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BBC NEWS | Health | Nursery: a melting pot for infection By Jane Elliott BBC News health reporter
Most parents will agree that nurseries are breeding grounds for coughs, colds, and tummy upsets. When a young child starts at nursery, they seem to suffer an endless cycle of minor ailments, that then seem to infect the whole family.
But the jury is still out about whether this is a bad thing, or whether early exposure to germs plays a key role in the development of a child’s immune system.
Little research has been done in the UK into how many respiratory infections are caught by children attending nursery – and the knock-on efects this can have on the rest of the family.
Dr Nicol Black, a public health expert in Newcastle, has examined the issue in close detail.
He has just completed an 18-month study to examine whether there is any truth in the anecdotal belief that nursery attendance is linked to a greater risk of infection – and whether there are good grounds for promoting vaccination against certain illnesses.
Dr Black collated data from around 100 local nurseries and involving 550 episodes of illness.
His findings seem to support his contention that nurseries are a “wonderful melting pot” for infections.
“Pre-school children in day-care are three to four times more likely to have a respiratory infection than a child who stays at home,” said Dr Black.
“And that fits what, anecdotally, parents are well aware of.”
He added that in half the households studied, when a child became sick, others in the house were also ill either just before or just after the child.
About 13% of the adults were quite ill and had to have an average of six days off work.
Dr Black is to analyse the data further to assess further not only the health impact, but the economic impact on families, and the wider population in general.
He will look at issues such as whether illness spreads to other members of the household, and how much time off parents need to care for a sick child.
He will also look at whether prevention measures, such as vaccinations against serious conditions such as pneumococcal infection and flu, are needed.
The completed data from the study, which is expected to be published early next year, will be sent to the Department of Health.
But should we keep our children away from nurseries until they are older, or would that just be delaying the inevitable?
Research from the US has shown that children who attend nursery may be less likely to develop childhood leukaemia and that delaying their exposure to infection may result in them having an underdeveloped immune system, which puts them at a greater risk.
Dr Jackie Bucknall, consultant paediatrician at the Homerton Hospital, in London, believes there is no good health ground for not sending children to nursery.
“If you have a child that is fit and well and has not got any condition that can make them immunosuppressed, such as receiving cancer treatment, then I would recommend all parents to send their children to a place where they have got a good peer group mix.
“Although it may often seem that they always have a runny nose this is the way they stimulate their immune system.
“There is no problem. Children are going to be exposed to infections at sometime and it is probably better that it happens when they are nursery than when they are older.”
Dr Bucknall stressed that toddlers were no more vulnerable to infection than those at school.
But she said it was important that children going to nursery were vaccinated against the most important childhood illnesses, such as measles, to protect themselves and others.
Mother Sam Salter, whose three-year-old Daisy goes to a local nursery agrees, saying she would rather Daisy had early exposure to infection.
“I would rather she had them now than when she went to school. It is easier for them when they are young and it is usually less serious.
“But I have noticed that Sean, my partner, has become more ill. He has had a lot more colds since Daisy started nursery.”
Sam, from Surrey, has not had Daisy vaccinated against any illness, but says she does not worry about her becoming exposed to them.
She was not vaccinated herself as a child and had most of the illnesses including measles, German measles and whooping cough.
“I do not worry about her coming into contact with any of these childhood illnesses.
Regards Francois Viljoen 082 805 0405 Sent from my I-Phone
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10 Common Childhood Illnesses And How To Treat Them
GP Dr Sarah Brewer explores some of the most frequent illnesses to strike children, and helps you to recognise them.
Tonsillitis, an infection of the tonsils, can be caused by a virus or bacteria, but most cases are viral. Symptoms include a sore throat with red, swollen tonsils, pain on swallowing, fever, coughing and headache. The glands in the neck are often swollen too, and there may be spots of pus on the tonsils.
Who gets it? It is most common in children aged five to 15. Infection is spread from person to person by coughing, sneezing or picking up germs after shaking hands or touching.
Treatment: See your GP for a throat swab to check if your child has a bacterial infection, which would need antibiotics. If your child has frequent and severe tonsillitis, your GP may suggest an operation to remove her tonsils. Paracetamol, ibuprofen, throat lozenges or throat sprays will help symptoms.
Whooping cough (Pertussis)
This is a bacterial infection of the airways that starts with cold-like symptoms and then progresses to severe coughing spasms. The characteristic ‘whoop’ sound occurs when the poorly child desperately tries to take in air between coughs.
Who gets it? Whooping cough is spread by coughing and sneezing. Vaccination has made whooping cough much less common in infants and young children, but it is making a come-back in older children who were vaccinated more than five to 10 years ago.
Treatment: See your GP as soon as possible for throat swabs or a blood test to confirm diagnosis. Your child will need antibiotics.
Slapped cheek syndrome
Also known as fifth disease, slapped cheek syndrome is a viral disease that triggers mild cold-like symptoms, such as a sore throat and headache, as well as one or two red cheeks, as if slapped. Your child can also develop a rash elsewhere on her body and may experience joint pains.
Who gets it? It usually occurs in children aged two to 14 years and is more common during the spring.
Treatment: Paracetamol if needed.
This highly contagious viral infection causes fever, headache and a red rash before developing into itchy, fluid-filled blisters. Some children get away with just a few spots, but others get them everywhere, including inside the mouth and on the scalp.
Who gets it? Mostly children under 10 years. Infection is spread by inhaling droplets of the virus from the air, but also by direct contact with the blister fluids – perhaps by touching clothing that the blisters have rubbed against.
Treatment: See your GP if you’re not sure of the diagnosis. Paracetamol will help with the pain and fever, while soothing lotions will relieve itching.
Hand, foot and mouth disease
This is a viral disease which causes a mild, non-itchy rash on the palms of the hands and soles of the feet. Some children also develop mouth ulcers and feel unwell.
Who gets it? Mainly children under 10 years of age, but older children are occasionally affected. You can catch it more than once.
Treatment: Paracetamol when needed.
This highly contagious bacterial infection starts with a throat or skin infection and leads to a fever, flushed face and wide-spread, pink-red rash. The rash feels rough, like sandpaper, and may be itchy. It’s caught through contact with an infectious person, or by touching infected items, such as door handles.
Who gets it? Children between the ages of four and eight years are more usually affected. Once they are 10, most children have developed a natural immunity to the toxins.
Treatment: See your GP as antibiotics are needed within 10 days. If not treated, immune reactions can lead to complications such as kidney problems or rheumatic fever.
Gastroenteritis is usually caused by a virus, but can be bacterial too. It triggers vomiting, diarrhoea, stomach pains and sometimes fever. It’s spread by touching the hands of someone who’s struck down with the illness, from eating infected food or by swimming in water containing the germs.
Who gets it? Children of any age can be affected.
Treatment: Replace lost fluids and salts with oral rehydration fluids, which you can buy in sachets from pharmacies or on prescription. See your GP if you see blood in your child’s poo, she develops a fever or does not improve within a couple of days. Always seek medical advice if a child passes six or more diarrhoea stools – or vomits three times or more – in 24 hours as young children can quickly become dehydrated.
An infection of the middle ear is usually viral but can be bacterial. Symptoms would include earache, reduced hearing, tinnitus and fever. The eardrum may perforate to discharge fluid and relieve the pressure pain, although it heals within a month.
Who gets it? Middle ear infections are most common in children aged six months to five years, usually after having a bad cold.
Treatment: Seek medical advice if your child is in severe pain or has a high temperature. If you see a discharge from her ear, cover it with a clean, dry gauze pad and contact your doctor, who may prescribe antibiotics. Recurrent middle ear infection may be associated with glue ear so tell your doctor if your child seems to have reduced hearing.
Impetigo is a highly contagious bacterial skin infection picked up through close contact with a child with the illness, or by touching infected toys, clothes or towels. Small red spots appear on the face, especially around the nose and mouth, neck or hands. The spots often cluster or merge, blister, then form a characteristic golden crust. New spots can appear over several days or weeks.
Who gets it? It affects two per cent of children aged five to 14, and three per cent of those aged four years and younger. It’s more common in children suffering from eczema, insect bites or nappy rash, as infection can enter the skin more easily.
Treatment: An antibiotic cream may be enough, but your GP may also prescribe oral antibiotics if your child feels unwell or has a fever. Keep kids away from school until all spots have crusted over, or for at least 48 hours after starting treatment. Make sure infected children have their own flannels and towels.
Flu is a viral infection of the nose, throat, ears and sinuses. Look out for your child developing a stuffy, runny nose, sore throat, cough and high temperature. She may also develop a headache and severe aches and pains, plus exhaustion.
Who gets it? Viruses are transmitted by coughing, sneezing and by hand contact, and can survive on objects such as door handles for several hours. Flu tends to occur as seasonal epidemics.
Treatment: Paracetamol as needed. See your GP if symptoms worsen or last longer than a week, or if your child develops trouble breathing. Also visit your GP if your child has a medical condition which can be difficult to control, such as asthma or diabetes. An annual flu vaccination may be suggested in some cases.
Words by Dr Sarah Brewer, who is a GP, medical nutritionist and the author of more than 50 popular health books, including The Essential Guide to Vitamins, Minerals and Herbal Supplements
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