Infection Prevention and Control in the Preschool

DR RABEEN LUTCHMANM.B.CH.B (UFS), DIP OBS ( SA), FC PAED (SA), MMED PAED(STEL)

GENERAL PAEDIATRICIAN – RONDEBOSCH MEDICAL CENTRE

Structure

Best Interests of the Child

Immune System of the Young Child

The Common Cold – Cause(s) and Symptoms

How Infection is Spread

Complications of a Cold/ Dangers Signs and When to Seek Help

Infection Prevention

Best Interests of the Child

Section28 (2) South African Constitution 1996: A child’s best interests are of paramount importance in every matter concerning the child

Best interests of the child:

The Immune System of a Young Child

Term baby – has essential components of immune system But still maturing

Immunoglobulins – Soldiers of the immune system

Different types : Immunoglobulin G (IgG), Immunoglobulin M (IgM), Immunoglobulin A (IgA) etc… - each different role and function

Birth – high level of IgG transferred from mom

IgG levels wane by first 6 months and then infant needs to start making his own immunoglobulin

Levels rise to about 60 % of adult levels by 1 year and only reach adult values by 6 – 10 years of life

Reason why children under 5 are susceptible to repeated infections

The Common Cold

A ‘cold’ is a viral infection of the upper respiratory system

Symptoms include stuffy nose/sneezing/sore throat/ mild cough

Cause by a number of viruses – Most common Rhinovirus (100 different strains) others include Coronavirus/Enterovirus

Respiratory Syncitial virus (RSV) – Can progress from upper respiratory symptoms to a wheezy chest and is the most common cause for a bronchiolitis

Adenovirus/ Influenza (A/B/C) – more ill child: fever/body aches/fatigue/headache – may lead to bronchitis/pneumonia

Symptoms

Begin 1-2 days after exposure

Usually last between 3-5 days but can last 10 – 14 days

Contagious during the first 2 – 4 days

Nasal Congestion is the most prominent symptom

Fever first 3 days

Sore throat, mild cough, irritability, difficult sleeping and poor feeding/decreased appetite

How Infection is Spread

Most Contagious during the first 2-4 days

Direct contact with the infected child : Typically carry the virus on hands – where it is capable of infecting another person for up to 2 hours

Indirect contact: Some virus can survive on surfaces (counter tops/door handles/ toys) for as long as 24 hours

Inhaling viral particles: Droplets containing the viral particles can be exhaled into the air by breathing/coughing/sneezing (Influenza/Coronavirus)

Complications of a Cold

Viral infection of URT makes it less resistant to secondary bacterial infections

Increased secretions and mucous in the airway – ineffectively cleared – favourable environment for bacteria to grow

Secretions block Eustachian tube - Secondary Middle Ear Infection (Otitis Media)

Collect in the sinuses – Secondary bacterial Sinusitis

Secretions can collect in the lower airways – progress to a Pneumonia or Bronchitis

Antibiotics ARE NOT INDICATED FOR A COLD Unless there are complications present

When to Seek Help (danger signs):

Refusing to drink/ not feeding/ vomiting

Difficult breathing: Breathing fast/ breathing noisily/ rib cage indrawing/

Fever > 38,5

Lethargy/ difficult to wake up/ irritability

Loose stools/bloody stools

Fewer wet nappies

Inconsolable crying

Fits/convulsions

Children at risk for complications

Other medical conditions:

Asthma

Diabetes

Chronic kidney Problems

Lung Disease

Malnourished

MAKE SURE CHRONIC CONDITIONS ARE WELL CONTROLLED

Prevention

Immunizations

Routine schedule up to date

Yearly flu vaccine

Hand Hygiene

Essential and effective way to prevent spread

Rubbed with soap for at least 30 seconds

Teach children to wash hands before and after eating/ after coughing and sneezing

Alcohol based hand rubs – alternative if sink not available spread over entire surface of hands fingers wrists until dry. May be used several times.

Prevention cont…

Limit contact

Children with colds/illness must be kept out of school or day care until symptoms improve - fever has settled for at least 24 hours OFF antipyretic medication

Schools should have a written sick-child policy and it needs to be strictly adhered too by parents and applied by staff

Eg: Children with fever should not be at school

Acute medication should not be administered at school

Children on antibiotics should be at home for the duration of the course

Prevention cont…

Nutrition and supplementation:

Breastfeed your baby – Antibodies help prevent and protect against infection and disease

Well balance diet – fruit and veg immune boosting nutrients

Processed food does not replace the real thing!

Fussy eater – needs a good multivitamin

Zinc and Vitamin C

Prevention Cont…

Healthy Hygiene:

Hand Hygiene – Disinfectants

Cough hygiene – cough into elbow

Bathroom hygiene

Meal time hygiene

Sleep hygiene – lack of sleep undermines the immune system

Family Stress levels –stressful family life directly impacts a child’s immunity

Conclusion

A healthy child under 5 years can have an average of 6 -8 colds per year

There are a number of viruses that can infect the child

Great burden on the child/home/workplace and school

Prevention is better than cure Immunizations

Hand hygiene

Limit exposure

Healthy lifestyle

Thank you!