CH 43

Staying Healthy in Child Care
Preventing infectious diseases in child care

Fourth Edition
I N V E S T I N G I N A U S T R A L I A S H E A L T H
Staying Healthy in Child Care
Preventing infectious diseases in child care
4th edition

Endorsed December 2005
Commonwealth of Australia 2005

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Reprinted December 2006
Staying HEaltHy in CHilD CarE - 4tH EDition
Foreword
ths publcaton provdes smple and effectve strateges for the preventon of nfectous
dseases n chld care.
it s desgned to be used by anyone carng for chldren, n home day care stuatons
or wthn chld care organsatons, and s a useful resource n Chld Care accredtaton
courses n australa.
there has been strong demand for earler versons of the publcaton, both n australa
and overseas, and t s expected that the latest verson wll also prove popular.
it s mportant that health advce s based on the best avalable evdence and sts wthn
current polcy. For these reasons, ths gude should be revewed n 2010.
Preface
Preventing illneSS
infectons are common n chldren and often lead to llness.
at home, chldren are reasonably well protected from nfectous dseases because they
dont come n contact wth many people. the adults they meet are generally mmune
to many chldhood llnesses because they had them as chldren or they have been
vaccnated. Because of ths mmunty, adults cannot transmt those nfectons to chldren.
Spendng tme n chld care centres or other facltes and beng exposed to a large number
of chldren for some tme, provdes an opportunty for nfectous dseases to be spread.
it s not possble to prevent the spread of all nfectons and llnesses wthn chld care centres.
However, a lot of llnesses from nfectous dsease can be prevented.
you can reduce llness. there s good evdence that the nfecton control methods gven n ths
publcaton reduce llness n chldren n chld care. the methods may ntally seem to be tme
consumng, but they quckly become part of acceptable daly routne.
i commend Staying Healthy in Child Care to you, as t wll assst n reducng llness n chldren,
and n preventng nfectous dsease.
Mr John tanton
Char
natonal Chldcare accredtaton Councl
australa
v
Contents
Part 1 Preventing infeCtiouS diSeaSe
How nfectons are spread 1
the three most mportant ways of preventng the spread of
nfectous dsease 3
Hand washng 3
Excluson of sck chldren and staff 5
recommended mnmum excluson perods for nfectous
condtons for schools, pre-schools and chld care centres 7
immunsaton 10
natonal immunsaton Program Schedule, australa 14
Comparson of effects of vaccnes and dseases 15
Parent advce sheet 17
Watchng for and recordng nfectons n chldren 18
a chld wth a fever 21
admnstraton of medcaton 21
Medcaton permsson form 23
Cover your cough to control the spread of germs 24
Brthday cakes and blowng out candles 24
Play dough 24
nappy changng and toletng 24
Cleanng the centre 26
Dealng wth splls of blood, faeces, vomt, urne
and nasal dscharge 29
Sandpts 31
anmals 31
Food safety 32
infectous dsease ssues for chld care staff 35
the role of publc health workers 38
Part 2 faCt SHeetS
Respiratorycomplaints
asthma 39
Broncholts 41
Bronchts 42
Common cold 43
Croup 44
v
Ear nfectons 45
Infuenza 46
Pneumococcal dsease 47
runny noses 49
Sore throats and streptococcal sore throat 50
tuberculoss 52
Whoopng cough 53

Gastrointestinalcomplaints
Campylobacter 55
Cryptospordoss 57
Darrhoea and vomtng 58
gardass 60
norovrus 61
rotavrus 63
Salmonelloss 64
Shgelloss 66
Worms 67
Hydatd dsease 67
Pnworms 68
roundworm, hookworm and tapeworm 69
Skincomplaints
general notes on rashes 71
Chckenpox 72
Cold sores 74
Parvovrus B19 75
Hand, foot and mouth dsease 76
Head lce 77
impetgo 80
Measles 81
Molluscum contagosum 83
Fungal nfectons of the scalp, skn or nals 84
roseola 86
rubella 87
Scabes and other mtes causng skn dsease 88
Scarlet fever 90
thrush 91
Warts 92
v
Othercomplaints
Conjunctvts 93
Cytomegalovrus 95
glandular fever 96
HaemophilusinfuenzaetypeB 97
Hepatts a 98
Hepatts B 99
Hepatts C 100
HiV 101
Menngococcal nfecton 103
Mumps 104
toxoplasmoss 105
Vral menngts 106
Part 3 gloSSary and reSourCeS
glossary of terms 107
Useful contacts 110
lst of forms 111
Useful webstes 116
aPPendix a Working Committee memberSHiP and termS of
referenCe
aPPendix b ProCeSS rePort
B.1 Submtters February 2005 119
B.2 Submtters august-September 2005 120
aPPendix C referenCeS
Part 1
Preventing Infectious Disease
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1
How infections spread
t
here are four essental steps to the spread
of nfectons. infecton control s amed at
breakng ths chan of nfecton. the steps are:
1. the person wth the nfecton spreads
the germ nto ther envronment,
2. the germ must survve n the
approprate envronment e.g. ar,
food, water, on objects and surfaces,
3. another person then comes
n contact wth the germ,
4. ths person then becomes nfected.
1. tHe PerSon WHo HaS tHe
infeCtion SPreadS tHe germ
into tHeir environment
ths chld or adult may or may not show any
sgns of llness. they may be nfectous before
they become unwell, durng ther llness, after
they have recovered, or wthout any sgns
of llness at all.
For example, n cases of darrhoea due
to Giardia, chldren and staff who no longer
have darrhoea may stll have nfectous
Giardia n ther bowel motons. For ths
reason, the nfecton control process must
always be followed by all people n the chld
care centre.
2. tHe germ muSt Survive in tHe
aPProPriate environment
infectous llnesses may be due to vruses,
bacteria,protozoaorfungi.Allofthese
organsms are too small to see wth the
naked eye. these germs can survve
on hands and objects, for example toys,
door handles and bench tops. the length
of tme a germ may survve on a surface
depends on the germ tself, the type of
surface t has contamnated and how often
the surface s cleaned. it s also dependent
upon envronmental condtons such as
temperature and humdty. Washng wth
detergent and water s a very effective way
of removng germs.
3. anotHer PerSon tHen ComeS in
ContaCt WitH tHe germ
germs can be transmtted n a number
of ways, ncludng through the ar by
droplets; through contact wth faeces and
then contact wth mouths; through drect
contact wth skn; and through contact wth
other body secretons (such as urne, salva,
dscharges or blood).
nose and throat
Some nfectons are spread when
aninfectedpersonsneezesorcoughsout
tny arborne droplets. the droplets n the
ar may be breathed n drectly by another
person, or ndrectly enter another person
through contact wth surfaces and hands
contamnated wth the droplets.
1
Some
dropletsareveryfneandcanbecarried
long dstances by ar currents. ths s known
as arborne spread, and ncludes:
Chckenpox
Measles
tuberculoss
other droplets are larger and travel less than
one metre n the ar. Examples are:
Common cold
Mumps
Dphthera
Haemophilusinfuenzaetypeb(Hib)
Infuenza
Streptococcal sore throat
Whoopng cough (Pertusss)
Pneumococcal dsease
rubella
Menngts (bacteral) ncludng
menngococcal nfecton
Parvovrus nfecton (human
parvovrus nfecton, parvovrus B19
nfecton, slapped cheek, slapped
face,erythemainfectiosum,ffth
dsease)
2
Saliva
Some nfectons are spread by drect
contact wth salva (such as kssng)
or ndrect contact wth contamnated
objects (chldren suckng and sharng toys).
Examples:
glandular fever (Mononucleoss)
Cytomegalovrus nfecton (CMV)
urine
Some nfectons are spread when urne
s transferred from soled hands or objects
to the mouth.
Examples:
Cytomegalovrus (CMV)
blood
Some nfectons are spread when blood
from an nfected person comes nto drect
contact through broken or abraded skn
or wth the mucous membranes of another
person. the transmsson of these nfectons
s extremely unlkely n the chld care settng.
Examples:
Hepatts B
Hepatts C
HumanImmunodefciencyVirus(HIV)
4. tHiS PerSon tHen beComeS
infeCted
When the germ has reached the next
personitmustfndawaytoenterthebody.
it can enter through the mouth, ntestnal
tract, nose, lungs, mucosa of eyes, gentals
or through a sore or broken and abraded
skn. We can prevent llness at ths stage by
preventng entry to the body (for example,
by makng sure all toys that chldren put
n ther mouths are clean, havng chldren,
parents and staff wash and dry ther hands,
coverng wounds) and by mmunsaton.
Whether a person develops llness after ths
germ has entered the body depends
on both the germ and the persons mmunty.
faecal-oral
Some nfectons are spread when
mcroscopc amounts of faeces from
an nfected person are passed drectly from
soled hands to mouth or ndrectly by way
of objects, surfaces, food or water soled
wth faeces, to another. an nfected person
doesnt necessarly have symptoms of ther
llness.
Examples:
Campylobacter nfecton
rotavrus nfecton
Cryptospordoss
Salmonella nfecton
gardass
thrush
Hand, foot and mouth dsease
Shgella nfecton
Hepatts a
Vral gastroenterts
Worms
Skin or mucous membrane (lining
of nose and mouth) contact
Some nfectons are spread drectly when
secretons come nto contact wth mucous
membranes, broken skn or, less commonly,
healthy ntact skn. infectons can also
be spread ndrectly after contact wth
contamnated objects.
Examples:
Chcken pox
Cold sores (herpes smplex)
Conjunctvts
Hand, foot and mouth dsease
Molluscum contagosum
rngworm
School sores (impetgo)
Staphylococcus aureus
thrush
Warts(common,fatandplantar)
3
The three most
important ways of
preventing the spread
of infectious disease
t
he three most mportant ways
of preventng the spread of nfectous
dsease are:
Effectve hand washng;
Excluson of sck chldren and staff; and
immunsaton.
if these are not done properly, the many
other processes that support nfecton
control, such as cleanng and food safety
procedures, wll not work well.
HoW eaSily are diSeaSeS SPread in
a CHild Care Centre
Some vruses such as measles and norovrus
are very nfectous and wll very easly nfect
non-mmune people. Measles vrus can
reman arborne for up to 2 hours after
a person has left a room so that further
people are exposed. norovrus s a very
common cause of darrhoea and can nfect
50% or more of people n a group.
at the other extreme, Hepatts B, Hepatts C
andHIVareverydiffculttospreadinachild
care settng.
Hand washing
I
nfections can be spread by a person who
shows no signs of illness. Hand washing
is one of the most effective ways
of preventing the spread of infection.
the best way to prevent the transmsson
of dsease s to wash and dry your hands
thoroughly. Educatng staff to wash and dry
ther hands effectvely decreases the amount
of dsease n nfants and toddlers. Hand
washng s effectve because
itloosens,dilutesandfushesoffgerms
and contamnated matter.
to promote and enable effectve hand
washng requres:
hand basns to be readly accessble
and located where they wll be
needed (ncludng nappy changng
areas, tolets, food preparaton areas
and outdoors); and
hand basns to be at an approprate
sizeandheight,forstaffandchildren.
Hands-free taps and lqud soap dspensers
wll reduce the opportuntes for cross-
contamnaton.
HoW to WaSH HandS
Use the followng method to make sure your
hands and the childrens hands are as germ-
free as possble. the process of thoroughly
washng and rnsng your hands should take
10 15 seconds. ths can be acheved
by slowly countng to 10 when you wash
and then slowly countng to 10 when you
rnse. ths s about as long as t takes to sng
Happy Brthday twce.
Wet hands wth runnng water.
Use lqud soap and spread over
hands.
rub your hands vgorously as you
wash them.
Wash your hands all over. Pay
partcular attenton to wash the palms
and backs of hands, n between
fngers,underfngernailsandaround
wrsts.
rnse your hands thoroughly
to remove all suds and germs.
thorough rnsng wll help prevent
dermatts from suds.
turn off the tap usng paper towel.
Pat dry your hands wth a new paper
towel.
4
teach the chldren under your care to wash
and dry ther hands n ths way. Staff need
to supervse and observe chldren so that
they develop hand washng as a good habt
and do t properly. Encourage the chldren
not to touch the tap after they have washed
and dred ther hands. the tap wll have lots
of germs on t.
babies need to have their hands
washed as well
Babes need ther hands washed as often
and as thoroughly as older chldren. if the
babyisabletostandatanappropriatesized
hand basn, you need to wash and dry ther
hands just as you would for yourself. if the
baby s unable to stand at a hand basn,
wash ther hands wth ether premostened
towelettes or wet dsposable cloths, then pat
dry wth paper towel.
Soaps, towels and lotion
lqud soap dspensers and dsposable paper
towels are the preferred opton for hand
washng. lqud soap s advocated rather
than sold bar soap because t s less lkely
to become contamnated and s more
lkely to be used.
2
if reusable contaners are
used for lqud soap, they must be cleaned
anddriedbeforerefllingwithfreshsoap.
antbacteral hand washes should not
be used routnely n chld care centres
as they are unnecessary and may
encourage the development of resstant
bactera.
3
alcohol-based hand cleaners can
have a role f proper hand washng facltes
are not avalable (e.g. on excursons). after
several uses of an alcohol-based hand
cleaner, you wll need to wash your hands
properly wth lqud soap and water.
4
Effectve hand drying s just as mportant
as thorough hand washng because wet
surfaces transfer germs more effectvely
than dry ones.
4
Dsposable paper towel s
the preferred opton. Cloth towels should
not be used as they allow re-contamnaton
of the hands. Warm ar dryers are also not
recommended as they take longer to dry
hands than wth paper towel, can only serve
one person at a tme and often people
do not spend long enough usng the dryer.
Hand care
Some nfectons are spread when blood
from an nfected person comes nto drect
contact through broken or abraded skn,
therefore healthy ntact skn can be a very
effectve barrer to dsease and nfecton.
Wash hands wth mld soap and water and
make sure that they are thoroughly dry.
Soaps and detergents remove ols from the
skn causng dryness and possble crackng.
5

Somestaffandchildrenmayfndthat
frequent hand washng may lead
to dry skn, whch may be prone to crackng
anddermatitis.Crackedorinfamedskin
s harder to clean properly and may become
nfected. applcaton of a hand cream may
help to prevent skn crackng and dermatts.
Prolonged contact wth water softens the skn
and makes t more susceptble to rrtaton.
reducng the dryness and rrtaton of the
skn s very mportant. applcaton of a hand
cream and powder-free gloves may be used
to reduce dryng of skn.
Sorbolene cream and water may be used
nstead of soap and water, and hands
patted dry, rather than rubbed vgorously.
apply more sorbolene cream as a hand
cream f needed.
Use barrer cream to protect skn that wll
be wet for long perods. Do not use barrer
cream on damaged skn.
6
treat mnor cuts
and abrasons promptly.
Childrenwitheczemahaveatypeofskin
that s dry, tchy and senstve. ther skn
iseasilyinfamed,getsitchyandismade
worse by rubbng and scratchng. reducng
the dryness and rrtaton of the skn s very
important.Thesechildrenmayfndthat
frequent use of soap and water may rrtate
ther skn. they can use sorbolene cream
nstead of soap. they can put the cream on
and then gently rub off under runnng water.
5
they should pat ther hands dry rather than
rub and apply more sorbolene cream
f needed.
Hand washing takes time
in the steps for good hand washng you
need to slowly count to 10 whle soapng
and rubbng your hands and then slowly
count to 10 whle rnsng your hands. ths
may seem lke a long tme. it s a challenge
to allow enough tme n your daly program
for chldren to wash and dry ther hands
well. But t can be done. Wearng jewellery
wll make t harder to clean your hands
effectvely and wll requre extra attenton.
When to wash your own hands
When you arrve at the centre. ths
reduces the ntroducton of germs;
Before handlng food, ncludng
babes bottles;
Before eatng;
after changng a nappy;
after removng gloves;
after gong to the tolet;
after cleanng up blood, faeces
or vomt;
after wpng a nose, ether a chlds
or your own;
Before gvng medcaton;
after handlng garbage;
after comng n from outsde play;
and
Before gong home. ths prevents
takng germs home.
When to wash the childrens hands
When they arrve at the centre. ths
reduces the ntroducton of germs.
Parents can help wth ths;
Before and after eatng and handlng
food;
after havng ther nappy
changed. ther hands wll become
contamnated whle they are on the
change mat;
after gong to the tolet;
after comng n from outsde play;
after touchng nose secretons;
after comng n contact wth blood,
faeces or vomt;
Before jonng the mxed age group
(f applcable); and
Before gong home. ths prevents
takng germs home. Parents can help
wth ths.
gloveS
Wearng gloves does not replace the need
for hand washng as gloves may have very
small holes or be torn durng use. Hands may
also become contamnated durng removal
of gloves. new gloves should be used for
each chld.
Exclusion of sick
children and staff
Excludng sck chldren and staff s one
of the three most mportant ways of lmtng
the spread of nfecton n the chld care
centre (see page 3). the spread of certan
nfectous dseases can be reduced
by excludng a person who s known
to be nfectous, from contact wth others
who are at rsk of catchng the nfecton.
Parentsmayfndanexclusionrulingdiffcult
and some parents may place great pressure
on the drector to vary from the centres
excluson rules. often these parents are under
greatpressurethemselvestofulflwork,study
or other famly commtments. ths may lead
tostressandconfictbetweenparentsand
centre staff.
6
Thebestwaytoavoidconfictistohave
a wrtten polcy that clearly states the
centres excluson crtera. ths polcy should
state the natonal Health and Medcal
research Councls recommended mnmum
exclusons perods (see page 7) as well
as any addtonal condtons or excluson
perods your centre may have. gve the
policytoallparentsandstaffwhentheyfrst
jon the centre.
Directorsshouldnotbeinfuencedbyletters
from doctors whch allow the chld back nto
care,unlessthechildsconditionfulflsthe
crtera for return to care. Sometmes doctors
make dfferent dagnoses for chldren n the
same centre wth llnesses that appear smlar.
your publc health unt should be able to help
you wth these stuatons or when you are n
doubt about excluson.
Whenever you exclude a chld, take the
opportunty to revew your nfecton control
technques wth all chld carers. in partcular,
check hand washng s beng done
as recommended n ths book.
involvement of parents
Provde parents wth a copy of the centres
polces on mmunsaton, medcaton,
nfecton control (hygene) and excluson
when the chld s enrolled. Encourage
parents to return and dscuss these polces
wth you. the excluson polcy s the polcy
most lkely to cause concern. Make sure that
parents understand why the centre has
an excluson polcy.
Most parents wll apprecate your attempts
to prevent llness n ther chldren. in partcular,
t s mportant that parents support the
centres polces on cleanlness. ask parents
to encourage ther chldren to wash and dry
their hands on arrval at the centre and when
leavng.
tHe need for exCluSion
dePendS uPon:
the ease wth whch the nfecton
can be spread;
the ablty of the nfected person
to follow hygene precautons; and
the severty of the dsease.
7
tHe exCluSion ProCedure
identfy when symptoms or a medcal
diagnosisftaconditionwith
an excluson perod;
refer to the table on page 7 for the
recommended mnmum perods
of excluson; and
advse the parents or staff member
when they may return to the centre.
recommended excluson perods are based
onthetimethatapersonwithaspecifc
dsease or condton s lkely to be nfectous.
recommended not excluded means there
isnosignifcantriskoftransmittinginfection
to others.
the followng are recommended mnmum
perods of excluson based on rsk of nfecton
but a chld or staff member may need to stay
at home longer than the excluson perod
to recover from an llness.
7
Recommended
minimum exclusion
periods for infectious
conditions for schools,
pre-schools and child
care centres
Children who are unwell should stay
home from schools, pre-schools and
child care centres.
DefnitionofContactswillvaryaccordingto
disease.PleaserefertospecifcFactSheets
fordefnitionofContacts.(Factsheetsare
lsted n the contents pages of the manual.)
Dfferent excluson perods wll apply to
people whose work nvolves food handlng:
f they have vomtng and/or darrhoea they
should not return to work untl they have
been symptom-free for 48 hours and do
not have loose bowel actons.
8
For some
condtons such as Campylobacter and
Giardia, even though the organsm may
stll found n the bowel actons, chldren may
be able to return to the chld care centre
24 hours after the darrhoea has ceased.
ths s because the number of organsms
wll be less and t wll be possble for good
hygene to be effectvely mantaned.
Condition ExclusionofCase ExclusionofContacts
Amoebiasis
(Entamoeba histolytica)
Exclude until there has not been a loose bowel
motion for 24 hours
Not excluded
Campylobacter Exclude until there has not been a loose bowel
motion for 24 hours
Not excluded
Candidiasis See Thrush
Chickenpox (Varicella) Exclude until all blisters have dried. This is
usually at least 5 days after the rash frst
appeared in unimmunised children and less in
immunised children.
Any child with an immune defciency
(for example, leukaemia) or receiving
chemotherapy should be excluded
for their own protection. Otherwise,
not excluded.
CMV
(Cytomegalovirus infection)
Exclusion is NOT necessary Not excluded
Conjunctivitis Exclude until the discharge from the eyes has
stopped unless doctor has diagnosed a non-
infectious conjunctivitis.
Not excluded
Cryptosporidium infection Exclude until there has not been a loose bowel
motion for 24 hours
Not excluded
Diarrhoea
(No organism identifed)
Exclude until there has not been a loose bowel
motion for 24 hours
Not excluded
Diphtheria Exclude until medical certifcate of recovery
is received following at least 2 negative throat
swabs, the frst swab not less than 24 hours
after fnishing a course of antibiotics followed
by another swab 48 hours later.
Exclude contacts that live in the same
house until cleared to return by an
appropriate health authority.
German measles See Rubella
Giardiasis Exclude until there has not been a loose bowel
motion for 24 hours
Not excluded
8
Glandular fever (Mononucleosis, EBV
infection)
Hand, foot and mouth disease Exclude until all blisters have dried Not excluded
Haemophilus infuenzae type b (Hib) Exclude until the person has received
appropriate antibiotic treatment for at least
4 days.
10
Not excluded
Head lice (Pediculosis) Exclusion is NOT necessary if effective
treatment is commenced prior to the next
day at child care (i.e. the child doesnt need
to be sent home immediately if head lice are
detected).
Not excluded
Hepatitis A Exclude until a medical certifcate of recovery
is received, but not before seven days after the
onset of jaundice.
Not excluded
Hepatitis B Exclusion is NOT necessary Not excluded
Hepatitis C Exclusion is NOT necessary Not excluded
Herpes simplex (cold sores, fever
blisters)
Exclusion is not necessary if the person is
developmentally capable of maintaining hygiene
practices to minimise the risk of transmission.
If the person is unable to comply with these
practices they should be excluded until the
sores are dry. Sores should be covered by a
dressing where possible.
Not excluded
Human Immunodefciency Virus
(HIV/AIDS)
Exclusion is NOT necessary. If the person is
severely immunocompromised, they will be
vulnerable to other peoples illnesses.
Not excluded
Hydatid disease Exclusion is NOT necessary Not excluded
Impetigo (school sores) Exclude until appropriate antibiotic treatment
has commenced. Any sores on exposed skin
should be covered with a watertight dressing.
Not excluded
Infuenza and infuenza-like illnesses Exclude until well Not excluded
Legionnaires disease Exclusion is NOT necessary Not excluded
Leprosy Exclude until approval to return has been given
by an appropriate health authority
Not excluded
Measles Exclude for 4 days after the onset of the rash Immunised and immune contacts are
not excluded.
Non-immunised contacts of a case
are to be excluded from child care
until 14 days after the frst day of
appearance of rash in the last case,
unless immunised within 72 hours
of frst contact during the infectious
period with the frst case.
All immunocompromised children
should be excluded until 14 days
after the frst day of appearance of
rash in the last case.
11
Meningitis (bacterial) Exclude until well and has received appropriate
antibiotics
Not excluded
Meningitis (viral) Exclude until well Not excluded
Meningococcal infection Exclude until appropriate antibiotic treatment
has been completed
Not excluded
Molluscum contagiosum Exclusion is NOT necessary Not excluded
Mumps Exclude for nine days after onset of swelling. Not excluded
Norovirus Exclude until there has not been a loose bowel
motion or vomiting for 48 hours
Not excluded
9
Parvovirus infection (ffth disease,
erythema infectiosum, slapped cheek
syndrome)
Pertussis See Whooping Cough
Respiratory Syncytial virus Exclusion is NOT necessary Not excluded
Ringworm/tinea Exclude until the day after appropriate
antifungal treatment has commenced
Not excluded
Roseola Exclusion is NOT necessary Not excluded
Ross River virus Exclusion is NOT necessary Not excluded
Rotavirus infection Children are to be excluded from the centre
until there has not been a loose bowel motion
or vomiting for 24 hours.
Not excluded
Rubella (German measles) Exclude until fully recovered or for at least four
days after the onset of the rash
Not excluded
Salmonella infection Exclude until there has not been a loose bowel
motion for 24 hours
Not excluded
Scabies Exclude until the day after appropriate
treatment has commenced
Not excluded
Scarlet fever See Streptococcal sore throat
School sores See Impetigo
Shigella infection Exclude until there has not been a loose bowel
motion for 24 hours
Not excluded
Streptococcal sore throat
(including scarlet fever)
Exclude until the person has received antibiotic
treatment for at least 24 hours and feels well
Not excluded
Thrush (candidiasis) Exclusion is NOT necessary Not excluded
Toxoplasmosis Exclusion is NOT necessary Not excluded
Tuberculosis (TB) Exclude until medical certifcate is produced
from an appropriate health authority
Not excluded
Typhoid, Paratyphoid Exclude until medical certifcate is produced
from appropriate health authority
Not excluded unless considered
necessary by public health authorities
Varicella See Chickenpox
Viral gastroenteritis (viral diarrhoea) Children are to be excluded from the centre
until there has not been a loose bowel motion
or vomiting for 24 hours.
Not excluded
Warts Exclusion is NOT necessary Not excluded
Whooping cough (pertussis) Exclude until fve days after starting
appropriate antibiotic treatment or for
21 days from the onset of coughing.
12
Contacts that live in the same house
as the case and have received less
than three doses of pertussis vaccine
are to be excluded from the centre
until they have had 5 days of an
appropriate course of antibiotics. If
antibiotics have not been taken, these
contacts must be excluded for 21
days after their last exposure to the
case while the person was infectious.
Worms Exclusion not necessary if treatment
has occurred
Not excluded
10
Immunisation
CHildHood immuniSation
t
he most effectve method of preventng
certan nfectons s mmunsaton.
immunsaton protects the person who has
been mmunsed, chldren who are too
young to be vaccnated, and other people
who have been vaccnated but dd not
respond to the vaccne.
the prncple of mmunsaton s smple: t gves
the body a memory of nfecton wthout the
rsk of natural nfecton.
ask all parents to provde a copy of ther
chlds mmunsaton records. if the chld has
not been mmunsed, tell the parents that
ther chld may, dependng upon advce
from the publc health unt, be excluded from
care durng outbreaks of some nfectous
dseases (such as measles and whoopng
cough), even f ther chld s well.
if the chld s vaccnated, make sure that
the chld has receved all the vaccnatons
recommended for ther age group.
Ways that you can encourage parents
to vaccnate ther chldren nclude:
put up wall charts n rooms;
sendhomefrstbirthdayimmunisation
remnder cards;
send home fourth brthday
mmunsaton remnder cards;
each month revew whch chldren
are behnd n ther vaccnatons,
update the chlds records kept
n the centre and send home
a remnder card;
put a computersed message at the
bottom of recepts; and
when enrollng chldren, make
a note n the drectors dary of
when updates wll be needed.
tHe immuniSationS and tHe
diSeaSeS tHey Prevent
diptheria, tetanus and Pertussis
immunisation
immunsaton wth DtPa vaccne s the best
way to prevent dphthera, tetanus and
pertusss (whoopng cough). DtPa vaccne
s three vaccnes combned nto one njecton
whch s safe and effectve, and several
njectons are needed to provde good
protecton. DtPa s smlar to the prevous DtP
(trple antgen) vaccne (DtPw) but contans
only small parts of the pertusss bactera
nstead of whole bactera. the possble
general sde effects of DtPa are much less
frequent than seen wth the prevous DtPw.
Severe sde effects are very rare.
diphtheria
Dphthera s caused by bactera whch
are found n the mouth, throat and nose
of an nfected person. Dphthera can cause
a membrane to grow around the nsde
ofthethroat,whichcanleadtodiffculty
n swallowng, breathlessness and suffocaton.
a powerful poson (toxn) s produced by the
dphthera bactera and may cause serous
complcatons.
tetanus
tetanus s an often-fatal dsease caused
by a toxn made by bactera present n sol
and manure. you dont catch tetanus from
other people. rather, the bactera enter
the body through a wound, whch may
beassmallandinsignifcantasapinprick.
tetanus attacks the nervous system, causng
severemusclespasms,frstfeltintheneck
and jaw muscles (lockjaw).
Pertussis (whooping cough)
Pertusss, or whoopng cough, s a hghly
contagous dsease caused by bactera
andisspreadbycoughingorsneezing.
Whoopng cough affects the ar passages
andcancausediffcultyinbreathing.Severe
11
coughng spasms occur and between these
spasms, the chld gasps for breath causng
the characterstc whoop sound. not all
chldren get the whoop. Vomtng often
follows a coughng spasm. the cough may
persst for up to 3 months.
13
Polio immunisation
Inactivated polio vaccine (iPV) and iPV-
contanng combnaton vaccnes are now
avalable n australa. these vaccnes contan
small amounts of three types of polo vruses,
whch have been nactvated. a course
of 3 njectons wth a booster dose at 4 years
produces long-lastng protecton to these
polovrus types. iPV replaced Oral polio
vaccine (oPV or Sabn) from 1
st
november
2005.
Polio
Followng the ntroducton of polo vaccnes
there has been a dramatc decrease
n polo nfecton. Snce 1995, no cases
of polo have been reported n australa.
14

australan chldren stll need to be mmunsed
aganst polo, even though cases do not
occur here. there s an ongong rsk of polo
beng mported from other countres and
re-establshed here f our chldren and adults
are not mmunsed. Polo may cause mld
symptoms or very severe llness ncludng
permanent crpplng.
measles-mumps-rubella (mmr)
immunisation
Chldren should be mmunsed aganst
measles, mumps and rubella at 12 months
of age and at 4 years of age. the vaccne
can also be gven to older chldren and
adults, and s very effectve. the combnaton
measles-mumps-rubella (MMr) vaccne
protects chldren and adults aganst all
three dseases. the MMr vaccne contans
small amounts of reduced strength lve
measles, mumps and rubella vruses, and
a small amount of an antbotc (neomycn).
reactons to MMr mmunsaton are much
less frequent than the complcatons
of natural measles. the most common
reacton s feelng unwell and havng a low
grade fever, possbly wth a rash, occurrng
5 to 12 days after mmunsaton. Chldren
who develop the rash durng ths tme are
not nfectous to others. occasonally chldren
wll develop mld swellng of the facal glands
about three weeks after the mmunsaton
because of the mumps component
of the vaccne. More serous reactons
to the vaccne are rare. although MMr
vaccnes are not recommended durng
pregnancy, there s no rsk to pregnant
women from contact wth recently
vaccnated ndvduals as the vaccne vrus
s not transferred from person to person.
measles
Measles s a serous, hghly contagous vral
llness of fever, rash, runny nose, cough
and conjunctvts. Complcatons followng
measles can be very dangerous, and
pneumona occurs n 4% of cases. For
every 10 chldren who contract measles
encephalts, one wll de and up to four wll
have permanent bran damage. Measles has
caused more deaths n australa n the past
15 years than dphthera, pertusss and rubella
combned.
mumps
Mumps s a vral dsease, whch causes
fever,headacheandinfammationofthe
salvary glands. occasonally t causes an
nfecton of the membranes coverng the
bran (menngts) but permanent effects are
rare.Inasmanyasfveper1,000patients
itcancauseinfammationofthebrain
(encephalts). Mumps can also cause
permanent deafness.
rubella
rubella, whch used to be called
german measles, s usually a mld dsease
of chldhood but t can also affect teenagers
and adults. the usual symptoms of rubella are
12
a slght fever, swollen glands, jont pan and
a rash whch appears on the face and neck
and lasts for two or three days. recovery
from rubella s almost always speedy
and complete. the most dangerous form
s congental rubella, where nfecton durng
thefrst20weeksofpregnancycanresult
n devastatng abnormaltes n the newborn
baby. the best way to protect expectant
mothers and ther babes from rubella
s to make sure that all women have been
mmunsed before they become pregnant,
and to mmunse all chldren to stop the
spread of nfecton.
Haemophilus infuenzae type b (Hib)
immunisation
Several doses of Hb vaccne are requred
toprotectachildagainstHib.Thefrstdose
s normally gven at two months of age.
However,childrenuptotheageoffveyears
who were not mmunsed as babes can
be gven Hb vaccne.
Haemophilus infuenzae type b (Hib)
Hb was the most frequent cause of lfe
threateninginfectioninchildrenunderfve
years of age before the ntroducton of Hb
vaccnes. Despte ts name, t s not related
inanywaytoinfuenza(thefu).Itmay
cause nfecton of the membranes coverng
the bran (menngts), swellng n the throat
(epglottts) whch can block breathng,
pneumona, jont nfecton or nfecton
of the tssue under the skn, usually on the
face (cellults).
Pneumococcal immunisation
routne pneumococcal mmunsaton
s gven at 2, 4 and 6 months of age.
it s recommended that the pneumococcal
vaccne be gven at the same tme as other
scheduled vaccnes. Some chldren may
need another dose or two dependng upon
where n australa they lve, and f they have
any rsk factors whch dentfy them as beng
at greater rsk of pneumococcal dsease.
Pneumococcal disease
Pneumococcal dsease s caused
by bactera and can lead to severe bran
nfecton (menngts), blood nfecton
(bacteraema), pneumona, and mddle
ear nfectons (otts meda). the bactera
are spread n droplets shed from the mouth
or nose through kssng or contact wth
artcles that have been contamnated
wth the nfected droplets. Pneumococcal
bactera are commonly carred n the back
of the throat and nose of healthy chldren
and adults. Pneumococcal dsease s most
common n chldren under the age
of 2 years.
15
Chickenpox immunisation (varicella)
From 1
st
november 2005, a sngle dose of the
lve vaccne s avalable to all chldren when
they turn 18 months of age or 13 years
of age. one dose of the chcken pox
vaccne protects up to 90% of vaccnated
chldren. if a vaccnated chld becomes
nfected despte vaccnaton, the nfecton
s usually very mld.
Chickenpox
Chckenpox s a hghly contagous dsease
causedbythevaricella-zostervirus.
Chckenpox starts wth cold-lke symptoms
such as a runny nose, mld fever, cough and
fatgue followed by a rash. the rash usually
starts on the trunk of the body and spreads
over the whole body. the rash starts as small
red spots whch rapdly turn nto blsters.
Chckenpox s spread through coughs and
sneezesandthroughdirectcontactwith
thefuidintheblistersoftherash.
in healthy chldren, chckenpox s usually
a mld dsease whch lasts about 5-10
days. the chckenpox rash can be very
tchy and scratchng can lead to bacteral
nfectons of the spots. Chldren wth other
medcal condtons are at rsk of developng
other lfe-threatenng complcatons such
aspneumoniaorinfammationofthe
bran (encephalts). if a woman develops
13
chckenpox durng pregnancy, there
s a small rsk (less than 2%) of damage
to the unborn baby. it tends to be more
severe n adults.
meningococcal C immunisation
a sngle dose vaccne s avalable to all
chldren when they turn 12 months of age.
the vaccne provdes over 90% protecton
aganst menngococcal C dsease.
16

ths vaccne can be gven at the same tme
as the other vaccnes that are due at 12
months of age. the vaccne s very safe and
does not contan lve bactera so cannot
cause menngts n the chld. there are other
strans of menngococcal nfecton (e.g. type
B) that are not covered by ths vaccne.
meningococcal C disease
Menngococcal C dsease s an uncommon
lfe-threatenng nfecton caused by bactera
that lve at the back of the throat or n the
nose n about 10% of people at any one
tme. although most people who carry these
bactera reman well, they can spread the
menngococcal C bactera to others. the
onset of menngococcal C dsease may
be very quck and can rapdly cause bran
nfecton (menngts) or blood posonng
(septcaema) or a combnaton of both.
in australa, 15% of people who develop
menngococcal C dsease de. the hghest
rate of menngococcal C dsease occurs
n chldren under 5 years of age.
17
Hepatitis b immunisation
Hepatts B mmunsaton s recommended
for all babes and teenagers. all babes
n australa are offered one dose of hepatts
B vaccne at brth to provde early protecton
aganst the dsease. a further three doses
of hepatts B vaccne are requred to provde
optmal protecton. these are 2 months,
4 months of age and ether 6 or 12 months
of age dependng on where n australa the
chld lves. Most sde effects of hepatts B
vaccne are mnor and dsappear quckly.
Soreness at the njecton ste may occur,
as may low grade fever, nausea, feelng
unwell and jont pan. More serous sde
effects are extremely rare.
Hepatitis b
Hepatts B vrus affects the lver and can
cause fever, nausea, tredness, dark urne
and yellow skn (jaundce). about 5% of
people nfected as adults, and most of
those nfected as chldren, become carrers
of the nfecton and can contnue to spread
t to other people. these carrers are also
at ncreased rsk of developng lver dsease
and cancer later n lfe.
14
National Immunisation Program Schedule, Australia
(EFFECTIVE FROM 1 NOVEMBER 2005)
extra vaCCinationS:
Pneumococcal vaccination
aborgnal and torres Strat islander
chldren are offered addtonal
pneumococcal vaccnaton
(23vPPV), between 18 and 24 months
n hgh rsk areas (Queensland,
northern terrtory, Western australa
and South australa);
Medcal at-rsk chldren are
offered addtonal pneumococcal
vaccnaton at 12 months (7vPCV)
and between 4 and 5 years of age
(23vPPV); and
aborgnal and torres Strat islander
people are offered pneumococcal
(23vPPV)andinfuenzavaccination
at 50 years of age.
Hepatitis a vaccination
aborgnal and torres Strat
islander chldren n hgh rsk areas
(Queensland, northern terrtory,
Western australa and South australa)
are offered two doses of hepatts a
vaccnaton 6 months apart startng at
ether 12 months or 18 months of age,
dependng on where they lve.
Vst the australan government Department of Health and ageng webste for the most
up-to-date vaccnaton schedules (http://mmunse.health.gov.au/schedule_nov02.pdf)
and detaled nformaton on vaccnes (http://www1.health.gov.au/mmhandbook/pdf/
handbook.pdf)
15
Comparison of effects of vaccines and diseases
18
Disease Effectsofdisease Sideeffectsofvaccination
Diphtheria - contagious bacteria spread
by droplets; causes severe throat and
breathing diffculties.
About 1 in 15 patients dies. The bacteria
release a toxin, which can produce nerve
paralysis and heart failure.
DTPa vaccine- about 1 in 10 has local
infammation or fever. Serious adverse
events are very rare, and much less
common than with DTPw.
Hepatitis B - virus spread mainly
by blood, sexual contact or from mother
to newborn baby, causes acute hepatitis
or chronic carriage.
About 1 in 4 chronic carriers will
develop cirrhosis or liver cancer.
About 1 in 15 to 1 in 100 will have pain
and fever. Anaphylaxis occurs in about
1 in 600 000.
Hib - contagious bacteria spread
by droplets; causes meningitis, epiglottitis
(respiratory obstruction), septicaemia,
osteomyelitis.
About 1 in 20 meningitis patients
dies and about 1 in 4 survivors has
permanent brain or nerve damage.
About 1 in 100 epiglottitis patients dies.
About 1 in 20 has discomfort or local
infammation. About 1 in 50 has fever.
Infuenza - contagious virus spread
by droplets; causes fever, muscle and
joint pains, pneumonia.
Causes increased hospitalisation in the
elderly. High-risk groups include the
elderly, diabetics, and alcoholics.
About 1 in 10 has local reactions.
Guillain-Barr syndrome occurs in about
1 in 1 million.
Measles - highly infectious virus spread
by droplets; causes fever, cough, rash.
1 in 25 children with measles develops
pneumonia and 1 in 2000 develops
encephalitis (brain infammation).
For every 10 children who develop
measles encephalitis, 1 dies and
4 have permanent brain damage. About
1 in 100 000 develops SSPE (brain
degeneration) which is always fatal.
About 1 in 10 has discomfort, local
infammation or fever. About 1 in 100
develops a rash which is non-infectious.
1 in 1 million recipients may develop
encephalitis (infammation of the brain).
Meningococcal infections - bacteria
spread by respiratory droplets. Cause
sepsis (infection of the blood stream)
and meningitis (infection of the tissues
surrounding the brain).
About 1 in 10 patients dies.
Of those that survive, 1 in 30 has severe
skin scarring or loss of limbs, and 1 in 30
has severe brain damage.
Polysaccharide vaccine: Local reactions
common. Mild fever, headache, malaise
in 1 in 30.
Conjugate vaccine: About 1 in 10 has
local infammation, fever, irritability,
anorexia or headaches.
Mumps - contagious virus spread
by saliva; causes swollen neck and
salivary glands, fever.
1 in 200 children develops encephalitis.
1 in 5 males past puberty develop
infammation of the testes. Occasionally
mumps causes infertility or deafness.
1 in 100 vaccine recipients may
develop swelling of the salivary glands.
1 in 3 million recipients develop mild
encephalitis.
Pertussis - contagious bacteria spread
by droplets; causes whooping cough
and vomiting, lasting up to 3 months.
About 1 in 200 whooping cough
patients under the age of 6 months dies
from pneumonia or brain damage.
As for DTPa vaccine (see diphtheria).
Pneumococcal infections - bacteria
spread by droplets; causes fever,
pneumonia, septicaemia, meningitis.
About 1 in 10 meningitis patients dies
Polysaccharide vaccine: Less than
1 in 20 has pain or local reaction.
Conjugate vaccine: About 1 in 10 has
local reaction or fever.
Polio - contagious virus spread
by faeces and saliva; causes fever,
headache, vomiting and may progress
to paralysis.
While many infections cause
no symptoms, about 1 in 20 hospitalised
patients dies and 1 in 2 patients who
survive is permanently paralysed.
OPV: Less than 1 in 100 recipients
develops diarrhoea, headache and/or
muscle pains. 1 in 2.5 million recipients
or close contacts develops paralysis.
IPV: Local redness (1 in 3), pain (1 in 7)
and swelling (1 in 10) common. Up
to 1 in 10 has fever, crying, and
decreased appetite.
Rubella - contagious virus spread
by droplets; causes fever, rash, swollen
glands, but causes severe malformations
in babies of infected pregnant women.
About 5 in 10 patients develop
a rash and painful swollen glands;
5 in 10 adolescents and adults have
painful joints; 1 in 3000 develops
thrombocytopenia (bruising or bleeding);
1 in 6000 develops infammation of the
brain; 9 in 10 babies infected during the
frst 10 weeks after conception will have
a major congenital abnormality (such
as deafness, blindness or heart defects).
About 1 in 10 has discomfort, local
infammation, or fever. About 1 in 20 has
swollen glands, stiff neck, or joint pains.
About 1 in 100 has a rash, which is non-
infectious. Thrombocytopenia (bruising
or bleeding) occurs after a frst dose
of MMR at a rate of about 1 in 30 500.
16
Disease Effectsofdisease Sideeffectsofvaccination
Tetanus - caused by toxin of bacteria
in soil; causes painful muscle spasms,
convulsions, lockjaw.
About 1 in 10 patients dies. The risk is
greatest for the very young or old.
As for DTPa vaccine (see diphtheria).
Varicella (chickenpox) - caused by highly
contagious virus; causes low-grade fever
and vesicular rash.
Reactivation of the virus later in life
causes herpes zoster (shingles).
1 in 5000 patients develop encephalitis
(brain infammation). About 3 in
100 000 patients die.
Infection during pregnancy can result
in congenital malformations in the
baby. Onset of infection in the mother
from 5 days before to 2 days after
delivery results in severe infection in
the newborn baby in up to one-third
of cases.
About 1 in 5 has a local reaction or
fever. A mild varicella-like rash may
develop in 3-5 per hundred recipients.
17
Parent advice sheet
COMMONLY OBSERVED
ADVERSE EVENTS FOLLOWING
IMMUNISATION AND WHAT TO
DO ABOUT THEM
a
ll the common adverse events
followng mmunsaton are usually mld
and transent and treatment s not usually
requred. if the adverse event followng
mmunsaton s severe or persstent,
or f you are worred about yourself
or your chlds condton, see your doctor
or mmunsaton clnc nurse as soon
as possble or go to a hosptal.
Commonly observed adverse events (conditions) following specifc vaccines used
in the national immunisation Program Schedule (niPS)
19
Varicella Measles,Mumps,Rubella Meningococcal
Localised pain, redness & swelling
at injection site
Occasionally, injection site nodule
may last many weeks (no treatment
needed)
Low grade temperature (fever)
Seen 5-26 days after vaccination:
Pustular rash (2-5 lesions) usually
at injection site which occasional
covers other parts of the body
Occasionally injection site nodule
needed)
Seen 7 to 10 days after vaccination:
Low grade temperature (fever) lasting
2-3 days, faint red rash (not infectious),
head cold and/or runny nose, cough
and/or puffy eyes
Drowsiness or tiredness
Swelling of salivary glands
Irritable, crying, unsettled and generally
unhappy
Loss of appetite
Headache (usually observed
in adolescent/adults)
at injection site
needed)
Vaccinescontainingdiptheria,
tetanus,pertussis
Infuenza VaccinescontainingIPV
Irritable, crying, unsettled and generally
unhappy
at injection site
needed)
Muscle aches
at injection site
needed)
Muscle aches
at injection site
needed)
HepatitisB
Haemophilusinfuenzaetype
B(Hib)
Pneumococcal23vPPV
at injection site
needed)
at injection site
needed)
at injection site
needed)
Pneumococcal7vPCV HepatitisA
at injection site
needed)
at injection site
needed)
18
What to do to manage injection
site discomfort
Many vaccne njectons may result
n soreness, redness, tchng, swellng
or burnng at the njecton ste for 1 to 2 days.
Paracetamol mght be needed to ease the
dscomfort. Sometmes a small, hard lump
may persst for some weeks or months. ths
should not be of concern and requres
no treatment.
managing fever after immunisation
Giveextrafuidstodrink.Donotoverdress
the baby f hot. although the routne use
of paracetamol at the tme of vaccnaton
s no longer necessary, t may be needed
f, for example, an nfant or chld appears
to be n dscomfort.
Watching for and
recording infections in
children
CHeCking for SymPtomS of illneSS
B
ecause you care for the chldren n your
group every day, you are probably used
to the way each of them looks and behaves
when they are healthy. ths wll help you
to notce quckly when one of them s sck.
Symptoms
Be aware of symptoms of llness throughout
the day. these are some of the thngs to look
for to help you answer the queston, is ths
chld sck?:
unusual behavour (chld s cranky
or less actve than usual, cres more
than usual, seems uncomfortable
or just seems unwell);
feversh appearance (see a chld
wth a fever, page 21);
darrhoea (an ncrease n the
frequency, runnness or volume
of the faeces);
vomtng;
loss of appette;
conjunctvts (tears, eyeld lnng s red,
rrtated eyes, followed by swellng
and dscharge of pus from eyes);
unusual spots or rashes;
patch of nfected skn (crusty skn
or dschargng yellow area of skn);
grey or very pale faeces;
unusually dark, tea-coloured urne;
yellowsh skn or eyes;
sorethroatordiffcultyinswallowing;
headache, stff neck;
severe, persstent or prolonged
coughng (chld goes red or blue
n the face, and makes a hgh-
ptched croupy or whoopng sound
after coughng);
frequent scratchng of the scalp
or skn; and
breathng trouble (partcularly
n babes under 6 months old).
What to do if a child seems unwell
tell the drector and nform the
parents that the chld needs
to go home as soon as practcable.
Separate the chld from other
chldren. the chld can stll reman
n the room, as long as nteracton
and sharng objects wth other
chldren does not occur. if they have
vomtng, darrhoea or suspected
measles, the need for separaton
becomes partcularly mportant.
STAYING HEALTHY IN CHILD CARE - 4TH EDITION
19
Remind a child who is coughing
or sneezing to cough into their elbow.
This reduces the risk of the child then
contaminating other children and
their surroundings. If the child covers
their mouth with their hands, ask the
child to wash and dry their hands
afterwards.
If you wipe a childs nose, dispose
of the tissue in a plastic-lined rubbish
bin, and then wash and dry your
hands;
If you touch a child who might
be sick, avoid touching other children
until after you have washed your
hands;
Keep moist skin conditions and
abrasions covered;
Encourage parents to tell you when
anyone in the family is ill. If someone
in the family is sick, watch for signs
of illness in the child; and
If a child vomits or has diarrhoea,
ensure spills are cleaned up promptly.
H[fehj_d]jej^[fWh[djWdZZeYjeh
It may be useful for the parents and the
childs doctor to have written information
on the childs illness. A sample report form
is given on page 20. A photocopy of this form
should be kept in the childs le.
I7CFB;H;9EH:E<?BBD;II?DJ>;9;DJH;
Name Age Symptoms Room or
Group
Date Time of
onset
Comments
John Smith 2 Rash on head and neck Toddlers 16/1/06 2 p.m.
Amy Johnson 6 months Fever, runny nose Babies 17/1/06 1.30 p.m.
Jason Brown 4 Weeping eye Pre-school 17/1/06 4 p.m.
June Jones Staff Weeping eye Pre-school 17/1/06 5 p.m.
H[c[cX[h
A record of illness in the centre must be kept as a condential document.
Symptoms Record what you see as best you can.
When Record when you rst noticed the illness. You may wish to include further
information, for example, the action taken (exclusion for four days, review
of nappy changing practices etc.) and the doctors diagnosis.
20
SamPle rePort form for Parent/doCtor
Make copies of this letter for easy use
Chld Care Centre: ________________________________________________________________________
address: __________________________________________________________________________________
Contact person: __________________________________________________________________________
Phone: ___________________________________________________________________________________
Dear Parent/Doctor,
re: (childs name) _________________________________ Date of brth: ________/________/________
Chld has: (comments, ncludng tme observed, number of tmes, severty)
Vomtng
Darrhoea
rash (description of rash and where rash started)
other
there has/has not been recent smlar llness n other chldren n the centre.
the dagnoss n the other chldren was:
the publc health unt s/s not nvolved.
the chld appears to have a fever. yes / no
the chld has eaten _______________________________________________________________________
the chld has drunk _______________________________________________________________________
the chld last passed urne at __________________ (tme).
Parent contacted by_____________________________________________ at ________________ (tme).
Sgned: _______________________________________
Date: _______/_______/_______ tme_____________
21
A child with a fever
all chldren wll occasonally have
an elevated temperature (fever).
20

Havng a fever s one of the most common
reasons for chldren to see a doctor and
t s one of the symptoms that cause most
worriesforparents.Thedefnitionofafever
s an oral (mouth) temperature greater than
37.5C or an axllary (armpt) temperature
greater than 37C. normal body temperature
may vary qute consderably accordng
to the age of the chld and the tme of day.
bringing a temperature down
Fever s one of the mechansms the body
uses to get rd of germs. there s no doubt
that fever can make a chld (or an adult) feel
mserable, qute apart from the symptoms
of the condton causng the fever. Many
people worry as soon as a chld gets a fever,
and thnk they must mmedately try to brng
t down. ths s usually unnecessary as fever
n tself s not harmful. Fever s a sgn that
suggests there s an nfecton, and s a sgn
thatthebodyisfghtingtheinfection.
21
if a chld has a fever, ensure the chld drnks
plenty of water and excessve clothng
s removed. avod cold-water spongng
that makes the chld shver. if spongng wll
make the chld feel more comfortable, use
lukewarm water.
there s some evdence that gvng
medcatons to reduce the fever can slow
the bodys mmune response to nfecton.
in most nstances we should not be worryng
about treatng the fever tself we should
be focusng our attenton of the way the
chld looks, behaves, the level of alertness
and whether there are any other symptoms
such as vomtng or cough.
Paracetamol s often gven to brng
a fever down. Many paedatrcans would
argue that we are gvng young chldren
too much paracetamol. Paracetamol
s safe when gven n recommended doses,
but an overdose can cause lver falure.
it s very mportant to read the label
carefully as paracetamol for chldren comes
n dfferent strengths and formulatons.
it s essental that the dosage s approprate
for the weght of the chld. Follow the
nstructons on the bottle or box.
ibubrofen s another over-the-counter
medcaton that s sometmes used
as an alternatve to paracetamol. ths s also
relatvely safe, although t s to be avoded
n a chld allergc to asprn or other ant-
infammatorymedicationorifthechildhas
gastrontestnal dsease or asthma.
Medcaton ncludng paracetamol and
bubrofen should only be gven accordng
to the centres medcaton polcy.
asprn should never be gven to chldren
because of ts sde effects. it can cause
stomach upset, gastrc bleedng and
s assocated wth a rare but potentally
fatal condton called reyes Syndrome.
keeping records
a record should be kept of any llness at the
centre. remember to record llness n both
staff and chldren. it s mportant to record
whch part of the centre the chld or adult
was n for most of the day. a sample record
s shown on page 20.
Keepng records can be a factor
n preventng the spread of nfecton.
records can demonstrate when your
approach to nfecton control s workng.
they are nvaluable n helpng you and
publc health workers dentfy the cause
of any outbreak and how to control t.
Administration of
medication
a
dmnsterng medcaton to chldren at
the request of ther parents s a task that
requres attenton to detal, metculous record
keepng, team work and common sense. it
22
s a responsblty that must be taken serously,
due to the potental health rsks, and ltgaton
ssues that may arse as a result of ncorrect
admnstraton.
in the nterest of chldrens safety and well-
beng, the centre should only admnster
medcaton f the medcaton s n ts orgnal
contaner wth the dspensng label attached
lstng the chld as the prescrbed person
and the dosage to be gven. ths apples
to all medcatons; regardless of whether
they are non-prescrbed (such as teethng
gels, nappy creams, cough medcnes etc)
or prescrbed (antbotcs etc). Pharmaces
can provde dspensng labels for non-
prescrbed medcaton.
an example of a Medcaton Permsson Form
s provded on page 23.
reSPonSibilitieS of CHild Care
ProviderS/Staff
Durng orentaton clearly explan
to parents the centres polcy for
admnsterng medcaton, ncludng
paracetamol. it s mportant that
parents understand both the centres
expectatons and the parents
responsbltes pror to the chld
becomng ll.
Explan to all parents the centre
s unable to admnster medcaton
unless t s n ts orgnal contaner wth
the dspensng label attached lstng the
chld as the prescrbed person and the
dosage to be gven.
Ensure parents fully complete the
medcaton record form.
Ensure parents delver medcaton
to a staff member, so that t can be
stored securely (out of chldrens access)
and at the recommended temperature
(e.g. n the frdge, cupboard etc). it s
vtal that medcaton s not left n the
chldrens bags where chldren may
gan access.
Ensure medcaton s admnstered
promptly at the prescrbed ntervals.
all medcaton must be checked
by two staff members before beng
admnstered to chldren. the
medcaton record form s to be sgned
by the staff member admnsterng the
medcaton and the staff member who
has cross-checked that the correct
medcaton and dose has been gven
to the correct person at the rght tme
accordng to the Medcaton Permsson
Form.
advse parents that the centre s unable
to admnster a medcaton at a dfferent
dosage or frequency other than that
recommended on the medcaton
label, unless alternatve wrtten advce
s receved from a medcal practtoner.
advse parents that the centre wll not
admnster medcaton that s labelled
for another person or that s past the
recommended use by date.
Use of nebulsers s permtted provdng
parents demonstrate ther use to staff
to ensure correct admnstraton.
the centres medcaton polcy should
address the management of unused
medcaton or medcaton that needs
to be returned for use at home.
reSPonSibilitieS of ParentS
Complete/revew a medcaton
permsson form at least weekly
when the chld attends and medcaton
s requred. these forms should nclude
detals such as the name of the
chld, the name of the medcaton,
dosage, storage requrements, how
t s to be admnstered (e.g. ear drops,
oral medcne, nebulser etc) and how
often t s to be admnstered.
Hand the medcaton and the
medcaton record form to the chld
carer upon arrval at the centre. Parents
must not leave medcaton n the chlds
bag.
Collect medcaton on departure from
the centre.
Confrmthechildwasgiventhe
requred medcaton by speakng wth
approprate staff on collecton of the
chld.
23
Medication permission form
in the nterest of chldrens safety and well-beng, the centre shall only admnster medcaton
f t s n ts orgnal contaner wth the dspensng label attached lstng the chld as the
prescrbed person, strength of drug and the frequency t s to be gven. ths apples to all
medcatons, regardless of whether they are non-prescrbed (such as teethng gels, nappy creams,
cough medcnes, etc) or prescrbed (antbotcs etc).
Chlds full name: __________________________________________________________________________
Medcal Practtoner/Chemst etc: __________________________________________________________
Medication:
name of medcaton ______________________________________________________________________
Date prescrbed ___________________________________________________________________________
Expry date of medcaton __________________________________________________________________
reason for medcaton ____________________________________________________________________
Storage requrements _____________________________________________________________________
tme and date of last dose gven ___________________________________________________________
i request that the above medcaton be gven n accordance wth the nstructon below:
Please complete table and lst any detaled nstructons n the box eg route (e.g. oral, nhaler),
dose (e.g. thn layer, no. of drops/mls/tablets), before or after food.
instructons:
Parents full name____________________________________________________Date: ____/____/_____
Sgnature__________________________________________________________________________________
Date Dosage Timeto
begiven
Time
medication
actually
given
Signature
of staff
administering
medication
Signature of
staff cross-
checking
medication
Comments
* Details should be reviewed at least 3-monthly.
24
Cover your cough to
control the spread of
germs
S
ome nfectons such as measles,
whoopingcoughandinfuenza,
are spread when an nfected person
sneezesorcoughsouttinyairbornedroplets.
the droplets n the ar may be breathed
n drectly by another person, or ndrectly
enter another person through contact wth
surfaces and hands wth the droplets
on them.
to control the spread of germs, chldren
should be encouraged to ether:
a) Cover ther mouth and nose
withatissuewhentheysneeze
or cough, then dspose of the used
tssue approprately. Wash ther hands
wth soap and water, and
dry thoroughly; or
b) Coughorsneezeintotheirupper
sleeve, or elbow, not nto ther hands.
then wash ther hands wth soap and
water, and dry thoroughly.
Birthday cakes and
blowing out candles
When t s a chlds brthday, many chldren
lke to brng a cake to share wth ther frends.
one of the ways of mnmsng the spread
of droplet nfecton, s to encourage parents
to provde ndvdual cupcakes wth a sngle
candle on the brthday chlds cake.
Play dough
P
lay dough can be great fun. Play
dough has a hgh salt content whch
dscourages germs from lvng and
multplyng. the followng smple steps wll
reduce the rsk of spread of dsease when
usng play dough:
Hand washng before and after usng play
dough;
Store the play dough n a sealed
contaner n the refrgerator between
uses;
Make a new batch of play dough each
week;
if there s an outbreak of vomtng and/or
darrhoea, dscard play dough at the end
of the day and make a new batch each
day durng the outbreak.
Nappy changing and
toileting
Haveanareaspecifcallysetasidefor
changng nappes. Do not share the same
nappy change mat wth chldren from
another room unless t has been effectvely
cleaned.
Check to make sure that all the supples
you need are ready.
get a walkng chld to walk to the change
area.
Carryng a chld away from your body s only
necessary f there are faeces on the chld
and/or ther clothng.
Dsposable nappes may reduce the rsk
of nfectons as dsposable nappes do not
leakas easly as cloth nappes and are able
to be dsposed of mmedately.
Use the followng method to stop dsease
spreadng through contact wth faeces:
25
Wash your hands.
Place paper on the change table.
always wear gloves when changng
nappes.
remove the chlds nappy and put t
n a hands-free ldded bn.
remove any clothes wth urne and/or
faeces on them.
Clean the chlds bottom.
remove the paper and put
t n a hands-free ldded bn.
remove your gloves now, before
you touch the chlds clean clothes.
remove gloves by peelng them
back from your wrsts, turnng them
nsde out as you go. Do not let your
skn touch the outer contamnated
surface of the glove. Put the gloves
n the bn.
Dress the chld. Wash and dry the
chlds hands. now you can hold the
chld close to you.
take the chld away from the change
table.
Clean the change table wth
detergent and warm water, payng
partcular attenton to the mat, at the
completon of each nappy change.
Wash your hands.
ClotH naPPieS
if a parent provdes cloth nappes for ther
chlds use, ensure the parent also provdes
plastc pants to help prevent faeces, and
therefore germs, from leakng. Wearng
clothng over plastc pants also reduces
the number of germs from the bowel beng
transferred to surfaces n the centre.
it s a good dea for the nappy and the
plastc pants to be covered wth clothng
at all tmes. Parents need to be aware that
cloth nappes wth urne and/or faeces wll
not be rnsed or washed at the centre. they
are to be placed nto a plastc bag and
laundered at home.
PaPer on tHe CHange table
Every tme a chld has ther nappy changed,
germs are put on the change table.
By placng a pece of paper on the change
table many of the germs from the chld are
kept on the paper and do not contamnated
the table at all. the paper s removed
n the mddle of the nappy change, before
the chlds clean clothes are put on, the
paper and the germs are then put n the
bn. any paper can be used for ths; paper
towel s easy to use but can be expensve,
greaseproof paper s another alternatve.
gloveS
gloves should be worn when changng
nappes because there are always bllons
of germs n faeces.
Cleaning tHe CHild
Damp paper towels, premostened
towelettes or dsposable cloths may be used
to clean the chld. However, each towel must
be removed mmedately after use and put
n the bn. Wet the towels wth water from the
tap or poured from bottles. Dont reuse water
from a bowl.
Cleaning tHe naPPy CHange table
Use ths method to help keep the nappy
change table clean.
after each change and at the end of
the day, thoroughly wash the table (mat)
well wth detergent and warm water. Use
paper towel for cleanng and dryng the
surface.
if faecal matter splls onto the change
table (mat) clean wth detergent and
warm water, dry wth paper towel.
Wash and dry your hands.
Mattresses and covers used on the nappy
change table need to be smooth and
n good condton because germs can
survve n cracks, holes, creases, pleats,
folds or seams.
26
toilet-training
ask parents to supply several changes
of clothng.
Place soled clothes n a plastc bag,
tyingthetopfrmly,forparentstotake
home at the end of the day. Soled
clothes wll not be rnsed or washed
at the centre. (Explan to parents that
washng soled clothes at the centre
can spread germs.)
Help the chld use the tolet.
Help the chld wash and dry ther
hands. ask older chldren f they
washed and rnsed ther hands,
countng slowly to 10 or sngng for
ths length of tme. Explan to the chld
that washng ther hands and dryng
them properly wll stop germs that
mght make them sck.
Usng a potty char ncreases the rsk
of spreadng dsease. if the chld can
use a tolet ths s preferable. if the
chld must use a potty, empty the
contents nto the tolet and wash the
char. Do not wash t n a snk used for
washng hands.
Wash your own hands.
Cleaning the centre
WaSHing germS aWay
W
ashng germs down the dran
s better than tryng to kll germs
wth dsnfectant. ordnary detergents
help to loosen the germs so that they
can be washed away.
Use colour-coded sponges n each area
(for example blue n the bathroom, yellow
n the ktchen) and keep them separate.
to protect your hands, wear general purpose
rubber gloves when cleanng and hang them
outsidetodrywhenfnished.Washanddry
your hands after removng the gloves.
diSinfeCtantS
Dsnfectants are usually unnecessary.
Most germs do not survve for long on clean
surfaces when exposed to ar and lght.
Even n hosptals, the emphass s on the use
of detergent and effectve cleanng and
dryng procedures rather than dsnfectants.
in an outbreak stuaton, publc health
unts may specfy the use of a partcular
dsnfectant. in ths stuaton, for the
dsnfectant to work effectvely, there
stll needs to be thorough cleanng usng
a detergent beforehand.
there is no ideal disinfectant.
Disinfectants cannot kill germs if the surface
is not clean. It is more important to make sure
that all surfaces have been cleaned with
detergent and warm water than to use
a disinfectant.
to kll germs, any dsnfectant needs:
a clean surface to be able to get
to the germ.
to be able to act aganst those
partcular germs.
to be of the rght concentraton.
enough tme to kll the germs.
ths s at least 10 mnutes.
Even when all of these condtons are
met a dsnfectant wll not kll all the germs
present. For example n one teaspoon
of faeces there may be 1,000,000,000,000
partcles of a vrus. after 10 mnutes
a dsnfectant may kll 99.99% of them.
ths sounds lke many of them were klled,
but because there were so many present,
the dsnfectant may have left around
100,000,000 stll alve. less than 100 of these
vrus partcles can be enough to make
another chld sck.
27
detergentS
Effectve cleanng wth detergent and
warm water, followed by rnsng and dryng
removes the bulk of germs from surfaces.
germs are unable to multply on clean, dry
surfaces.
22
Ensure that cleanng equpment
s cleaned and stored so t can dry between
uses. it should be well mantaned, and
desgned to reduce dust durng use.
approprate equpment ncludes mops wth
detachable heads (to allow for launderng n
washng machne usng hot water) or cloths
that are dsposable or can be laundered.
23
Washdailyplus
whenvisiblysoiled
Washweeklyplus
whenvisiblysoiled
Bathrooms. Wash tap handles, toilet seats, toilet handles and
door knobs. Check the bathroom during the day and clean if
obviously soiled.

Toys and objects put in the mouth.
Surfaces the children have frequent contact with, for example,
bench tops, taps, cots and tables.
Mattresscoversandlinen, if each child does not use the

same mattress cover every day.
Doorknobs.
Floors.
Lowshelves.
Othersurfaces often touched by children.
SPeCial areaS for Cleaning
nappy change area
Clean the nappy change area (table
or mat) thoroughly after each nappy
change wth detergent and warm water.
if faecal matter splls onto the change
table or mat, clean wth detergent and
warm water, and leave to dry. at the end
of the mornng and at the end of the day,
remove the mat; wash wth warm water and
detergent and leave to dry, preferably n the
sun.
Clothing
Staff clothng, or over-clothng, should
be washed daly. Staff may wear overclothes,
such as aprons to cover clothng that cannot
be washed daly. another opton s for staff
to have a change of clothng avalable for
accdents or after dealng wth potentally
nfectous stuatons. these measures also
help to protect the famles of chld care staff
when they return home.
the chldrens dress-up clothes should be
also be washed regularly. We recommend
washng them once a week n hot water and
detergent.
28
linen
Wash lnen n hot water. Do not carry used
lnen aganst your own clothng or coverall.
instead, take t to the laundry n a basket
or plastc bag. treat soled lnen as you would
a drty nappy. if washed at the centre, soled
lnen should be:
soaked to remove the bulk of the
contamnaton;
washed separately n hot water; and
dred n the sun or on a hot cycle
n the clothes dryer.
Wear gloves when handlng soled lnen.
dummies
Dummes must never be shared by chldren.
When not n use, dummes should
be stored n ndvdual plastc contaners.
Each contaner should have the chlds
name on t. Do not store dummes where they
may come n contact wth another dummy
or toy. Store dummes out of chldrens reach.
toothbrushes
toothbrushes must never be shared
by chldren. toothbrushes should be labelled
wth the chlds name. Store them out of the
reach of chldren. Do not let them drp
on one another. the brstles should be
exposed to the ar and allowed to dry.
Do not store toothbrushes n ndvdual
contaners because ths stops them from
dryng. Bactera grow on wet toothbrushes.
Cots
if a chld sols a crb or cot:
Put on gloves.
Clean the chld.
remove your gloves.
Dress the chld.
Wash and dry the chlds hands.
Put on gloves.
Clean the cot.
Place soled lnen n a lned, ldded
laundry bn.
remove bulk of solng/spll wth
absorbent paper towels.
remove any vsble solng by cleanng
thoroughly wth detergent and water.
remove gloves.
Provde clean lnen.
toys
Washng toys effectvely s very mportant
to reduce spread of dsease. toys, especally
those n rooms wth younger chldren, need
to be washed at the end of each day. Warm
water and detergent help to loosen the
germs so that they can be washed away.
remove toys for washng durng the day.
Start a toys to Wash box and place toys
initduringthedayifyouseeachildsneeze
on a toy, f t has been mouthed or f the toy
has been dscarded after play by a chld
who s unwell.
in the nappy change area have a box
of clean and a box of to-be-washed toys.
gve a chld a clean toy f they need one
whle beng changed and after the nappy
change place t mmedately n the toys
to Wash box.
Buy only washable toys. avod
non-washable toys. indvdual non-
washable toys may be assgned
to a chld and kept n the chlds
cot for the use of that chld only.
Wash toys daly n warm water and
detergent, rnse them well and dry
them. Many toys can be cleaned
n the dshwasher.
all toys, ncludng cloth toys and
books, can be dred by sunlght.
it s useful to separate toys nto
baskets. the toys n each basket can
then be rotated between washng
one day and n use the next.
Books should be nspected for vsble
drt and solng. Books can be cleaned
by wpng them wth a most cloth
wth detergent on t, and then dryng
them. leave damp or wet books out
of crculaton untl dry.
29
Wading pools
Wadng or paddlng pools should be empted
after use, cleaned and dred pror to storage.
Chldren should go to the tolet before usng
the pool. if a chld passes a bowel moton
whle n the pool, remove all chldren from
the pool mmedately. Empty the pool, clean
itthoroughlyandrefll.
Centres should be aware of ther states or
terrtorys legslaton regardng pools and pool
fencng. For further advce regardng water
qualty, contact your local publc health unt.
Dealing with spills of
blood, faeces, vomit,
urine and nasal
discharge
Prevention iS better tHan Cure
a
ccdental splls and secretons of body
fuidsareafactoflifewithinachildcare
centre. Managng these splls ncludes:
avodng drect contact wth blood
orotherfuids.
When cleanng or treatng a chlds
face whch has blood on t, ensure
you are not at eye level wth the chld.
if you are at eye level and the chld
s upset, there s a chance, through
ther cryng or coughng for ther
blood to enter your eyes or mouth.
if blood does enter the eye, rnse the
eyes, whle they are open, gently but
thoroughly for at least 30 seconds.
if blood does enter the mouth, spt
t out and then rnse the mouth wth
water several tmes.
24
Wear gloves f possble.
Cover any cuts and abrasons on your
hands wth a waterproof dressng.
Healthy, ntact skn s an effectve
barrer aganst you becomng
nfected from splled blood and other
bodyfuids.
Supervse chldren at all tmes,
ensurng safety and safe play
s a prorty at all tmes. When a chld
s njured, there are several thngs you
wll need to do. these nclude lookng
afterthechild,sendingforthefrst
aidoffcer,checkingthatno-oneelse
has come n contact wth the njured
chlds blood, and cleanng up the
blood.
regularly tolet chldren.
Use dsposable nappes rather than
cloth.
Exclude chldren wth darrhoea and/
or vomtng.
it s suggested that the centre stores
equipmenttobeusedforbodyfuid
splls together to enable rapd ease
of access.
diSCarded needleS and SyringeS
another potental source of exposure
to blood s from dscarded needles. if your
centre s at rsk check the grounds at the
begnnng of each day.
Ifyoufndadiscardedsyringe:
25
Do not attempt to recap the needle;
Fnd a rgd-walled, puncture resstant,
sealable contaner;
Put on gloves;
Brng the contaner to the needle/
syrnge;
Pck up the needle/syrnge by the
mddle;
Keep the sharp end of the needle
away from you at all tmes;
Place the needle/syrnge n the
container,sharpendfrst;
Securely place ld on the contaner;
Place the sealed contaner nto the
rubbsh bn; and
remove gloves and wash and dry
hands.
30
if a needlestck njury occurs:
Stay calm;
Staff should wear gloves and
encourage the wound to bleed
(gentlysqueeze);
Wash the area wth cold runnng
water and soap (f avalable);
apply an antseptc and bandad;
and
as soon as possble contact the
drector and the chlds famly.
advce should be sought from
a doctor, hosptal, sexual health
clnc or communty health centre for
advce about the need for HiV and
hepatts B/C testng, counsellng and
possble hepatts B mmunsaton.
tHe CHild
When attendng an njured chld
who s bleedng, take care to avod
contact wth the blood.
Comfort the chld and move them
to safety.
apply pressure to the bleedng area.
Use gloves f avalable. (if gloves
arenotavailable,takethefrst
opportunty to get someone wearng
gloves to take over from you. then
wash and dry your hands.)
rase the njured part above the level
of the heart, unless you suspect
a broken bone.
Sendforthepersonwithfrstaid
tranng.
When the wound s covered and
no longer bleedng, remove gloves.
Put them n a plastc bag and place
the bag n the rubbsh bn.
Wash your hands thoroughly wth
soap and water.
tHe firSt aid offiCer:
Wear gloves f there s tme.
Dress the chlds wound wth
a bandage or sutable substtute
and seek medcal assstance.
remove gloves. Put them n a plastc
bag and place the bag n the rubbsh
bn.
Wash hands thoroughly wth soap and
warm water.
blood exPoSure
Because of the rsk of nfecton, t s mportant
for everyone to avod contact wth an njured
chlds blood. But f t does spll onto another
adult or chld, take the followng precautons:
Wash the area of contact thoroughly
wth soap and warm water.
if contact has been wth an open
wound, broken skn, mucous
membrane (mouths, eyes, gentals)
or a penetratng njury:
- f the blood contacted your
mouth or your eyes, rnse the area
very well wth water.
- f the blood contacted a wound
or broken skn, wash the area
thoroughly wth soap and water.
- seek medcal advce.
dealing WitH blood SPillS
Wear gloves.
Place paper towel over the spll.
Carefully remove the paper towel
and contents. Place the paper towel
and gloves n a plastc bag, seal the
bag and put t n the rubbsh bn.
if there s a large spll n a wet area,
such as a bathroom or tolet area, you
may be able to carefully wash the spll
nto the sewerage system nstead
of usng paper towels.
31
Put on new gloves and clean the
surface wth warm water and
detergent, and allow to dry.
remove and dscard gloves.
Wash hands thoroughly wth soap
and warm water.
dealing WitH faeCeS, vomit and
urine
Wear gloves.
Place paper towel over the spll.
Carefully remove the paper towel
and contents. Place the paper towel
and gloves n a plastc bag, seal the
bag and put t n the rubbsh bn.
Put on new gloves and clean the
surface wth warm water and
detergent, and allow to dry.
remove and dscard gloves.
Wash hands thoroughly wth soap
and warm water.
dealing WitH naSal diSCHarge
Washng your hands every tme after you
wpe a chlds nose wll reduce the spread
of colds. if you cannot wash your hands
after every nose wpe, use gloves and clean
tssues whch must be dsposed of safely and
approprately.
26
remove the glove by pullng
over the hand coverng the tssue at the
same tme.
Sandpits
S
andpts can be great fun. they are also
a potental source of nfecton. they need
to be well mantaned and kept clean.
Sandpts must be closely covered when
the chld care centre s unattended
to prevent contamnaton from anmal
faeces or napproprately dscarded sharp
or dangerous objects such as broken glass.
the sand should be raked over before
each use to help screen for foregn objects.
Sandpts should be dug over to a depth
of about 25cm at least monthly to reduce
mosture n the sand, whch can turn the sand
sour.
Sand that s contamnated by anmal
or human faeces, blood or other body
fuidsshouldberemoved.Useashovel
and dspose of the sand n a plastc bag.
the remanng sand should be raked over
at ntervals durng the day and left exposed
to the sun. Where extensve contamnaton
has occurred, all sand should be replaced.
Chldren must wash and dry ther hands wth
soap and water after playng n the sandpt.
Animals
i
n chld care settngs, anmals should
generally be kept separate from chldren.
Whle anmals can be a great source of joy
and stmulaton for chldren they can also
be a source of nfectous dsease. if chldren
do have contact wth anmals, they should
be closely supervsed.
Bactera and vruses can be present on the
skn, har, feathers and scales of anmals
andintheirfaecesandurine.Evenfshcan
carry bactera. the mouths and claws of
anmals can carry bactera whch can cause
infectionsinfesharoundbitesandscratches,
and eventually, f untreated, may spread nto
the bloodstream.
Some smple preventatve measures wll
mnmse rsks to health from supervsed
contact wth anmals.
Chldren should be dscouraged from
playng wth anmals whle anmals are
eatng.
Dont let chldren put ther faces close
to anmals.
Make sure that chldren wash and dry
ther hands after touchng anmals.
32
Ensure that anmals are treated,
wormed and mmunsed
as recommended by a vet.
Cleanfshtanksregularly.
anmals that are ll should be treated
promptly by a vet. an anmal that
s rrtable because of pan or llness
s more lkely to bte or scratch.
Do not allow anmals to contamnate
sandpts, sol, pot plants and
vegetable gardens.
always wear gloves when handlng
anmal faeces, emptyng ltter trays
and cleanng cages.
Dspose of anmal faeces and ltter
daly and more often f necessary.
Place faeces and ltter n a plastc
bag and put t out wth the garbage.
Pregnant women n partcular should
avod contact wth cat faeces.
if you have a brd cage, wet the
foorofthecagebeforecleaning
t to avod nhalaton of powdered,
dry brd faeces.
avod brngng n or keepng ferrets,
turtles,iguanas,lizardsorother
reptles, psttacne brds (brds
of the parrot famly) or any wld
or dangerous anmals.
Chldren should not assst n the
cleaningofbirdcages,fshtanks
or other anmal cages or pens.
bat bites
australan bats harbour a Lyssavirus whch
s very smlar to the rabes vrus. only people
who are mmunsed wth rabes vaccne
should approach or handle bats. if you are
scratched or btten by a bat, mmedately
clean the wound by washng gently but
thoroughly wth soap and water for at least
5 mnutes, apply a povdone-, odne-
or alcohol-based antseptc and contact
your doctor or a publc health unt as soon
as possble.
fish and other marine organisms
Scratchesfromfshandothermarine
organsms such as coral can cause unusual
infections.Ifaninjurycausedbyafsh,
or a wound contamnated by sea, pond,
or aquarum water, becomes nfected,
t s mportant to see your doctor and explan
how the njury occurred.
fleas
Fleas nfect both anmals and humans
causingirritationandinfammationofthe
skn. treat anmals, ther beddng and ther
mmedate envronment (that s, where they
usually rest) to destroy adult and mmature
feas.
Food safety
the preventon of food borne llness nvolves
attenton to hygene, proper handlng and
preparaton of food and care durng food
storage and dstrbuton.
Food handlers should not prepare food
f they have a dsease lkely to be transmtted
through food, (e.g. gastroenterts, hepatts
a, norovrus) and they should advse the
drector.
you should be aware of your responsbltes
under your state or terrtory food safety
legslaton.
getting ready for mealS and
SnaCkS
Before meals, clean tables that are
to be used for the meal.
Wash and dry your hands before
preparng or servng food. if you
are nterrupted to care for another
chld whle preparng food or spoon-
feedng an nfant, be sure to wash
and dry your hands agan before
you contnue.
Check that all the chldrens hands
are washed before they eat or drnk.
33
teach chldren to turn away from
foodwhentheycoughorsneeze,
and then to wash and dry ther hands.
if chldren are servng themselves
from the same contaner, they must
be supervsed and utensls used
to prevent chldren from touchng
food that other chldren wll eat. ths
wll assst to mantan food safety whle
also encouragng chldren to develop
ndependence and self-help sklls.
Use a separate spoon for each baby
you feed.
PreParing food
Food s an excellent place for bactera
to grow. germs, such as vruses, do not grow
n foods but can stll be passed from one
person to another n food. Bactera that are
common on our skn and n the envronment
can cause food posonng f allowed to grow
to large numbers n food.
Chld care centres where staff members
change nappes and prepare or serve food
on a daly bass have over three tmes
as much darrhoea as centres where staff
do not do both these jobs. For ths reason, the
person who prepares and serves food should
not be the person who changes nappes
or helps chldren go to the tolet on that day.
the chld care centre should have a hand
basn wth hot and cold water, soap and
dsposable towels n the ktchen so that staff
who are preparng food can easly wash and
dry ther hands. Staff should te back long har
and wear a clean apron when workng n the
kitchen.Thekitchenshouldbefyandpest
proof.
if you are nvolved n handlng, preparng
or servng food (ncludng gvng a baby
a bottle), remember these basc ponts:
Wash and dry your hands. Wearng
jewellery wll make t harder to clean
your hands effectvely and wll requre
extra attenton.
if you have cuts or wounds on your
hands make sure they are completely
covered by a waterproof dressng.
the use of dsposable gloves over the
dressng wll provde an extra level
of protecton.
to prevent cross-contamnaton
between raw and cooked foods:
- keep raw and cooked foods
separate (even n the frdge);
- do not keep uncooked food
above cooked food n the frdge;
and
- use separate utensls (ncludng
cuttng boards, knves, etc) for
raw and cooked food.
Keep food hot (over 60C) or cold
(5C or less
27
); otherwse dont keep t
at all.
Whle the legal requrement
for reheatng food s 60C, t s
recommended that food should
be reheated to 70C for 2 mnutes.
Heatng to ths temperature wll
destroy germs that may have grown
n the food. reheatng to 70C s
recommended as you do not know
f the food has been cooked, stored
and transported to the centre
correctly.
28
the best way of checkng
food temperatures s wth a probe
thermometer.
Ensure the food s allowed to cool
before t s gven to the chld to eat.
remove a small pece of food wth
a spoon to another plate and test the
temperature of the food wth your
hand. throw ths pece of food away
and wash the spoon.
Keep a non-mercury thermometer
n your frdge so that you can check
that the temperature s 5C or less.
throw out left-overs. tell parents what
ther chld left, but do not return the
left-over food.
Heat food once only.
Heat mlk for bottles once only.
34
tHe 4-Hour/2-Hour rule
the 4-hour/2-hour rule
29
provdes gudelnes
regardng the safety of food when t has not
been stored under 5C or over 60C. ready-
to-eat food that has been at temperatures
between 5C and 60C:
for a total of less than 2 hours, must
be refrgerated or used mmedately
(do not reheat mlk/formula).
for a total of longer than 2 hours
but less than 4 hours, must be used
mmedately.
for a total of 4 hours or longer, must
be thrown out.
breaSt milk
Whle breast mlk s best for babes,
contanng mmunologcal propertes that are
very mportant n preventng llness n babes,
staff must be aware that t s a mothers
ndvdual decson to breast feed/provde
expressed breast mlk. Mothers of breast-fed
babes should be encouraged to provde
expressed breast mlk or to vst the centre
to feed ther babes. Encouragng words from
chld care staff go a long way to helpng
a mother who s tryng to work and breast
feed. Whlst encouragement and supportve
practce to allow mothers to ether feed ther
babes or provde expressed breast mlk
s mportant, mothers who choose not
to do so, or who are unable to do so, should
not be made to feel they are experencng
any negatve judgement from staff.
Breast mlk can be stored n the refrgerator
for48hoursorinadeepfreezerfor
6 12 months, dependng upon the deep
freeze.
30
Frozenbreastmilkshouldbethawed
qucklybut dont put t n bolng water
or t wll curdle. Place the contaner under
cold runnng water. gradually allow the
water to get warmer untl the mlk becomes
lqud. it s not recommended to use
a mcrowave to thaw or warm expressed
breast mlk.
31
,
32
Do not shake the thawed
breast mlk roll gently to mx. Ensure the
temperature s not excessve and there s
no danger that the baby could be scalded.
Ensure breast mlk s clearly labelled wth the
chlds name and the tme and date the mlk
was expressed. two staff members should
check the label of the breast mlk before
t s gven. throw away any mlk that s left
over.Donotre-freezeorre-heatleft-over
mlk. ask mothers to supply breast mlk
n multple small quanttes to prevent
wastage.
formula
it s recommended that formula s prepared
as requred. When preparng formula, follow
the manufacturers nstructons carefully.
throw away any formula that s left over.
Donotfreezeorre-heatleft-overformula.
Ensure the bottles are clearly labelled wth
the chlds name and date the formula was
made up.
Warming bottleS
Do not warm bottles n the mcrowave.
Mcrowave ovens dstrbute heat unevenly.
also, water n the mlk turns to steam and
collects at the top of the bottle. there
s a danger that the baby could be scalded.
there are specal bottle warmers avalable.
CHildren and Cooking
Chldren love to cook. Cookng s a safe
and enjoyable actvty for chldren n chld
care centres provded that a few smple
precautons are taken.
always be aware of the dangers
of heat.
if they have had vomtng or
darrhoea they should not partcpate
untl they have not had any symptoms
for 48 hours.
Make sure chldren wash and dry ther
hands before startng.
te up any long har.
lmt the type of food that chldren
prepare to food that wll be cooked.
germs n the food wll be destroyed
when the food s cooked.
35
Foods sutable for chldren to cook
nclude: cooked bscuts, fresh pasta,
soupsandpizza.
Foods not sutable for chldren to cook
nclude: frut salad and refrgerator
bscuts.
rsk wll be mnmsed f food s
consumed mmedately after cookng.
Infectious disease
issues for child care
staff
E
mployers have a duty to take reasonable
care of ther own safety and health
at work and to provde and mantan a work
envronment where ther employees are not
exposedtohazards.Employersmustalso
ensure, as far as practcable, that the health
of other people who are not employees
s not harmed by ther work.
Employees should take reasonable care for
ther own safety and health at work. they
should also avod adversely affectng the
safety and health of chldren, staff members
and other people.
KEy ACTIONS TO PREVENT
INFECTIOuS DISEASES:
exCluSion of SiCk CHildren and
Staff
Excludng sck chldren and staff s one of the
most mportant ways, together wth good
hygene and mmunsaton, of lmtng the
spread of nfecton n the chld care centre.
the spread of certan nfectous dseases
can be reduced by excludng a person
who s known to be nfectous from contact
wth others who are at rsk of catchng the
nfecton. Staff, as well as chldren, need
to adhere to the centres excluson polcy
for nfectous condtons (see page 5).
immuniSation
Chld care staff may be exposed to dseases
that are preventable by mmunsaton
ncludng hepatts a, measles, mumps,
rubella, varcella and pertusss. Staff that
have not prevously been nfected wth
or mmunsed aganst these dseases are
at rsk of nfecton. all of these dseases can
cause serous llness n adults. Some of these
dseases, such as rubella and chckenpox,
can cause serous damage to an unborn
baby f a woman s nfected durng her
pregnancy. Chld care staff wll normally
be at mnmal rsk of hepatts B. if advce
on rsk s needed, ask the local publc health
unt.
Employers have an oblgaton to prevent
or mnmse the rsk to chldcare staff from
exposure to dseases that are preventable
by vaccnaton. immunsaton of staff s one
effectve way to manage the rsk n chldcare
settngs, as these dseases are usually
nfectous before the onset of symptoms.
the natonal Health and Medcal research
Councl (nHMrC) recommend that chldcare
staff should be mmunsed aganst
33
:
Hepatts a.
Measles-Mumps-rubella (MMr).
Chldcare staff born durng or snce
1966 who do not have vaccnaton
records of two doses of MMr,
or do not have antbodes for
rubella, requre vaccnaton.
Varcella, f they have not prevously
been nfected wth chckenpox.
Pertusss. an adult booster dose
s especally mportant for those staff
carng for the youngest chldren who
are not fully vaccnated.
although the rsk s low, staff who care
for chldren wth ntellectual dsabltes
should seek advce about hepatts
B mmunsaton f the chldren are
unmmunsed.
36
Employers should
34
:
develop a staff mmunsaton polcy;
ths would state the mmunsaton
requrements for chldcare staff at the
centre;
develop a staff mmunsaton record;
ths should document prevous
nfecton or mmunsaton for the
relevant dseases (as lsted above).
a sample staff mmunsaton record
s provded below;
requre all new and current staff
to complete the staff mmunsaton
record;
regularly update staff mmunsaton
records as staff become vaccnated;
provde staff wth nformaton about
dseases that are preventable
by mmunsaton, for example through
n-servce tranng and wrtten materal
such as fact sheets; and
take all reasonable steps
to encourage non-mmune staff
to be vaccnated.
SamPle Staff immuniSation reCord for CHild Care Staff
name: ____________________________________________________________________________________
Date of Brth: _____/_____/_____
address: __________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
the natonal Health and Medcal research Councl (nHMrC) recommend that chldcare staff
should be mmunsed aganst:
Disease/Vaccine Disease Vaccine Date
Hepatitis A
Measles, Mumps and Rubella*
Varicella (Chickenpox)
Pertussis (Whooping cough)
* Childcare workers born during or since 1966 who do not have vaccination records of two doses of MMR, or do not have
antibodies for rubella, require vaccination.
37
Hand WaSHing
the prncples of hand washng are detaled
on page 3.
PregnanCy and infeCtiouS
diSeaSeS
Chld care staff who are pregnant need
to be aware of how some nfectons can
affect the unborn chld. ths s a good
tme for the centre to make sure that all
workers are followng good nfecton control
practces.
rubella (german measles)
rubella s a vaccne-preventable dsease.
it s especally mportant for women of chld
bearng age to be protected aganst rubella.
if a pregnant woman contracts rubella,
her baby may be born deaf, blnd or wth
heart and lung damage. if non-mmune
motherscatchrubellainthefrst8-10weeks
of pregnancy, up to 90% of babes wll have
some rubella-assocated problems. the rsk
decreases but contnues untl week
20 of pregnancy.
35
Becauserubellaisdiffculttodiagnose,
a past hstory of the dsease s unrelable
as a gude to mmunty. a blood test wll
show whether or not you have had rubella.
all chld care staff born durng or snce 1966,
ether wthout vaccnaton records, or who
have a negatve blood test, should
be vaccnated both for ther own protecton
and to avod the rsk of transmttng rubella
to pregnant colleagues.
36
(rubella vaccne
should not be gven to a woman known
to be pregnant, and pregnancy should
be avoded for 28 days after vaccnaton.)
Cytomegalovirus (Cmv)
CMV nfecton n early pregnancy may
affect the unborn chld. the nfant may
be unaffected, deaf or have multple
abnormaltes. Whether the baby s affected
depends on many factors. the two man
factors are prevous CMV nfecton and the
stage of pregnancy. the rsk s very low
f the mother has had CMV nfecton before.
the rsk of severe effects may be hgher
f the mother catches the dsease n early
pregnancy. People who have contact wth
young chldren and are exposed to chldrens
urne and salva are at rsk of CMV nfecton.
Studes show that workers n chld care
centres are at a hgher rsk of contractng
CMV than the general communty, especally
when carng for chldren younger than two
years of age.
37
Chld care staff may wsh to have a blood
test for CMV mmunty before becomng
pregnant. ths would allow them to make
an nformed decson about work practces
and to dscuss these wth ther doctor.
toxoplasmosis
Chld care staff are not at greater rsk
of contractng toxoplasmoss than other
people. toxoplasma nfecton n pregnancy
may lead to congental abnormaltes.
there s no rsk f the mother has had the
dsease before, but ths s often unknown.
toxoplasmoss s acqured from contact wth
cat faeces (e.g. n sol or sandpts) or eatng
poorly cooked meat.
if you are consderng pregnancy, then
a blood test wll tell you f you have already
had toxoplasmoss.
Parvovirus b19 (erythema infectiosum,
slapped cheek syndrome, ffth disease)
Parvovrus causes mscarrage or stll-brths
n a small percentage of women nfected
durng pregnancy. Malformatons do not
appear to occur n babes who survve ths
nfecton n the mother. the symptoms of ths
dsease may nclude a slapped cheek rash
(red cheeks that look as though they have
been slapped) or arthrts.
if there s a case n the centre, or a pregnant
woman develops these symptoms, she
should consult wth her medcal practtoner.
38
varicella (Chickenpox)
Most chld care staff wll probably have had
chckenpox as a chld and wll be mmune. a
blood test wll tell f a person s mmune
to varicella. if they are not mmune,
vaccnaton s recommended for chld care
staff.
38
(Chckenpox vaccne should not be
gven to a woman known to be pregnant,
and pregnancy should be avoded for
28 days after vaccnaton.) infecton wth
chickenpoxinthefrstthreemonthsof
pregnancy may damage the unborn chld.
Pregnant women who are exposed
to chckenpox at any stage of the
pregnancy should see ther doctor as soon
as possble after exposure. the doctor may
givevaricellazosterimmunoglobulin(VZIG)
followng varcella nfecton exposure f the
pregnant woman does not have antbodes
tovaricella.VZIGmustbegivenwithin96
hoursofexposure.VZIGisaninjectionof
antbodes aganst chckenpox.
The role of public
health workers
t
he health department n each state or
terrtory has publc health staff. these
people are avalable to advse and assst
ndvduals and nsttutons n the communty
about nfectous dseases, nfecton control
practces and other publc health matters.
Each state or terrtory has laws statng that
doctors must notfy certan nfectous dseases
to publc health authortes.
Chld care centres should nform the local
publc health unt of the followng condtons:
Darrhoea (f several chldren n one
group are ll);
HaemophilusinfuenzaetypeB(Hib);
Hepatts a;
Hepatts B (recent llness only);
Measles;
Menngococcal nfecton;
Parvovrus B19 (f 2 or more cases);
Pertusss;
roseola (f two or more chldren n
one group are ll);
Scarlet fever; and
tuberculoss (tB).
By nformng the publc health unt, the centre
benefts because publc health staff may
be able to help:
dentfy the cause of the llness.
explan the consequences to chldren
and staff of an nfecton.
trace the source of the nfecton
(for example, contamnated food).
advse on approprate control
measures (for example, vaccnes,
antbotcs, excluson, educaton,
nfecton control practces).
Public health staff can provide valuable
advice and support and have access to
resources that may be necessary to manage
outbreaks.
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Fact Sheets
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Staying HealtHy in CHild Care - 4tH edition
39
RespiRatoRy
complaints
Asthma
DescRiption
o
ne in fve Australian children has
asthma, making it the most common
chronic medical condition in childhood.
39

Apart from the normal coughs and colds
of childhood, it is the condition most likely
to be encountered in early childhood
settings. Not all of these children will have
symptoms all of the time. There is a range
of severity of asthma, from those children
who have only one or two attacks in their
lifetime through to those who need to take
medication every day. Most children with
asthma are able to lead essentially normal
lives, provided they receive the correct
medical management.
In asthma, the smaller airways in the lungs
become narrow due to infammation and
then swelling of their walls; in addition there
is a lot of mucus production and tightening
and spasm of the smooth muscle in the walls.
This results in further narrowing of the airways,
which reduces the fow of air in and out
of the lungs, and is also responsible for the
wheeze, cough, and diffculty in breathing
that are the hallmarks of acute asthma.
Severe attacks can be life threatening.
incubation peRioD
Nil.
infectious peRioD
Nil.
exclusion peRioD
Nil.
Responsibilities of chilD caRe
pRoviDeRs/staff
Ensure staff are aware of which children are
known asthmatics and are aware of the
centres Asthma First Aid Plan.
40
reSPonSibilitieS of tHe ParentS
Ensure staff of the centre are aware of the
chlds asthma. Every chld wth asthma
should have a written action plan so t s clear
exactly what needs to be done durng
an acute attack. ths should be obtaned
by the parent from the chlds doctor
and gven to the centre when the chld
s enrolled, or dagnosed as asthmatc.
Controlling tHe SPread of
infeCtion
asthma s not an nfecton, and s not
a dsease that other chldren can catch
from beng near an asthmatc chld.
treatment
Thefrstprincipleoftreatmentistotryand
prevent attacks from occurrng at all. if acute
attacks do occur, or symptoms are present,
then the am s to lmt both ther severty
and duraton. For many chldren, the most
effectve treatment of asthma s to take
medcatons every day to prevent attacks
these are chldren who would otherwse have
attacks relatvely frequently. Most chldren
have only occasonal attacks and do not
need to take preventatve medcaton
they only take medcaton when they have
symptoms. More chldren wth asthma get
nto trouble because they are under-treated
than because they use medcatons too
often.
Medcatons used n asthma can be dvded
nto relievers and preventers.
40
Relievers are quck actng and are used
to treat the symptoms of an attack, so they
are gven when the chld begns to cough
andwheeze.Theyactonthesmoothmuscle
surroundng the arways to make them wder
and so releve the symptoms. they are usually
gven by nhalaton every three to four hours,
though f the symptoms are severe, can be
gven safely more frequently. relevers are
also used before exercse or sport n those
chldren who get symptoms such as cough,
wheezeorshortnessofbreathwhenthey
exert themselves. the chld takes a dose
of medcaton just before the actvty begns
and agan durng t f needed.
Preventers are used to prevent attacks
or daly symptoms. Some chldren take both
preventers and relevers.
asthma medcatons are generally gven by
nhalaton. Chldren from about the age of
7-8 years of age are able to use puffers.
younger chldren are able to use the puffers
n conjuncton wth a spacer, whch s a
plasticcylinder.Thepufferftsintooneend
and the chld then puts ther lps over these
devces whch delver the medcaton drectly
nto the lungs. Sometmes a nebulser s used
- ths s an electrcal pump and the
medicationisturnedintoafnemistvia
an ar pump. ths s especally useful n an
acute attack, though for most chldren
medcaton delvered by a spacer devce
s lkely to be just as effectve.
asthma first aid Plan
41
1. St the person uprght and reman
calm. Dont leave them alone.
2. gve 4 puffs of a blue relever, (aromr,
asmol, Brcanyl**, Epaq or Ventoln)
one puff at a tme, through a spacer*.
(*Use a blue puffer on ts own f there
s no spacer. **Brcanyl s not used
wth a spacer).
3. Wat for 4 mnutes.
4. if there s lttle or no mprovement,
repeat steps 2 and 3.
if there s stll lttle or no mprovement, call
an ambulance mmedately (Dal 000).
Contnue to repeat steps 2 and 3 whle
watng for the ambulance.
41
Bronchiolitis
deSCriPtion
B
roncholts s a chest condton caused
by an nfecton wth a vrus. ths
potentally serous nfecton s common n
nfants under 12 months of age and usually
happens n wnter. the nfecton begns lke
any common cold, but soon develops nto
acough,rapidbreathingandwheezing
to the extent that feedng becomes
diffcult.Wheezingwhenbreathingoutis
characterstc of broncholts. ths happens
wheninfammationcausesthesmall
arways (called the broncholes) to become
obstructed. Seek medcal advce f the chld
develops these symptoms. the respratory
syncytal vrus (rSV) s most often responsble
for broncholts, although other vruses may
cause outbreaks.
Most chldren wth broncholts get better
withinaweektotendays.Thewheezing
sound usually lasts for two to three days.
Asthewheezingsettles,thechildgradually
mproves. However, the cough may last up
to a month.
42
the dsease s transmtted drectly by oral
contact or arborne droplets, or ndrectly
by hands, tssues, eatng utensls, toys or other
artcles freshly soled by the nose and throat
dscharges of an nfected person.
inCubation Period
Usually 48 hours.
43
infeCtiouS Period
Shortly before the onset of symptoms and
durng the actve stage of the dsease.
exCluSion Period
the chld should stay at home untl they
are feelng well.
ProviderS/Staff
report the nfecton to the drector.
advse the parent to keep the chld away
from other chldren untl they are feelng well.
the chld should stay at home untl they are
feelng well.
infeCtion
a) Cover ther mouth and nose wth
atissuewhentheysneezeorcough,
then dspose of the used tssue
approprately. Wash ther hands wth
soap and water, and dry thoroughly; or
b)Coughorsneezeintotheirupper
Ensure staff wash and dry hands after
contact wth soled tssues or contact wth
nose and throat dscharges.
treatment
Because ths s a vral nfecton there
s no medcne that wll cure the nfecton
and antbotcs wll not help.
a chld wth mld broncholts may be treated
athome.Thechildmaybeneftfromawarm,
humidatmosphere(ahumidiferorsteam).
Increasethechildsfuidintake.Paracetamol
may be used to releve a sore throat.
Decongestant medcaton may help releve
symptoms.
a chld wth acute broncholts wll need
medcal assessment. Some chldren wth
broncholts may need to stay n hosptal
for a short tme to receve specalsed
medcal treatment.
42
Bronchitis
deSCriPtion
M
any chldren, when they get a cold,
also develop a cough. ths can be due
to bronchts, whch s when the lnng of the
trachea and bronch (the tubes leadng from
the throat to the lungs) becomes reddened
and swollen, and there s more mucus than
normal.
Itiscausedbyviruses(especiallyinfuenza
vrus), bactera (especally Streptococcus
pneumoniae, see strep throat, page 50),
and several other organsms.
a chld wth bronchts may have the usual sgns
of a cold ncludng a runny nose, sore throat
and mld fever, and then develop a cough.
Thecoughisoftendryatfrst,thenmoistafter
a couple of days. there may be a slght
wheezeandafeelingofshortnessofbreath.
Chldren usually recover from an acute
epsode of bronchts n 5 to 10 days. Some
chldren keep gettng attacks of bronchts
or can get chronc bronchts. ths can be due
to allerges, someone smokng around them
or, to other problems n the lungs.
note that asthma s often msdagnosed
as bronchts. therefore, bronchts should only
be dagnosed by a doctor.
the dsease s transmtted drectly by oral
contact or arborne droplets, or ndrectly
by hands, tssues, eatng utensls, toys or other
artcles freshly soled by the nose and throat
dscharges of an nfected person.
inCubation Period
13daysifcausedbyinfuenzavirus
or Streptococcus pneumoniae.
infeCtiouS Period
exCluSion Period
feelng well.
ProviderS/Staff
advse the parent to keep the chld home untl
they are feelng well.
feelng well.
infeCtion
to control the spread of germs, chldren should
be encouraged to ether:
b)Coughorsneezeintotheiruppersleeve,
or elbow, not nto ther hands. then wash
ther hands wth soap and water, and dry
thoroughly.
Ensure staff wash and dry hands after contact
wth soled tssues or contact wth nose and
throat dscharges.
treatment
Bronchts n chldren s nearly always due
to a vrus and antbotcs are not effectve.
44
in mld cases, bed rest n a warm
envronment for a few days, wth a lght
det and nourshng drnks, may be all that
s needed. Cough medcnes may help
releve symptoms. From the onset of the
attack, warmth to the chest may gve relef.
ths can be n the form of a rubber hot water
bottleflledwithwarm(nothot)waterora
medcnal chest rub.
in more serous cases where bronchts may
be due to a bactera, the doctor may
prescrbe antbotcs.
43
Common cold
deSCriPtion
t
he common cold s caused by many
dfferent vruses that affect the nose and
throat. it s the most common nfectous
llness, especally for young chldren. young
chldren may have 8 to 10 colds each year
45
,
wth the hghest number usually beng durng
thefrsttwoyearsinchildcare,kindergarten
or school. a cold n tself s not serous but
colds can sometmes lead to other nfectons
such as ear nfectons and tonsllts.
Symptoms nclude a runny, stuffed up nose,
sneezing,coughingandamildsorethroat,
wth lttle or no fever. nasal dscharge
s usually clear to start wth, and then wthn
a day can become thcker, yellow and
sometmes green. Up to a quarter of young
chldren wth a cold go on to have an ear
nfecton as well, but ths happens less often
as the chld grows older.
46
Colds are spread drectly by contact wth
airbornedroplets(coughingandsneezing),
or ndrectly by contamnated hands, tssues,
eatng utensls, toys or other artcles freshly
soled by the nose and throat dscharges
of an nfected person.
inCubation Period
about 13 days.
infeCtiouS Period
2-4 days after the cold starts.
exCluSion Period
there s no need to exclude a chld wth
a common cold, unless the chld s unwell.
ProviderS/Staff
advse the parent the chld should stay
at home untl they are feelng well.
reSPonSibilitieS of tHe Parent
feelng well.
infeCtion
treatment
Nospecifctreatment.Rest,extradrinksand
comfortng are mportant. Decongestants
and other cold remedes are wdely
promoted for the relef of symptoms of colds
andfu.Howeverthereislittleevidencethat
any of these help.
47
in fact, there may
be evdence that they can be harmful
and may cause unpleasant sde effects such
as rrtablty, confuson and sleepness. oral
decongestants are not recommended for
chldren under the age of 2 years. Cough
medcnes are not effectve n reducng the
frequency, ntensty or duraton of cough.
lke fever, the cough s there for a reason
t serves a useful functon n clearng mucus
from the chlds arways and preventng
secondary nfecton. if concerned, take
chldren to the doctor. Do not gve asprn
to any chld wth a fever.
CommentS
Watch for new or more severe symptoms.
they may ndcate other more serous
nfectons.
44
Croup
deSCriPtion
C
roup s caused by a vrus nfecton. it s
anykindofinfammationofthelarynx
or voce box that occurs n chldren. it s not a
sngle dsorder n tself. a young chld (usually
under 5 years of age) becomes mldly unwell
wth what seems to be a normal cold. the
vrus nfecton causes the lnng of the arway
n the chlds neck to swell, causng the
arway to get narrower and makng t harder
to breathe.
the characterstc features of croup are a
harsh, barkng cough and a nosy, harsh
sound when breathng n. ths nose s caused
by ar vbratng as t passes through the
narrowed,infamedlarynx.Thiswillusually
happen durng the nght. Durng the day the
chld s usually well apart from the cold. Seek
medcal advce f the chld develops these
symptoms.
Several vruses may cause croup. these
includeparainfuenza,respiratorysyncytial
virus(RSV)andvariousinfuenzaviruses.
inCubation Period
Diffculttodefne,butabout24days.
infeCtiouS Period
exCluSion Period
feelng well.
ProviderS/Staff
advse the parent to keep the chld home
untl they are feelng well.
feelng well.
infeCtion
soap and water, and dry thoroughly, or
treatment
a chld wth croup wll need medcal
assessment.
the doctor may recommend that a chld
wth mld croup be treated at home. Havng
a croupy cough and nosy breathng
frghtens chldren, and beng scared makes
the stuaton worse. Comfortng s very
mportant. Cuddlng, sttng the chld up
48

(n ther parents arms or on pllows) and
gvng somethng to drnk (whch helps wth
the sore throat) can all be mportant. the
childmaybeneftfromawarm,humid
atmosphere(e.g.ahumidifer).Increasetheir
fuidintake.Paracetamolmaybeconsidered
to releve a sore throat.
it s lkely that a chld wth severe croup wll
need to stay n hosptal for a short tme
to receve specalsed medcal treatment.
45
Ear infections (otitis)
deSCriPtion
a
n ear nfecton s one of the most
common health problems for young
chldren.
49
it causes pan and dstress to
chldren and s one of the reasons why they
may wake at nght. Up to 80% of chldren wll
have an ear nfecton at least once
50
and
many have them several tmes. Ear nfectons
can affect chldrens hearng.
they may be mddle ear nfectons (otts
meda) or outer ear nfectons (otts externa).
Mddle ear nfectons occur on the nsde
of the ear drum. Because ths s a small
space, nfecton leads to an ncrease n
pressure on the eardrum and pan. a young
chld wll not be able to tell you they have
a sore ear. However, they may be pullng
or rubbng ther ear, have a fever or vomt.
the chld may be dstressed. Cryng that stops
suddenly may mean that the ear drum has
burst. Mddle ear nfectons can be caused
by bactera or vruses and often occurs
a few days after a chld gets a cold. the
most common age for mddle ear nfectons
s between 6 months and 2 years.
outer ear nfectons occur on the outsde
of the ear drum or ear canal and are often
assocated wth swmmng.
inCubation Period
a few days.
infeCtiouS Period
Ear nfectons are not contagous, but the
cold or other nfecton whch caused them
s. organsms can only be passed from one
childtoanotherifthereisinfectiousfuid
dranng out of the ear.
exCluSion Period
a chld should not attend the centre whle
thereisanyfuidcomingoutoftheear.
feelng well.
ProviderS/Staff
well.
Control of SPread
any dscharge from an ear should be
treated as nfectous. Wash and dry hands
thoroughly.
the chld wll often stll need to be takng
antbotcs after returnng to care.
treatment
Mddle ear nfecton - most chldren wll have
healthy ears by about 2 weeks from when
the mddle ear nfecton started, even f
they do not take antbotcs. antbotcs are
usually prescrbed when a chld has a mddle
ear nfecton. antbotcs probably help the
nfecton to get better more quckly and they
prevent some of the severe nfectons whch
can develop from a mddle ear nfecton.
the use of paracetamol may be consdered
to releve pan.
outer ear nfecton usually treated wth
antbotcs, gven as drops n the ear
or placed n the ear canal wth a wck.
CommentS
as ear nfectons are hard to detect n young
chldren, suspect an ear nfecton wth all
fevers and vomtng. Watch the chld for any
sgns of pullng or rubbng of ears. rarely,
a mddle ear nfecton may spread and the
chld may develop mastodts. the area
behnd the ear wll be red and the ear lobe
wll stck out and down. a chld wth these
symptoms should see a doctor as soon as
possble.
46
Infuenza
deSCriPtion
Infuenzaisanacuteviraldiseaseofthe
respratory tract charactersed by fever, chlls,
headache, muscle pan, a head cold and
a mld sore throat. the cough s often severe.
Usually the person wll recover naturally wthn
27 days.
inCubation Period
Usually 13 days.
infeCtiouS Period
Probably 3-5 days from onset of symptoms n
adults and up to 7 days n young chldren.
51

exCluSion Period
feelng well.
ProviderS/Staff
advse the parent the chld should stay
at home untl they are feelng well.
feelng well.
infeCtion
Adefnitediagnosisofinfuenzarequires
a blood test or throat swab. generally ths
test s not consdered necessary by the
general practtoner.
approprately. Wash ther hands
wth soap and water, and dry
thoroughly; or
treatment
Nospecifctreatment.Antibioticsshould
be gven for bacteral complcatons only.
Decongestants and other cold remedes are
wdely promoted for the relef of symptoms
ofcoldsandfu.However,thereislittle
evdence that any of these help. in fact,
there may be evdence that they can
be harmful and may cause unpleasant
sde effects such as rrtablty, confuson
and sleepness. oral decongestants are not
recommended for chldren under the age
of 2 years. Cough medcnes are not
effectve n reducng the frequency, ntensty
or duraton of cough. lke fever, the cough
s there for a reason t serves a useful
functon n clearng mucus from the chlds
arways and preventng secondary nfecton.
if concerned, take chldren to the doctor.
Do not gve asprn to any chld wth a fever.
CommentS
Watch for new or more severe symptoms.
they may ndcate other, more serous
nfectons.
Infuenzavaccineisavailableandmay
protectstaffagainstinfuenza.Staffwishing
tohavetheinfuenzavaccineshouldconsult
ther own doctor.
Infuenzavaccineisnotgivenroutinely
to chldren unless the chld has a chronc,
debltatng dsease, for example, a chronc
cardac (heart) dsorder, a pulmonary (lung)
dsorder, a renal (kdney) dsorder or
a metabolc dsorder.
47
Pneumococcal disease
deSCriPtion
Pneumococcal dsease refers to a number
of dfferent types of nfecton due to the
bactera called the pneumococcus (also
called Streptococcus pneumoniae). the
bactera are commonly found n the nose
and throat of healthy people and usually
lve there harmlessly, especally n young
chldren (up to 1 n 4 chldren n wnter).
52
it s
not known why the bactera cause dsease n
some people and not n others. the bactera
s spread n droplets shed from the mouth
ornosethroughcoughingandsneezing
or contact wth artcles that have been
contamnated wth the nfected droplets.
Pneumococcal dsease occurs most
commonly n chldren under the age of
2 years.
53
in chldren less than 5 years of
age, Pneumococcal bactera s the most
common bacteral cause of otts meda
(mddle ear nfecton), pneumona (lung
nfecton), bacteraema (nfecton of
the blood stream) and menngts (a lfe
threatenng nfecton of the lnng of the
bran).
54
in chldren, severe pneumococcal
dsease (menngts, septcaema) peaks
at around 12 months of age but cases of
menngts may occur from about 2 months of
age.
55
the symptoms of pneumococcal dsease
depend upon the ste of the nfecton. the
symptoms are not exactly the same as
menngococcal dsease and a skn rash s
not common wth pneumococcal dsease.
When the bactera nvade the blood stream
the dsease can become a lfe-threatenng
condton.
inCubation Period
not well determned. it may be as short as 1-3
days.
56
infeCtiouS Period
the person s nfectous whlst nasal
and mouth secretons stll contan the
pneumococcal bactera. People are
no longer nfectous 24-48 hours after
commencng an approprate antbotc.
exCluSion Period
the chld needs to be excluded untl 48 hours
after the commencement of an approprate
antbotc.
ProviderS/Staff
advse the parent the chld needs
to be excluded untl 48 hours after the
commencement of an approprate
antbotc. Even after ths perod of tme, the
chld should stay at home untl they
are feelng well.
the chld needs to be excluded untl 48 hours
after the commencement of an approprate
antbotc. Even after ths perod of tme,
feelng well.
Controlling tHe SPread
soap and water, and dry thoroughly;
or
b) Coughorsneezeintotheirupper
48
routne pneumococcal mmunsaton s gven
at 2, 4 and 6 months of age. Some chldren
may need another dose or two dependng
upon where n australa they lve, and f they
have any rsk factors whch dentfy them
as beng at greater rsk of pneumococcal
dsease.
treatment
invasve pneumococcal dsease can usually
be treated wth antbotcs f detected early
enough; however the dsease can develop
very quckly.
49
Runny noses
(with green or
yellow discharge)
deSCriPtion
W
hen germs that cause colds (cold
viruses)frstinfectthenoseandsinuses,
the nose makes clear mucus. ths helps wash
the germs from the nose and snuses. after
two or three days, the bodys mmune cells
fghtback,changingthemucustoawhite
or yellow colour.
57
as the bactera that lve
n the nose grow back, they may also be
found n the mucus, whch changes to
a greensh colour. ths colour change s
normal and does not mean the chld needs
antbotcs or that they need to be excluded.
inCubation Period
2-3 days.
infeCtiouS Period
nl.
exCluSion Period
nl.
ProviderS/Staff
report the dscharge to the drector.
if the chld s unwell, the chld should stay
at home untl they are feelng better (ths
s out of concern and consderaton of the
chld t s not an nfecton control ssue for
the centre).
if the chld s unwell, the parent should
keep the chld at home untl the chld
s feelng better (ths s out of concern and
consderaton of the chld not an nfecton
control ssue for the centre).
infeCtion
treatment
Nospecifctreatment.Antibioticsarenot
needed to treat a runny nose.
50
Sore throats and
streptococcal sore
throat (strep throat)
deSCriPtion
S
ore throats are caused by vruses
or bactera. Chldren do not commonly
complan of a sore throat. However, they
may have a fever or be reluctant to eat or
drnk. Chldren wth a sore throat should see
a doctor to assess any need for antbotcs.
a strep sore throat s a bacteral nfecton
of the throat caused by Streptococcus
pyogenes. Possble complcatons of a strep
throat nclude:
Scarlet fever
the chld shall have all the symptoms
ofthroatinfectionplusafnered
rash on the lmbs and trunk and
reddenng of the tongue (strawberry
tongue). Durng the recovery from
the nfecton, the skn may peel off the
fngersandtoes.
58
Quinsy
an abscess (collecton of pus) next to
a tonsl.
Rheumatic fever
a rare complcaton. Fever, jont pan
and a skn rash develop soon after a
sorethroat.Later,infammationofthe
heart (rheumatc cardts) or shakng
and unsteadness (Sydenhams
chorea or St Vtus dance) may occur.
Infammationandreducedfunction
of the kidney
a rare complcaton.
Vral and bacteral throat nfectons are
spread drectly by contact wth arborne
droplets(coughingandsneezing),or
ndrectly by contamnated hands, tssues,
soled by the nose and throat dscharges of
an nfected person.
inCubation Period
Usually 13 days.
infeCtiouS Period
Bacterial sore throats: Untreated people
reman nfectous for 2 to 3 weeks after
becomng ll.
59
treated people are not
nfectous about 24 hours after approprate
antbotc treatment begns.
Viral sore throats: as long as organsms
arebeingspreadbycoughing,sneezing,
etc. Vral tonsllts and sore throats may last
several days.
exCluSion Period
Exclude a chld wth a strep sore throat untl
the chld has receved antbotc treatment
for at least 24 hours and they feel well.
Exclude a chld wth a vral sore throat untl
the chld s feelng well.
60
ProviderS/Staff
report the nfecton to the drector. advse
the parent to seek medcal assessment and
treatment. Parents must keep the chld home
for the excluson perod.
Keep the chld home for the excluson perod
and untl the chld s feelng well.
infeCtion
Exclude the person untl they have receved
antbotc treatment for at least 24 hours and
they feel well.
51
Do not share eatng utensls, food or drnkng
cups. thoroughly wash toys that nfants and
toddlers put n ther mouths.
treatment
a bacteral sore throat s treated wth
penclln or other antbotcs as prescrbed by
a doctor. to prevent potental complcatons
such as rheumatc fever, the full course of
antbotcs should be completed.
antbotcs are not approprate for vral sore
throats.
52
Tuberculosis (TB)
deSCriPtion
t
uberculoss s a bacteral nfecton that
can affect almost any part of the body
but s most common n the lungs.
tB s spread by nhalng tB germ-contanng
droplets expelled drectly from the lungs of
infectiouspersonsduringcoughing,sneezing,
laughng and speakng.
61
it s not heredtary.
the symptoms of tB nclude a cough that
lasts longer than 3 weeks and doesnt go
away wth normal treatment, fever, cough,
loss of energy and beng tred. there may
also be sweats, partcularly at nght, and
weght loss can also occur. the cough may
produce phlegm and sometmes blood. tB
can be suspected when there are changes
seen on a chest x-ray.
inCubation Period
about 2-10 weeks from nfecton to postve
tuberculn skn test.
62
the rsk of actve
diseaseisgreatestwithinthefrstyearortwo
after ntal nfecton, although the germs may
le nactve for many years.
infeCtiouS Period
young chldren wth ther ntal nfecton rarely
spread the dsease. adults who develop
actve tB are most nfectous when they are
coughng and have not receved treatment
orareinthefrstfewweeksoftreatment.
exCluSion Period
People are excluded from chld care untl
theyhaveamedicalcertifcatefroman
approprate health authorty.
ProviderS/Staff
untl they have proof of clearance from the
treatng medcal practtoner.
Parents should nform the drector f ther chld
has tB or f the chld s on tB medcatons.
Keep chld home untl they have proof
of clearance from the treatng medcal
practtoner.
infeCtion
the most mportant way to prevent tB
s to reduce the source of the germs by
dagnosng people wth tB and ensurng they
are fully treated. By reducng the number
of people wth nfectous tB n the communty
the chance of exposure to tB s reduced for
the general populaton.
treatment
People wth tB requre ant-tB drugs for a
mnmum of 6 months contnuous treatment.
the exact length of tme vares and depends
upon many factors. Completng a full course
of therapy s essental.
53
Whooping cough
(pertussis)
deSCriPtion
W
hoopng cough s a hghly contagous
bacteral dsease whch can affect
nfants, chldren and adults. it may start wth
arunnynose,sneezingandthendevelop
nto coughng bouts. these coughng bouts
can be very severe and frghtenng. they
may end wth a crowng nose (the whoop)
as ar s drawn back nto the chest. Vomtng
or gaggng may follow the coughng bouts.
in babes, breathng may be obstructed due
to the coughng and as a consequence,
they may lack oxygen and turn blue.
adolescents and adults may just have
a persstent cough. young chldren are
especally at rsk of severe llness, whch
may result n hosptalsaton. Some have
fts(convulsions)andsomemaydevelop
infammationofthebrain(encephalitis).
Whoopng cough s partcularly serous
n chldren under 2 years of age and
hosptalsaton s usually necessary.
Whoopng cough s transmtted by drect
contact wth droplets from the nose and
throat of an nfected person.
inCubation Period
Commonly 710 days and not more than
21 days.
infeCtiouS Period
a person s nfectous from the begnnng
of the llness and may reman nfectous for
up to three weeks. ths tme frame can
be shortened to 5 days when the person
s treated wth an approprate antbotc.
exCluSion Period
Exclude for 21 days from the onset
of coughng or untl the person has taken
5 days of an approprate antbotc.
63
ProviderS/Staff
inform the drector. the drector should nform
parents mmedately f ther chld exhbts
symptoms. Parents should then consult ther
doctor or clnc mmedately.
in some states and terrtores, the drector s
requred to report detals to the local publc
health unt.
Parents of frends and contacts of the
infectedchildshouldbenotifedthat
the chld has been dagnosed as havng
whoopng cough and advsed to contact
ther doctor.
for 21 days from the onset of coughng
or untl they have taken 5 days of an
approprate antbotc.
Keep the chld home for 21 days from the
onset of coughng or untl they have taken
5 days of an approprate antbotc.
infeCtion
Whoopng cough can be prevented by
mmunsaton. Fully mmunsed communtes
offer the best protecton aganst whoopng
cough. Erythromycn may be gven to
famly and people n close contact wth
the dsease. adults and teenagers are
susceptble to the llness as well and may
carry the bactera whle exhbtng only mld
symptoms.
soap and water, and dry thoroughly: or
54
if there is a case of whooping cough
within the centre:
Check the mmunsaton records for every
chld who has contact wth the chld wth
whoopng cough. look for evdence
of vaccnaton wth the DtP vaccne
at 2, 4 and 6 months of age, and at 4 years
of age. the P n the vaccne s for pertusss
whch s whoopng cough. Chldren who
have receved CDt (dphthera and tetanus
for chldren) at any of these tmes have not
been vaccnated aganst whoopng cough.
any chld or adult who lves n the same
house as the case and also attends the
centre and has receved less than three
doses of pertusss vaccne s to be excluded
from the centre untl they have had 5 days
of an approprate course of antbotcs.
if antbotcs have not been taken, these
contacts must be excluded for 14 days after
ther last exposure to a case of whoopng
cough at home.
treatment
antbotcs may be gven n the early stages
to shorten the perod of contagousness
of a chld wth whoopng cough. However,
these do not lessen the severty or duraton
of the llness.
55
gaStrointeStinal
ComPlaintS
Campylobacter
deSCriPtion
C
ampylobacter nfecton s a type
of gastroenterts caused by a bactera
known as Campylobacter. Symptoms may
nclude darrhoea (sometmes bloody),
a low-grade fever, abdomnal crampng
and nausea and vomtng.
Campylobacter bactera are found n the
faeces of many anmals, ncludng farm
anmals and household pets. People are
nfected when bactera are taken n
by mouth and ths can happen by:
Eatng undercooked meat, especally
chcken;
Drnkng unpasteursed mlk or
contamnated drnkng water;
Eatng cooked food whch has
been cross-contamnated wth
campylobacter bactera from raw
food; or
Handlng nfected anmals and not
washng hands afterwards.
infecton can also be spread from person
to person when:
People wth campylobacter bactera
n the faeces do not wash and dry
ther hands effectvely after gong
to the tolet. Contamnated hands
can then contamnate food whch
may be eaten by others; or
Hands become nfected when
changng the nappy of an nfected
nfant. People and anmals can carry
and spread the nfecton even f they
dont have symptoms.
inCubation Period
Usually 2 - 5 days after comng n contact
wth the bactera, but may range from 110
days.
56
infeCtiouS Period
For as long as the bactera are n the persons
faeces. ths may be for a few days or weeks
after symptoms are gone.
exCluSion Period
Exclude untl darrhoea has stopped for at
least 24 hours.
ProviderS/Staff
Contact your publc health unt f two or
more chldren n one group are ll. Publc
health workers may be able to help dentfy
how the nfectous agent has spread through
the centre and prevent further nfecton.
observe the excluson perod.
infeCtion
Exclude a person wth nfectous darrhoea
from the centre untl darrhoea has stopped
for at least 24 hours.
Make sure that effectve hand washng
and cleanng procedures are beng followed
n the centre and at home.
Ensure sandpts are raked regularly and
remove any anmal faeces. Cover the sand
pt when t s not n use.
64
treatment
antbotcs are usually prescrbed only when
a chld s not recoverng from the llness.
recovery usually occurs wthn a few days
of the onset of symptoms. Parents should
consult ther doctor about treatment.
Make sure the chld has plenty to drnk, see
Safe drnks on page 59.
57
Cryptosporidiosis
deSCriPtion
C
ryptospordoss s a type of
gastroenterts caused by the paraste
Cryptosporidium. the paraste nfects the
ntestne. often, the nfected person has
no symptoms at all. the organsm s usually
identifedbylaboratoryexaminationof
a faecal specmen.
Symptoms nclude vomtng, loss of appette,
stomach pan and foul-smellng darrhoea.
the faeces are often watery n appearance
or may contan mucus.
in healthy young chldren the llness s self-
lmtng and lasts only a few days.
65
in people
wth normal mmune systems the symptoms
oftenfuctuatebutrecoveryisexpectedin
less than 30 days.
Cryptosporidium parastes lve n the bowels
of humans and n wld, pet and farm anmals.
People wth cryptospordoss have the
paraste n ther faeces. the nfecton spreads
when:
infected people do not wash and dry
ther hands effectvely after gong to
the tolet. Contamnated hands can
then spread the parastes to food that
may be eaten by others and surfaces
that may be touched by others;
Hands become contamnated
whle handlng nfected anmals or
nfant; or
People who drnk contamnated
water, unpasteursed mlk or swallow
contamnated swmmng pool water.
inCubation Period
Uncertan, probably an average of 7 days,
wth a range of 1-12 days.
66
infeCtiouS Period
For as long as the organsm s n the persons
faeces, whether or not the person has
symptoms (usually 24 weeks).
exCluSion Period
Exclude untl darrhoea has stopped for
at least 24 hours.
ProviderS/Staff
Contact your publc health unt f two
or more chldren n one group are ll. Publc
infeCtion
Make sure that effectve hand washng and
cleanng procedures are beng followed n
the centre and at home.
as people wth Cryptosporidium nfecton
can contnue sheddng egg cells even after
symptoms have settled, people should not
go swmmng whle they have darrhoea and
for 2 weeks after darrhoea stops.
67

treatment
no treatment s avalable but all chldren wth
darrhoea should see a doctor.
Make sure that the chld has plenty to drnk,
see Safe drnks on page 59.
58
Diarrhoea and vomiting
(gastroenteritis)
deSCriPtion
g
astroenterts s an llness trggered
bytheinfectionandinfammation
of the dgestve system. typcal symptoms
nclude abdomnal cramps, darrhoea (an
ncrease n the frequency, runnness or
volume of the faeces) and vomtng.
in many cases the condton s self-lmtng
and resolves n a few days. the man
complcaton of gastroenterts s dehydraton,
butthiscanbepreventedifthefuidlost
n vomt and darrhoea s replaced. a person
sufferng from severe gastroenterts may
needfuidsintravenously.Someofthecauses
of gastroenterts are:
Vruses such as Norovirus, Rotavirus
and Adenoviruses.
Bactera such as Campylobacter,
Salmonella and Shigella.
Parastes such as Giardia and
Cryptosporidium.
Bacteral toxns the bactera
themselves dont cause llness but
ther posonous by-products can
contamnate food. For example some
strans of staphylococcal bactera
produce toxns that can cause
gastroenterts.
68
Chemcals copper posonng, for
example, can cause gastroenterts.
Drugs certan drugs, such as
antbotcs, can cause gastroenterts
n susceptble people.
the exact cause of the darrhoea can only
be dagnosed by laboratory tests of faecal
specmens. Sometmes multple specmens
must be tested.
inCubation Period
Vral and bacteral nfectons, usually 13
days.
Parastc nfectons, 515 days.
infeCtiouS Period
People are nfectous for as long as the
organsms are present n ther faeces,
whether or not they have symptoms.
exCluSion Period
Chldren are to be excluded from the centre
untl there has not been a loose bowel
moton or vomtng for 24 hours.
ProviderS/Staff
inform the drector, who can then nform
parents that the llness s present n the
centre.
When two or more chldren n one group
are ll wth darrhoea, your publc health unt
should be contacted for advce and help n
controllng the outbreak.
infeCtion
a person wth actve darrhoea s more
lkely to spread the dsease than one who
s well but has nfectous organsms n ther
faeces. For ths reason, chldren and staff
wth nfectous darrhoea should not attend
the centre untl darrhoea has stopped for at
least 24 hours.
Do not exclude chldren or staff wth dsease-
causng organsms n ther faeces but no
darrhoea.
Staff wth dsease-causng organsms n ther
faeces but no darrhoea should not be
nvolved n the preparaton of food.
59
Keep cold food cold (below 5Celsus)
and hot food hot (above 60Celsus) to
dscourage the growth of bactera. reheat
food and hold at 70Celsus for 2 mnutes.
treatment
Preventing dehydration in children with
gastroenteritis
Childrenwithdiarrhoeaneedextrafuidto
replacewhattheylose.However,manyfuids
have too much sugar and the wrong amount
of salt. gvng a sck chld the wrong knd
offuidcanleadtomoredehydrationand
llness.
breastfed children
Breastfeedng mothers should contnue to
breastfeed and offer the breast more often.
Safe drinks
Thebestfuidstogivecontainamixtureof
specal salts (electrolytes) and sugars. you
can buy oral rehydraton soluton from the
chemst. Mx the sachet of powder wth
water,nototherkindsoffuids.Mixsolution
accordng to manufacturers nstructons.
if chldren refuse oral rehydraton soluton
they may be gven dluted soft drnks or frut
juce.
Dluted cordal 10ml + 150ml water.
Dluted soft drnk (e.g. lemonade)
50ml + 150ml water.
Dluted frut juces 50ml + 150ml water.
unsafe drinks
Donotgiveundilutedfruitjuice,fzzydrinks,
sports drnks or energy drnks
69
or cordal to
chldren wth darrhoea. they may ncrease
darrhoea and dehydraton.
bottle/formula fed babies
Contnue normal strength formula or mlk f
the chld s hungry, and offer oral rehydraton
soluton or safe drnks as recommended
above.
remember that wthholdng formula for more
than 24 hours may result n the baby losng
weght.
re-introducing food
re-ntroduce food wthn 24 hours, even f
the darrhoea has not settled. Sutable foods
to start off wth nclude bread, plan bscuts,
potatoes, rce, noodles, vegetables, plan
meats,fshandeggs.Graduallyreintroduce
other foods, such as dary foods and sweet
foods such as jelly, honey and jam.
CommentS
Chldren wth darrhoea, who vomt or who
refuseextrafuidsshouldseeadoctor.In
severe cases hosptalsaton may be needed.
the parent and doctor wll need to know
the detals of the chlds llness whle at the
centre. Photocopy the letter on page 20 and
fllinthedetails.
60
Giardiasis
deSCriPtion
g
ardass s a form of gastroenterts
caused by a paraste called Giardia
lamblia whch lves n the bowel. Giardia
parastes are also found n wld anmals, pets
and farm anmals. Untreated water that
comes drectly from lakes and rvers may also
contan Giardia parastes.
Symptoms nclude darrhoea, foul-smellng
faeces, crampng, excessve gas or bloatng,
fatgue, nausea, and sometmes vomtng
or weght loss. Fever and bloody faeces are
not usually symptoms of giardia nfectons.
Many nfected people and anmals have no
symptoms.
in chld care centres, chldren and adults
may be well and not have darrhoea but
stll be nfected wth the paraste. ths makes
ther faeces potentally nfectous to others.
a person wth actve darrhoea s more
lkely to spread the dsease than one who
doesnt have darrhoea but stll has nfectous
organsms n ther faeces. Giardia nfectons
are spread when:
then spread the parastes to food that
may be eaten by others and surfaces
that may be touched by others.
Hands become contamnated
whle handlng nfected anmals or
nfant.
People drnk contamnated water.
inCubation Period
Commonly 6 9 days but may range from 5
15 days.
infeCtiouS Period
For as long as the organsm s n the persons
faeces, whether or not the person has
symptoms.
exCluSion Period
least 24 hours.
ProviderS/Staff
infeCtion
Be sure that effectve hand washng and
treatment
the person wll not usually be nfectous after
beng treated for several days. ask parents to
check wth ther doctor about treatment. it s
not usually necessary to test or treat chldren
who have no symptoms.
61
Norovirus
deSCriPtion
g
astroenterts can be caused by
norovruses. Vomtng s usually the man
symptom and can be volent and profuse.
other symptoms may nclude darrhoea,
nausea, stomach cramps, fever, headache
and muscle aches.
the llness s hghly nfectous and often
occurs n outbreaks. it s hghly nfectous
for several reasons. Vomt can contan one
mllon vrus partcles per mllltre. Faeces are
also very nfectous. Because volent vomtng
can produce aerosolsed partcles (partcles
suspended n the ar) or can contamnate
surfaces, norovrus s easly spread. it only
takes a small number of germs to cause
an nfecton and the germs are resstant to
dsnfectants.
the vruses can spread n many dfferent
ways:
Person-to-person (e.g. by germs from
vomt or faeces gettng onto hands
then nto someone elses mouth).
aerosols from projectle vomtng.
Food (for example, an nfected
person wth germs on ther hands can
contamnate food, as can aerosols
from vomtng).
Surfaces that become contamnated
(e.g. tolets).
Contamnated water.
inCubation Period
about 15 to 48 hours.
infeCtiouS Period
For as long as symptoms are present, and
usually for 48 hours after symptoms have
stopped. Some people are stll nfectous up
to 10 days after symptoms have stopped.
exCluSion Period
Staff who handle food should be excluded
from food preparaton, food handlng and
assstng others wth feedng untl at least 48
hours after the symptoms have stopped.
large outbreaks have occurred when food
handlers have returned to preparng food
whle stll nfectous.
70
ProviderS/Staff
the centre and wll provde advce on how to
prevent a large scale outbreak occurrng.
infeCtion
Do not prepare food for anyone untl at least
48 hours after recovery.
Ensure hands are washed thoroughly,
especally after gong to the tolet, before
eatng, before preparng or handlng food,
after changng nfants nappes and after
supervsng chldren at the tolet.
62
Surfaces that could have become
contamnated should be scrupulously
cleaned,frstwithdetergentandwaterto
ensure no partcles reman, followed by
dsnfectant (e.g. bleach dluted 1 n 10).
Make sure that all surfaces are kept clean
ncludng ktchens and bathrooms.
treatment
Plentyoffuids(e.g.water,dilutefruitjuiceor
specal oral rehydraton solutons) should be
consumed to prevent dehydraton, see Safe
Drnks on page 59. Food can be eaten as
tolerated. antbotcs wll not help as they do
not kll vruses.
63
Rotavirus
deSCriPtion
g
astroenterts can be caused by
rotavrus. the people most at rsk
for rotavrus nfecton are young chldren
especally those under 2 years old.
71
almost
all people worldwde wll have a rotavrus
nfecton before they are 5 years old. in
australa 20-40% of all admssons of young
chldren to hosptal wth darrhoea are due to
rotavrus nfectons.
Symptoms nclude vomtng, fever and
watery darrhoea. onset s usually sudden,
and the llness manly affects nfants and
young chldren up to 3 years of age.
rotavruses are n the faeces of a person
whle they have darrhoea and for several
weeks after the darrhoea stops (sometmes
up to 2 months or longer). rotavrus nfectons
are spread when:
then spread the vrus to other people
and surfaces that may be touched by
others.
Hands become contamnated whle
nfant.
inCubation Period
Usually about 48 hours, but may range from
24 72 hours.
72
infeCtiouS Period
the vrus may be excreted n the faeces for
12 days before the llness and up to eght
days after the llness.
exCluSion Period
ProviderS/Staff
infeCtion
and vomtng from the centre untl vomtng
and darrhoea has stopped for at least 24
hours.
treatment
take a chld wth vomtng and darrhoea to
the doctor. Drugs are usually not prescrbed.
64
Salmonellosis
deSCriPtion
S
almonelloss s a form of gastroenterts
caused by Salmonella bactera.
Symptoms nclude darrhoea, fever,
abdomnal pan, nausea and vomtng,
sometmes wth blood or mucus n the
faeces. the severty of symptoms depends
upon the number of bactera you swallow,
your age and your general health.
Salmonelloss occurs when Salmonella
bactera are taken n by mouth. ths may
happen n any of the followng ways:
Eatng undercooked meat, especally
poultry, and raw or undercooked
eggs.
Eatng cooked or ready to eat food
that has been contamnated wth
Salmonella bactera from raw food,
such as chcken. ths s called cross-
nfecton and can also happen
when food comes nto contact wth
contamnated ktchen surfaces, such
as choppng boards and utensls that
have been used wth raw food.
People wth salmonelloss have
Salmonella bactera n the faeces. if
these people do not wash and dry
ther hands properly after gong to
the tolet, ther contamnated hands
can spread the bactera to surfaces
and objects that may be touched
by others. Hands can also become
contamnated when changng the
nappy of an nfected nfant.
Pets and farm anmals may have
Salmonella bactera n ther faeces
wthout havng any symptoms. People
can get salmonelloss from these
anmals f they do not wash and dry
ther hands after handlng them.
inCubation Period
6 hours to 3 days, usually 1236 hours.
infeCtiouS Period
you may be nfectous for several weeks.
although the symptoms usually only last for
a few days, the bactera may be present n
faeces for several weeks.
exCluSion Period
least 24 hours.
ProviderS/Staff
Staff may resume handlng food 48 hours
after darrhoea has ceased.
how the germ has spread through the centre
and prevent further nfecton.
infeCtion
from the centre untl the darrhoea has
stopped for at least 24 hours.
Do not exclude a person wth organsms n
ther faeces but no darrhoea.
a person wth Salmonella n ther faeces must
not be nvolved n food preparaton untl
darrhoea has ceased for at least 48 hours.
73

65
treatment
treatment wth antbotcs s not usually
recommended for Salmonella nfectons. Use
of antbotcs sometmes results n the person
becomng a carrer. the person then appears
well but s nfectous to others.
recovery from Salmonella nfecton usually
occurs wthn a few days of the onset of
symptoms. Parents should consult a doctor
about treatment.
66
Shigellosis
deSCriPtion
S
hgelloss s a severe ntestnal nfecton
caused by Shigella bactera. the germ
canbeidentifedbyafaecalculture.
Symptoms nclude darrhoea (sometmes
contanng blood or mucus), fever, vomtng
and cramps. Some nfected people have
no symptoms. Shigella spreads when hands,
objects or food become contamnated
wth the faeces of nfected people, and the
bactera are then taken n by mouth. Very
smallnumbersofthebacteriaaresuffcient
to cause an nfecton. Strngent control
measures are needed.
inCubation Period
17 days, usually 13 days.
infeCtiouS Period
Whle ll and untl the nfectous agent s no
longer present n the faeces, whch s usually
no longer than four weeks. rarely excreton
may persst for months.
74

exCluSion Period
least 24 hours.
ProviderS/Staff
Staff may resume handlng food 48 hours
after darrhoea has ceased.
how the germ has spread through the centre
and prevent further nfecton.
infeCtion
from the centre untl the darrhoea has
stopped for at least 24 hours.
a person wth Shigella n ther faeces must
not be nvolved n food preparaton untl
darrhoea has ceased for at least 48 hours
75
.
treatment
a chld wth ths nfecton may become
serously ll. the chld may need
hosptalsaton. Seek medcal advce on
treatmentandfuidreplacement.Thedoctor
may prescrbe antbotcs.
67
Worms: Hydatid disease
deSCriPtion
H
ydatd dsease s caused by a small
tapeworm called Echinococcus
granulosis. ths s passed to humans from
nfected dogs. the dsease s transmtted
when tapeworm eggs n dog faeces are
transferred from hands to mouths. ths may
happen when a person handles dogs or
objects soled wth dog faeces, or ngests
contamnated food or water. Hydatd
dsease s not transmtted drectly from person
to person.
Hydatd dsease causes cysts to grow n
dfferent parts of the body. any organ may
be affected. Sometmes these cysts cause no
symptoms at all and are found durng routne
chest X-rays. However, f the cysts grow n
vtal organs (such as the lver, lungs or bran)
they may cause dsease. Hydatd dsease s
essentally a problem of the rural communty,
especally for sheep farmers.
inCubation Period
Varable, from months to years, dependng
upon the number and locaton of cysts and
how rapdly they grow.
infeCtiouS Period
Dogs begn to pass eggs of the paraste
approxmately seven weeks after becomng
nfected. Most nfectons n dogs resolve
wthn 6 months, but some adult tapeworms
may survve as long as 23 years. Dogs can
become nfected repeatedly.
exCluSion Period
Excluson not necessary f treatment
has occurred.
ProviderS/Staff
Ensure routne de-wormng of dogs n the
communty and partcularly dogs that
frequent the centre.
Ensure that adults and chldren wash and dry
ther hands before eatng.
Dspose of dog faeces regularly, wearng
gloves.
infeCtion
Ensure that adults and chldren wash and dry
ther hands before eatng.
Dspose of dog faeces regularly, wearng
gloves.
treatment
treatment may be drug therapy, or surgery
to remove the cysts.
68
Worms: Pinworms
deSCriPtion
t
here are many worms that can nfest
chldren. Most, however, need to lve
for a perod n water, sol or anmals before
they become nfectous to humans. in
australa, wth ts temperate, dry clmate and
adequate town sewerage facltes, very few
worms are transmtted.
in chld care centres, the most common
worm s the pnworm (also called Enterobius
vermicularis). other names for a pnworm
nfecton are seatworm nfecton,
threadworm nfecton, enterobass
or oxyurass
76
. People are nfected by
unknowngly eatng mcroscopc pnworm
eggs. the eggs pass nto the dgestve system
and hatch n the small ntestne. From the
small ntestne, pnworm larvae contnue ther
journey to the large ntestne, where they lve
as parastes ther heads attached to the
nsde wall of the bowel. Pnworms are spread
when the person scratches or touches the
anal area (where the pnworm lays ts eggs)
and then puts ther hands to ther mouth.
occasonally eggs on nfected clothng
may be breathed n and then enter the gut
(where the adult pnworm lves). Pnworms do
not nfect dogs and cats so domestc pets
are not a source of nfecton.
Symptoms of pnworm nfecton nclude tchy
bottom, rrtablty and behavoural changes.
Sometmes a thn, adult pnworm, about 1 cm
long, s found on freshly passed faeces.
inCubation Period
approxmately 2 to 4 weeks after eggs enter
the ntestnes, the female pnworm begns
movng from the large ntestne to the area
around the rectum.
infeCtiouS Period
Pnworms can spread as long as worms lve
n the gut. infecton wll contnue untl the
person s treated. immunty does not occur.
Both adults and chldren are susceptble.
exCluSion Period
has occurred.
ProviderS/Staff
Sgns of pnworm nfecton should be
reported to the drector.
Seek medcal treatment for nfected chldren.
the chld wll be free of pnworm nfecton
wthn a day f the chld receves treatment
and clothes and bed lnen are washed n hot
water.
cleanng procedures are beng followed at
home.
infeCtion
treatment
treatment of pnworm s smple, safe and
effectve. the famly doctor may wsh to
confrmtheinfectionwithasimplelaboratory
test. in most cases, though, the doctor wll
prescrbe treatment on symptoms alone. a
sngle-dose therapy s gven to the chld and
each famly member. ths may be repeated
after two weeks. treatment of other chldren
at the centre s not necessary.
69
Worms: Roundworm,
hookworm and
tapeworm
deSCriPtion
i
nfecton wth roundworms, hookworms and
tapeworms (ncludng hydatd tapeworm
page 67) s uncommon. However, t s
stll mportant to observe good personal
cleanlness, as nfectons wth hydatd
tapeworm or roundworms can have serous
effects.
inCubation Period
Eggs or larvae can begn to be passed n
the faeces several weeks after nfecton,
dependng on the speces of worm nvolved.
Symptoms may not be obvous untl months
or years after the nfecton was acqured.
infeCtiouS Period
transmsson s possble throughout the perod
of nfestaton. infecton wll contnue untl the
person s treated. immunty does not occur.
Both adults and chldren are susceptble.
exCluSion Period
has occurred.
ProviderS/Staff
Sgns of worm nfecton should be reported to
the drector.
infeCtion
Dspose of anmal faeces frequently (usng
gloves) and prevent chldren from eatng drt.
Ensure that anmals are wormed regularly
withanti-parasiticpreparationsspecifcto
the worms present n that area.
Pregnant dogs should be treated for
roundworms. larvae whch are dormant n
the btchs body from a prevous nfecton
may nfect the unborn puppes. Dogs should
be re-treated 34 weeks after havng the
puppes.
treatment
Dagnosng worm nfectons requres
laboratory tests. Seek medcal advce.
treatment of worm nfectons vares
accordng to the type of worm and the
persons symptoms.
71
Skin ComPlaintS
General notes
on rashes
r
ashes are common n chldren. they
can be caused by many dfferent vral
nfectons and may not be nfectous. it s
mportant to be able to descrbe the rash as
ths may help wth dagnoss.
Some features to notce wth rashes are:
illness
Does the chld look unwell? the rash may not
affect the chlds well-beng at all.
fever
Does the chld look feversh?
appearance
What colour s the rash? (is t dark red lke a
blood blster? red? Pnk?)
What does the rash look lke?
small, red, pn-heads
fneandlacy
large red blotches
sold red area all joned together
blsters
How does the rash feel to the touch?
rased slghtly, wth small lumps
swollen
is the rash tchy?
Where on the body dd the rash start (for
example, head, neck)?
Where s the rash now (for example, head,
neck, abdomen, arms, legs)?
72
Chickenpox (varicella)
deSCriPtion
C
hckenpox s a vral llness that comes on
suddenly and s hghly contagous. the
chckenpox vrus s also called varicella virus.
Chckenpox usually starts wth one spot, but
more quckly appear, wth fever, headache,
runny nose, a cough and feelng very tred.
the rash starts on the chest and back and
spreads to the face, scalp, arms and legs.
the rash can develop all over the body,
nsde the ears, on the eyelds, nsde the nose
and wthn the vagna, everywhere. the rash
contnues to spread for three or four days. it s
usually very tchy.
Wthn a few hours after each spot appears,
a blster forms. it may appear full of yellow
fuid.Afteradayorso,thefuidturnscloudy.
these spots are easly broken and form a
scab. the spots heal at dfferent stages, some
faster than others, so t s possble the chld
may have the rash n several stages at once.
Somechildrenappeartobreezethrough
chckenpox wth just a few spots. others
have a terrble tme wth hundreds of tchy
spots. Chckenpox s more severe n adults
and can cause serous and even fatal llness
n people who are mmunosuppressed.
77

in famles wth several chldren, outbreaks
can last for weeks, because of the relatvely
long ncubaton perod. Congental varcella
syndromehasbeenreportedinthefrsthalf
of pregnancy and may result n congental
malformatons, skn scarrng and other
abnormaltes. Severe varcella nfecton can
occur n a newborn baby f the mother has
varcella.
it s spread by coughng and contact wth
thefuidfromtheblisters.Oneinfectiongives
long-lastng mmunty. People rarely get
chickenpoxtwice.Herpeszoster(shingles)
s caused by the same vrus. it s an erupton
n someone who has prevously had
chckenpox. Drect contact wth the most
shngles rash can cause chckenpox n a
person who has not already had t.
inCubation Period
the average ncubaton perod s 14 to 15
days, but may range from 10 to 21 days.
78

infeCtiouS Period
From two days before the rash appears (that
s, durng the coughng, runny nose stage)
and untl all blsters have formed scales or
crusts.
exCluSion Period
Exclude untl all blsters have dred. ths s
usuallyatleast5daysaftertherashfrst
appeared n unmmunsed chldren and less
n mmunsed chldren.
79
ProviderS/Staff
remnd parents that asprn should not be
gven. (See below n treatment - reyes
Syndrome.)
Pregnant women should be advsed to avod
contact wth chckenpox. immunsaton
for chckenpox durng pregnancy s not
recommended and pregnancy should be
avoded for one month followng chckenpox
mmunsaton.
80
if pregnant women are
concerned, they should contact ther doctor.
Keep the chld home untl all blsters have
dred. ths s usually at least 5 days after the
rashfrstappearedinunimmunisedchildren
and less n mmunsed chldren.
81

infeCtion
Chckenpox can be prevented
by mmunsaton. Fully mmunsed
communtes offer the best protecton
aganst chckenpox. Chckenpox vaccnaton
s free for all chldren at 18 months of age
from 1
st
november 2005. Vaccnaton after
exposure s usually successful n preventng
73
chckenpox when gven wthn 3 days of
exposure and may be successful when gven
up to 5 days after exposure.
non-mmune chld care staff should be
mmunsed aganst chckenpox.
82
Varicellazosterimmunoglobulin(VZIG)may
be gven to some contacts that are at very
hgh rsk of complcatons because of other
medcal problems. ths s not recommended
for normal healthy chldren.
Cover the nose and mouth when coughng
orsneezing.
Dspose of soled tssues after wpng a runny
nose or whch are soled wth nose or throat
dscharges. Wash and dry hands carefully.
Do not share eatng utensls, food or drnkng
cups.
thoroughly wash toys that nfants and
toddlers put n ther mouths.
treatment
Thereisnospecifctreatment,butcalamine
loton or phenergan may soothe the tch.
the use of a medcne contanng
paracetamol may be consdered to lower
the chlds temperature or releve dscomfort.
never gve asprn to chldren who develop
fever after exposure to chckenpox. asprn
appears to ncrease the rsk of reyes
Syndrome, a rare but serous dsorder
charactersed by sleepness and vomtng.
reyes Syndrome can lead to coma and
death.
74
Cold sores
(herpes simplex)
deSCriPtion
C
old sores are caused by herpes simplex
vrus (HSV). Cold sores are very common
andmostchildrenwillhavehadtheirfrst
coldsorebytheageoffveyears.
83
after
thefrstinfection,thevirusthatcausesthem
hdes n the nerves of the skn and can
cause new cold sores from tme to tme.
the most common place for cold sores s on
or next to the lps, less often on the nose, chn
and other parts of the face but they can
occur on any part of the body. in babes,
they often come on the chn of a drbblng
baby. the vrus can (rarely) affect the eye f
the vrus s carred by the chlds hand from
an actve cold sore to the eye. Cold sores on
the surface of the eye can affect eyesght
and any chld wth a panful red eye should
be seen by a doctor.
there s often an rrtaton or burnng feelng
frst,thenoneortwoblistersform,which
break, form a yellow scab and then heal.
they usually dont leave any scars. Cold sores
usually last from 3 7 days.
84
Cold sores can be trggered by such thngs
as cold, sunburn, fever, llness or worres and
stress.
inCubation Period
2 12 days.
85
infeCtiouS Period
Spread of nfecton s most lkely when there
isfuidpresentintheblister.However,people
wth a hstory of cold sores may shed the vrus
n ther salva (and are capable of nfectng
others) even wthout a blster beng present.
86
exCluSion Period
Excluson s not necessary f the person s
developmentally capable of mantanng
hygene practces to mnmse the rsk of
transmsson. if the person s unable to
comply wth these practces they should be
excluded untl the sores are dry. Sores should
be covered by a waterproof dressng where
possble.
ProviderS/Staff
report the nfecton to the drector. Staff
members wth cold sores may need to be
gven dutes nvolvng less drect contact
wth chldren.
if the chld s unable to comply wth good
hygene practces, (.e. not touch cold sores,
not kss other chldren, wash and dry hands
thoroughly, dspose of tssues approprately,
etc), they should be kept at home untl the
blsters have dred completely.
Cover the leson wth a waterproof dressng
f possble.
infeCtion
anyone wth a cold sore should avod
contact wth newborn babes.
87
Follow good hand washng and cleanng
procedures.
Do not allow kssng on or near the nfected
area or sharng of food or drnk contaners.
Dspose of used tssues approprately. Wash
toys that chldren put n ther mouths daly
and store dummes separately. Do not allow
chldren to drnk from another chlds bottle.
treatment
Usng antvral creams or lotons such as
doxurdne or acyclovr at the very early
stages may help keep the sore small and
help t heal more quckly.
88
it s mportant to try to stop any other germs
gettng nto the cold sores, so try not to
scratch them, and wash and dry hands
thoroughly.
75
Parvovirus B19 (Erythema
infectiosum, slapped cheek
syndrome, ffth disease)
deSCriPtion
t
hs s a mld vral llness. about 20% of
nfected chldren wll have no symptoms
at all.
89
in others, early n the nfecton there
may be mld cold-lke symptoms, then
twotofvedayslater,thechildtypically
develops a slapped cheek rash on the
face and a lacy red rash on the trunk and
lmbs. the chld s usually not very ll, though
the rash occasonally can be tchy. the rash
dsappears after 7 to 10 days, although t
may come and go for several weeks, often
n response to heat. on recovery, the chld
develops lastng mmunty, and s protected
aganst future nfecton.
infecton wth parvovirus B19 generally
only causes a mld llness. the llness may
be more severe n some people who have
uncommon types of red blood cell dsorders.
if a pregnant woman s nfected, the
nfecton may be transmtted to her unborn
baby. in less than 5% of cases,
90
parvovirus
B19 nfecton may cause the unborn baby
to have severe anaema (low blood count),
and the woman may have a mscarrage.
ths occurs more commonly f nfecton
occursduringthefrsthalfofpregnancy.
Malformatons do not appear to occur
n babes who survve ths nfecton n the
mother.
Parvovrus s spread by droplets or by
secretons from the nose and throat.
inCubation Period
Varable; 4-20 days.
91

infeCtiouS Period
not nfectous once the rash appears.
exCluSion Period
nl.
ProviderS/Staff
report the nfecton to the drector. the
drector should advse pregnant women to
consult wth ther medcal practtoner.
advse the parent the chld should stay at
home untl they are feelng well.
feelng well.
infeCtion
Follow good hand washng practces.
Clean surfaces contamnated by respratory
secretons.
Dspose of soled tssues approprately.
treatment
Nospecifctreatment.
76
Hand, foot and mouth
disease
deSCriPtion
t
hs s a mld vral llness and has nothng to
do wth anmal dseases wth smlar names
(e.g. foot and mouth dsease n lvestock).
Symptoms nclude a slght fever, loss of
appette, blsters n the mouth and on the
hands and feet, and a sore mouth for a few
days before the ulcers or blsters appear.
affected young chldren may refuse to eat
or drnk. less commonly, blsters may be seen
n the nappy area.
Hand, foot and mouth dsease s spread
throughcontactwiththefuidintheblisters.
ths s most lkely to occur when the vrus
becomes arborne durng coughng, sngng,
talkng, etc. Contact wth faeces can also
spread the nfecton.
inCubation Period
Usually 35 days.
92

infeCtiouS Period
Aslongasthereisfuidintheblisters.
the faeces can reman nfectous for
several weeks.
exCluSion Period
Exclude untl all blsters have dred.
ProviderS/Staff
report the llness to the drector.
observe excluson perod.
infeCtion
allow blsters to dry naturally. the blsters
should not be delberately perced because
thefuidwithintheblistersisinfectious.
Follow good hand washng and cleanng
procedure.
treatment
Usually none s requred.
77
Head lice
(Pediculosis capitis)
deSCriPtion
H
ead lce are tny nsects. they do not
havewings,sotheycannotfy.Headlice
have strong claws and swng from har to har
they cannot jump. they lve on the har and
suck blood from the scalp. Head lce can
only be spread from one person to another
by drect head-to-head contact.
anyone can get head lce they have
no preferences for cleanlness, har colour,
har type, ethncty or age. Head lce are
a nusance but they do not cause dsease
orillness.Itchingisoftenthefrstthingthat
rases concern about head lce, however
t s not a relable sgn of head lce.
Head lce need to spend ther entre lfe on
human heads to survve. Head lce wll de
from dehydraton wthn 6 24 hours when
removed from the human head, dependng
upon humdty and when they last fed.
Scientifcresearch
93
has shown:
Sharng hats presents no rsk. it does
not ncrease the chance of gettng
head lce. researchers examned
hats worn by 1000 school chldren
and found no head lce even when
many head lce were found on the
chldrens heads.
Placng har groomng mplements
n a contaner of very hot water
(60C) for at least 30 seconds wll kll
any head lce caught n the comb
after groomng. a domestc hot water
servce usually does not reach 60C.
if you do not have a thermometer,
t may be easest to use water shortly
after t has gone off the bol.
researchers examned 118 carpeted
classroomfoorsandfoundnohead
lce or eggs. When the students from
those rooms were examned, they
had a total of 14, 563 lve head lce
on ther heads.
inCubation Period
the head louse starts as a small egg about
thesizeofagrainofsaltwhichthefemale
louse glues to the base of the har shaft. Most
often these eggs (nts) are found n the har
behnd the ears, at the back of the neck,
or around the crown and under the frnge.
the eggs hatch n 710 days. they mature
nto an adult louse, whch s a wngless nsect
23mmlongwithafatbodyandsixlegs.
the adult louse s capable of layng eggs
after 6-10 days.
infeCtiouS Period
as long as the eggs or lce are alve. lve
eggs are glued to the har shaft, usually
wthn 1.5cm from the scalp.
94
Head lce
can only survve on human heads and they
must feed every 6 hours or they wll de from
dehydraton.
95
Eggs need to be on the head
to hatch.
exCluSion Period
Excluson s not necessary f effectve
treatment (see treatment) s commenced
pror to the next day at chld care (.e.
the chld doesnt need to be sent home
mmedately f head lce are detected).
an effectve treatment s when a treatment
s used and all the lce are dead.
ProviderS/Staff
reducng head-to-head contact between
all chldren durng actvtes when the centre
s aware that someone n the centre has
head lce.
Support parents and chldren who have
head lce by provdng factual nformaton,
reducng parental anxety and by not
dentfyng ndvdual chldren as havng head
lce.
Check chlds head once a week for head
lce. if head lce are found, begn treatment
mmedately and check for effectveness
78
(see treatment) and keep checkng
every 2 days untl no lce are found for
10 consecutve days.
you may send your chld back to chld
care as soon as effectve treatment has
commenced. your chld s not a rsk to others
as long as treatment has commenced.
infeCtion
Educate staff, chldren and parents about
head lce.Identifcationofanindividualchild
with head lice is usually a marker of head
lice in a much larger group and a group
approach rather than an individual approach
is needed.
Keep famles nformed f there
s someone wthn the centre wth head lce.
recommend that staff and chldren te back
long har to reduce the chance
of transmsson.
deteCtion
Itchingisoftenthefrstthingthatraises
concern about head lce; however t s not
a relable sgn of head lce. Most chldren
who tch do not have head lce. you can
have head lce and not know. lce move
fast n dry har and are easy to mss. if you
fndheadliceearly,theyareeasiertotreat.
Everyone (adults and chldren) n the famly
needs to be checked.
Check everyones head once a week. if a
close contact has head lce, keep checkng
every 2 days untl no lce are found for
10consecutivedays.Ifyoufndheadlice,
you need to decde on a treatment opton.
Usng har condtoner and combng s the
mosteffectivewayoffnding,andtreating,
head lce.
96
Condtoner and combng can
be used for detecton and/or treatment. the
condtoner stuns the lce for some mnutes
so they can be easly removed. Condtoner
and combng are reasonably nexpensve.
it also avods the use of head lce chemcals
(pestcdes).
Conditioner and Combing
teCHnique
1. Untangle dry har wth an ordnary
comb.
2. apply har condtoner to dry har
(use whte condtoner as t makes
t easer to see the nts). Use enough
condtoner to thoroughly cover the
whole scalp and all har from roots
to tps.
3. Use the ordnary comb to evenly
dstrbute condtoner and dvde the
har nto four or more sectons usng
har clps. a mrror helps f combng
yourself.
4. Change to a head lce comb.
5. Start wth a secton at the back
of the head. Place the teeth of the
head lce comb aganst the scalp.
Comb the har from the roots through
to the tps.
6. Wpe the comb clean on a tssue after
each stroke. in good lght, check for
head lce. adult lce are easer
toseeyounglicearediffculttosee.
a magnfyng glass wll help. you may
see some eggs.
7. Comb each secton twce untl you
have combed the whole head. if the
comb becomes clogged, use an old
toothbrush,dentalfossorsafetypin
to remove the head lce or eggs.
treatment oPtionS
the two most mportant thngs to thnk about
when choosng and usng treatments are
safety and effectveness.
Conditioner and Combing treatment
if you choose the condtoner and combng
as a treatment, follow all the steps descrbed
n Condtoner and combng technque.
Keep combng the whole head untl all
the har condtoner s gone. repeat the
condtoner and combng daly
97
untl you
79
fndnomoreheadlicefor10consecutive
days. it s mportant to contnue for 10 days
to remove all the adult lce and any young
lce that hatch from the eggs before they
can reproduce.
Chemical treatment
When choosng a chemcal treatment
product, ensure you only choose chemcal
treatmentsthataredesignedspecifcally
to treat head lce.
Choose only chemcal treatments whch
have an aust. l or aust. r number
on the label. these products are lcensed
or regstered wth the therapeutc goods
admnstraton (tga) n australa. ths means
they are approved for safety. Be wary
of chemcal treatments whch are not
offciallyapproved.
Chemcal treatments are dvded nto
4 groups accordng to the actve ngredent.
these groups are: Pyrethrns, Synthetc
Pyrethrods, organophosphates and Herbal
and Essental ols.
if you use a chemcal treatment and t does
not kll the head lce, choose a product wth
a dfferent actve ngredent from a dfferent
group. Products from the same group wll
probably not work as the actve ngredent
s lkely to be the same. your pharmacst can
help you choose a product.
there s no chemcal treatment whch wll
kll eggs.
98
the eggs wll contnue to hatch
after the treatment. therefore t s essental
to apply the second treatment one week
later to kll any young lce that have hatched.
the condtoner and combng treatment can
be used n between to help remove the lce
that are hatchng.
there s no chemcal treatment that wll
work for everyone. resstance to chemcal
treatments s a problem n australa. research
nto ths problem s contnung. the only way
of dealng wth resstance s to check for
effectveness every tme you use a chemcal
treatment.
effeCtiveneSS of CHemiCal
treatmentS
it s essental to check for effectveness after
each applcaton of a chemcal product
(refer to nstructons above). Some head lce
are resstant to some chemcal treatments.
ths means that ths treatment wll not be
effectve n kllng head lce.
to check for effectveness after treatng for
headlice,useafnetoothheadlicecomb
(preferably a metal comb) to comb all
of the hars from roots to tps. after each
sweep, wpe the combngs onto a tssue.
repeat untl all the har has been combed
at least twce. Wat for 5 mnutes. observe
the lce for movement.
Effective: if all the lce are dead the
treatment has been effectve.
apply the same product every
7 days (maxmum 3 tmes) to kll the
lce hatchng from the eggs. Use
condtoner and combng every
2 days n between to mprove the
effectveness of the treatment.
99
Afterfrstapplicationeggswillbe
present. in 7 days use condtoner
and combng to detect lce. if lce are
found, apply product agan n 7 days.
after thrd applcaton, f lce are stll
present, contnue usng condtoner
and combng only.
Ineffective: if some lce run around or wave
ther legs and antennae, the treatment has
not been effectve.
if a treatment has not been
effectve, select a product wth a
dfferent actve ngredent. Show the
pharmacst your current treatment
and request advce on choosng
an alternatve treatment or consder
usng the condtoner and combng
technque.
80
Impetigo (school sores)
deSCriPtion
i
mpetgo s a bacteral skn nfecton
caused by ether the Staphylococcus or
Streptococcus organsm, or both. it s very
common n chldren and s very easly spread,
but wth care spread can be reduced.
Impetigoappearsasafat,yellow,crusty
or most patch on the skn, usually on
exposed parts of the body such as the face,
arms and legs. the sores are often greater
than 1cm n dameter. it usually starts wth
a blster or a group of blsters
Dry, cracked skn s an deal area for growth
of bactera. ths nfecton spreads easly
to other parts of the nfected persons body.
it s transferred to other people by drect
contact wth sores or contamnated clothes.
StaPHyloCoCCuS
Staphlococcus (or staph) are bactera that
are found on the skn and n the nose
of people. Staph are usually harmless, but
they can sometmes cause nfecton and
serous llness.
StrePtoCoCCuS
Streptococcus (or strep) are bactera usually
known as ether group a or group B. group
a strep s often found n the throat and on the
skn and cause no symptoms of llness. Most
group a strep nfectons are relatvely mld
llnesses such as strep throat or mpetgo.
on rare occasons, these bactera can
cause other severe and even lfe-threatenng
dsease.
group B strep s the most common cause
of sepss (blood nfecton) and menngts
(infectionofthefuidandliningsurrounding
the bran) n newborns. group B strep s a
frequent cause of newborn pneumona.
inCubation Period
13 days.
infeCtiouS Period
Aslongasthereisfuidweepingfromthe
sores. Usually t has stopped beng nfectous
about 24 hours after treatment wth an
antbotc has started and healng has begun.
exCluSion Period
Exclude untl the chld has receved antbotc
treatment for at least 24 hours.
ProviderS and ParentS
any sores on exposed skn should be covered
wth a waterproof dressng.
infeCtion
Emphasse the mportance of good hand
washng procedures for all personnel and
chldren n the centre.
Sores on exposed surfaces should be
covered wth a waterproof dressng.
treatment
the doctor may recommend the use
of antbotc ontment or antbotcs taken
by mouth. refer the chld back to the doctor
f the condton does not mprove.
81
Measles
deSCriPtion
M
easles s a hghly nfectous and
serous vral llness. it begns wth
fever, tredness, a cough, a runny nose and
infamedeyes.Thesesymptomsusually
worsen over 3 days. the cough tends
to be worse at nght. the chld may avod
lightbecausetheeyesareinfamed.Atthis
stage, there may be small whte spots on
a red base present n the mouth on the
nsde of the cheek. Between days 3 and 7,
a rash begns at the har lne. the fever wll
stll be present when the rash begns. in 2448
hours, ths wll spread over the entre body.
When the rash reaches the legs, the rash on
the head and face begns to fade. the rash
usually dsappears after 6 days. Measles lasts
about 10 days. the cough may be the last
symptom to dsappear. a chld wth measles
usually feels very ll.
in a farly hgh number of cases, the measles
vrus causes serous complcatons, such
aspneumoniaorinfammationofthe
bran. that s why there s so much concern
about the dsease. Measles s not a smple
chldhood dsease.
the number of cases n australa has fallen
dramatcally over the past 10 years
as a result of mmunsaton programmes
and other publc health measures.
inCubation Period
infeCtiouS Period
about 45 days before the rash begns
untl the fourth day after the rash appears.
exCluSion Period
Exclude for at least 4 days after the
appearance of the rash.
ProviderS/Staff
all chldren wth a fever and a rash should
see a doctor. Copy the letter on page 20
andfllinthedetails.Ensuretheparents
realse that before takng a chld to a doctor
they must rng and nform the health staff
that they are brngng a chld wth suspected
measles. Measles can spread very easly
to other people n a doctors watng room.
Encourage the parents to ask the doctor
forabloodtesttoconfrm/excludemeasles.
inform the publc health unt mmedately.
(one case of measles s consdered
an outbreak.)
observe the excluson perod. if the chld
feels unwell, keep them home untl they are
feelng better.
advse any frends, famly or socal contacts
that your chld has measles. these contacts
may need to seek medcal advce f they are
pregnant, unmmunsed or have a medcal
condton whch compromses ther mmune
system (such as cancers, HiV/aiDS, some
medcaton).
infeCtion in tHe Centre
Measles s best prevented through
mmunsaton wth the MMr vaccne.
Chldren should be mmunsed at 12 months
of age and agan at 4 years of age. the
vaccne gves lastng mmunty. all chld
care staff born durng or snce 1966, ether
wthout vaccnaton records or are negatve
on blood test should be vaccnated both for
ther own protecton and to avod the rsk
of nfectng ther pregnant colleagues.
Ifyouhaveasuspectedordefnitecase
ofmeaslesthefrstthingyoumustdoisnotify
the publc health unt. Because measles s a
82
serous dsease, every effort s beng made
to elmnate the nfecton from australa.
the staff from the publc health unt wll assst
your centre and local doctors to control the
dsease.
Wrte down the dates that the chld/adult
wth measles was n the centre over the last
10 days.
Dscuss wth the publc health staff who n the
centre mght need preventve treatment and
who should be excluded from care.
Exclude a person wth measles for at
least four days after the rash appears.
Exclude chldren over 6 months
of age who have not had MMr
vaccne, ths wll be most babes
between 6 and 12 months of age
and some older chldren. Exclude
these chldren quckly and gve the
parents the dates that the case of
measles was n the centre. the un-
mmunsed chldren may return after
they have the approprate preventve
treatment. ths treatment wll depend
on ther age and when they were
exposed to the case of measles. they
may requre MMr vaccne or normal
immunoglobuln as advsed by the
publc health unt. MMr vaccne can
be used to protect unmmunsed
contact. to be effectve, MMr
vaccne must be gven wthn 72 hours
of contact wth the nfected person.
if they do not receve MMr vaccne
wthn 72 hours, they may be gven
normal immunoglobuln wthn 7 days
of exposure.
Babes under 6 months of age
probably stll have mmunty to
measles from ther mother and do not
need mmedate excluson. the baby
wll only be mmune f hs/her mother s
mmune. inform the parents of babes
under 6 months of age of a case of
measles n the centre. ask the mother
to contact the publc health unt
to dscuss whether her baby needs
treatment.
Exclude staff who were born after
1966 and who have no evdence
of havng receved 2 doses of the
vaccne or havng had measles. these
staff may return as soon as they are
vaccnated or have evdence from
a blood test that they are mmune.
People born before 1966
are consdered mmune because
of the measles vrus they would have
been exposed to n chldhood.
Exclude chldren or staff whose
mmune system s compromsed (such
as chldren wth some cancers, HiV/
AIDSorspecifctreatments)regardless
of ther vaccnaton status. Dscuss
wth the publc health staff and local
doctors when these people should
return.
inform any vstors to the centre, part-
tme staff, and parents of part-tme
chldren about a case of measles.
anyone who s not mmune and has
not receved preventve treatment
recommended by the publc health unt
must be excluded for 14 days after the
appearance of the rash n the laSt case
of measles n the centre.
treatment
none.
83
Molluscum
contagiosum
deSCriPtion
a
common skn nfecton caused by the
Molluscipox vrus.
the vrus causes small, usually 2-5mm,
panless, pnk or pearly whte lumps on the
skn. the top of the lump s ndented and
contans a whte core.
the nfecton s not serous, only affects the
skn, and wll dsappear wthout treatment,
although ths may take several months.
indvdual lumps often dsappear after about
two months, but often there wll be more
than one lump and they wll not all dsappear
untl 6-9 months. there are no long-term ll
effects followng molluscum contagiosum.
People who are mmunosuppressed may
have more lesons, and these may take
longer to clear up.
the vrus s spread by drect skn-to-skn
contact where there are mnor breaks
n the skn, and s most common n chldren.
inCubation Period
2-7 weeks, sometmes longer.
100
infeCtiouS Period
as long as the lumps are present. ths may
be for several months.
exCluSion Period
nl.
ProviderS/Staff
inform the drector of the nfecton.
inform chld care provder/staff of nfecton.
infeCtion
Drect contact wth the lumps should
be avoded.
Coverng lumps s not necessary.
treatment
lumps wll dsappear wthout treatment,
although ths may take several months.
Varous treatments such as laser therapy,
freezingandsurgeryareoccasionallyused
for cosmetc reasons.
84
Fungal infections of the
scalp, skin or nails
(ringworm, tinea, athletes foot)
deSCriPtion
t
hese nfectons are commonly called
rngworm but are not caused by worms,
but a spreadng area of fungal dermatts.
these nfectons are passed on by drect
skn contact or ndrectly by touchng
contaminatedarticles,clothingandfoors.
Whle some of these nfectons can be
caught from anmals, humans also have
some speces of fungal nfectons that
do not occur n anmals at all. Dfferent types
of anmals have dfferent types of fung that
cause rngworm. if a specmen from the
nfected area s cultured n the laboratory,
t s often possble to narrow down the source
of nfecton to humans, cats and dogs,
cattle, horses, pgs, etc.
Fungal nfectons can be found n dfferent
areas of the body (scalp, skn and nals).
the condton looks dfferent dependng
where t s locatedon the scalp, the nals,
the body or the foot.
Skin (otHer tHan of tHe SCalP,
bearded areaS and feet)
Thisappearsasafat,spreading,ring-shaped
leson. the outer edge s usually reddsh.
Itoftencontainsfuidorpus,butmayalso
be dry and scaly or most and crusted.
the centre of the patch may appear
to be healng.
foot (Commonly knoWn aS tinea
or atHleteS foot)
the characterstcs of ths common condton
are scalng or crackng of the skn, especally
between the toes, or blsters contanng a thn
wateryfuid.
toenailS and fingernailS
ths condton tends to be a long-term fungal
disease.Itisdiffculttotreat.Itusuallyaffects
one or more nals of the hands or feet.
the nal gradually thckens and becomes
dscoloured and brttle. Cheesy lookng
materal forms beneath the nal, or the nal
becomes chalky and dsntegrates.
ringWorm of tHe SCalP and beard
ths condton begns as a small pmple.
Itspreadsoutwardleavingfnescalypatches
of temporary baldness. infected hars
become brttle and break off easly.
inCubation Period
Vares wth the ste of nfecton. the
ncubaton perod for tnea of feet and nal
s unknown. the ncubaton perod for tnea of
the skn s usually 4 10 days. the ncubaton
perod for tnea of the scalp s usually 10 14
days.
infeCtiouS Period
as long as the condton perssts.
exCluSion Period
Exclude untl the day after approprate
treatment has been commenced.
ProviderS/Staff
observe excluson perod. Commence
approprate treatment. others n the famly
should be nspected for sgns of nfecton.
Follow good hand washng technques.
infeCtion
Seek approprate treatment early. Follow
good hand washng technques.
85
treatment
Theconditionfrstneedstobediagnosed
correctly. it s treated by applyng or takng
ant-fungal medcatons. these may need
to be used for a long tme f the nals are
nfected. Parents should seek medcal
advce.
rngworm n anmals can be treated wth
ant-fungal preparatons and tablets. these
can be obtaned from vets.
86
Roseola (exanthum
subitum, sixth disease)
deSCriPtion
t
hs common contagous vral nfecton
s marked by the sudden onset of a hgh
fever whch lasts 3 5 days and then falls,
at whch tme a rash appears. the rash may
look smlar to the measles rash, but appears
frstonthebody.Thehightemperaturecan
last from a few hours up to 3 5 days. the
rash lasts from a few hours to 1 2 days.
it usually affects chldren between the ages
of 6 months and 3 years.
101
although t can
lead to febrle convulsons, roseola s usually
a mld llness.
roseola s spread by arborne droplets
from the nose and throat, and ndrectly
by contact wth hands, tssues and other
artcles soled by nose and throat dscharges.
the dsease s also spread by drect contact
wth the salva of an nfected person.
inCubation Period
around 10 days.
infeCtiouS Period
Salva, nasal dscharge and other respratory
secretons are most nfectous from a few
days before untl several days after the rash
appears.
exCluSion Period
nl. if the chld feels unwell they should not
attend the centre untl they are feelng
better.
ProviderS/Staff
although there s no excluson perod for
roseola, f the chld feels unwell they should
not attend the centre untl they are feelng
better.
Control of SPread
Follow good hand washng procedures.
treatment
none.
87
Rubella
(german measles)
deSCriPtion
r
ubella s a mld vral dsease. the onset
of rubella s rather lke a mld cold, wth
a slght fever, sore throat and enlarged lymph
glands n the neck. the characterstc rash
appears 2-3 days later. it begns on the face
andspreadstothetrunk.Thespotsareatfrst
pale pnk n colour and soon merge to form
patches. the rash lasts only a few days and
then dsappears. Durng ths tme the chld
remans mldly unwell wth swollen glands
n the neck and back of the head.
rubella s spread through arborne droplets
or drect contact wth the nose or throat
secretons of nfected persons.
rubella usually causes only mld llness
n chldren. However, nfants born to mothers
whohadrubelladuringthefrst20weeks
of pregnancy may have severe brth defects.
the rsk s hghest n early pregnancy.
inCubation Period
1421 days, usually 14 - 17 days.
102

infeCtiouS Period
Up to 7 days before and at least 4 days after
appearance of the rash.
exCluSion Period
Exclude for at least 4 days after the
appearance of the rash and untl the chld
feels well.
ProviderS/Staff
refer anyone wth suspected rubella
to a doctor.
all staff members should be aware of ther
mmune status and f not mmune, they
should be mmunsed.
if pregnant staff members are concerned,
refer them to ther doctor. immunsaton
durng pregnancy should be avoded.
103

although mmunsaton for rubella durng
pregnancy s not recommended, the
nadvertent admnstraton of the vaccne
durng early pregnancy s not cause for
undue concern.
advse any pregnant frends or famly who
may have been exposed to consult wth ther
doctor.
infeCtion
the affected chld should reman away from
the centre for at least 4 days after onset
of the rash and untl fully recovered.
Chldren should be mmunsed twce aganst
rubella, at 12 months of age and agan
at 4 years of age. the rubella vaccne s
part of the MMr (measlesmumpsrubella)
mmunsaton.
anyone who works wth chldren should
be mmunsed or be certan that they have
had a blood test whch demonstrates that
they are mmune to rubella. if there s
aconfrmedoutbreakofrubella,non-
mmune pregnant women should be
excludedfor17daysafteridentifcation
of the last case.
treatment
nl.
88
Scabies and other mites
causing skin disease
deSCriPtion
S
cabes s an nfectous dsease of the
skn caused by a mte. Scabes and
other mtes causng skn dsease are
dagnosed by examnng a skn scrapng
under a mcroscope for mtes or eggs.
Scabes and other mtes usually cause
ntense tchng. Scabes s usually found
betweenthefngers,onthefrontofthewrists,
and n the folds of the elbows, wrsts, armpts,
buttocks and gentala. thread-lke tunnels
(about 10 mm long) may be present n the
skin,butareoftenverydiffculttosee.When
mtes have been transmtted from anmals
to humans, the mtes are commonly found
on contact areas, such as the arms, chest
and neck.
Scabes s usually transmtted by skn-to-
skn contact. Very rarely, t s spread on
underclothng or bed clothes that have
been freshly contamnated by an nfested
person. the mtes only lve for a few days off
the human or anmal body. although scabes
mtes from anmals can reman alve on
humans, they do not reproduce.
Some forms of skn dsease n anmals
caused by mtes (such as mange) can
also be spread to humans. if an anmal has
mange, t s mportant to have a veternaran
dagnose whch mte s causng the mange.
Some mange mtes on anmals can spread
to humans (for example, scabes and
Cheyletiella), whle others do not spread
to humans (for example, Demodex).
Sarcoptes (whch causes scabes) can nfest
a wde varety of anmals (ncludng cats and
dogs), whle Cheyletiella usually nfests rabbts
but can also nfest cats and dogs. Sarcoptes
and other anmal mtes can lve on humans,
but do not reproduce on them.
104
Scabes s not an ndcaton of poor
cleanlness.
inCubation Period
itchng begns 26 weeks after nfestaton
n people not prevously exposed to scabes
and wthn 14 days for people prevously
exposed. itchng due to Cheyletiella can
develop wthn hours of handlng the anmal.
infeCtiouS Period
Untl the mtes and eggs are destroyed
by treatment.
exCluSion Period
the chld s to be excluded and may return
to the centre the day followng treatment.
ProviderS/Staff
report mte nfestatons to the drector.
any anmals n the chld care centre wth skn
dsease caused by mtes (mange) should
be treated. a vet should examne a skn
scrapingtoconfrmthepresenceofmites
and dentfy whether the mte can spread
to humans.
observe excluson perod.
See controllng the spread of nfecton
for further responsbltes.
infeCtion
all close (skn-to-skn) contacts and other
people n the same household should be
treated at the same tme, even f no tchng
or other symptoms are present. By the tme
scabes s dagnosed n one person, many
other people may have been nfested. if
everyone s not treated at the same tme,
treatment s lkely to be unsuccessful.
Contamnated underwear, bed lnen and
other clothng worn by nfested people n the
48 hours pror to treatment should be washed
89
n hot water and detergent. all tems such
as toys whch cannot be washed or dry-
cleaned should be placed n a plastc bag
for 4 days to kll any mtes or eggs.
it s not lkely that scabes wll be spread
by furnture, carpets, mattresses, etc but they
could be vacuumed or gently roned.
treatment
Skn dsease caused by mtes can easly
be confused wth other skn dseases.
treatment should not begn untl a doctor
hasconfrmedthediagnosisfollowing
examnaton of a skn scrapng for mtes. ths
s partcularly mportant for babes, pregnant
women or people who already have other
forms of skn dsease.
treatment nvolves applcaton of nsectcdal
cream, loton or soluton as prescrbed by
a doctor. if the mte has spread wthn the
centre, all staff and chldren wll need to
be treated at the same tme.
anmals wth skn dsease caused by mtes
(mange) should be treated. a vet should
examineaskinscrapingtoconfrmthe
presence of mtes and dentfy whether the
mte can spread to humans. anmals and
ther beddng should then be treated wth
nsectcdal washes, accordng to the vets
nstructons.
90
Scarlet fever
deSCriPtion
S
carlet fever begns suddenly, sometmes
causng a convulson n a very young
chld. it begns wth a sore throat, hgh
temperature and frequent vomtng. ths
isfollowedwithin1236hoursbyafnered
rash on the lmbs and trunk and reddenng
of the tongue (strawberry tongue). ths
appearsfrstontheneckandchest,rapidly
spreadingoverthebody,fnallyreachingthe
legs. Durng the recovery from the nfecton,
theskinmaypeeloffthefngersandtoes.
105
Scarlet fever s caused by a streptococcal
nfecton (see Sore throats and strep throat
on page 50).
it s spread drectly by contact wth arborne
droplets(coughingandsneezing),or
ndrectly by contamnated hands, tssues,
soled by the nose and throat dscharges
of an nfected person.
inCubation Period
Usually 13 days.
infeCtiouS Period
For about 24 hours after approprate
treatment begns. Untreated people reman
nfectous as long as they are sck. ths s
usually 37 days.
exCluSion Period
Exclude untl the chld has receved antbotc
treatment for at least 24 hours and they feel
well.
ProviderS/Staff
advse the parent to seek medcal
assessment and treatment as untreated
scarlet fever may result n serous llness.
Parents must keep the chld home for the
excluson perod.
infeCtion
Follow good personal cleanlness practces.
Cover the nose and mouth when coughng
orsneezing.Disposeofsoiledtissues
approprately. always follow ths wth proper
hand washng. Do not share eatng utensls,
food or drnkng cups. Wash toys that nfants
and toddlers put n ther mouths.
treatment
Penclln or other effectve antbotcs as
prescrbed by a doctor. take the full course
of antbotcs.
91
Thrush (candida)
deSCriPtion
t
hrush s a common nfecton n the mouth
of babes, on rashes (especally nappy
rashes and rashes n most places such as
under the chn of a drbblng baby), on the
npples of breastfeedng mothers and n the
vagna of women. it can be very rrtatng but
t s treatable.
thrush s caused by a yeast (a very small
lvng cell) called candida. Most people
have candida on ther skn, n ther mouths
and n ther gut most of the tme wthout
havng any problems wth t.
106
Sometmes
the candida can start growng fast and can
cause an nfecton (thrush).
thrush s common n very young babes
and nfants. they are susceptble at ths
tme because ther mmune systems are stll
mmature. thrush s often found nsde the
mouthaswhitespotsorfakesthatcannot
be removed by cleanng the mouth. another
ste of nfecton s the vulva and vagna.
Frequently thrush s a secondary nfecton
to nappy rash. thrush s spread by drect
contact wth fung lvng n the mouth, vagna
and faeces and on the skn. a mother can
nfect her newborn baby durng the brth.
inCubation Period
Varable, but 25 days n nfants.
infeCtiouS Period
Aslongasthewhitespotsorfakesare
present.
exCluSion Period
nl.
ProviderS/Staff
if bottle feedng, clean and sterlse teats
and dummes (or replace them) to prevent
re-nfecton.
any nappy rash that s not clearng after
3 days, or not respondng to your usual
cream, may nvolve thrush and needs
treatment.
infeCtion
Make sure effectve hand washng and
cleanng procedures are beng practsed.
treatment
For moderate to severe nfecton of the
mouth or the vulva/vagna the parent should
take the chld to a doctor. the doctor may
prescrbe ant-fungal medcatons. Wash
the affected area wth water, apply the
prescrbed cream, and expose the nappy
area to ar as much as possble.
92
Warts (common, plane
and plantar)
deSCriPtion
W
arts are thckenngs of the skn, usually
round or oval shaped, and clearly
dfferent from the surroundng skn. Warts
are caused by a vrus nfecton of the skn
(Human papillomavirus). the vrus enters the
skn through scratches or other damage
to the skn. People cannot get warts from
anmals.
107
there are many types of warts.
Common warts develop on the skn
of chldren and adolescents. they manly
occur on the knuckles, backs of hands and
knees. occasonally, common warts come
out n a crop. they are usually rased and
separate from each other. they are spread
by skn-to-skn contact such as holdng hands.
Plane wartsarefat-topped.Theyaremost
commonly found on the face and on the
back of the hands. they occur n lnes where
the vrus has nfected a scratch.
Plantar warts occur on the soles of the
feet. they are found mostly n older chldren
and adolescents. infecton can come from
walkingwithbarefeetonwetfoorssuch
as n school or swmmng pool change rooms.
Plantar warts can be qute panful, unlke
other warts.
inCubation Period
2-3 months
108
, but ranges from 120 months.
infeCtiouS Period
Unknown, but f untreated probably as long
as warts can be seen.
exCluSion Period
nl.
ProviderS/Staff
advse chldren not to pck or scratch
at warts. Wash and dry hands after any
contact wth warts.
infeCtion
avod drect contact wth warts.
cleanng procedures are beng practsed.
treat warts f the affected area s exposed
(for example, on the hands or legs). after
treatment the warts are not contagous.
the wart vrus may enter va most skn
surfaces, such as abrasons and cuts.
therefore t s mportant to get chldren to:
dry hands well after washng them;
cover abrasons and cuts wth a clean
dressng; and
wear shoes to protect the feet.
treatment
Warts wll usually go away naturally, but
ths may take a long tme. if treatment s
necessary the followng may be used:
lqud ntrogen;
Chemcal paste applcatons; or
laser therapy.
93
otHer ComPlaintS
Conjunctivitis
deSCriPtion
C
onjunctivitisisaninfammationofthe
conjunctva, the clear membrane that
covers the whte part of the eye and lnes the
innersurfaceoftheeyelids.Theinfammation
can have many causes, the commonest of
whch are nfecton, allergy and rrtaton.
109

Infectious conjunctivitis s usually caused
by ether bactera or vruses. if t s caused
by a bactera both eyes are almost always
nfected, although t may start n one eye.
there s lkely to be a grtty feelng and pus.
Conjunctvts from a vrus may nvolve one
or both eyes, causng red, tchy eyes and
waterng of the eyes.
Allergic conjunctivitis occurs more frequently
among chldren wth allergc condtons such
as hay fever. if t comes from an allergy, there
are often other sgns of allergy such as tchy
noseandsneezing,theeyesfeelitchyand
are watery.
110
allergc conjunctvts typcally
affects both eyes at the same tme.
Irritant conjunctivitis can be caused
by chemcals such as those n chlorne
and soaps or ar pollutants such as smoke
and fumes.
allergc and rrtant conjunctvts s not
nfectous.
the dfferent types of conjunctvts can have
dfferent symptoms. in addton, symptoms
can vary from chld to chld. one of the most
common symptoms s dscomfort or pan
n the eye, whch may feel lke havng sand
n the eye. Many chldren have redness of
the eye. they may also have swollen eyelds
and be senstve to brght lghts.
Dscharge from the eye may accompany the
other symptoms. in nfectous conjunctvts
caused by bactera, the dscharge wll be
somewhat thck and coloured whte, yellow
or green. Sometmes the dscharge wll
cause the eyelds to stck together when
94
the chld awakens n the mornng. in allergc
conjunctvts or nfectous conjunctvts
caused by a vrus, the dscharge may
be thnner and may be clear.
Vral and bacteral conjunctvts can
be spread by drect contact wth eye
secretons or ndrectly by contact wth
towels, washcloths, and tssues etc that
have been contamnated wth eye
secretons. in some cases t can be spread
byinsectssuchasfies.
inCubation Period
2472 hours.
infeCtiouS Period
Vral and bacteral conjunctvts are
nfectous whle there s dscharge from the
eye. Conjunctvts caused by chemcals
or allerges s not nfectous.
exCluSion Period
Exclude untl the dscharge from the eyes
has stopped unless doctor has dagnosed
a non-nfectous conjunctvts.
ProviderS/Staff
inform the drector and the parents of the
chld.
the chld should see a doctor for proper
dagnoss and treatment.
observe the excluson perod. the chld
should see a doctor for proper dagnoss
and treatment.
infeCtion
Effectve hand washng s essental, especally
before and after touchng the eyes or face.
Do not share towel, washcloths, etc.
treatment
antbotc eye drops or ontment may
be prescrbed by a doctor. regular cleanng
of the eyes may make the chld feel better.
it s mportant to use a separate cotton wool
ball or tssue for each eye to avod cross-
nfecton and use warm but not hot water.
Wipetheclosedeyegentlybutfrmlyto
remove the excess pus do not clean nsde
the eyelds as ths may cause damage to the
conjunctva or the cornea (the clear front of
the eye).
95
Cytomegalovirus (CMV)
deSCriPtion
C
ytomegalovrus (CMV) s a common
vrus worldwde. CMV s a member
of the herpes vrus group but t cannot
cause other herpes nfectons.
111
Most CMV
nfectons cause ether no symptoms or only
mld symptoms. occasonally, symptoms
smlar to glandular fever can occur (see
page 96). these nclude fever, sore throat
and swollen glands.
once people are nfected wth CMV they
are thought to reman nfected for the rest
of ther lves, even when they do not become
ll. Sometmes the vrus can be reactvated
such as at tmes of other llnesses or stress,
and may then cause symptoms.
112
Durng
an nfecton the vrus can be spread n
many ways, for example through coughng,
through contact wth blood, faeces or salva.
infecton can also occur before brth, at brth,
or early n lfe.
Most women (5060%) have been
nfected wth CMV n the past and f they
are nfected a second tme the rsk to
the unborn baby s very small. However,
women who are nfected wth CMV for the
frsttimewhilepregnantmayinfectthe
unborn baby. infecton of the unborn baby
occasonally leads to eye dsease, deafness,
developmental delay or death. therefore
pregnant women who are carng for young
chldren need to be partcularly careful and
t s a good dea for chldcare workers who
areconsideringpregnancytofndoutifthey
are mmune to CMV.
inCubation Period
not accurately known. Probably 312 weeks.
infeCtiouS Period
the vrus s often shed for months n urne
or salva. infants can shed the vrus for months
to years followng nfecton or reactvaton
of the vrus.
113
exCluSion Period
nl.
ProviderS/Staff
report the nfecton to the drector. the
drector may then need to revew wth staff
the need for good personal cleanlness.
if a pregnant woman s known to be non-
mmune, consder relocatng her to care for
chldren older than 2 years of age as these
chldren are less lkely to be nfectous.
114
good hand washng after handlng artcles
contamnated wth urne or salva, partcularly
after changng nappes.
infeCtion
good hand washng, and washng of shared
toys etc; should be done all the tme, not
only when a chld s known to be unwell.
Women of chld bearng age workng wth
young chldren should always practse good
personal cleanlness, especally:
good hand washng after contact
wth body secretons, and especally
after changng nappes or assstng
n tolet care;
not kssng nfants on the mouth
(huggng s acceptable).
treatment
Usually none s requred.
96
Glandular fever (Epstein
Barr virus, Infectious
Mononucleosis)
deSCriPtion
a
n nfecton caused by the Epsten Barr
vrus (EBV). once a person catches
Epsten Barr vrus, t s beleved that the vrus
remans n ther body for lfe, though t usually
does not cause further llness. By adulthood,
90 95% of people have EBV.
115
Symptoms of acute glandular fever nclude
fever, sore throat and swollen glands.
Stomach pan and jaundce (yellowng
of skn and eyes) occur less frequently.
Symptomatc nfecton most often occurs
n older chldren and young adults. When the
nfecton occurs n young chldren, symptoms
are mld or absent. Ffty percent of people
nfected have no symptoms of nfecton
at all. the llness can last between one
and several weeks.
the dsease s spread from person-to-person
through contact wth salva. young chldren
may be nfected by salva on the hands
of care gvers or by suckng and sharng toys,
but the vrus doesnt survve very well n the
envronment.
inCubation Period
4 6 weeks.
infeCtiouS Period
not accurately known. the vrus s shed
n the salva for up to one year after llness
and ntermttently after that.
exCluSion Period
nl.
ProviderS/Staff
if the chld s unwell, advse the parent that
feelng better (ths s out of concern and
consderaton of the chld t s not
an nfecton control ssue for the centre).
if the chld s unwell, the chld should stay
at home untl they are feelng better.
infeCtion
Follow good hand washng technques.
Mnmse contact wth salva where possble.
avod sharng cups.
treatment
there s no effectve antvral medcaton
avalable. Most people wth glandular fever
recover eventually.
97
Haemophilus infuenzae
type b (Hib)
deSCriPtion
B
efore the ntroducton of Hb mmunsaton
n 1993, the bacteral nfecton
Haemophilus infuenzae type b was one
of the most common causes of menngts
n young chldren (usually under the age
of 2 years), and the most common cause
of epglottts, whch causes breathng
diffculties.
116
it can also cause pneumona,
jont nfecton or cellults (nfecton of the
tssue under the skn). it s not related to the
virusthatcausesinfuenza.
Symptoms of menngts nclude severe
headache,stiffneck,fts,severedrowsiness,
diffcultywakingup,andloss
of conscousness.
117

the dsease s spread drectly from person-
to-person, by contact wth arborne droplets
from the nose or throat, or ndrectly, by
contact wth artcles contamnated wth
dscharges from nose or throat.
inCubation Period
24 days.
infeCtiouS Period
Hb s nfectous as long as there are
organsms present n the nose and throat.
Hb s not able to be spread after recevng
1-2 days of an approprate antbotc.
exCluSion Period
Exclude untl the person has receved
approprate antbotc treatment for at least
4 days.
118
ProviderS/Staff
report the nfecton to the drector. any chld
wth the above symptoms should be seen
by a doctor mmedately. See Controllng
the spread of nfecton below.
infeCtion
Hb can be prevented by mmunsaton.
Fully mmunsed communtes offer the best
protecton aganst Hb.
Check the mmunsaton records of all
chldren n contact wth a chld wth Hb.
Unmmunsed chldren who have had close
contact wth the chld wth Hb wll need
specal antbotcs.
if needed, the publc health authortes may
help arrange for other chldren and staff
to be gven courses of the antbotc
rfampcn by mouth.
adults may also be gven the antbotc. they
are not at rsk of dsease but may be carryng
the germ n ther throat.
treatment
a chld wth Hb wll be treated n hosptal
wth antbotcs.
98
Hepatitis A
deSCriPtion
H
epatts a nfecton s caused by the
Hepatitis A vrus. the vrus grows wthn
the lver, and passes nto the ntestnes. the
man way t s spread s through faeces,
when the faeces gets onto the hands of
other people, and then moved from hands
to mouth. it can also be spread through
contamnated water or food (when faeces
gets nto the water supply or onto food).
Chldren under the age of 3 years rarely
have symptoms.
119
older chldren and adults
are more lkely to have symptoms lastng
one to two weeks, or n severe cases, up to
several months. Symptoms, when present,
may nclude abdomnal dscomfort, loss
of appette, nausea, low-grade fever and
tredness, sometmes followed by yellow skn
and eyes, dark urne and pale faeces.
inCubation Period
1550 days, usually 28-30 days.
infeCtiouS Period
a person s most nfectous n the two weeks
before yellowng (jaundce) occurs, and then
slightlyinfectiousduringthefrstweek
of havng jaundce.
exCluSion Period
Excludeuntilamedicalcertifcate
of recovery s receved, but not before seven
days after the onset of jaundce or llness.
ProviderS/Staff
ThefrstsignofahepatitisAoutbreakislikely
to be an ll parent or employee, not an ll
chld. the drector should mmedately notfy
and seek help from the local publc health
unt.
observe excluson perod. Follow good
personal hygene practces, especally
effectve hand washng.
infeCtion
it s mportant for the nfected person
to consult ther doctor. the doctor may
offer mmunoglobuln to all people lvng
n the same house as the nfected person.
if gven wthn 14 days after exposure,
mmunoglobuln may prevent hepatts
a or lessen the severty of the symptoms.
120

the staff from the local publc health unt wll
advse on the need for mmunoglobuln for
chldren and chld care staff n the centre.
Make sure that good hand washng and
cleanng procedures are beng followed
n the centre and at home.
Hepatts a vaccne s recommended for
chld care staff, partcularly those who care
for chldren who are not tolet traned.
Hepatts a vaccne s recommended for
aborgnal and torres Strat islander chldren
lvng n Queensland, northern terrtory,
Western australa and South australa,
because of the hgher burden of dsease
from hepatts a these chldren experence.
For all other chldren, hepatts a vaccne
s not recommended because nfecton
does not usually occur n these chldren
and s usually mld wth lttle or no llness.
treatment
there s no treatment for hepatts a but
symptoms can be eased wth medcatons.
99
Hepatitis B
deSCriPtion
H
epatts B nfecton s caused by the
Hepatitis B vrus. the Hepatitis B vrus
s spread through drect contact wth
nfected blood and blood products, and
throughsaliva,semenandvaginalfuids.
it can also be spread from an nfectous
mother to her baby at the tme of brth.
although the vrus has been solated n urne
and faeces, t has not been proved to be
nfectous n these products.
it s not spread through food or water
or through ordnary socal contact.
Women who have ths dsease durng
pregnancy may transmt t to ther newborn
babes. Many of these babes become long-
term carrers of the vrus.
Symptoms of hepatts B may nclude
abdomnal dscomfort, loss of appette,
nausea, fever, tredness, jont pan, dark urne,
and yellow skn or eyes (jaundce). about 50%
of adults and 90% of chldren do not develop
any symptoms at the tme of nfecton.
121
inCubation Period
26 months.
infeCtiouS Period
From about one month before jaundce
occurs to the end of the tme when they
feel ll, (about 13 months after jaundce
appears). People wth chronc hepatts
B may carry the vrus for lfe and always
be able to nfect others.
exCluSion Period
Excluson s not necessary.
a chld who s unwell may need to stay away
ProviderS/Staff
if the chld feels unwell, they should reman
at home untl they feel better.
infeCtion
Effectve vaccnes are avalable, and
are now routnely gven at brth, 2, 4 and
6 months of age. a course of 3 njectons
over 6 months can be gven at other ages
for people who have not prevously been
vaccnated. Completon of a full course
of vaccne wll gve protecton aganst
hepatts B nfecton n over 90% of people.
122
Hepatts B mmunoglobuln s offered to non-
mmune people havng close contact wth
a person known to be nfected wth hepatts
B n the followng stuatons:
after brth;
after needle sharng or needlestck
njury; and
after sexual exposure;
Standard nfecton control prncples should
be employed n all stuatons dealng wth
blood-contamnated tems, regardless
of whether or not t s known that a chld has
a blood borne vrus. More nformaton on ths
subject s gven on page 30.
re-emphasse good hand washng and
cleanng practces.
Cover any open sores, cuts or abrasons that
are weepng or most.
treatment
Thereisnospecifctreatmentforacute
hepatts B. Chronc hepatts B can now
be managed wth a range of drugs that
decrease the amount of vrus n the
body and mprove the lver dsease (e.g.
interferon).
123
100
Hepatitis C
deSCriPtion
H
epatts C nfecton s caused by the
Hepatitis C vrus, whch s carred n the
blood and causes damage to the lver. the
vrus s found n the blood of an nfected
person. transmsson of hepatitis C only
occurs va blood to blood contact, where
the blood of an nfected person gets nto the
bloodstream of another person. People most
at rsk are those wth a hstory of njectng
drug use, tattoos, body percng, blood
transfuson or haemohla treatment before
1990. about 2-5%
124
of nfected mothers wll
pass hepatts C to ther babes durng brth.
there s no rsk from fathers wth hepatts C
at concepton or durng delvery.
Hepatts C s not transmtted though ar or
water, the sharng of plates, cups or cutlery,
swmmng pools tolets, kssng, coughng,
sneezingorspitting.
125
out of 4 people found to be nfected wth
the hepatts C vrus:
1 person wll elmnate the vrus from
ther bodes spontaneously wthn the
frst612monthsofinfection;and
3 people wll go on to develop
chronc hepatts C nfecton; and
some wll develop lver damage.
Symptoms of hepatts C may nclude
abdomnal dscomfort, loss of appette,
nausea, fever, tredness, jont pan, dark urne,
and yellow skn or eyes (jaundce). the vrus
may be carred wthout symptoms.
inCubation Period
6-8 weeks.
infeCtiouS Period
Indefnitely,inthosewithchronichepatitisC.
the blood of the nfected person must enter
nto the blood stream of another person for
the vrus to be transmtted.
126
exCluSion Period
a chld who s unwell may need to stay away
ProviderS/Staff
if the drector s nformed that a chld
hashepatitisC,confdentialitymustbe
mantaned.
127
to protect the lver from further vral
nfectons, t s mportant that the chld
be vaccnated aganst hepatitis A
and hepatitis B, f they are not already
vaccnated or mmune.
128

infeCtion
Standard nfecton control prncples should
of whether or not t s known that a chld
has a blood borne vrus.
129
More nformaton
on ths subject s gven on page 30.
treatment
treatment ams to clear hepatts C from
the body and mnmse damage to the lver.
Hepatts C treatment has advanced rapdly
n the past few years and around 80% of
people wth some strans of hepatts C, and
about 50 to 60% of all people treated wth
current therapy, clear the vrus
130
from ther
bodes.
101
HIV (Human
Immunodefciency
Virus), AIDS (Acquired
Immune Defciency
Syndrome)
deSCriPtion
H
iV s a vrus carred n blood and body
fuids.Itdamagestheimmunesystem
of the person nfected to the extent that the
person becomes susceptble to a varety
of common and rare dseases. HiV nfecton
iscalledAIDS(AcquiredImmuneDefciency
Syndrome) when t becomes fully developed
n the body. People wth aiDS contract
repeated nfectons wth unusual organsms
and cancers that do not normally affect
people wth healthy mmune systems.
there s no evdence that HiV s spread from
chld to chld n chld care, pre-school
or school through normal socal contact.
HiV s not transmtted through ar or water, the
sharng of plates, cups or cutlery, swmmng
pools,toilets,kissing,coughing,sneezing
or spttng. there s no evdence that HiV
can be spread by mosqutoes or other btng
nsects, as the vrus des rapdly outsde the
human body.
HiV can be spread by:
Unprotected sexual ntercourse (anal
or vagnal) wth an nfected person.
Sharng of njectng drug equpment.
infecton passng from mother to chld
just before or durng brth, or through
breast mlk. However, n australa there
have been very few cases of chldren
beng nfected before, durng or
after brth when born to HiV nfected
mothers. in australa, from 2001 2004
96
131
chldren were exposed to HiV
before, durng or after brth, and
two were subsequently found
to be nfected.
Penetraton of the skn by nfected
blood.
inCubation Period
Varable. the tme from nfecton
to development of detectable antbodes
s generally 1 3 months.
132
Symptoms of the
dsease may not be evdent for months
or even years after HiV nfecton. in adults,
an llness lke glandular fever occurs a month
or so after nfecton n about 50% of people.
Wthout treatment, most ndvduals develop
severeimmunedefciencywithin5-10
years.
133

infeCtiouS Period
People become nfectous about 2 - 4 weeks
after beng exposed to the HiV vrus. a blood
test for antbodes to the vrus wll show
whether a person has been n contact wth
and become nfected by the HiV vrus. at
the moment HiV nfecton s consdered to be
lfelong. there have been no reported cases
of nfecton wth the vrus through ordnary
socal contact, through nvolvement wth
schools, pre-schools or chld care centres,
or through ordnary nonsexual famly contact.
exCluSion Period
Chldren who have developed mparment
of mmunty should reman away from school
durng outbreaks of serous contagous
dseases such as measles or chckenpox.
Chldren wth HiV are more susceptble
to such nfectons.
ProviderS/Staff
if the chld care faclty drector s nformed
thatachildhasHIV,confdentialitymust
be mantaned.
Followng medcal advce, t can be
expected that parents would consult wth
chld care staff f ther chld has HiV nfecton.
102
Such chldren are more lkely to have
severe nfectons than others, and more
consderaton and care must be gven to
ther mmunsaton wth common vaccnes.
infeCtion
Standard nfecton control practces should
of whether or not t s known that a chld has
a blood borne vrus. More nformaton on ths
subject s gven on page 30.
treatment
For patents wth HiV and/or aiDS, medcal
practitionersusespecifcdrugs(forexample,
antbotcs and antretrovral drugs)
to overcome HiV-related llnesses. Drugs
that nterfere wth the replcaton of HiV
are avalable. these drugs do not cure HiV
or aiDS, but help to lmt ts progress and ts
nfectvty.
103
Meningococcal infection
deSCriPtion
a
severe nfecton caused by Neisseria
meningitidis bactera, also commonly
known as the the menngococcus. there
are 13 dfferent groups of menngococcus,
but most nfectons n australa are caused
by groups B and C. the menngococcus s
carred harmlessly n the nose and throat
of up to 20% of people.
134
in a small number
of people, for uncertan reasons, the
menngococcus wll spread from the nose
and throat nto the blood stream, and cause
serous llness. Menngococcal dseases can
affect all age groups, but s most common
n chldren under 5 years of age, and n the
15-24 years group. in australa, 5 to 10% of
people
135
who have menngococcal dsease
de wthn a few hours of becomng unwell
despte rapd treatment.
Symptoms n babes and young chldren
nclude fever, refusng feeds, fretfulness,
vomtng, rash of reddsh purple spots
or bruses, hgh-ptched or moanng cry, pale
orblotchyskin.Thechildmaybediffcultto
wake.
the bactera s spread n respratory
secretons by close and prolonged person-
to-person contact such as occurs n a
household. Menngococcal dsease can
happen at any tme of the year, but s most
common n wnter and sprng.
inCubation Period
Usually 34 days.
infeCtiouS Period
the chld s nfectous as long as organsms
are present n the nose and throat. ths wll
be less than 24 hours after they are treated
wth effectve antbotcs.
exCluSion Period
Exclude untl a course of an approprate
antbotc has been completed.
136
ProviderS/Staff
a chld wth ths nfecton should see a doctor
mmedately. the drector should mmedately
nform and seek help from the local publc
health unt.
any very close contacts of someone wth
menngococcal dsease, such as famly
members, need a short course of antbotcs
to kll any of the bactera they may have
n ther nose or throat. all very close contacts
are usually treated because there s no easy
andquickwayoffndingoutwhomayhave
the bactera n ther nose or throat.
infeCtion
if approprate, publc health authortes
wll arrange for other chldren and staff
of the centre to be gven a course
of an approprate antbotc.
Careful hygene practces are mportant
to prevent the spread of any nfecton.
these nclude effectve hand washng and
approprate dsposal of used tssues. the
menngococcus does not survve for long
outsde the human body.
Menngococcal C nfecton can be
prevented by mmunsaton. Menngococcal
C mmunsaton s recommended for all
chldren at 12 months of age. Fully mmunsed
communtes offer the best protecton aganst
menngococcal C nfecton. Menngococcal
C vaccnaton does not protect aganst
menngococcal B nfecton.
treatment
a chld wth menngococcal nfecton wll be
treated n hosptal wth antbotcs.
104
Mumps
deSCriPtion
M
umps s an nfecton caused by a
vrus. Mumps s now uncommon, snce
chldren are mmunsed aganst t, but before
the days of mmunsaton, most people had
mumps when they were chldren (most often
between 5 and 9 years of age).
Symptoms, when present, nclude swellng
of one or more of the salvary glands, hgh
fever and headache. about 30% of people
wth mumps wll have only mld symptoms
or no symptoms at all. in males, tenderness
n the testcles may occur. Females may have
some lower abdomnal pan.
Complcatons can occur, ncludng
infammationofthespinalcordandbrain,
hearng loss, sterlty (very rare) or death
(extremely rare).
Spread s by drect contact wth droplets from
thesneezeorcoughofaninfectedperson.
inCubation Period
infeCtiouS Period
Up to 6 days before swellng of the glands
begns and up to 9 days after the onset
of swellng.
exCluSion Period
Exclude the chld from the centre for 9 days
after onset of swellng.
ProviderS/Staff
infeCtion
Mumps can be prevented by mmunsaton.
Fully mmunsed communtes offer the
best protecton aganst mumps. Chldren
should be mmunsed aganst mumps at 12
months of age and agan at 4 years wth the
measlesmumpsrubella (MMr) vaccne.
it s recommended that non-mmune staff
are mmunsed.
137
the vaccne provdes
long-term mmunty. illness provdes lfelong
mmunty.
Careful hygene practces are mportant
to prevent the spread of any nfecton.
these nclude effectve hand washng and
approprate dsposal of used tssues.
treatment
none.
105
Toxoplasmosis
deSCriPtion
t
oxoplasmosisisaprotozoaninfection.Itis
contracted by eatng raw or undercooked
meat, or through contact wth cat faeces.
apart from transmsson from mother to
unborn chld, person-to-person spread
does not occur. toxoplasmoss n pregnant
women can affect the unborn chld. it may
cause rashes, damage to the chlds nervous
system, lver or other organs or, rarely, death.
Usually, though, the newborn baby s not
affected at all. in australa, very few cases of
affected newborn chldren have occurred.
toxoplasmoss acqured after brth usually
results n ether no symptoms or mld llness.
When mld llness occurs, common symptoms
are enlarged lymph nodes, muscle pan,
ntermttent fever and generally feelng ll.
Toxoplasmosisinfectionisconfrmedby
a doctors examnaton and blood tests.
no mmunsaton s avalable.
inCubation Period
Uncertan, but probably from several days
to months.
infeCtiouS Period
infected meat s not safe untl cooked
properly.Freezingmeatdoesnotnecessarily
make t safe. Cat faeces contanng
toxoplasma can become nfectous 24 hours
after beng passed.
exCluSion Period
nl.
ProviderS/Staff
report a dagnosed case to the drector.
See Controllng the spread of nfecton.
infeCtion
Cook meat adequately. Hands, knves and
other ktchen utensls should be thoroughly
washed after beng n contact wth raw
meat.
Dspose of cat faeces and ltter daly (as t
can become nfectous after 24 hours). Wear
gloves when handlng cat faeces or ltter
trays. Dsnfect ltter trays daly by scaldng
wth bolng water.
Pregnant women wthout antbodes
to toxoplasma should avod cleanng ltter
trays and avod contact wth cats
of unknown feedng hstory.
Cover chldrens sandpts when not n use
and keep stray cats away from the sandpt.
Feed cats dry, canned or boled food.
Dscourage them from huntng and
scavengng.
treatment
Medicationisavailableforsignifcant
nfectons. in most people, nfecton passes
unnotced.
106
Viral meningitis
deSCriPtion
V
ral menngts s an nfecton
of the coverng of the spnal cord
or bran caused by a varety of vruses,
most commonly those assocated wth
gastroenterts
138
(infammationofthe
stomach and ntestnes). other examples
of vruses that can cause menngts are
measles, mumps, chckenpox and herpes.
139

Vral menngts s relatvely common, but
rarely serous, though symptoms may
be severe. recovery s usually complete.
Symptoms may nclude headache, fever,
vomtng, neck stffness and jont pan,
drowsness or confuson and photophoba
(dscomfort when lookng at brght lghts).
Spread s by drect or ndrect contact wth
droplets from the nose or throat of nfected
people, or by contact wth nfected faeces
or contamnated surfaces.
inCubation Period
Variesaccordingtothespecifcinfectious
vrus.
infeCtiouS Period
Variesaccordingtothespecifcinfectious
vrus.
exCluSion Period
Exclude untl well.
ProviderS/Staff
Chld care staff should nform the parents
mmedately f ther chld has symptoms.
Parents should then seek medcal help.
feelng well.
infeCtion
Make sure effectve hand washng
procedures are beng followed.
treatment
Unless t s very clear what the cause s (e.g.
obvous mumps) a lumbar puncture may be
needed to tell whether or not there s a
bacteral nfecton. a lumbar puncture s
when a needle s put nto the spne n the
lowerbacktocollectsomeofthefuidfrom
around the bran and spnal cord. antbotcs
may be started just n case but these wll
not treat the vrus. once t s certan that
t s a vral nfecton, no specal treatment
s needed.
Part 3
Glossary and Resources
g
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y

a
n
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s
107
Glossary of terms
Bactera a group of small mcro-organsms (larger than vruses) that lve
n the sol, plants and anmals as well as n the body. not all
bactera are harmful, although some may cause llness
or produce a poson known as a toxn.
Cleanng removng nfectous agents and matter from surfaces. Cleanng
by washng or scrubbng wth warm water and soap
or detergent, followed by rnsng and dryng removes the bulk
of germs from surfaces. germs are unable to multply on clean,
dry surfaces.
Contact a person who has had the opportunty to acqure an nfecton
fromaspecifedtypeofexposureduringtheinfectiousperiod.
Contagous dsease a dsease that can be passed from one person to another.
it s the same as an nfectous dsease.
Dermatts Anyconditionoftheskinwherethereisinfammation.
Infammationisusuallymarkedbyrednessandswelling.
Drector the person n charge.
Dsnfecton Kllng nfectous agents that are outsde the body by chemcal
or physcal means.
Endemc a dsease or nfectous agent present n a communty or regon
at all tmes.
Epdemc an llness or dsease whch attacks many people n a communty
or regon at the same tme. it may spread rapdly over a wde
area.
Febrle convulson Convulsion(ft)whenachildhasafeverorhightemperature.
germ a mcro-organsm, e.g. bactera, vrus or fungus that may cause
dsease.
immune ndvdual a person who s hghly resstant to a dsease. a person becomes
mmune as a result of mmunsaton or from prevous nfecton.
108
immunsaton the process of makng a person mmune by use of oral
or njected vaccnes.
immunty resstance to an nfecton. a person acqures mmunty after
havng an nfecton or by beng mmunsed. the persons body
can then recognse and destroy the mcro-organsms that cause
that nfecton before symptoms occur.
immunoglobulns Protens whch protect the body aganst nfectous mcro-
organsms. they do ths by carryng antbodes that can kll the
nvadng organsms. immunoglobulns can be njected to gve
mmedate protecton aganst dseases such as hepatts a,
hepatts B, tetanus, measles, etc. ths protecton s temporary.
incubaton perod the tme between an nfectous agent enterng a persons body
and the appearance of a symptom of the dsease. incubaton
perods may range from a few hours to several years dependng
on the dsease.
infecton the entry and development or multplcaton of an nfectous
agent n the body of a human beng or anmal. in many cases,
nfectons can occur wthout leadng to llness or nfectous
dsease.
infectous agent Anorganism(virus,bacteria,fungus,protozoaorparasitic
worm) that s capable of producng nfecton or nfectous
dsease.
infectous dsease a dsease that s caused by an nfectous agent or that can
be passed on (transmtted) by an nfectous agent. it may affect
humans and/or anmals.
infectous perod the length of tme a person who s nfectous can pass the
nfecton on to others.
Mucous membrane the thn lnng of body passages and cavtes such as the
mouth, respratory tract, gento-urnary tract and eye. its glands
produce mucus.
oocysts Egg cells.
Phlegm thck mucus secreted n the respratory tract. (Pronounced
fem.)
Protozoa Mcroscopc organsm. Some are parastes whch can cause
nfectons such as gardass and toxoplasmoss.
109
Publc health unt these are part of state or terrtory health departments and deal
wth the nvestgaton and advce on communcable dseases
ncludng outbreak management, mmunsaton and other
publc health matters. they may be located n your area
or n a captal cty.
Pustular Contanng pus.
replcaton Process of duplcatng or reproducng an exact copy.
Soled Unclean, drty.
Vaccnaton See immunsaton.
Vaccne Vaccinescauseresistancetospecifcinfections.Theymay
contan lve or dead organsms, or parts or products of
organsms.
Vrus a group of nfectous agents that s much smaller than bactera.
they can only multply n lvng cells. they are responsble for
some of the most mportant dseases affectng human bengs,
for example, most chldhood llnesses wth rashes, such
as measles, chckenpox and rubella.
110
useful contacts
oCCuPational HealtH and Safety autHoritieS
ACT ACT Workcover Tel: (02) 6205 0200 www.workcover.act.gov.au
NewSouthWales NSW Workcover Authority Assistance Service number:
13 10 50
www.workcover.nsw.gov.au
Tasmania Workcover Tasmania Tel: (03) 6233 7657 (outside
Tasmania), 1300 366 322
(inside Tasmania)
www.workcover.tas.gov.au/
node/workcover.htm
WesternAustralia Worksafe Western Australia Tel: (03) 9327 8777 www.safetyline.wa.gov.au
Queensland Queensland Division of
Workplace Health and Safety
Infoline: 1300 369 915 www.whs.qld.gov.au
Victoria Victorian Workcover
Authority Workcover
Advisory Service: (03) 9327
8777
workcover.vic.gov.au
SouthAustralia South Australian Workcover
Authority
Customer information
Offcers: 13 18 55
www.workcover.com
NorthernTerritory Northern Territory
Workhealth Authority
Tel: 1800 019 115 www.nt.gov.au/deet/worksafe/
food Safety autHoritieS
ACT ACT Health Protection
Service
Tel: (02) 6205 1700 www.health.act.gov.au
NewSouthWales NSW Food Authority Tel: 1300 552 406 www.foodauthority.nsw.gov.au
Tasmania Department of Health and
Human Services food unit
Tel: 1800 671 738 www.dhhs.tas.gov.au
WesternAustralia Health Department of WA
food unit
Tel: (08) 9388 4999 www.health.wa.gov.au
Queensland Queensland Health food
unit
Tel: 3234 0938 www.health.qld.gov.au
Victoria Food Safety Victoria Tel: 1300 364 352 www.health.vic.gov.au/
foodsafety
SouthAustralia Department of Health food
section
Tel: (08) 8226 7107 www.health.sa.gov.au
NorthernTerritory Department of Health and
Community Service food
unit
Tel: 1800 095 646 www.nt.gov.au/health/
111
List of forms
t
he followng are sample forms that centres may wsh to adapt and use. Centres may wsh
to add a prvacy statement or other nformaton to these forms.
112
reCord of illneSS in tHe Centre
Name Age Symptoms Room
orGroup
Date Time
ofonset
Comments

113
rePort form for Parent/doCtor
Chld Care Centre: ________________________________________________________________________
address: __________________________________________________________________________________
Contact person: ___________________________________________________________________________
Phone: ____________________________________________________________________________________
Dear Parent/Doctor,
re: (childs name) _____________________________________________ Date of brth: ____/____/____
Chld has: (comments, ncludng tme observed, number of tmes, severty)
Vomtng
Darrhoea
rash (description of rash and where rash started)
other
there has/has not been recent smlar llness n other chldren n the centre.
the dagnoss n the other chldren was:
the publc health unt s/s not nvolved. the chld appears to have a fever. yes/no
the chld has eaten ________________________________________________________________________
the chld has drunk ________________________________________________________________________
the chld last passed urne at _______________ (tme).
Parent contacted by________________________________________________ at _____________ (tme).
Sgned: ___________________________________________________________________________________
Date: ____/____/____ tme____________
114
mediCation PermiSSion form
i
n the nterest of chldrens safety and well-beng, the centre shall only admnster medcaton
f t s n ts orgnal contaner wth the dspensng label attached lstng the chld as the
prescrbed person, strength of drug and the frequency t s to be gven. ths apples to all
medcatons, regardless of whether they are non-prescrbed (such as teethng gels, nappy
creams, cough medcnes, etc) or prescrbed (antbotcs etc).
Chlds full name: __________________________________________________________________________
Medcal Practtoner/Chemst etc: __________________________________________________________
Medication:
name of medcaton ______________________________________________________________________
Date prescrbed ___________________________________________________________________________
Expry date of medcaton __________________________________________________________________
reason for medcaton ____________________________________________________________________
Storage requrements ______________________________________________________________________
tme and date of last dose gven ___________________________________________________________
i request that the above medcaton be gven n accordance wth the nstructon below:
Please complete table and lst any detaled nstructons n the box e.g. route (e.g. oral,
nhaler), dose (e.g. thn layer, no of drops/mls/tablets), before or after food.
instructons:
Parents full name____________________________________________________Date: ____/____/_____
Sgnature _________________________________________________________________________________
Date Dosage Time
tobe
given
Time Signature
ofstaff
administering
medication
Signatureof
staffcross
checking
medication
Comments
* Details should be reviewed at least 3-monthly.
115
Staff immuniSation reCord for CHild Care Staff
name: ____________________________________________________________________________________
Date of Brth: ____/____/____
address: __________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
the natonal Health and Medcal research Councl (nHMrC) recommend that chldcare staff
should be mmunsed aganst:
Disease/Vaccine Disease Vaccine Date
Hepatitis A
Measles, Mumps and Rubella*
Varicella (Chickenpox)
Pertussis (Whooping cough)
* Childcare workers born during or since 1966 who do not have vaccination records of two doses of MMR or do not have
antibodies for rubella require vaccination.
116
useful web sites
(adapted from Health n Early Chldhood
Settngs by Professor Frank oberklad.
Publshed by Pademelon Press (2004),
Sydney, australa).
attention defiCit HyPeraCtivity
diSorder (adHd):
http://www.chadd.org/ (ths s the web ste
of an amercan organsaton whch provdes
nformaton about aDHD to parents and
professonals)
http://www.nhmrc.gov.au/publcatons/
adhd/contents.htm (a report on aDHD from
the natonal Health and Medcal research
Councl wrtten n 1997 but stll relevant)
CHild abuSe:
http://www.napcan.org.au/home.php
(natonal Preventon of Chld abuse and
neglect (naPCan))
http://www.aaca.com.au/ (Web ste of the
australan Chldhood assocaton)
CHild Care
http://www.ncac.gov.au/(Theoffcialsiteof
the natonal Chldcare accredtaton Councl
ncludes nformaton for parents about
qualty n chld care and choosng a chld
care centre)
CHildren and televiSion:
http://www.racp.edu.au/hpu/paed/meda
(a comprehensve revew of the subject
undertaken by the organsaton representng
all paedatrcans n australa - ncludes
recommendatons)
divorCe and CHildren:
http://dvorceandchldren.com/
(a useful amercan ste)
early literaCy and reading to
young CHildren:
http://www.rch.org.au/ccch/research/ndex.
cfm?doc_d=5821 (a program of the Centre
for Communty Chld Health at the royal
Chldrens Hosptal Melbourne)
family day Care
http://www.famlydaycare.com.au/
(OffcialsiteoftheNationalFamilyDayCare
assocaton of australa)
firSt aid:
http://www.stjohn.org.au/emergency.
htm (St. Johns ambulance australa - a
comprehensiveresourceonallaspectsoffrst
ad, ncludng tranng courses)
food Safety:
http://www.foodstandards.gov.au/_srcfles/
complete_safefood.pdf Safe Food australa
2nd Edton (January 2001) (Food Standards
AustraliaNewZealand),
Head liCe:
www.health.qld.gov.au/germbusters
(Queensland Health)
www.health.wa.gov.au/headlce (Wa
Health)
immuniSation:
http://mmunse.health.gov.au/(Theoffcial
australan government ste that covers
all aspects of mmunsaton check ths
tofndoutthelatestandmostuptodate
mmunsaton schedules)
infeCtion Control:
http://www.health.gov.au/nternet/wcms/
publshng.nsf/Content/cg-gudelnes-ndex.
htm (australan government nfecton
control gudelnes for the preventon of
transmsson of nfectous dsease n the
health care settng)
117
injurieS and injury Prevention:
http://www.kdsafe.com.au/ (a natonal
organsaton whch also has state branches.
offers useful and easly accessble
nformaton on all aspects of njury preventon
for chldren of all ages)
Parent information (general)
www.rasngchldren.net.au (ths s funded by
the australan government and s desgned
to be a comprehensve resource for parents)
http://www.cyh.com (a comprehensve
ste mantaned by the South australan
government has nformaton on a long lst
of topcs n chld health and behavour)
http://www.dh.sa.gov.au/pehs/youve-got-
what/ (a comprehensve ste mantaned
by the South australan government has
nformaton on common condtons durng
chldhood)
http://www.rch.org.au (a comprehensve
ste mantaned by Centre for Communty
Chld Health, royal Chldrens Hosptal,
Melbourne - has nformaton on a long lst of
topcs n chld health and behavour)
PoiSonS information:
http://www.health.qld.gov.au/
PosonsinformatonCentre/homepage.htm
(Queensland Health Posons informaton
centre whch ncludes nformaton about
btes and stngs, posonous plants, and
posons preventon as well as what to do n
an emergency)
the natonal Posons informaton Centre tel:
13 1126
Smoking and HealtH:
http://www.qut.org.au/ (Has nformaton
onthehealthhazardsofsmoking,aswellas
helpful resources on how to qut)
Sudden infant deatH Syndrome
(SidS):
http://www.sdsandkds.org (the australan
organsaton representng SiDS groups n
each state)
118
Appendix A
Working Committee
Membership and
Terms of Reference
membership of Working Committee
Dr andrew langley (Char)
Publc Health Physcan
Central area Populaton Servces
Sunshne Coast
HAC member
Ms Desole lovegrove
SeniorProjectOffcer
Darlng Downs Publc Health Unt
Ms Debbe neucom
Publc Health nurse
Central area Populaton Servces
Sunshne Coast
Professor Frank oberklad
Drector of Centre for Communty
and Chld Health
Centre for Communty Chld Health
royal Chldrens Hosptal
HaC Member
Mr John tanton
Char, natonal Chldcare accredtaton
Councl
nHmrC Secretariat
Ms Smone Patton
Ms lorrane oConnor
Ms Stephane gates
Ms Kate Fddy
terms of reference
1. Update the 3rd edton of Stayng Healthy
n Chldcare, takng nto consderaton
comments from nHMrC Publcatons
revew Workng Commttee and key
stakeholders.
2. Undertake publc consultaton, n
accordance wth nHMrC requrements.
3. report to the nHMrC Health advsory
Commttee (nHMrC-HaC).
119
Appendix B
Process Report
Durng 2004, the natonal Health and
Medcal research Councl (nHMrC)
receved a number of requests from varous
stakeholders for the 2001 Staying healthy in
childcare: Preventing infectious diseases in
child-care 3
rd
Edition to be updated.
although t was not yet due for revew
of currency, the nHMrC Health advsory
Commttee (HaC) agreed to assess the
document through the nHMrC Review of
Publications process. Fourteen submssons
were receved from the Review of
Publications publc consultaton n February
2005 [refer B.1].
in May 2005, HaC establshed the Workng
Commttee for Stayng Healthy n Chld Care,
to revse the gude. Workng Commttee
representaton ncluded expertse from publc
health, regulatory and chld care ndustry
bodes.
the Workng Commttee consdered relevant
lterature and sought expert opnon durng
revson of the gude. the non-regulatory
nature of the document precluded the need
to rank evdence.
revsons to the gude nvolved consultaton
wth the australan communty durng
august-September 2005. advertsements
were placed n the natonal press, the
Commonwealth of Australia Government
Notices Gazette and on the nHMrC webste.
twenty-nne submssons were receved
[refer B.2]. the Workng Commttee met to
consder the submssons and to revse the
gude n the lght of comments receved.
as part of ts normal qualty assurance
process, HaC also commssoned an
ndependent revew of the draft gude durng
october 2005.
the gude was consdered by the HaC for
approval and endorsed by the nHMrC at ts
159
th
sesson on 8 December 2005.
dissemination
Followng endorsement of the gude,
the HaC secretarat wll crculate a letter
along wth a copy of the publcaton, to
australan Chld Care organsatons, key
stakeholders and submtters, advsng that
the publcaton has been revsed, and that
the gude s avalable on nHMrC webste for
downloadng.
b.1 Submitters: february 2005
Submssons receved n response to the Review of Publications publc consultaton were from
the followng ndvduals/organsatons:
Robert G Batey
Chair
Hepatitis C Sub-Committee
Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis (MACASHH)
Australian Government
Department of Health and Ageing
Hepatitis Council
Lisa Bryant
Consultant
Community Child Care Co-op NSW
George Davey
Director-General
NSW Food Authority
Dr David Dumbrell
Director
HIV/AIDS and STIs
Population Health Division
Rachael Farquharson Promoting Health in Early Childhood Environments Project
Brisbane Southside Public Health Unit
120
Tom Fisher
A/g Chief Executive Offcer
National Occupational Health and Safety Commission
Dr John Frith
Convenor
NSW Childrens Services Health and Safety Committee
Dr Rod Givney
Director
Communicable Disease Control Branch
Department of Health
Government of South Australia
Dr Robert Hall
Director Public Health and
Chief Health Offcer
Department of Human Services
Government of Victoria
Maureen Hickman
Dr Brian Lloyd
Chief Medical Offcer
Government of Western Australia
Julianne Quaine
Director
Hepatitis C Section
Targeted Prevention Programs Branch
Letitia Toms
A/g Director
Immunisation Section
Jack Wallace
Executive Offcer
Australian Hepatitis Council
b.2 Submitters: august-September 2005
Submssons receved n response to the publc consultaton on the revsed draft document
were from the followng ndvduals/organsatons:
Geraldine Andrews
Director
Offce of Child Care
NSW Department of Community Services
Rachel Balmanno
A/g Assistant Secretary
Strategic Planning Branch
Chris Brenton
Chris Buck
National Secretary
Australian Childcare Centres Association
Helen Bull
Assistant Secretary
Offce of the Australian Safety and Compensation Council
Department of Employment and Workplace Relations
Anne Clarke
President
Childcare SA
Joy Copeland
Senior Project Offcer
STD Services
Royal Adelaide Hospital
Megan Counahan
Patricia Coward
Principal Adviser
Occupational Health Unit
Workplace Health and Safety Queensland
A/Prof Mark J Ferson
Director & Medical Offcer of Health
South Eastern Sydney Public Health Unit
South Eastern Sydney & Illawarra Area Health Service
John Frith
Convenor
NSW Childrens Services Health and Safety Committee
Dr Rod Givney
Director
Communicable Disease Control Branch
121
Karen Heel
Public Health Nurse
Brisbane Southside Public Health Unit
Stephanie Jackiewicz
Senior Project and Research Offcer
Collaboration for Applied Research and Evaluation
Debra Kay
Manager
Interagency Health Care
Department of Education and Childrens Services
Helen Kenneally
President
ACT Childrens Services Association
Brenda Kilgore Food Standards Australia New Zealand
Jonathon Kruger
Executive Director
Childcare Associations Australia
Violette Lazanas
Food Safety Offcer
Food Safety Unit
Fiona MacIver HIV/AIDS and STIs Section
Brad McCall Brisbane Southside Public Health Unit
Rodney Moran
Manager, Information Services
Communicable Diseases Section
Tim Muirhead
Chairperson
Child Care Advisory Committee
Pam Price
Coordinator, HIV Womens Project
Womens Health Statewide
Department of Human Service
Barbara Romeril
Executive Director
Community Child Care
Victoria
Alanna Stewart
Health Promotion Offcer
West Moreton Public Health Unit
Queensland
John Tainton
Chair
National Childcare Accreditation Council
Australia
Helen Tyrrell Australian Hepatitis Council
Dr Tony Watson
Medical Coordinator
Communicable Disease Control Directorate
122
Appendix C
References
1
youve got what? 2004. the ways
nfectous dseases spread, vewed 22
March 2005,
< http://www.dh.sa.gov.au/pehs/youve-
got-what/stop-dsease-spread.htm>
2
gudelnes for the Control of infecton and
Communcable Dsease n nurseres and
other insttutonal Early years Settngs n
South West london Sector, 2003. South
West london Health Protecton Unt.
Vewed 5 aprl 2005, <http://www.hpa.
org.uk/hpa/publcatons/reports/S_W_l_
nurseres.pdf>
3
youve got what? 2004. Hand washng,
vewed 11 aprl 2005, < http://www.dh.sa.
gov.au/pehs/youve-got-what/hand-
washng.htm>
4
gudelnes for the Control of infecton and
Communcable Dsease n nurseres and
other insttutonal Early years Settngs n
South West london Sector, 2003. South
West london Health Protecton Unt.
Vewed 5 aprl 2005, <http://www.hpa.
org.uk/hpa/publcatons/reports/S_W_l_
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5
Dermatts the facts startng from
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26 May 2005, <http://www.workcover.
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12aa-405B-a50C-0458FFF4D7EC/0/fact_
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6
Contact dermatts, Safeguards,
government of South australa 2000,
vewed 26 May 2005, <http://www.erc.
sa.gov.au/uploaded_fles/gs30i.pdf>
7
nfectous dseases spread, vewed 7 aprl
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htm>
8
FoodStandardsAustraliaNewZealand
(FSANZ).SafeFoodAustralia.2
nd
edton,
January 2001. Vewed 6 aprl 2005,
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9
Varcella. in: Heymann Dl, edtor. Control
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ed. Washngton DC: amerca Publc
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Qheps.health.qld.gov.au/PHS/CDPM/
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11
Measles, Publc Health Fact Sheets,
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Pertusss. in: Heymann Dl, edtor. Control
th

13
the australan immunsaton Handbook,
8
th
ed 2003, natonal Health & Medcal
research Councl, australan government
Department of Health and ageng, p205
14
8
th
15
immunse australa Program 2004,
australan government Department of
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16
8
th
17
8
th
18
8
th
Department of Health and ageng, back
cover
19
8
th
Department of Health and ageng, nsde
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the royal Chldrens Hosptal Department
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21
Medcaton management n chldrens
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Vol 8 no 2 aprl 2005, vewed 21 June
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pdf>
22
infecton Control gudelnes, Queensland
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23
Health 2001, p54
24
Health 2001, p295
25
Managng a needlestck njury, local
government assocaton of Qld inc &
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26
Chldcare and chldrens health, Centre
for Communty Chld Health, royal
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<http://www.rch.org.au/emplbrary/
ecconnectons/2003_June_newsleter.
pdf>
27
(FSANZ)SafeFoodAustralia.2
nd
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28
(FSANZ).SafeFoodAustralia.2
nd
edton,
January 2001. Vewed 6 aprl 2005,
29
(FSANZ)SafeFoodAustralia,2
nd
edton,
January 2001 vewed 8 September 2005,
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Detary gudelnes for Chldren and
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September 2005, <http://www.nhmrc.gov.
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31
a Caregvers gude to the Breastfed
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vewed 27 September 2005,
<http://www.breastfeeding.asn.au/bfnfo/
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32
Detary gudelnes for Chldren and
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the nfant feedng gudelnes for health
workers, 2003 natonal Health & Medcal
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September 2005, <http://www.nhmrc.gov.
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33
8
th
Department of Health and ageng, pp101,
156, 185, 211, 225
34
immunsaton requrements for Chld Care
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au/safetylnk/health/health11.pdf>
35
8
th
Department of Health and ageng, pp251
36
8
th
37
Cytomegalovrus n Chld Care, Workplace
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gov.au/safetylnk/health/health08.pdf>
38
8
th
39
Professor Frank oberklad. Health n Early
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124
40
Professor Frank oberklad. Health n Early
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Frst ad asthma Queensland, vewed 19
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hghlght2=#plan>
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Broncholts, the Chldrens Hosptal at
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<http://www.chw.edu.au/parents/
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43
Broncholts. in: Heymann Dl, edtor.
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ed. Washngton DC: amerca
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Parentng and Chld Health Bronchts
2004, vewed 19 aprl 2005, <http://www.
cyh.com/Healthtopcs/HealthtopcDetals.
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45
Parentng and Chld Health Colds 2004,
vewed 19 aprl 2005, <http://www.cyh.
com/Healthtopcs/HealthtopcDetals.
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46
Parentng and Chld Health Colds 2004,
vewed 19 aprl 2005,<http://www.cyh.
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47
Medcaton management n chldrens
servces, Childcare and Childrens Health
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2005, http://www.rch.org.au/emplbrary/
ecconnectons/CCH_Vol8_no2_aprl2005.
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Parentng and Chld Health Croup 2004,
aspx?p=114&np=304&d=1854>
49
Parentng and Chld Health Ear nfecton
aspx?p=114&np=304&d=1855>
50
Parentng and Chld Health Ear nfecton
aspx?p=114&np=304&d=1855>
51
Infuenza.In:HeymannDL,editor.Control
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52
Pneumococcal dsease and your famly.
Fact sheet. the Chldrens Hosptal at
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<http://www.edu.au/parents/factsheets/
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53
immunse australa Program 2004,
australan government of Health and
ageng. Vewed 4 May 2005, <http://
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54
Pneumococcal dsease and your famly.
Fact sheet. the Chldrens Hosptal at
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55
Conjugate Pneumococcal vaccne and
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health.qld.gov.au/phs/Documents/
cphun/12665.pdf>
56
Pneumococcal. in: Heymann Dl, edtor.
manual. 18
th
57
a gude for Parents Questons and
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yellow mucus) Know When antbotcs
Work, 2004. Centre for dsease control
and preventon, vewed 19 aprl 2005.
<http://www.cdc.gov/drugresstance/
community/fles/GetSmart_RunnyNose.
pdf>
58
March 2005, <http://www.dh.sa.gov.
au/pehs/Youve-got-what/specifc-
condtons/streptococcal.htm>
59
March 2005, <http://www.dh.sa.gov.
condtons/streptococcal.htm>
60
acute Febrle respratory Dsease.
in: Heymann Dl, edtor. Control of
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th
ed.
Washngton DC: amerca Publc Health
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125
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tuberculoss. Fact sheet, 2002. Qld
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tuberculoss. in: Heymann Dl, edtor.
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th
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Pertusss. in: Heymann Dl, edtor. Control
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gastroenterts campylobacter, Dept of
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bhcartcles.nsf/pages/gastroenterts_
campylobacter?open>
65, 66 and 67

Cryptospordoss, Publc Health Fact
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26 May 2005, <http://www.health.qld.gov.
au/phs/Documents/cdu/13533.pdf>
68
gastroenterts an overvew, Dept of
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2004, vewed 26 May 2005 <http://
www.betterhealth.vc.gov.au/bhcv2/
bhcartcles.nsf/pages/gastroenterts_an_
overvew?open>
69
Parentng and Chld Health
gastroenterts 2004, vewed 19 aprl 2005,
<http://www.cyh.com/Healthtopcs/
HealthtopcDetals.aspx?p=114&np=303&
d=1845>
70
Vral gastroenterts: nformaton for
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Health (undated), vewed 23 may 2005
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71
Parentng and Chld Health - rotavrus
d=1437>
72
Parentng and Chld Health - rotavrus
d=1437>
73
Safe Food australa: a gude to the food
safety standards, Commonwealth of
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74
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75
Safe Food australa: a gude to the food
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76
Pnworms, KdsHealth 2005 vewed 22 aprl
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77
8
th
78
8
th
79
th

80
8
th
81
th

82
8
th
83
Parentng and Chld Health Cold sores
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85
Herpes smplex. in: Heymann Dl, edtor.
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th
86
youve got what? 2004. Herpes smplex
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87
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88
aspx?p=114&np=303&d=1492>
89
youve got what? 2004. Ffth dsease
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what/specifc-conditions/ffth-disease-
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90
youve got what? 2004. Ffth dsease
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what/specifc-conditions/ffth-disease-
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91
Erythema nfectosum human parvovrus
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92
Coxsackevrus dseases. in: Heymann Dl,
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93
Understandng head lce management,
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94, 95 and 96

headlce/default.html
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Head lce Fact sheet. Department of
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aprl, 2005, <http://www.health.wa.gov.
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99
headlce/default.html>
100
youve got what? 2004. Molluscum
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got-what/specifc-conditions/molluscum.
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101
Parentng and Chld Health roseola
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102
rubella. in: Heymann Dl, edtor. Control of
th
ed.
103
8
th
104
Scabes. in: Heymann Dl, edtor. Control of
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youve got what? 2004. Streptococcal
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106
Parentng and Chld Health thrush 2004,
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107
Parentng and Chld Health Warts 2004,
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108
youve got what? 2004. Warts (common,
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109
Pnkeye (conjunctvts) KdsHealth for
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110
Parentng and Chld Health Conjunctvts
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127
111
Cytomegalovrus 2004, vewed 22
aprl 2005, <http://www.cyh.com/
Healthtopcs/HealthtopcDetals.aspx?p=1
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112
Cytomegalovrus 2004, vewed 22
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113
youve got what? 2004. Cytomegalovrus
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114
australan infecton Control gudelnes,
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115
youve got what? 2004. glandular fever,
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116
Parentng and Chld Health Haemophlus
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117
Parentng and Chld Health Haemophlus
infuenzaetypeB2004,viewed22
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118
Qheps.health.qld.gov.au/PHS/CDPM/
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119
youve got what? 2004. Hepatts a,
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120
8
th
121
youve got what? 2004. Hepatts B,
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122
youve got what? 2004. Hepatts B,
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Parentng and Chld Health Hepatts B
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124
natonal Hepatts C resource Manual,
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125
Hepatts C, Queensland Health, 2005
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126
qld.gov.au/sexhealth/Hepatts_c.shtml#
How%20do%20you%20get%20t>
127
128
129
qld.gov.au/sexhealth/Hepatts_c.shtml#H
ow%20do%20you%20avod%20gettng%20
t>
130
Hepatts C n bref, australan Socety HiV
Medcne, natonal Hepatts Educaton
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131
natonal Centre n HiV Epdemology and
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AcquiredImmunodefciencySyndrome.
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HiV and aiDS, Vctoran government
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134
youve got What? Menngococcal
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Menngococcal dsease 2004, vewed 22
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136
youve got What? Menngococcal
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137
8
th
138
youve got What? Vral Menngts,
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Parentng and Chld Health Menngts
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specifc-conditions/meningitis-viral.htm>

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Staying Healthy in Child Care

Preventing infectious diseases in child care

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