All about nursery germs
Contributing article by Dr Sarah Taylor, paediatric registrar in West London.
We all worry about our children becoming unwell when they first start attending nursery. And with good reason. Children attending group settings have been shown to contract more infections than those looked after at home. Of course, this needs to be weighed against the numerous educational, developmental and social benefits of nurseries for children, and the ability that they give to parents to return to work. But not all nurseries are created equally – and this article is also going to explore what settings can do to limit the spread of infections and keep illnesses to a minimum.
Introduction
Nurseries can be the perfect environment for viral illnesses to spread, with children in close proximity, coughing and sneezing, wiping runny noses, putting everything into their mouths and sharing toys. For most children, nursery will be the first time they are exposed regularly to a wide variety of infections, and, at the start, it can feel as though they are constantly sick. It is normal for nursery children to have between eight to twelve viral illnesses each year. The good news is that, as they get older, the frequency of infections usually decreases.
It is difficult to say whether there is any advantage of these illnesses to children. Some studies have suggested that children who attend group settings have more infections at a younger age than those who are cared for at home, but fewer infections once they reach school age, where it could be argued that continuous attendance is more important. Other studies suggest that exposure to common infections before the age of two years may be protective against childhood leukaemia. While the evidence cannot provide certainty of these advantages, it certainly helped me as a parent to think that there may be a benefit to my child when he started attending nursery and seemed to be unwell constantly.
Exclusion policies
The UK Health Security Agency (UKHSA), previously Public Health England, provides clear guidance around managing infectious diseases in childcare settings. This includes information on preventing and controlling infections, supporting immunisation programmes, managing outbreaks and incidents, as well as providing tools and resources for all settings.
There is also clear guidance on exclusions from nursery and school for common childhood infections.
In the case of outbreaks or new diseases, the UKHSA will provide further guidance based on emerging evidence and expert opinion, for example during the high numbers of group A Streptococcus cases late last year.
As nurseries create their own sickness and exclusion policies, it is important that they follow national guidance in order to minimise the spread of infection, without going beyond what is advised and therefore being unnecessarily onerous for working parents / carers.
What else can nurseries and preschools do?
The staff in a preschool have a key role in helping to reduce the spread of infection within their setting:
- Sickness and hygiene policies should follow national guidance and staff should receive regular training in these areas
- Exclusion policies must be upheld
- Staff should practise regular hand hygiene, in particular around meal times, nappy changes and toileting
- Staff should teach and model good hand hygiene to the children, encouraging them to practise their own hand hygiene
- Children should be taught to cover the noses and mouths when coughing and sneezing and should be supported to blow or wipe their noses with a tissue as often as needed
Preschools should also communicate clearly with parents, for example in the case of an outbreak of an infectious illness such as chicken pox. By doing this, nurseries and families can work together to promote health and reduce spread of infection.
What else can parents and carers do?
The NHS provides guidance to aid parents in deciding whether a child is too unwell to attend their usual setting. Is my child too ill for school? - NHS (www.nhs.uk). Simple strategies that parents and carers can use to reduce the spread of infection include to:
- Keep your child up to date with their immunisations, including the annual flu vaccination where possible
- Encourage good hand hygiene, before and after eating, before and after nappy changes or using the toilet
- Encourage children to cover their mouths and noses when coughing and sneezing
- Discourage thumb and finger sucking
- Encourage general health and wellbeing for the whole family through a varied and nutritious diet, plenty of exercise and good quality sleep
- Keep your child home when they are too unwell to attend their usual setting
- Avoid the temptation to give Calpol and sending you child into their setting if you know they aren’t well
Final points
While unpleasant for children and their families, and certainly frustrating for working parents, it is inevitable that children will pick up infections in a nursery setting. However, there are plenty of strategies that families and preschool staff can put into place to reduce the impact on children. When nurseries and families work together, children are most likely to be healthy and to thrive in their setting.
Disclaimer: Always consult medical professionals for full diagnosis and treatment.
At Two Hands Preschool, we are committed to providing a clean and hygienic environment for children and staff. This requires a commitment from all staff members, both with regard to their personal hygiene and their modelling and teaching about cleanliness and hygiene to the children. We follow strict cleanliness procedures throughout the preschool and have two dedicated housekeepers each day. We also have clear infection control procedures to minimise the risk of infections spreading. You can read our Cleanliness and hygiene and Sickness and infection control policies here.
