NCEDL Spotlights

No. 4 October 1998

Diarrhea & Child Care

Controlling Diarrhea in Out-of-Home Child Care

These measures may help control and prevent diarrheal disease in child care environments:

• In child care centers, food preparation areas should be completely separate from diapering and toilet areas.
• Diaper-changing areas should never be used for temporary placement of food.
• There should be an adequate number of sinks adjacent to child-size toilets and diapering areas.
• The use of potty-chairs should be discouraged.
• The use of automated faucet-handle-free handwashing sinks should be considered because they may aid in decreasing fecal contamination.
• Surfaces should be designed and built for ease of cleaning. For example, diaper-changing surfaces should be non-porous to allow adequate sanitization between uses.

• Facilities should allow separation of children by age group. Children in diapers especially should be separated from toilet-trained children.
• Written handwashing procedures and sanitation policies should be available to all staff and procedures should be enforced.
• Interventions involving parents and the community can be a valuable adjunct in controlling enteric diseases in child care centers. Education on hygienic practices on a community-wide basis has been shown effective in controlling community outbreaks of shigellosis associated with child care centers.

The Cost of Diarrheal Disease

The rate of diarrheal disease in children cared for out of the home is two to three times that in children cared for at home.

One study puts the mean cost per episode of diarrhea at $289, while another finds an average cost of $172 per child-year.

The education of child care providers and parents in handwashing and other hygienic practices and strict adherence to these practices remain the cornerstone of prevention and control of diarrheal disease in the child care setting. Management of children with diarrhea and control of diarrheal outbreaks in the child care setting may include:

• excluding children with diarrhea from center
• grouping infected children in a separate area with separate staff
• excluding new admissions temporarily
• offering alternative care arrangements including referral to a sick care center
• closing a center temporarily if all other measures fail.

• An increased rate of diarrheal disease has been shown to occur in children newly enrolled in child care centers, and this is likely due to exposure to pathogens not previously found in the home environment.
• Studies show that fecal contamination in infant and toddlers areas of child care environments is common. Dry surfaces, diapering areas and bathroom sinks and faucets were less likely to be contaminated than the hands of children and staff, classroom sinks and faucets, and toys. Classrooms with high levels of coliform bacteria on the hands of staff also tend to have high levels on the hands of children.

Note: Until recently, the only FDA-approved vaccines against gastrointestinal tract pathogens had no role in prevention of diarrheal disease in the child care environment. This changed on August 31, 1998, when Rotashield--a tetravalent, live oral rotavirus vaccine--was approved by the US FDA. This vaccine has the potential to have major impact in the prevention of diarrheal disease due to rotavirus, an important pathogen in child care center outbreaks.

Drs. Pickering and Churchill are at the Center for Pediatric Research, Children's Hospital of The King's Daughters, Eastern Virginia Medical School. NCEDL is administratively housed at UNC-CH. This project is supported under the Education Research and Development Centers Program, PR/award number R307A60004, as administered by the Office of Educational Research and Improvement, US Department of Education. Opinions expressed in these reports do not necessarily represent the positions or policies of the National Institute on Early Childhood Development and Education, the Office of Educational Research and Improvement, or the US Department of Education. Permission is granted to reprint this; we ask that you attribute the authors of the study and the National Center for Early Development & Learning.

Other articles in the Spotlights Series include

No. 5 • November 1998 • Respiratory Infections

No. 3 • September 1998 • Assessing Readiness

No. 2 • August 1998 • Quality Care Does Mean Better Child Outcomes

No. 1 • July 1998 • Kindergarten Transitions

For more information, or to request printed copies , contact

Lloyd Little 
UNC-CH CB # 8185 
Chapel Hill NC 27599-8185 
919-966-0867 
loyd_little@unc.edu

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