Dr. Elsje van Niekerk
BMedSci(pret) MBBCh(wits) DA(SA) FCFP(SA)
All the information below is based on the latest medical research published by the UpToDate database, Centre for Disease Control and the World Health Organization.
As parents, healthcare providers and teachers we all want our children to stay healthy, happy and thriving in a safe environment. We need to stand together and play our part to ensure the absolute best for our children.
Crèche syndrome is a well-known syndrome amongst infants and toddlers attending daycare or preschool, it refers to an on-going cycle of colds, flu and more serious illnesses. When infants and toddlers have repeated infections their immature immune systems become weak and they lose ability to optimally fight infections. Recurrent infections also influence their nutrition, growth, weight gain and overall well-being; therefore we need to understand how these cycles start, how to stop them and most importantly how to prevent them. It is extremely important to pay attention to a change in behaviour, irritability and your child just simply not being him-/ or herself as that may be a warning sign that something is starting. Do not wait for a fever before taking action as that might be too late and not all children will develop a fever.
Colds & Flu (Respiratory viruses):
Infants and toddlers can have up to 8 common cold episodes in a year. They are caused by viruses that usually spread through coughing, sneezing, secretions and through objects that came into contact with infected secretions.
These episodes can range from minor sniffles to very severe disease with complications. Different viruses have different incubation, illness and contagious periods. See the table below for the specific viral timelines. These viruses are responsible for most upper and lower respiratory tract infections.
How do they present: Most respiratory viruses presents with a runny nose, blocked nose, sneezing, lethargy and irritability they might also present with a fever, cough, difficulty breathing, red eyes or a rash. Although high fever is associated with respiratory viruses, not all children will have fever. Clear nasal secretions do not mean that your child is not sick or contagious. Clear secretions are usually the start of viral infections and highly contagious. A change in colour may indicate a secondary bacterial infection or late stage viral infection.
Management: Most viral infections just require supportive care and symptom management; antibiotics are not routinely indicated as they do not work in viral infections. Some influenza viruses might require specific anti-viral treatment that your doctor will prescribe. Rest, adequate fluid intake and enough time away from school activities will allow your child to fully recover from the illness. Remember to consult your Healthcare provider if your child has a fever of more than 38,5’C, not eating or drinking, vomiting, very lethargic, breathing fast and generally unwell.
How to prevent spread: Most importantly is to keep your child isolated from other children and not attend day care or crèche for at least 3 days from the start of symptoms. If possible, it will be best for your child to stay at home for 5-7 days to ensure that they recover fully and prevent infection by another virus while their immune systems are weak. As we do not routinely test to identify the specific virus, we need to adhere to the general 3-7 day isolation rule in order to prevent the spread to others and allow a sick child to recover from their illness. Remember that your child might only have a fever and a runny nose, but the same virus can lead to very serious disease and complications in another child. General hygiene, hand washing and cleaning of toys and surfaces will prevent indirect spread.
Fever:
Fever is defined as an abnormally elevated body temperature. It is important to measure temperature the right way to get an accurate reading so make sure you read the thermometer’s manufacturer’s recommendations. In children between 3 months and 3 years a fever is considered if the temperature is more than 38’C. In older children a fever is considered if the temperature is more than 37,8’C. Fever might be the first sign of the body’s response to an infection and therefore it is important to keep your child home if they have a fever. A fever can have serious complications such as febrile seizures and therefore it is important to monitor your child closely if they have a fever. Always consult your healthcare provider the moment a child’s fever goes above 39’C. Your child should stay home till 48hours after the last fever spike and should be free of any fever medications for 48hours before they can return to school. This is to protect your own child as well as others.
Teething:
It is normal for teething infants to be cranky, have excessive drooling and chew on objects. According to the latest evidence; gum irritation, drooling and irritability are the most common symptoms of teething. Teething is associated with a slight elevation in body temperature but not a fever (>38’C). If your child has a fever of more than 37,9’C there is likely another reason for the fever. While teething, children’s immune systems are low and they are more susceptible to other infections. It is important to consult your healthcare provider not to miss serious causes of the fever. Be very careful to attribute a fever to teething. An elevated temperature without gum irritation and drooling is unlikely to be due to teething.
Bacterial infections:
Bacterial infections are defined as an infection that is caused by a bacterium. These infections include bacterial sinusitis, ear infections, tonsillitis, pharyngitis, bronchitis, pneumonia, skin infections, eye infections and urinary tract infections to name a few. A bacterial infection might be treated with antibiotics. If your Healthcare provider prescribed antibiotics to your child, your child should stay home for 48 hours after the first dose of antibiotic was given. This will give the medicine some time to work and will decrease the spread to other children. Your child will also start to feel better after 48hours and will be able to part take in school activities.
Measles, Mumps, Rubella, Varicella Zoster (Chicken pox) and Hand foot and mouth disease and:
See summary table below
Eye infections:
Bacterial and viral eye infections are highly contagious. They spread through direct contact with eye secretions. If your child has any sign of a possible eye infection; redness, swelling, discharge, crusting or excessive tearing you should consult your healthcare practitioner as soon as possible and your child should not be sent to school. Your child can return to school after 48hours of antibiotic eye drops and provided the symptoms have resolved.