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Day Care Centers: Health Risks

Introduction

In the world today, most families have both parents going to work to make to boost family income. Their children, with no one to take care of them, end up at childcare facility centers, where they spend substantial time during the day. The advantages associated with daycare centers about a child’s overall development are evident- they provide a rich environment for educational and social interaction and experience. However, parents should equally be wary of the attendant health risks associated with children’s daycare facilities. Pauline Go (2009) says that “Children have always been susceptible to infections but when it comes to a caring facility, the crowded scenario can expose a child to a larger variety of infections than what the child would have been exposed to at home.” Children under daycare are also vulnerable to bacterial, fungal, and protozoa infections (Clements, 2007), as well as “strep throat which is common and contagious by the oral route.” Also prevalent in daycare centers and easily transmitted include giardia (intestinal protozoa), and the fungus-caused ringworm.

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Common infections

Gastroenteritis is an infection very common at daycare centers, characterized by severe vomiting and/or diarrhea. The infection is very contagious and spreads mainly through the fecal-oral cavity. It is common among young children because they are naturally inclined not to wash their hands after visiting the toilet. Another intestinal infection is giardia, which is transmitted by a vector parasite. This infection is symptomatic of chronic diarrhea, stomach gas, and cramps. It quickly gets transmitted among children in crowded places. Hepatitis is also common. It is a viral disease and as such, transmission is through the oral-fecal route. Hepatitis A, particularly, is contracted through contaminated food. In health care centers, where several children are likely to share food, chances of infection and transmission are very high.

Children with undiagnosed mild symptoms

Children who are enrolled in Health Maintenance Organization (HMO) health programs may not be equally exposed as those in the Medicaid program due to varying degrees in healthcare access. But those who lack adequate access to medical services are likely to attend child care centers with undiagnosed mild symptoms of infectious diseases. This increases the chances of them spreading the infections even to those without infections and with better access to medical care. The impact of infections contracted at daycare centers may also vary depending on the educational level of their parents. At one level, it will be determined by their ability to access and utilize health-related knowledge and information. Illiterate parents are likely to ignore first-phase mild symptoms, until such a time when the infection has reached an advanced stage. In the meantime, they will be spreading the infection to other children. Secondly, the level of educational attainment reflects the economic status of parents and by extension, their ability to afford better health care services for their children. Poor families are thus less likely to have their children diagnosed with mild symptoms.

Researches related to the topic

In their findings, Samuels et al (2004) noted that while risks of common infections varied among children from different economic backgrounds, they were all at a higher risk of exposure to infections than children who did not attend daycare facilities. In another study, (Fleming et al, 1987) it was found that children in daycare centers were prone to contracting diarrhea-related infections and upper respiratory infection compared to those under home care services. The higher infection risks were attributed to the conditions of daycare facilities, such as crowded spaces, unhygienic food, and poor handling of children. Besides the chances of Medicaid program children arriving with undiagnosed infections and spreading them to others, they get clustered in daycare centers with inferior facilities, which increases the risks for more infection. They concluded that daycare facilities posed a greater risk of infection even to those with access to health facilities (Fleming et al, 1987; Hofferth & Philips, 1997).

Placing young children in daycare centers (Howard Center 2007) exposes them to health risks not faced by those cared for by their mothers. The risks of diarrhea and URI are higher within a daycare setting. The researchers calculated the risk at daycare centers and compared it to those under home care. The chances of infection were given as “Mild Diarrhea (Odds Ratio of 1.83), Severe Diarrhea (Odds Ratio of 1.79), Mild Upper Respiratory Illness (Odds Ratio of 1.96), and Severe Upper Respiratory Illness (Odds Ratio of 1.64)” (Howard Center 2007).

During outbreaks of infectious diseases, daycare centers, schools, and other social places are the first to be hit. Duram Region Care (2009) studied the infection trends of H1NI swine flu and found that children in crowded areas were greatly prone to infection. Children, they noted, “are virtual microbe-spreading machines, and those in daycare situations are at a high risk of contracting the swine flu….serious infection should be prevented by avoiding contagious infection from those with H1N1 swine flu” (Duram Region Daycare, 2009 ).

Trigger of infections

Children are susceptible to various indoor and outdoor environmental pollutants such as cigarette smoke, cooking equipment, art supplies, asbestos, and lead. A research paper on how to assess, manage and prevent environmental problems to help child caregivers create a healthy environment, noted that “overcrowding and air pollution at child care centers pose great health risks” (Gratz and Boulton 1993).

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The U.S. Centers for Disease Control and Prevention (CDC, 2003) issued a research report on reptiles linked to Salmonellosis (infection with Salmonella bacteria). Salmonellosis, the paper reports, is a serious and potentially fatal infection, especially in younger children or people with weak immune systems. The CDC estimates that more than seventy incidences of Salmonella infections result from the “frequent exposure to reptiles and amphibians, making it a serious health concern” (McLeod 2010). Children at daycare centers are at higher risks of exposure to such reptiles, and therefore with higher chances of infection. They also noted that “Turtles and other reptiles such as iguanas, snakes, and lizards are popular pets in childcare and early childhood education settings” (McLeod 2010).

The American Center of Disease Control Planning Unit reports that these animals look attractive to young children, but they carry harmful and infectious bacteria that cause diseases. Reptiles and amphibians to be found in child care centers pose a great risk even if the children do not touch or come into close physical contact with them. Turtles and other reptiles, the report adds, are dangerous in classroom settings and child care facility centers. “Direct and indirect contact,” says the report, “creates exposure to infection since Salmonella bacteria can live on surfaces for months” (ACDCP 2008). When these reptiles are kept at homes and daycare facilities, parents and caregivers assume that it is safe to have and treat them as pets. However, they are often unaware of the health risks that they pose to their children and daycare workers. Most of the infections transmitted in this manner are most contagious and can spread quickly among children.

Apart from vector carriers, various other factors contribute to the contraction and spread of infections in child-care facility centers. They include “personal hygiene and health status of the caregivers and the children” (Mink 2009). Hernández et al (2009) say that there are no seasonal variations in infection incidences at the facility centers, suggesting that constant contact between those infected and the uninfected was the main cause of frequent outbreaks. Generally, (Clements, 2007) “young children at daycare centers contract new viral infection almost every four weeks and portray signs of illness about every two months.” This re-occurring contraction of infections, adds Clements, “do not allow the child’s physiology to resume to a normal and stable state, making some of them prone to chronic infections like ear infections.”

General unhygienic conditions at the care centers as compared to the home environment could be another trigger of infections. When young children get clustered together at the centers, they become more vulnerable to infections. Ingrid Koo observes that “Daycares and preschools have a horrible reputation for being “germ factories” where being sick is the rule, not the exception” (Koo, 2008). But then, financial and personal inconveniences, daycare facility centers are preferred over home care services. As a result, more parents frequently seek outside care services for their children provided by the daycare facilities. The appeal for daycare and pre-school daycare centers, writes Koo, is that “they offer high-quality care and intellectual experiences from qualified professionals, besides excellent socialization skills using social interaction with other children” (Koo, 2008). But then they are also ‘germ centers.’ Koo says that the chances of respiratory infections, diarrhea, and ear infections are increased two to three times three times at the facility centers. Furthermore, the high infection risks are not dependant on social class, age or race.

Behavior patterns and habits, that expose children to various infections

Behavior patterns and habits common at daycare centers could expose children to various infections. Keeping close interpersonal contact, handling of children and other forms of physical contact increases the chances of disease contraction and spread. Since it is difficult to isolate children especially during physical exercise and playtime, exposure to infection from one person to another is usually high.

Unless directed and closely monitored, children lack the predisposition of adults to observe basic hygienic practices, such as washing hands or avoiding putting dirty objects in their mouths. “Young children at the initial stages of caring for their own toilet needs and spending most of their time at the daycare centers “can easily infect others with all sorts of germs” (Oswalt et al, 2008). Sharing of contaminated objects among potentially sick kids increases the chances of contagious diseases spreading.

Children’s immune system

Generally, children’s immune system is not as strong as that of adults. Consequently, the immature immune system in young children means that they have a weakened defense mechanism to fight off new infections. This significantly makes infants at daycare centers more susceptible to diseases they have not been exposed to before (Koon, 2008). Daycare facility centers, by nature of their routine, cluster kids who are vulnerable to diseases and diseases. At such a tender age, “children have ineffective and undeveloped disease defense mechanisms, which make them contract almost every virus or bacteria to which they get exposed” (Clements, 2007). Consequently, “when infection takes place at the care center, it usually spreads around the whole room and can easily affect every child within the center. And nowhere is exposure to new infections as serious as a daycare center, where children of different health statuses converge. Additionally, lack of adequate diagnosis and isolation measures makes it difficult to detect early infections before they spread to others, or prevent those infected from affecting others.

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Hygiene conditions

Physical malformations associated with age like a “stunted Eustachian tube make children prone to ear infections” (Koon 2008). Poor or lack of prior training in hygienic practices such as toilet use could also increase the chances of diarrhea diseases. The high numbers of children who attend daycare centers make it difficult for caregivers to pay particular attention to each child in this regard. While in most daycares strict standards for proper hygiene practices are observed, “Situations occur that can interrupt this preferred technique and result in cross-contamination” (Clements, 2007), Dirty diapers and underwear, therefore, could be sources of infection if not properly handled. Their innate behavioral habits such the needing very close inter-personal contact poor personal hygiene practices and physical underdevelopment “all contribute to the spread of infectious diseases” (Go, 2009). At the same time, daycare service providers “are often inadequately trained in hygienic skills to avoid the fast and uncontrolled spread of infections” (Koo, 2009). Most of the centers experience very high employee turnover rates, making it expensive and time-costly to maintain constant training of new workers. They end up having inexperienced and untrained staff members who could not observe the necessary basic hygiene conditions.

The rate of infections transmission

The rate of transmission also makes it difficult to monitor infections at daycare centers. After an infection has been contracted by any child “transmission is usually very fast (Clements, 2007). Further, he says that researches have shown that if a toy is contaminated with a marked virus, it can be transmitted to about eighty percent of the children in 12 hours and fifty percent of their parents in twenty-four hours. Some infections, especially those transmitted through the oral-fecal route spread fast even when their symptoms are visible. The study further says that infections that are spread through the oral-fecal channel can easily pass from one person to another “as different babies teethe on the same toys or as toddlers suck their thumbs after touching contaminated surfaces” (Clements (2007). Most of these infections are easily traced to daycare centers where children share objects and keep close physical contact. Most of the time, reports the American Academy of Family Physicians (2008) “it’s easy to see the cause of an infection, such as being in day-care centers….children in day-care centers give infections to each other…they drool and their noses drip…they touch each other and touch all the toys.” This provides a perfect ground for an uncontrolled infection and contamination to take place.

Solution

However, despite all the health risks associated with childcare centers, they are increasingly becoming central to most families, especially in the face of economic pressures, modern social lifestyles, and emerging family systems such as single parenting. In this regard, efforts to solve the health problems they pose would be directed towards the control and prevention of outbreaks. Thus, infections in children in daycare centers can be limited by educating service providers and staff in standards of hygiene, maintaining basic infection control techniques, appropriate use of the physical facilities of the daycare unit, and maintenance of recommended levels of children and staff (Pickering, 2002). Similarly, the quality of care provided at these facilities should be analyzed in more depth for proposing measures aimed at decreasing ARI-related infections” (Hernández et al 2009).

David Clements observes that while initiatives by day caregivers may speed up the process, it should not be forgotten that children will still get infected with the majority of diseases that spread at the daycare centers at a given point in their lives, even if they don’t attend daycare facilities. On the other hand, “most infections at the daycare centers are caused by viruses and are therefore self-limited, which means that that they usually disappear without treatment” (Clements 2009). However, some may develop resistance to medication and become persistent. Alan Carlson says that finally, “…the risks posed to infant and child health by daycare is not going away…antibiotics are a fading asset; virulent new strains of disease-resistant to these drugs now find their way into the (childcare) centers” (Carlson, 2003).

Dr. Luis Rodriguez, Assistant Executive Director of Quality Improvement & Health Services at Episcopal Social Services, recommends for children and their caregivers to practice handwashing with soap and water, “especially before handling food or after wiping the face of a child.” He adds that hands should also be washed after changing diapers, assisting children with toilet needs, and attending to wound cuts and other skin infections.

More often than not, children are reluctant to get their hands (Oswalt et al 2008). In this regard, caregivers should try to make hand washing an enjoyable experience, for instance by singing while washing them. Equally significant, basic hygiene should be observed “after using the bathroom, before eating, after playing outside, after sneezing, or after fondling the dog” (Oswalt et al 2008). Parents are also advised to choose the smaller daycare groups to reduce the number of other children from whom they can get infections. In addition, they should ensure the daycare employees observe daily basic hygiene. And when children get sick, parents should “give them lots of liquids and fever control medications for comfort, and encourage them him or her to get as much sleep as possible to aid recover” (Clements 2007). However, seeking physician medical attention is the surest way to handle infections, especially those caused by bacteria. Thus, parents should be taught “how to handle infectious symptoms, when to consult a physician, and when an antibiotic prescription is needed” (Hedin et al, 2007).

Chances of infection can be reduced by “breastfeeding infants, developing policies and training programs that help reduce the spread of bacteria and viruses at the daycare center, preparing food and changing diapers in different areas and making sure daycare staff and children have up-to-date immunizations” (Kaneshiro, 2008).

Conclusion

Nonetheless, childcare centers still pose the greatest exposure to infections compared to home-based care. Poor facilities and hygienic conditions are sources of most infections. Overcrowding and inadequate staff training make it difficult to control contagious infections from spreading among the children. Similarly, children have a weak immune system that could not protect them against most viral and bacterial infections. They also lack training in observing basic hygiene such as hand washing and toilet use. These factors, among others, expose children to a host of health risks in daycare centers.

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References

American Academy of Family Physicians. (2008). Repeated Infections in Children. Web.

Carlson, A. (2003). “The Fractured Dream of Social Parenting.” Family Policy Review. Web.

Clements, D. (2007). Day Care Diseases. Web.

Duram Region Care. (2009). Why aren’t daycare workers considered “high priority for the H1N1 vaccine? Web.

Go, P. (2009). Health Risks at Daycare Centers. Web.

Gratz R., Boulton, P. (1993). Environmental hazards in child care center. Web.

Healthopedia.com. (2010). Day Care Health Risks. Web.

Hedin, et al. (2007). “Physician Consultation and antibiotic prescription in Swedish infants: population based comparison of group day care and home care.” Day Care, Symptoms and Antibiotics. Sweden: Foundation Acta Paedatrica.

Hernández, H. Morales, R. Cuevas, H. Gallardo. (2009). “The Day Care Center As a Risk Factor for Acute Respiratory Infections.” Science Direct. Web.

Kaneshiro, N. K. (2008). Day Care Health Risks. Medline Plus. Web.

Koo, I. (2008). “The Truth About Daycares.” Infectious Diseases. Web.

McLeod, L. (2010). Salmonella and Reptiles. About.com. Web.

Oswalt A., Reiss N. S., Dombeck, D. (2008). “Early Childhood Hygiene.” Child Development and Parenting; Early Childhood. Web.

Pickering, L. K. (2002). Infectious diseases in child day care facilities. Web.

Samuels N. L., Shi, M. E., Baker, S. L., Glover, S. H. Sanders, J. M. (2004).Child day care risks of common infectious diseases revisited. Wiley InterScience. Web.

The Howard Center. (2007). “Family Research Abstract of the Week: High Risk for Infants.” World Congress of Families, Vol. 08, Issue13. Web.

Tushnet, E. (2001). Day Care Dangers (and the Double-Income Myth). National Catholic Register. Web.

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