MIDModule1 Speaker Notes

Curriculum for Managing Infectious Diseases
in Early Education and Child Care Settings
Module 1
Understanding Infectious Diseases
• Impact
• Vulnerability
• Symptoms
• Spread
Script:
Hello and welcome to today’s presentation on Managing Infectious Diseases in Early
Education and Child Care Settings.
My name is [insert your name and tell a little bit about yourself and your interest/connection
to child care- limit yourself to two minutes or so].
Note: Go around the room and ask each person to introduce themselves. If you are short
on time, ask for a show of hands, asking questions like– How many of you are teachers?
How many of you are new to the field of child care? [See the presentation tips resource for
guidelines, ideas and timing].
Before we delve into the content of the day, here are a few housekeeping details:
[insert here information about restrooms, turning cellphones off, when and how breaks will
occur, where emergency exits are located, signing–in roster etc.]
Script: In the first section of this module we will be covering understanding infectious
diseases – defining some basic terms, looking at the impact of infectious diseases, who
is vulnerable, symptoms of infectious diseases and how infectious diseases spread.
The objectives for the module are the following:
1. Identity 3 ways infectious diseases impact our society.
2. State reasons why some children with special health care needs are at higher risk for
acquiring infectious diseases.
3. Name the 3 most common symptoms of infectious diseases in children in early
education settings.
4. Identify 5 ways infectious diseases are spread.
At the end of this module each participant should have an understanding of how infectious
diseases impact parents, caregivers/teachers, and health care professionals. Participants
should also be able to educate parents and other child care staff members on methods to
decrease the spread of infectious diseases.
Trainer note: You may wish to write the objectives on flip chart paper and leave them up in
the room so that participants can refer to them throughout the training and so that they are
available for review at the end of the session.
Activity:
If you are giving the pre-test for this module, have participants take the pre-test at this time.
1
Types of Germs
• Viruses
• Bacteria
• Fungi
• Parasites
Script:
I am going to start by going over some definitions of words that often are used when talking
about managing infectious diseases.
First, Virus
A virus is a microscopic organism, smaller than a bacterium, containing DNA or RNA but
not both, that may cause disease. Viruses can grow or reproduce only in living cells. 1
If someone has a virus they frequently get better on their own

• Limited treatment, other than rest and control of symptoms
• There are very few medications to treat viruses
Examples of viruses are the common cold, influenza, measles, hepatitis B virus, and
chicken pox.
Bacteria are organisms that, with proper conditions, can survive in many environments.
Some cause diseases in humans. If someone has a bacterial infection they often need to
be treated with antibiotics. Examples of bacterial infections are are staphylococcus,
streptococcus, salmonella, and shigella.
A fungus may do no harm and may be helpful as in making bread with yeast. These
organisms get their nutrition from other living organisms or dead organic matter. 1 However,
they can also cause illness such as diaper rash and ringworm. They often occur on the
surface of the body and can be treated with creams or oral medication.
Parasites are multicellular organisms that live on or in another living organism. Examples are
ticks, tapeworm, pinworms, and lice. 1
Source:
1. Aronson, S. S., T. R. Shope, eds. 2019. Managing infectious diseases in child care and
schools: A quick reference guide, 5th Edition. Elk Grove Village, IL: American Academy of
Pediatrics
2
What does infection mean?

What does contamination mean?
Script:
What does the word infection mean? Does anyone want to take a guess at a defining
infection? [give a few moments to see if a participant wants to answer the question]
• Infection is a condition that is caused by a multiplication of an infectious agent in the

body. It is when a germ causes an illness or disease like the flu or strep throat.
How about the word contamination? Does anyone want to take a guess at defining what
contamination means? [give a few moment to see if a participant wants to answer the
question]
• Contamination is the presence of infectious microorganisms in or on the body,

environmental surfaces, articles of clothing, food, or water. It is when a germ is placed in
or on the body, a surface, or in food or water.
Source:
Aronson, S. S., T. R. Shope, eds. 2019. Managing infectious diseases in child care and
schools: A quick reference guide, 5th Edition. Elk Grove Village, IL: American Academy
of Pediatrics
• Contagious
• Infectious
• Communicable
Script:
Just a few more words.

Contagious – when germs can spread to others
Infectious- capable of causing an infection
Communicable- can be transmitted to others
These three words essentially all mean the same thing.
Child Care at 2:00 pm

A 20-month-old child wakes up from a nap and is flushed. She does not want to
play with other children and is irritable. Her temperature was
taken and is 101°F.
How does this affect:

Parents?
Caregivers/teachers ?
Health care professionals?
How will the impact influence their decision making?
Script:
How infectious diseases are managed can have impact on a number of different people.
Think about this situation:
It is 2:00 pm at a child care center. A 20-month old child wakes up from a nap and is
flushed. She does not want to play with other children and is irritable. Her temperature
was taken and it is 101 degrees farhenheit.
Show of hands- have you been involved in a similar situation? How many of you were the
parents or guardians in a similar situation? How many of you were the caregiver or
teacher?
Small Group Activity:

I’m going to divide the room into 2 groups. [ have one half be parents and the other
caregivers or teachers].
In your group discuss how this could affect you and how that impact could influence your
decision making.
Bring the groups back together and discuss as a large group the affects and how it could
influence your decision making.
Ask the large group how they think if affects health care professionals.
Optional: If you have flip chart paper and markers you can have the groups write their
thoughts on flipchart paper and then share them with the group.
Possible answers for the activity:

– Parents: Missing work, not getting paid at work when you have to leave early,
worrying about who will care for the sick child, fear of exposing family/friends,
guilt.
– Caregivers: Concern about other children being exposed, concern about
themselves being exposed, extra work to care for a sick child, frustration from other
parents about their child being exposed to illness, wondering if the child need to be
seen by a health care professional
– Health care professionals: Does this child need to be seen, or should the child be
observed at home with symptomatic care? Are there any reasons to exclude this
child from care or to report this illness to the health department?
5
Impact of Infectious Diseases
• Economic
• Contagion
• Disruptions
• Health care provider issues
Script:
Infectious diseases impact people’s lives in many ways.
There are economic costs such as loss of income for a family.

Findings published from a 2017 Kaiser/HRET Employer Health Benefits Survey, note that
there is no federal requirement for paid leave or sick days, which can leave many
people, particularly low-income workers, to face tradeoffs such as taking time off without
pay, going to work while sick or contagious, sending children to school or child care sick,
or paying for caregivers for their children and family members. 1 As of October 2017,
only 9 states and Washington, DC require paid sick leave. 2
Infectious diseases can also cause disruptions such needing to find alternative care or
having to fill-in for a colleague who needs to stay home to take care of a sick child.
Health care professionals are affected as well:

• Office visits to get “sick notes” 3
• Inappropriate use of antibiotics (See the resource handout for a link to “Antibiotic
Prescriptions for Children: 10 Common Questions Answered”
• Added responsibility of administering medication in child care
Sources:
1. https://www.kff.org/womens-health-policy/fact-sheet/paid-family-leave-and-sick-days-in-
the-u-s-findings-from-the-2017-kaiserhret-employer-health-benefits-survey/
2. http://www.ncsl.org/research/labor-and-employment/paid-sick-leave.aspx
3. Skull SA, Ford-Jones EL, Kulin NA, Einarson TR, Wang EEL. Child care center staff
contribute to physician visits and pressure for antibiotic prescription. Arch Pediatr Adolesc
Med. 2000;154:180–183
6
Impact of Infectious Diseases

Everyone is affected.
Script:
In other words, everyone is affected.

Bad News: Frequency of Illness

Children in early education
and child care
• Sick more often
• Illnesses last longer
• More ear infections
• More antibiotic-resistant
bacterial infections
Script:
In your experience, have you observed these findings from research studies of children in
early education and child care?
Children:
• Get sick more often
• Have illnesses that last longer
• Get more ear infections and are more likely to have tubes placed in their ears to drain
fluid to the outside
• And, have more antibiotic-resistant bacterial infections
What are thoughts on this? Any surprises?
Trainer note: You may wish to ask the question on the slide 7:---Has this been your
experience that children in early education and child care settings get sick more often,
have illnesses that last longer, have more ear infections, and more antibiotic-resistant
bacterial infections?. And then on this slide state that studies confirm these experiences.
Sources:
1. Wald ER, Guerra N, Byers C. Frequency and severity of infections in day care: three-
year follow-up. J Pediatr. 1991;118:509–514
2. Holmes, SJ, Morrow, AL, Pickering, LK. Child-care practices: effects of social change on
the epidemiology of infectious diseases and antibiotic resistance. Epidemiologic Review.
1996;18:10–28
Good News: Annual Illness Incidence by Age
Script:
The good news is that there is good news. This graph shows that as children age, the
incidence of illness decreases from around 12 per year to
4 per year by the time the child is around 5 years old.
Source:
1. Cordell RL, Waterman SH, Chang A, et al. Provider-reported illness and absence due
to illness among children attending child-care homes and centers in San Diego, Calif.
Arch Pediatric Adolescent Medicine. 1999;153:275–280
More Good News

• Germs in early education programs are the same as those in community
outbreaks
• 90% of infections are mild, self-limited, and require no treatment
Script:
And there is even more good news.
Germs in early education programs are the same as those in community outbreaks. 90% of
infections are mild, self-limited, and require no treatment.
Good News for Child Care
• Illness incidence decreases after the first full year

of attendance
• Kindergarten children with prior early education
program attendance have fewer infections
• Children who attended early education programs were
less likely to develop asthma at 6 years of age
Script:
• Illness incidence decreases after the first full year of attendance.1,2
• Kindergartners with prior early education program attendance have fewer infections.3,4
• Many factors contribute to causing asthma and this needs further study, but the
association between attending early education and a decrease in asthma is present.5
Sources:
1. Hurwitz ES, Gunn WJ, Pinsky PF, et al. Risk of respiratory illness associated with day-
care attendance: a nationwide study. Pediatrics. 1991;87:62–69
2. Collet JP, Burtin P, Bossard N, et al. Type of day-care setting and risk of repeated
infections. Pediatrics. 1994;94:997–999
3. McCutcheon H, Woodward A. Acute respiratory illness in the first year of primary school
related to previous attendance at child care. Australian and New Zealand Journal of
Public Health. 1996;20:49–53
4. Ball TM, Holberg CJ, Aldous MB, Martinez FD, Wright AL. Influence of attendance at
day care on the common cold from birth through 13 years of age. Arch Pediatric
Adolescent Medicine. 2002;156:121–126
5. Ball TM, Castro-Rodriguez JA, Griffith KA, et al. Siblings, day-care attendance, and the
risk of asthma and wheezing during childhood. New England Journal of Medicine.
2000;343:538–543
Why are children more vulnerable to

infectious diseases?
Script:
Why do you think children are more vulnerable to infectious diseases?
Reasons why children are more vulnerable to infectious diseases include:

• Frequent hand-to-mouth behaviors
• Still learning appropriate hygiene skills (keeping fingers out of nose, covering coughs,
proper hand washing, etc.)
• Some children may not be fully immunized, such as young infants
• Children have close physical contact and do not practice much social distancing
Trainer Notes:
If time allows, ask the question above and let the participants offer the answers they believe
are correct and then discuss the list in the notes above, affirming any accurate answers
the participants offer.
Who is most vulnerable to

infection?
• Young infants
• Children with special health care
needs
• Children with impaired immune
systems
• Pregnant women
Script:
• Young infants are more susceptible because their immune systems are immature and
don’t have a lot of defenses (antibodies) built up yet. Some immunity is received from the
mother and some can be passed through breast milk, but it is still less than adults have.
• Children with special health care needs, including those with equipment in their bodies
are more vulnerable because foreign bodies like metal devices can carry or capture
bacteria, even if they were sterile when the device was placed. Devices like catheters can
also carry bacteria even if the catheter is sterile and good cleaning procedures are
followed.
• Children with impaired immune systems, including HIV/AIDS, chemotherapy, genetic
conditions, transplants, or high-dose steroid therapy for longer periods are also more
vulnerable
• Pregnant women are not necessarily more susceptible themselves, but they can pass on
certain infections to the fetus if the mother is not immune to the disease.
Symptoms of Infectious Diseases
What symptoms might this child have

or develop in the next few days?
Script:
Earlier we talked about this child: A 20-month-old child wakes up from a nap and is flushed.
She does not want to play with other children and is irritable. Her temperature was taken
and is 101°F.
What are some possible symptoms that this child might develop?
• Do not linger over these points. Keep the discussion moving.

• If audience is not responding, suggest an answer, such as a runny nose. [The next slide
has more possible symptoms]
Symptoms of Infectious Diseases

• Cough • Drainage or irritation of eye or other
• Runny nose and/or congestion infected body part
• Difficult or noisy breathing • Fever
• Vomiting, nausea, or • Aches or pains: Sore throat, earache,
stomachache headache, body ache
• Diarrhea • Mouth sores
• Rash • Swollen glands
• Itching • Behavior changes
Script:
Here’s a list of symptoms of infectious diseases.

How do you or your staff keep track of the symptom’s a child has in your
program?
[Share the symptom record available at

http://nrckids.org/files/appendix/AppendixF.pdf and or print copies if you do not
have access to the internet.]
What do you think are the most common symptoms that

children in early education settings have?
Script:
What do you think are the most common symptoms that children in early education settings
have?
[See the next slide for answers]

Common Symptoms Reported in Early Education settings
Respiratory
66%
Fever
14%
Gastroenteritis
9%
Earache
Rash
6%
5%
Script:
Do the results here match your experiences? What if anything surprises you about these
findings?
• Respiratory symptoms (cough, congestion, runny nose) are the most common symptoms
seen in early education settings. They comprise
66% of the total.
• The second most common is fever (14%).
• The third most common is gastrointestinal (vomiting and diarrhea) (9%).
Ask the audience if this matches with their experience.
Source:
1. Cordell RL, Waterman SH, Chang A, et al. Provider-reported illness and absence due to
illness among children attending child-care homes and centers in San Diego, Calif. Arch
Pediatric Adolescent Medicine. 1999;153:275–280
What symptoms do you think cause the most absence?
Script:
What symptoms do you think cause the most absence?
[See next slide for the answers]
Symptoms that Cause the Most Absence
Script:
• Although respiratory symptoms are the most common (65%), they only cause
11% of the absences
• Symptoms that are more likely to cause absence are rash, gastrointestinal (vomiting and
diarrhea), and pinkeye
• The difference between which symptoms are common and which ones cause absence
probably has to do with exclusion policies
• Vaccines like rotovirus and pneumococcal may change these statistics
Source:
1. Cordell RL, Waterman SH, Chang A, et al. Provider-reported illness and absence due to
illness among children attending child-care homes and centers in San Diego, Calif. Arch
Pediatric Adolescent Medicine. 1999;153:275–280
How Infectious Disease Spreads
• Respiratory droplets
• Fecal-oral
• Direct contact with people or objects
• Body fluids
• Insects
Script:
Infectious disease can spread in a number of ways:
• They can spread through respiratory droplets
– Some germs from the respiratory tract can spread by breathing the air close to
someone who has coughed or sneezed.
– Most germs from the respiratory tract, however, are spread when a person’s hands
are contaminated by touching moist secretions from an infected person’s nose, eye,
or mouth, and then touching his or her own eyes, nose, or mouth.
• Germs spread from the feces to the mouth, usually via the hands with typical diaper
changing and mouthing behaviors. This can lead to fecal matter being found on hands,
floors, toilet and faucet handles, diaper changing areas
Infectious diseases can also spread through direct contact, such as touching the person or
the object that has live germs on it.
– Examples are: hands mix germs into modeling compound, and mucus is mouthed
onto toys.
– This can be easily confused with the other methods since there is always some
direct contact with the germs.
• Body fluids such as blood, urine, and saliva have germs that can enter the body through
open skin, the mouth, nose, or other mucous membranes. In most cases, intimate contact
is required for transmission and does not usually occur in child care settings.
• Insects can harbor germs that can be passed, especially if the insects pierce the skin.
Bingo Matching Exercise
• Pull out your blank bingo card

• In random order on your card, fill in the squares with these methods of
how infectious diseases are spread
• There are 9 squares and 8 items including free space
Direct Contact 1 Direct Contact 2
Fecal Oral 1 Fecal-Oral 2
Body Fluids 1 Body Fluids 2
Insects Free Space
Script:
Now we are going to play a bingo game. Take out your bingo card. In random order, fill in
the squares with these methods of how infectious diseases are spread.
Trainer note: The bingo card is available for printing online from the Healthy Futures
website at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-
child-care/Pages/Healthy-Futures.aspx
Materials
• Bingo card
Bingo Matching Exercise
• The next slides will have photos of ways that disease can
spread
• Match the photo with the way it spreads disease and put an x
on that box
• Call out if you get BINGO!
Script:
The next slides will have photos of ways that disease can spread
Match the photo with the way it spreads disease and put an x on that box
Call out if you get BINGO!
Participant Activity:
• Show the slides depicting how infectious diseases are spread.
• The participants will mark the right response on their cards.
• The first participant to have “BINGO” should read out the 3 items that made the bingo
and connect those with the pictures.
• There might be some controversy over whether something is “direct contact” or “body
fluid” or “respiratory.”
Answer
• Sneeze spray: Respiratory
Answer
• First aid to a cut: Body Fluids
Answer
• Diaper changing: Fecal-Oral
Answer
• Child mouthing a toy: Body Fluid/Direct Contact
Answer
• Child with a weeping sore: Body Fluid/Direct Contact
Answer
• Mosquito: Insect
Answer
• Changing diaper: Fecal-Oral
Answer:
• Sharing food: Body Fluid
Answer
• Spoiling food: Direct Contact
Answer
• Runny nose: Direct Contact
Summary
• Everyone is affected by the spread of infectious diseases in groups of children

• Children are more vulnerable
• Infectious diseases spread by different methods
• Each method of spread can be prevented by specific strategies, which will be
discussed in the next module
Questions?
In summary:
• Everyone is affected by the spread of infectious diseases in groups of children
• Children are more vulnerable because of immature immune systems
Children are more vulnerable to infectious diseases for a number of reasons including:
• Frequent hand-to-mouth behaviors
• Still learning appropriate hygiene skills (keeping fingers out of nose, covering
coughs, proper hand washing, etc.)
• Some children may not be fully immunized, such as young infants
• Children have close physical contact and do not practice much social
distancing
• Infectious diseases spread by different methods
• Each method can be prevented by specific strategies, which will be discussed in the
next module
Acknowledgements
• This curriculum has been developed by the American Academy of Pediatrics (AAP).
The authors and contributors are expert authorities in the fields of pediatrics and early
childhood education and care.
• The recommendations in this curriculum do not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking into account
individual circumstances, may be appropriate.
• Listing of resources does not imply an endorsement by the AAP. The AAP is not
responsible for the content of resources mentioned in this curriculum.
• Web site addresses are as current as possible, but may change at any time.
• Support for the Heathy Futures curricula has been provided through funding from
Johnson & Johnson Consumer Inc.
34
Acknowledgements
American Academy of Pediatrics Council

on Early Childhood Reviewer:
Susan S. Aronson, MD, FAAP
Curriculum Content Consultant:

Kelly Towey, M.Ed.
35
Copyright Information
© Copyright 2019 American Academy of Pediatrics. All rights

reserved. Specific permission is granted to duplicate this
curriculum for distribution to child care providers for educational,
noncommercial purposes.
36

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Curriculum for Managing Infectious Diseases

in Early Education and Child Care Settings

If someone has a virus they frequently get better on their own

What does infection mean?

• Infection is a condition that is caused by a multiplication of an infectious agent in the

• Contamination is the presence of infectious microorganisms in or on the body,

Just a few more words.

Child Care at 2:00 pm

How does this affect:

How will the impact influence their decision making?

Small Group Activity:

Possible answers for the activity:

Impact of Infectious Diseases

Infectious diseases impact people’s lives in many ways.

There are economic costs such as loss of income for a family.

Health care professionals are affected as well:

Impact of Infectious Diseases

In other words, everyone is affected.

Bad News: Frequency of Illness

What are thoughts on this? Any surprises?

Good News: Annual Illness Incidence by Age

More Good News

Good News for Child Care

• Illness incidence decreases after the first full year

Why are children more vulnerable to

Why do you think children are more vulnerable to infectious diseases?

Reasons why children are more vulnerable to infectious diseases include:

Who is most vulnerable to

Symptoms of Infectious Diseases

What symptoms might this child have

• Do not linger over these points. Keep the discussion moving.

Symptoms of Infectious Diseases

Here’s a list of symptoms of infectious diseases.

[Share the symptom record available at

What do you think are the most common symptoms that

[See the next slide for answers]

Common Symptoms Reported in Early Education settings

What symptoms do you think cause the most absence?

Symptoms that Cause the Most Absence

How Infectious Disease Spreads

Bingo Matching Exercise

• Pull out your blank bingo card

Bingo Matching Exercise

• Everyone is affected by the spread of infectious diseases in groups of children

American Academy of Pediatrics Council

Curriculum Content Consultant:

© Copyright 2019 American Academy of Pediatrics. All rights

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