Reducing the Spread of Illness in Child Care

Whenever children are together, there is a chance of spreading infections. This is especially true among infants and toddlers who are likely to use their hands to wipe their noses or rub their eyes and then handle toys or touch other children. These children then touch their noses and rub their eyes so the virus goes from the nose or eyes of one child by way of hands or toys to the next child who then rubs his own eyes or nose. And children get sick a lot in the first several years of life as their bodies are building immunity to infections.

In many child care facilities, the staff simply cannot care for a sick child due to space or staff limitations, although in others, the child can be kept comfortable and allowed to rest as needed in a separate area of the room where they have already exposed the other children. When waiting to be picked up, an ill child who is being excluded should be in a location when no contact occurs with those who have not already been exposed to their infection. Often, it is best for the child not to be moved to another space to prevent their illness from spreading throughout the facility and to maintain good supervision of the child. In some programs, a staff member who knows the child well and who is trained to care for ill children may care for the child to a space set aside for such care and where others will not be exposed. If the child requires minimal care for a condition that doesn’t require exclusion, there may a place for the child to lie down while remaining within sight of a staff member when the child needs to rest. In some communities, special sick child care centers have been established for children with mild illnesses who cannot participate or need more care than the staff can provide in the child’s usual care setting.

Even with all these prevention measures, it is likely that some infections will be spread in the child care center. For many of these infections, a child is contagious a day or more before he has symptoms. Be sure to wash your and your child’s hands frequently. You never know when your child or another child is passing a virus or bacteria. Sometimes your child will become sick while at child care and need to go home. You will need to have a plan so someone can pick him up.

Fortunately, not all illnesses are contagious (like ear infections). In these cases, there’s no need to separate your sick child from the other children. Most medications can be scheduled to be given only at home. If your child needs medication during the day, be sure that the facility has clear procedures and staff who have training to give medication. Ask what they do to be sure they have the right child, receiving the right medication, at the right time, by the right route and in the right dose–-and document each dose.


Prevent Bite Wounds

Each year, many parents rush their children to the pediatrician’s office or the emergency department after their youngsters have been bitten by animals or other humans. Consider the following statistics: there are about 4.5 million dog bites reported annually in the United States, along with 400,000 cat bites and 250,000 human bites. It is likely that the actual number of bites is much higher. While many of these bites cause only minor injuries, others are much more serious. In many cases, these bites produce infections. This occurs in more than 50% of cat bites and 15% to 20% of dog or human bites.

Many people don’t realize that most bites come from domesticated animals that the child knows, not from wild or unfamiliar animals. A major concern for parents about animal bites is the child’s risk of contracting rabies. Rabies is a very serious viral infection that affects the central nervous system and brain, causing a high fever, swallowing difficulties, convulsions, and eventually, death.

Fortunately, rabies in humans is rare today (most domesticated animals are vaccinated for rabies), but even so, the animal that bit your child may need to be confined and observed for 10 days for the presence of rabies. (Don’t attempt to capture the animal yourself. Contact animal control officials.) However, confinement is not always possible, especially when a wild animal is responsible for the bite. The greatest risk for rabies comes from wild animals such as bats, raccoons, foxes, skunks, and coyotes.

Even when rabies isn’t present, an infection can develop at the site of the bite. Contact your pediatrician if any of the following signs of an infection are present:

  • Pus or drainage from the bite wound
  • Swelling and tenderness in the area around the bite
  • Red streaks that extend from the bite
  • Swollen glands that occur above the bite

Prevention of Bites and Infections

To prevent bites and the infections associated with them, here are some tips to keep in mind.

  • Teach your child to avoid contact with wild animals. She also needs to stay away from dead animals, whose nervous system tissues and saliva may contain the rabies virus and who may be infested with fleas or ticks carrying various bacteria, viruses, and other infectious organisms.
  • Never leave a young child alone with an animal. Even playful interaction between the child and a pet can overexcite the animal and lead to an unexpected bite.
  • Don’t allow your child to tease a pet, play roughly with it (eg, pulling its tail), or grab its toys, bones, or food.
  • Educate your youngster never to kiss or place her face close to an animal, nor to awaken a pet from sleep or bother it while it’s eating. Teach your child how to behave when approached by an unfamiliar dog. She shouldn’t run from the dog or make any aggressive movements, but instead face the dog, allow the dog to sniff her, and then back away slowly.
  • Instruct older children to recognize the signs of a potentially unsafe dog, including a rigid body, a stiff tail at half-mast, a staring expression, hysterical barking, or a crouched position.
  • Cover and secure all garbage containers, which will keep raccoons and other wild animals from being attracted to your home and places where children play. How Animal Bites Are Treated Here are some guidelines on treating an animal bite to lower the risk of developing an infection.

How Animal Bites Are Treated

Here are some guidelines on treating an animal bite to lower the risk of developing an infection.

  • Apply firm pressure to the area of the bite using a clean bandage or towel until the flow of blood ceases. If you can’t stop the bleeding, contact your pediatrician.
  • Wash the wound gently but thoroughly with soap and water, dry it, and cover it with gauze.
  • Contact your pediatrician whenever any animal bite breaks the skin, even if the wound seems minor. Your pediatrician may decide to suture (stitch) the wound and perhaps prescribe antibiotics or treatment to prevent rabies or tetanus. Antibiotics are given most often for moderate to severe bites, puncture wounds, or bites to the face, hand, foot, or genital area. They are also used for children with a weakened immune system.

If the animal is unavailable to be observed and the risk of rabies is considered high, your doctor will give your child a specific type of immune globulin and begin a series of immunizations against the rabies virus, which will prevent the infection from occurring. The immune globulin is injected into the bite wound. It must be given as soon as possible to be most useful.

What should you do in the case of human bites, perhaps from a sibling or playmate? Contact your pediatrician and describe the wound. Your pediatrician will want to know whether the bite has broken the skin and if the injury is large enough to need stitches. If your doctor wants to examine the bite, wash it with soap and water before leaving for the office visit. For minor wounds that barely break the skin, a thorough washing and bandaging may be all that’s needed.


Precautions for International Travel: Information for Parents

​When you and your c​hild are traveling abroad, you want the experience to be fun, educational, and disease free. 

Talk to Your Pediatrician Before Your Trip

A good starting point is right in your pediatrician’s office many weeks before your trip. 

  • Review your child’s immunizations with your doctor. 
  • Make sure your child has recieved the recommended immunizations necessary for his or her age. ​These include vaccinations for diphtheria-tetanus-acellular pertussis (DTaP), measles-mumps-rubella (MMR), chickenpox (varicella), hepatitis B, polio, Haemophilus influenzae type B, meningococcal and pneumococcal infections, and the fl​u.
  • Immunizations against diseases such as polio​, for example, are especially important when your family travels internationally. Even though the number of countries where travelers face a risk of getting polio is small, outbreaks do occur, and it’s important for your child to be fully immunized and protected.

Other (Non-Routine) Immunizations May Be Needed

In addition to the routine vaccines, your child may need others as well. This will depend on the parts of the world to which you’re traveling and the activities in which you and your child will be participating. 

Here are some examples:

  • Meningococcal vaccine is recommended for travelers to areas of Africa.
  • Rabies vaccines may make sense for children who will be traveling to areas such as developing countries where they could meet rabid dogs and other animals. These vaccines are particularly important when going to parts of the world where it could be difficult to quickly obtain rabies immunizations and medical care if needed.
  • Yellow fever may be found in parts of South America and Africa. Some countries require the yellow fever vaccine before allowing travelers to enter. Keep in mind, however, that your pediatrician may not have the vaccine available in the office, so plan ahead. Certain vaccines are usually given only at places chosen by state health agencies.
  • The typhoid vaccine is recommended for children and other travelers who could be exposed to contaminated food or water.
  • A flu shot may be given to a child traveling abroad, depending on issues such as the youngster’s current health and chances of being exposed to the flu. Flu season is different in the southern hemisphere than it is in the United States.

For other immunizations, such as the MMR vaccine, talk to your pediatrician about the advisability of accelerating the vaccination schedule if your young child hasn’t yet been immunized. The first MMR vaccine, usually given at or after 12 months of age, can be given earlier (between 6 and 11 months of age) in children traveling to places where the risk for measles is higher. Before 6 months of age, an infant is protected by antibodies passed from his or her mother. 

You can obtain up-to-date travel health information and advice from the Centers for Disease Control and Prevention ( or by calling a toll-free phone number, 877/394-8747. When traveling, it is a good idea​ to bring an up-to-date record of your child’s vaccinations. This record will be useful when entering a country that asks for proof of immunization against certain infectious diseases.

Other Travelers’ Diseases

There are no immunizations for some of the diseases that may be found in other countries. 

There are some steps you can take to protect your child:

Travelers’ diarrhea is the most common illness affecting international tourists. It occurs most often in developing countries in Latin America, Africa, Asia, and the Middle East. Carefully choose foods and drinks for your child to prevent diarrhea. 

  • Do not eat anything from street vendors and stay away from food prepared and served in unclean conditions. 
  • Also avoid raw or undercooked meat, as well as raw fruit and vegetables. 
  • Only drink water that comes from treated sources. Safe drinks include bottled carbonated water and water boiled or treated with chlorine or iodine.

Preventing mosquito bites can lower the risk of getting certain infections, including Zika virus​, chikungunya, ​malaria and dengue fever. 

  • Have your child wear long-sleeved cotton shirts and long pants. Apply insect repellent ​containing DEET (diethyltoluamide) to bare skin. It should be put on lightly and washed off once the child comes inside. 
  • Use bed nets and window screens for added protection. 
  • If preventive medicine has been prescribed for malaria, make sure it is taken as directed.​

Hand Washing: A Powerful Antidote to Illness

Hand Washing: A Powerful Antidote to Illness

How many times have you and your child washed your hands today? You might not have given it much thought. It’s either part of your routine, done frequently without thinking, or maybe you don’t do it much at all. But as your pediatrician may have told you, hand washing may be the single most important act you and your child have for disease prevention.

Making hand washing a habit

As early as possible, get your child into the habit of washing their hands often and thoroughly. All day long, your child is exposed to bacteria and viruses—when touching a playmate, sharing toys, or petting the cat. Once their hands pick up these germs, they can quickly infect themselves by:

  • Rubbing their eyes
  • Touching their nose
  • Placing their fingers in their mouth

The whole process can happen in seconds, and cause an infection that can last for days, weeks, or even longer.

When to wash hands

Hand washing can stop the spread of infection. The key is to encourage your child to wash their hands throughout the day. For example, help or remind them to wash their hands:

  • Before eating (including snacks)
  • After a trip to the bathroom
  • Whenever they come in from playing outdoors
  • After touching an animal like a family pet
  • After sneezing or coughing if they cover their mouth
  • When someone in the household is ill
Studies on hand washing in public restrooms show that most people don’t have very good hygiene habits. “Hand washing” may mean just a quick splash of water and perhaps a squirt of soap, but not nearly enough to get their hands clean.

About antibacterial soaps

Drugstore shelves are full of trendy antibacterial soaps, but studies have shown that these antibacterial products are no better at washing away dirt and germs than regular soap. Some infectious disease experts have even suggested that by using antibacterial soaps, you may actually kill off normal bacteria and increase the chances that resistant bacteria may grow.

The best solution is to wash your child’s hands with warm water and ordinary soap that does not contain antibacterial substances (eg, triclosan). Regular use of soap and water is better than using waterless (and often alcohol-based) soaps, gels, rinses, and hand sanitizer rubs when your child’s hands are visibly dirty (and with children, there usually is dirt on the hands!). However, when there is no sink available (eg, the car), hand rubs can be a useful alternative.

How long to wash hands

Keep in mind that although 20 seconds of hand washing sounds like an instant, it is much longer than you think. Time yourself the next time you wash your hands. Watch your child while they’re washing their hands to make sure they are developing good hygiene behaviors. Pick a song that lasts for 20 seconds and sing it while you wash. Encourage your child to wash their hands not only at home, but also at school, at friends’ homes and everywhere else. It’s an important habit to get into, and hopefully one that’s hard to break.


Germ Prevention Strategies

Germ Prevention Strategies

Hygiene Strategies

When your child or another family member has a cold or cough, there are extremely important steps in addition to frequent hand washing that can lower the risk of spreading the infection to others. Some experts call these strategies respiratory hygiene, and they can be very effective if followed carefully. For example, to keep your sick child from blowing secretions into the air, where they can land on other people or on toys and other objects:

  • Encourage her to cough or sneeze into a tissue or, if a tissue isn’t available, onto her sleeve.
  • Discourage your child from covering her mouth with her hands while coughing or sneezing because this will leave germs on the hands that can be spread by touching other people or objects. Most often, germs are spread by the hands, not through the air.
  • Throw away tissues immediately after each use, putting them in a nearby wastebasket or other container.
  • Once your child is old enough, teach her how to blow her nose into a tissue.
  • Don’t allow your child to share pacifiers, drinking cups, eating utensils, towels, or toothbrushes whether she is sick.

Clean & Disinfect

Housecleaning may not be the most enjoyable activity in your day. If you spend a few minutes killing germs, especially those in the kitchen and bathroom, it can go a long way toward keeping your child healthy.

After you’ve prepared a meal, wash the kitchen counters with hot, soapy water and disinfect them using a household bleach solution or other disinfectant. Infectious bacteria can thrive in foods like uncooked beef and chicken. In the bathroom, use the same cleaning and disinfecting routine on the toilet, sink, and other surfaces. This is especially important when a family member is sick with an infectious disease, particularly one that causes diarrhea. Also, frequently clean the area where you change diapers, including the changing table. (Be sure you keep the bleach and all cleaning products out of the reach of infants and young children.) Avoid changing diapers in areas where food is being prepared or consumed.

Some germs can survive and thrive for hours unless you take steps to wipe them away. After using soap and disinfectant, dry the cleaned surfaces with paper towels or a clean cloth. After you clean up, be sure to wash your own hands.

Handle Food Safely

Food can become contaminated with bacteria and other germs that can cause stomach pain, vomiting, and worse. To limit problems:

  • Make sure your hands are washed and the kitchen surfaces are clean before and after preparing meals.
  • Clean your cutting board or kitchen surface after preparing raw meats for cooking and clean before using the surface to prepare any food that is not to be cooked such as salads, fruits, or vegetables.
  • Cook ground meat all the way through.
  • Wash raw vegetables and fruit thoroughly before eating.
  • Avoid eating raw or undercooked eggs.
  • Cook frozen food right after it’s defrosted.
  • Clean utensils frequently during food preparation, washing them after they’re used on raw foods and before using them again on cooked foods.
  • When it comes to leftovers, store them properly and get them into the refrigerator or freezer right away to prevent germ growth. Don’t leave perishable items out for more than a couple hours.

Collectively, Americans are sick more than 4 billion days a year—and many of those sick days can be prevented. If you follow the guidelines, you will go a long way toward helping your child, as well as the rest of your household, have fewer infections; fewer missed days of child care, school, and work; less frequent visits to the doctor; and lower medicine costs.


Food-Borne Illnesses Prevention

An estimated one in six Americans get sick each year after eating contaminated food. Anyone can get food poisoning, but children are more likely to be affected and have more serious illness.The good news is that most food-borne illness can be prevented by follow these safety guidelines.


  • Be especially careful when preparing raw meats and poultry. Wash your hands and all surfaces that have come in contact with the raw meat and poultry, with hot, sudsy water before continuing your preparation.
  • Always wash your hands before preparing meals and after going to the bathroom or changing your child’s diaper.
  • If you have open cuts or sores on your hands, wear gloves while preparing food.
  • Do not prepare food when you are sick, particularly if you have nausea, vomiting, abdominal cramps or diarrhea.

Food selection

  • Carefully examine any canned food (especially home-canned goods) for signs of bacterial contamination. Look for milky liquid surrounding vegetables (it should be clear), cracked jars, loose lids, and swollen cans or lids. Don’t use canned or jarred goods showing any of these signs. Do not even taste them. Throw them away so that nobody else will eat them. (Wrap them first in plastic and then in a heavy paper bag.)
  • Buy all meats and seafood from reputable suppliers.
  • Do not use raw (unpasteurized) milk or cheese made from raw milk.
  • Do not eat raw or undercooked meat.
  • Do not give honey to a baby under one year of age.
  • If your child turns away from a particular food or drink, smell or taste it yourself; you may find that it is spoiled and that it shouldn’t be eaten.

Food preparation and serving

  • Do not let prepared foods (particularly starchy ones), cooked and cured meats, cheese, or anything with mayonnaise stay at room temperature for more than two hours.
  • Do not interrupt the cooking of meat or poultry to finish the cooking later.
  • Do not prepare food one day for the next unless it will be frozen or refrigerated right away. (Always put hot food right into the refrigerator. Do not wait for it to cool first.)
  • Make sure all foods are cooked thoroughly. Use a meat thermometer for large items like roasts or turkeys, and cut into other pieces of meat to check if they are done.
  • When reheating meals, cover them and reheat them thoroughly.

Cleaners, Sanitizers and Disinfectants

Housecleaning may not be the most enjoyable activity in your day, but a few minutes killing germs can go a long way toward keeping your family healthy.

  • Routine cleaning with detergent or soap and water removes dirt and grime from surfaces (ex: floors, walls, carpet, windows).
  • Sanitizing removes dirt and small amounts of germs. Some items and surfaces are cleaned to remove dirt then sanitized (ex: bathrooms, counters, toys, dishes, silverware).
  • Some items and surfaces require the added step of disinfecting after cleaning to kill germs on a surface (ex: changing tables, sinks, counters, toys).

Use caution around cleaners, disinfectants & sanitizers

Although chemical disinfectants and sanitizers are essential to control communicable diseases, they are potentially hazardous to children, particularly if the products are in concentrated form.

  • Products must be stored in their original labeled containers and in places inaccessible to children.
  • Diluted disinfectants and sanitizers in spray bottles must be labeled and stored out of the reach of children.
  • Solutions should not be sprayed when children are nearby to avoid inhalation and exposing skin and eyes.
  • Before using any chemical, read the product label and manufacturer’s material safety data sheet.

Questions to consider when selecting a disinfectant

  • Is it inactivated by organic matter?
  • Is it affected by hard water?
  • Does it leave a residue?
  • Is it corrosive?
  • Is it a skin, eye, or respiratory irritant?
  • Is it toxic (by skin absorption, ingestion, or inhalation)?
  • What is its effective shelf life after dilution?

About bleach

Household bleach (chlorine as sodium hypochlorite) is active against most microorganisms, including bacterial spores and can be used as a disinfectant or sanitizer, depending on its concentration.

Bleach is available at various strengths:

  • Household or laundry bleach is a solution of 5.25%, or 52 500 parts per million (ppm), of sodium hypochlorite.
  • The “ultra” form is only slightly more concentrated and should be diluted and used in the same fashion as ordinary strength household bleach.
  • Higher-strength industrial bleach solutions are not appropriate to use in child care settings.

Household bleach is effective, economical, convenient, and available at grocery stores. It can be corrosive to some metal, rubber, and plastic materials. Bleach solutions gradually lose their strength, so fresh solutions must be prepared daily, and stock solutions must be replaced every few months. Bleach solution should be left on for at least 2 minutes before being wiped off. It can be allowed to dry, because it leaves no residue. Household bleach can be used to sanitize dishes and eating utensils. The concentration of chlorine used in the process is much less than that used for disinfecting other objects.

Cleaners containing disinfectants:

By separating out the cleaning and disinfecting processes, you will reduce the amount of disinfectant chemicals used.

  • Soiled objects or surfaces will block the effects of a disinfectant or sanitizer. Therefore, proper disinfection or sanitizing of a surface requires that the surface be cleaned (using soap or detergent and a water rinse) before disinfecting or sanitizing.
  • Bleach (the sanitizer/disinfectant) and ammonia (the cleaner) should never be mixed, because the mixture produces a poisonous gas.
  • Not all items and surfaces require sanitizing or disinfecting. See the Cleaning, Sanitizing, and Disinfecting Frequency Table from the National Association for the Education of Young Children (NAEYC) for more information.

Alternative/less toxic homemade cleaning products

Alternative or less toxic cleaners are made from ingredients such as baking soda, liquid soap, and vinegar. Many of the ingredients are inexpensive, so you may save money over time. However they may require more “elbow grease,” which means you may have to scrub harder.

Although the ingredients in homemade cleaners (e.g., baking soda for scrubbing, vinegar for cutting grease) are safer, not all are nontoxic. Treat them as you would any other cleaner, with caution.

Talk with your pediatrician

If you’re concerned about cleaning product safety, talk with your pediatrician. Your regional Pediatric Environmental Health Specialty Unit (PEHSU) have staff who can also talk with parents about concerns over toxins in cleaning products.