i v v o o s s t t o o m m a a t t i i t t i i s s 3 3 5 5 A A v v u u l l s s i i o o n n ( ( T T o o o o t t h h L L o o s s s s b b y y T T r r a a u u m m a a ) ) 3 3 6 6 Childcare Manual 3 C C h h a a p p t t e e r r 8 8 . . Q Q u u i i c c k k R R e e f f e e r r e e n n c c e e S S h h e e e e t t s s – – F F a a c c t t S S h h e e e e t t s s : : 3 3 7 7 A A s s t t h h m m a a 3 3 8 8 B B a a b b y y B B o o t t t t l l e e T T o o o o t t h h D D e e c c a a y y 3 3 9 9 B B a a c c t t e e r r i i a a l l M M e e n n i i n n g g i i t t i i s s 4 4 0 0 B B i i t t i i n n g g I I n n c c i i d d e e n n t t s s 4 4 1 1 C C a a m m p p y y l l o o b b a a c c t t e e r r I I n n f f e e c c t t i i o o n n s s 4 4 2 2 C C h h i i c c k k e e n n p p o o x x ( ( V V a a r r i i c c e e l l l l a a ) ) 4 4 3 3 C C o o l l d d S S o o r r e e s s 4 4 4 4 C C o o m m m m o o n n C C o o l l d d 4 4 5 5 C C r r y y p p t t o o s s p p o o r r i i d d i i o o s s i i s s 4 4 6 6 C C y y t t o o m m e e g g a a l l o o v v i i r r u u s s ( ( C C M M V V ) ) 4 4 7 7 D D i i a a r r r r h h e e a a l l D D i i s s e e a a s s e e s s 4 4 8 8 D D i i p p h h t t h h e e r r i i a a 4 4 9 9 E E a a r r a a c c h h e e ( ( O O t t i i t t i i s s M M e e d d i i a a ) ) 5 5 0 0 E E s s c c h h e e r r i i c c h h i i a a c c o o l l i i 0 0 1 1 5 5 7 7 : : H H 7 7 I I n n f f e e c c t t i i o o n n s s 5 5 1 1 F F i i f f t t h h D D i i s s e e a a s s e e ( ( H H u u m m a a n n P P a a r r v v o o v v i i r r u u s s B B 1 1 9 9 ) ) 5 5 2 2 F F o o o o d d b b o o r r n n e e I I l l l l n n e e s s s s e e s s 5 5 3 3 G G i i a a r r d d i i a a s s i i s s 5 5 4 4 H H a a n n d d - - F F o o o o t t - - M M o o u u t t h h D D i i s s e e a a s s e e ( ( C C o o x x s s a a c c k k i i e e A A ) ) 5 5 5 5 H H e e a a d d L L i i c c e e ( ( P P e e d d i i c c u u l l o o s s i i s s C C a a p p i i t t i i s s ) ) 5 5 6 6 H H e e p p a a t t i i t t i i s s A A 5 5 7 7 H H e e p p a a t t i i t t i i s s B B 5 5 8 8 H H u u m m a a n n I I m m m m u u n n o o d d e e f f i i c c i i e e n n c c y y V V i i r r u u s s / / A A c c q q u u i i r r e e d d I I m m m m u u n n o o d d e e f f i i c c i i e e n n c c y y S S y y n n d d r r o o m m e e ( ( H H I I V V / / A A I I D D S S ) ) 5 5 9 9 - - 6 6 0 0 I I m m p p e e t t i i g g o o 6 6 1 1 I I n n f f e e c c t t i i o o u u s s M M o o n n o o n n u u c c l l e e o o s s i i s s 6 6 2 2 I I n n f f l l u u e e n n z z a a 6 6 3 3 I I n n j j u u r r i i e e s s - - I I n n t t e e n n t t i i o o n n a a l l / / U U n n i i n n t t e e n n t t i i o o n n a a l l 6 6 4 4 - - 6 6 5 5 L L y y m m e e d d i i s s e e a a s s e e ( ( n n o o n n - - i i n n f f e e c c t t i i o o u u s s ) ) 6 6 6 6 M M e e a a s s l l e e s s 6 6 7 7 M M u u m m p p s s 6 6 8 8 P P e e r r t t u u s s s s i i s s ( ( W W h h o o o o p p i i n n g g C C o o u u g g h h ) ) 6 6 9 9 P P i i n n k k e e y y e e ( ( C C o o n n j j u u n n c c t t i i v v i i t t i i s s ) ) 7 7 0 0 P P i i n n w w o o r r m m s s 7 7 1 1 P P n n e e u u m m o o n n i i a a 7 7 2 2 R R e e s s p p i i r r a a t t o o r r y y S S y y n n c c y y t t i i a a l l V V i i r r u u s s ( ( R R S S V V ) ) 7 7 3 3 R R i i n n g g w w o o r r m m ( ( T T i i n n e e a a ) ) 7 7 4 4 R R o o s s e e o o l l a a ( ( H H u u m m a a n n H H e e r r p p e e s s v v i i r r u u s s 6 6 ) ) 7 7 5 5 R R o o t t a a v v i i r r u u s s 7 7 6 6 R R u u b b e e l l l l a a ( ( G G e e r r m m a a n n M M e e a a s s l l e e s s ) ) 7 7 7 7 S S a a l l m m o o n n e e l l l l a a 7 7 8 8 S S c c a a b b i i e e s s 7 7 9 9 S S h h i i g g e e l l l l o o s s i i s s 8 8 0 0 S S t t r r e e p p T T h h r r o o a a t t ( ( S S t t r r e e p p t t o o c c o o c c c c a a l l P P h h a a r r y y n n g g i i t t i i s s ) ) a a n n d d S S c c a a r r l l e e t t F F e e v v e e r r 8 8 1 1 S S u u d d d d e e n n I I n n f f a a n n t t D D e e a a t t h h S S y y n n d d r r o o m m e e ( ( S S I I D D S S ) ) 8 8 2 2 - - 8 8 4 4 T T e e t t a a n n u u s s 8 8 5 5 T T u u b b e e r r c c u u l l o o s s i i s s ( ( T T B B ) ) 8 8 6 6 U U r r i i n n a a r r y y T T r r a a c c t t I I n n f f e e c c t t i i o o n n ( ( U U T T I I ) ) 8 8 7 7 W W e e s s t t N N i i l l e e V V i i r r u u s s 8 8 8 8 Y Y e e a a s s t t I I n n f f e e c c t t i i o o n n s s ( ( T T h h r r u u s s h h / / D D i i a a p p e e r r R R a a s s h h ) ) 8 8 9 9 Childcare Manual 4 C C h h a a p p t t e e r r 9 9 . . P P a a r r e e n n t t / / G G u u a a r r d d i i a a n n A A l l e e r r t t S S a a m m p p l l e e L L e e t t t t e e r r s s 9 9 0 0 C C a a m m p p y y l l o o b b a a c c t t e e r r 9 9 1 1 - - 9 9 2 2 C C h h i i c c k k e e n n p p o o x x 9 9 3 3 - - 9 9 4 4 C C o o n n j j u u n n c c t t i i v v i i t t i i s s 9 9 5 5 - - 9 9 6 6 E E . . c c o o l l i i 0 0 1 1 5 5 7 7 : : H H 7 7 9 9 7 7 - - 9 9 8 8 F F i i f f t t h h D D i i s s e e a a s s e e 9 9 9 9 - - 1 1 0 0 0 0 G G i i a a r r d d i i a a 1 1 0 0 1 1 - - 1 1 0 0 2 2 H H i i b b D D i i s s e e a a s s e e 1 1 0 0 3 3 - - 1 1 0 0 4 4 H H a a n n d d - - F F o o o o t t - - M M o o u u t t h h D D i i s s e e a a s s e e 1 1 0 0 5 5 - - 1 1 0 0 6 6 H H e e a a d d L L i i c c e e 1 1 0 0 7 7 - - 1 1 1 1 0 0 H H e e p p a a t t i i t t i i s s A A 1 1 1 1 1 1 - - 1 1 1 1 2 2 I I m m p p e e t t i i g g o o 1 1 1 1 3 3 - - 1 1 1 1 4 4 M M e e n n i i n n g g o o c c o o c c c c a a l l I I l l l l n n e e s s s s 1 1 1 1 5 5 - - 1 1 1 1 6 6 P P i i n n w w o o r r m m 1 1 1 1 7 7 - - 1 1 1 1 8 8 R R i i n n g g w w o o r r m m 1 1 1 1 9 9 - - 1 1 2 2 0 0 S S a a l l m m o o n n e e l l l l a a 1 1 2 2 1 1 - - 1 1 2 2 2 2 S S c c a a b b i i e e s s 1 1 2 2 3 3 - - 1 1 2 2 4 4 S S h h i i g g e e l l l l a a 1 1 2 2 5 5 - - 1 1 2 2 6 6 S S t t r r e e p p T T h h r r o o a a t t 1 1 2 2 7 7 - - 1 1 2 2 8 8 C C h h a a p p t t e e r r 1 1 0 0 . . B B i i o o t t e e r r r r o o r r i i s s m m : : 1 1 2 2 9 9 C C r r e e a a t t i i n n g g W W r r i i t t t t e e n n E E m m e e r r g g e e n n c c y y P P l l a a n n s s f f o o r r N N a a t t u u r r a a l l & & M M a a n n - - m m a a d d e e D D i i s s a a s s t t e e r r s s 1 1 2 2 9 9 C C h h a a p p t t e e r r 1 1 1 1 . . R R o o l l e e o o f f t t h h e e H H e e a a l l t t h h C C a a r r e e C C o o n n s s u u l l t t a a n n t t i i n n C C h h i i l l d d c c a a r r e e a a n n d d S S c c h h o o o o l l s s 1 1 3 3 0 0 - - 1 1 3 3 1 1 G G l l o o s s s s a a r r y y 1 1 3 3 2 2 - - 1 1 3 3 5 5 R R e e s s o o u u r r c c e e s s 1 1 3 3 6 6 - - 1 1 4 4 1 1 R R e e f f e e r r e e n n c c e e s s 1 1 4 4 1 1 Childcare Manual 5 A A b b o o u u t t T T h h i i s s B B o o o o k k This manual is the 2 nd edition of the Infectious Diseases in Childcare Settings. It was developed as a tool to encourage common understanding among caregivers, teachers, families, and health care professionals about infectious diseases and to aid with efforts for reducing illnesses, injuries and other health problems in childcare settings. This guide explains the health history of immunizations, ways to prevent and control the spread of communicable diseases, symptoms of common infections seen in childcare settings, how infections are spread, when to seek medical care, inclusion/exclusion criteria, fact sheets, and sample letters to give to parents. The information in this guide is based on the latest recommendations addressing health and safety in childcare settings from the following organizations: → American Academy of Pediatrics → American Public Health Association → US Department of Health and Human Services → Centers for Disease Control and Prevention → State of Delaware Department of Services for Children, Youth and their Families Should you have concerns regarding the contents of this manual, please direct your inquiries to: D D e e p p a a r r t t m m e e n n t t o o f f H H e e a a l l t t h h a a n n d d S S o o c c i i a a l l S S e e r r v v i i c c e e s s D D e e l l a a w w a a r r e e D D i i v v i i s s i i o o n n o o f f P P u u b b l l i i c c H H e e a a l l t t h h H H e e a a l l t t h h I I n n f f o o r r m m a a t t i i o o n n a a n n d d E E p p i i d d e e m m i i o o l l o o g g y y J J e e s s s s e e C C o o o o p p e e r r B B u u i i l l d d i i n n g g 4 4 1 1 7 7 F F e e d d e e r r a a l l S S t t r r e e e e t t D D o o v v e e r r , , D D e e l l a a w w a a r r e e 1 1 9 9 9 9 0 0 1 1 3 3 0 0 2 2 - - 7 7 4 4 4 4 - - 4 4 5 5 4 4 1 1 8 8 8 8 8 8 - - 2 2 9 9 5 5 - - 5 5 1 1 5 5 6 6 Funding for the Infectious Diseases in Childcare Settings, 2nd edition, was provided in part by Grant No.1 U93 MC 00225-01 from the Maternal and Child Health Bureau (Title V., Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. Childcare Manual 6 C C h h a a p p t t e e r r 1 1 . . I I n n t t r r o o d d u u c c t t i i o o n n : : K K e e e e p p i i n n g g C C h h i i l l d d r r e e n n H H e e a a l l t t h h y y Delaware’s early care providers, teachers, families and health professionals are committed to keeping all children healthy. As families enter the workforce, they must rely on childcare centers to provide a safe, healthy and caring environment for their child. These children are very susceptible to contagious diseases because they have not been exposed to many infections (e.g., viruses, bacteria, parasites, fungi) and have no resistance to them, or have not received recommended immunizations. Therefore, children are acquiring infections at an earlier age. A variety of infections has been documented in children attending childcare, sometimes with spread to caregivers and to others at home. Infants and toddlers have high hand to mouth activity. They play and eat close together. Their hygiene habits and immune systems are not well developed. In addition, wherever there are children in diapers, the spread of diarrheal diseases my readily occur as the result of poor or inadequate hand-washing, diaper changing and environmental sanitation measures. In general, sending home (excluding) mildly ill children is not an effective way to control the spread of most germs. Individuals who are not ill or never become ill can spread many infections. All of these factors make infections in childcare settings common and fast spreading. This manual contains disease fact sheets specifically meant for childcare settings. These fact sheets may be distributed to parents and staff; fact sheets will help staff determine when children should be sent home or readmitted to your facility. Childcare Manual 7 C C h h a a p p t t e e r r 2 2 . . H H e e a a l l t t h h H H i i s s t t o o r r y y o o f f I I m m m m u u n n i i z z a a t t i i o o n n s s P P o o l l i i c c y y f f o o r r C C h h i i l l d d r r e e n n i i n n C C h h i i l l d d c c a a r r e e You need to know the health history and medical emergency information for every child in your care. When a child enrolls in your childcare facility, you should find out: → Where parents can be reached full names, work, and home phone numbers and addresses. → At least two people to contact if parents cannot be reached phone numbers and addresses. → The child's regular health care providers names, addresses, and phone numbers. → The hospital that the child's family uses name, address, and phone number. → The date of the child's last physical examination. Any child who has not had a well baby or well child examination recently (within the past 6 months) should be examined within 30 days of entering your childcare facility. → Any special health problems or medical conditions that a child may have and procedures to follow to deal with these conditions. Examples of conditions needing procedures are allergies, asthma, diabetes, epilepsy, and sickle cell anemia. These conditions can cause sudden attacks that may require immediate action. → You should know: 1) What happens to the child during a crisis related to the condition. 2) How to prevent a crisis? 3) How to deal with a crisis? 4) Whether you need training in a particular emergency procedure. → The child's vaccination status. Whether the child has been evaluated with a TB skin test (using the Mantoux method with tuberculin purified protein derivative [PPD]. You should require that all children admitted to your care be up to date on their vaccinations. The state of Delaware requires you to have written proof of each child's up-to-date vaccinations. Children attending childcare especially need all of the recommended vaccinations to protect themselves, the other children, and the childcare provider, and their families. Several diseases that can cause serious problems for children and adults can be prevented by vaccination. These diseases are chicken pox, diphtheria, Haemophilus influenzae meningitis, hepatitis A, hepatitis B, influenza, measles, mumps, pneumococcal disease polio, rubella (German measles or 3-day measles), tetanus, and whooping cough (pertussis). Many of these diseases are becoming less common because most people have been vaccinated against them. However, cases still occur and children in childcare are at increased risk for many of these diseases because of the many hours they spend in close contact with other children. State law requires that all children undergo lead screening at 1 year of age. Medicaid children must also be screened again at 2 years of age. Children who are not up to date on their vaccinations should be taken out of childcare (excluded) until they have begun the series of shots needed. Each child in your care should have a certificate of up-to-date immunizations in your files. Each child shall also have on file an age-appropriate health appraisal certified by a licensed physician or nurse practitioner that shall be updated yearly up to school age. Included in this health appraisal should be a description of any disability or impairment that may affect adaptation to childcare. Childcare Manual 8 STATE OF DELAWARE DEPARTMENT OF SERVICES FOR CHILDREN, NAME_____________________ YOUTH AND THEIR FAMILIES Family Childcare OFFICE OF CHILDCARE LICENSING Large Family Childcare Home Day Care Center BIRTHDATE_____________ CHILD HEALTH APPRAISAL SECTION A: TO BE COMPLETED BY PARENT BEFORE PHYSICAL EXAMINATION SECTION B: TO BE COMPLETED BY EXAMINING PHYSICIAN/PEDIATRIC NURSE PRACTITIONER DTP/Hib 1 / / DTP/Hib 2 / / DTP/Hib 3 / / DTP/ Hib 4 / / DTaP/Hib 4 / / DTP/DTaP 1 / DT / / DTP/DTaP 2 / DT / / DTP/DTaP 3 / DT / / DTP/DTaP 4 / DT / / DTP/DTaP 5 / DT / / Td 1 / / Td 2 / / Td 3 / / / / / / OPV/IPV 1 / / OPV/IPV 2 / / OPV/IPV 3 / / OPV/IPV 4 / / TB Screening 12 mo / / MMR 1 / / MMR 2 / / HepB 1 / / HepB 2 / / HepB 3 / / Hib 1 / / Hib 2 / / Hib 3 / / Hib 4 / / Hep B/Hib 1 / / Hep B/Hib 2 / / Hep B/Hib 3 / / Varicella 1 / / Varicella 2 / / Influenza 1 / / Influenza 2 / / Pneumococcal Polysaccharide1 / / Pneumococcal Polysaccharide 2 / / Pneumococcal Conjugate 1 / / Pneumococcal Conjugate 2 / / Pneumococcal Conjugate 3 / / Pneumococcal Conjugate 4 / / Hep A 1 / / Hep A 2 / / Lyme Vax 1 / / Lyme Vax 2 / / Lyme Vax 3 / / Other: / / Lead Screening 12 mo / / Examiner’s Signature_________________________________________ ∂ M.D. ∂ P.N.P. Date: _____________________________________ Printed Name: ________________________________________________ Telephone: ___________________________________________________ CHECK IF CHILD HAS PROBLEMS WITH ANY OF THE FOLLOWING: GIVE ADDITIONAL COMMENTS BELOW ψ Allergies ψ Frequent Colds ψ Fainting ψ Physical Handicap (food, medicine, bee sting etc.) ψ Hearing Difficulty ψ Speech Difficulty ψ Behavior Problem ψ Constipation/Diarrhea ψ Seizures ψ Vision Difficulty ψ Asthma Other______________________________________________________________________________________________________ Comments: _________________________________________________________________________________________________ ADDITIONAL INFORMATION ABOUT YOUR CHILD (include serious illness, accidents, operations, medications, etc. with dates): __________________________________________________________________________________________________________ ________________________________________________________________________________________________ Parent/Guardian’s Signature_________________________________________Date_____________________________ CODE: X - Within Normal Limits O - See Remarks Below _____ Scalp, Skin _____ Heart _____ Vision _____ Ear, Nose _____ Lungs _____ Hearing _____ Throat _____ Abdomen _____ Blood Pressure _____ Eyes _____ Genitalia _____ Teeth _____ Extremities _____ Neck, Glands _____ Nervous System _____ Height _____ Weight REMARKS AND RECOMMENDATIONS ________________________________________________________________ _________________________________________________________________________________________________ IS CHILD PROGRESSING NORMALLY FOR AGE GROUP? _______________________________________________ Childcare Manual 9 H H e e a a l l t t h h H H i i s s t t o o r r y y a a n n d d I I m m m m u u n n i i z z a a t t i i o o n n P P o o l l i i c c y y f f o o r r C C h h i i l l d d c c a a r r e e P P r r o o v v i i d d e e r r s s Children, especially those in groups, are more likely to get infectious diseases than are adults. As a childcare provider, you will be exposed to infectious diseases more frequently than will someone who has less contact with children. To protect yourself and children in your care, you need to know what immunizations you received as a child and whether you had certain childhood diseases. If you are not sure, your health care provider can test your blood to determine if you are immune to some of these diseases and can vaccinate you against those to which you are not immune. Child caregivers shall also have on file written evidence of health appraisals signed by a licensed physician or nurse practitioner. These shall include a health history, physical examination, immunization status, vision/hearing screening, TB screening (see below), and assessment of any health related limitations or communicable diseases that may impair the caregiver's ability to perform specific job duties. Tuberculosis Screening Persons who are beginning work as childcare providers should have a TB skin test (Mantoux method using tuberculin purified protein derivative [PPD]) to check for infection with the TB germ, unless there is documentation of a positive test result in the past, or of active TB that has been treated already. The first time that they are tested, persons who cannot document any previous TB skin test results should have a two-step test. (That is, if the first test result is negative, the skin test is repeated within one month.) Persons who have negative results from their skin tests when they start childcare work should have their skin tests repeated every 2 years while the results are still negative. Recommended Immunization Schedule for Childcare Providers: IMMUNIZATION HOW OFTEN Influenza Annually, (in Oct. or Nov.) for all providers Measles, Mumps, Rubella (MMR) Providers born before 1957 can be considered immune to measles and mumps. Others are immune if they have a history of measles or mumps or have received at least one dose of rubella vaccine on or after their first birthday. A blood test indicating immunity to rubella or one dose of rubella vaccine is required. Tetanus, Diphtheria (Td) Childcare providers should have a record of receiving a series of 3 doses (usually given in childhood) and a booster dose given within the past 10 years. Polio Childcare providers, especially those working with children who are not toilet-trained, should have a record of a primary series of 3 doses (usually given in childhood) and a supplemental dose given at least 6 months after the third dose in the primary series. Hepatitis A CDC recommends Hepatitis A vaccine for childcare providers. Chickenpox CDC recommends Chickenpox vaccine for all childcare providers who have not had Chickenpox. Providers who know they have had the disease are considered immune. Hepatitis B Childcare providers who may have contact with blood or body fluids, or who work with developmentally disabled or aggressive children, should be vaccinated against Hepatitis B with one series of 3 doses of vaccine. Childcare Manual 10 [...]... cleaning Do NOT rinse the potty in a sink used for washing hands A sink used for food preparation should NEVER be used for this purpose → Dump the rinse water into the toilet 16 Childcare Manual → Wash and disinfect the potty chair → Wash and disinfect the sink and all exposed surfaces → Wash your hands thoroughly Washing and Disinfecting Clothing, Linen and Furnishings Do not wash or rinse clothing... hands and teaching children in your care good hand washing practices When Hands should be washed: Children: → Upon arrival at the childcare facility → Immediately before and after eating → After using the toilet or having their diapers changed → Before using water tables → After playing on the playground → After handling pets, pet cages, or other pet objects → Whenever hands are visibly dirty → Before... gloves* used for any purpose → Before giving or applying medication or ointment to a child or self → Before going home * If gloves are used, hands should be washed immediately after gloves are removed even if hands are not visibly contaminated Use of gloves alone will not prevent contamination of hands or spread of germs and should not be considered a substitute for hand washing Rubbing hands together... wash water and washbasins 19 Childcare Manual How to Wash Hands → Always use warm, running water and a mild, preferably liquid, soap Antibacterial soaps may be used, but are not required Pre-moistened cleansing towelettes do not effectively clean hands and do not take the place of hand washing → Wet the hands and apply a small amount (dime to quarter size) of liquid soap to hands → Rub hands together... a soapy lather appears and continue for at least 15 seconds Be sure to scrub between fingers, under fingernails, and around the tops and palms of the hands → Rinse hands under warm running water Leave the water running while drying hands → Dry hands with a clean, disposable (or single use) towel, being careful to avoid touching the faucet handles or towel holder with clean hands → Turn the faucet off... (made of nonporous materials such as glass, Formica, or plastic), and use separate boards for ready-to-eat foods (including foods to be eaten raw) and for foods which are to be cooked, such as meats 24 Childcare Manual → Use proper hand washing techniques Proper hand washing is important for everyone in a childcare setting, but is especially necessary for food handlers to prevent the spread of infections... children for love and affection Caring for pets also gives children an opportunity to learn how to treat and be responsible for others However, some guidelines for protecting the health and safety of the children should be followed Delaware childcare licensing allows pets if there is proof of rabies vaccination from each dog or cat 6-months or older Animals shall be free from disease and shall be cared for. .. and wash thoroughly → Rinse dish or utensil in second dishpan of clear water → Immerse dish or utensil in third dishpan of chlorinated water for at least 1 minute → Place dish or utensil in rack to air dry Dishwashers are approved to use for cleaning and sanitation of dishes and utensils Note: Food preparation and dishwashing sinks should only be used for these activities and should never be used for. .. cleaned and sanitized daily, and crib mattresses should be cleaned and sanitized weekly and when soiled or wet Linens from beds of older children should be laundered at least weekly and whenever soiled However, if a child inadvertently uses another child’s bedding, you should change the linen and mattress cover before allowing the assigned child to use it again All blankets should be changed and laundered... soiled Toys and equipment used by older children and not put into their mouths should be cleaned at least weekly and when obviously soiled A soap and water wash followed by clear water rinsing and air-drying should be adequate No disinfection is required (These types of toys and equipment include blocks, dolls, tricycles, trucks, and other similar toys.) Do not use wading pools, especially for children . INFECTIOUS DISEASES IN CHILDCARE SETTINGS Informational Guidelines for Directors, Caregivers, and Parents Second Edition January 2006 D D e e p p a a r r t t m m e e n n t t . common understanding among caregivers, teachers, families, and health care professionals about infectious diseases and to aid with efforts for reducing