Prevention and management of common childhood diseases in day care institutions

By focusing on the three core links of "hardware prevention and control, dynamic care and leakage correction, and tripartite collaboration between doctors, families, and schools" and focusing on the three most common diseases of respiratory tract infections, digestive tract infections, and infectious rashes, we can suppress more than 80% of the risk of group clusters of morbidity, and there is no need to engage in excessive prevention and control of the "every tree and tree" style.

When I was working as a public health supervisor for day care institutions in the district maternal and child health hospital two years ago, I came across a high-end chain park with an excellent reputation: the hardware configuration was fully equipped, the entire area was regularly disinfected with ultraviolet lamps, tableware and meals were steamed at high temperatures, public areas were wiped with chlorine-containing disinfectant every two hours, and even the access control was equipped with smart temperature measuring gates. As a result, a noro cluster epidemic broke out just after autumn, and 17 of the 22 children in a middle class were killed. The reason that was finally traced back to the source was extremely amusing: the life teacher on duty that day took a temporary leave, and the logistics teacher who was on duty did not know that a child had vomited at home the day before. The parents were afraid of delaying work and concealed the illness, so after wiping the child's mouth without changing gloves, he turned around and distributed cantaloupe to the whole class, and the virus spread directly to the whole class.

In fact, there is a huge controversy in the industry over the scale of prevention and control. Most managers with backgrounds in the public health system tend to "strict admissions": as long as the child's body temperature exceeds 37.3°C and has symptoms such as cough and diarrhea, he or she will be advised to return. Even if it is a common cold, the symptoms must completely disappear for 48 hours before returning. After all, once a cluster of epidemics occurs, the entire park will have to be shut down for rectification, and no one can bear the responsibility. However, many experts in the field of child health do not agree with this approach: the cough symptoms of a common cold sometimes last for 2 to 3 weeks, and children with allergic rhinitis sneeze every day. If the symptoms are completely stuck, half of the children will not be able to go to school for half a month, which not only affects the children's social adaptation, but also adds huge trouble to working parents. The "symptom level admission" we have piloted in the past two years is actually a compromise between the two sides: as long as the child does not have a fever, is in a normal mental state, has a cough without yellow and thick sputum/continuous projectile cough, and has diarrhea and vomiting symptoms that have disappeared for 24 hours, he can enter the kindergarten by wearing a small mask.

Many kindergartens always think that everything will be fine if they spend money on disinfection equipment. In fact, the real loopholes are all in the small places that no one pays attention to. When I visited the kindergarten last time, I saw children queuing up to drink water. The child in front took a sip from the water outlet, and all the saliva hung on the water outlet, and the children behind him followed suit. Hand, foot, and mouth, and herpetic angina are most commonly spread along this route. Some kindergartens have children sleep with their heads in the same direction during lunch break. The faces of the two children are less than 20 centimeters apart. If one sneeze, the three next to him will be exposed to droplets. A slight modification is made so that the children sleep one end and one end apart, and the risk of infection is directly reduced by half.

Don’t always think that prevention and control is the job of health care doctors alone. I once took over an inclusive kindergarten. The principal was very smart. He set up two afternoons every month to provide life teachers of each class with common disease identification training. They tested the difference between rashes on the hands, feet and mouth and mosquito bites, and how to disinfect Noru’s vomit so as not to spread. They also set up a small bonus of 50 yuan for those who find suspicious cases. One time, the life teacher in the middle class was braiding the little girl's hair and felt a small light red rash behind her ears. When asked about the parents, the fever had reached 37.8°C the night before. The parents thought it was food accumulation and did not take it seriously. They sent her to the health care center that day, and she was immediately isolated after being diagnosed with rubella. There was not even a second case in the entire kindergarten, which was much more effective than the health doctor checking once a week.

There is another topic that has been debated for many years: Should all children in the kindergarten be given preventive medicine during the flu season? In the past, many kindergartens gave their children isatis root to drink in order to prevent influenza, but they were later reported by parents. Both sides have different opinions on this matter. Some experts in traditional Chinese medicine and pediatrics believe that for susceptible children, drinking mild traditional Chinese medicine instead of tea during the flu season can indeed reduce the probability of infection. However, the consensus of Western medicine in pediatrics is that taking medicine casually when children have no symptoms will increase the burden on the liver and kidneys, which is not necessary at all. Our current unified requirement is that kindergartens must not feed any medicine to children without authorization, not even isatis root. They can only send the official prevention advice to parents. It is up to the parents to decide whether to prepare it for their children.

I have been working as a public health director in child care institutions for almost 10 years. To be honest, 90% of the cluster epidemics I have seen are caused by poor hardware, either because someone is lazy, or because there is a lack of information. Or during the morning check-up, the health doctor was busy chatting, touching the forehead and then it was over, and the child with fever was put in directly. ； Or the child was absent from school, and the teacher only asked, "Something happened at home," without asking if he was sick. ； Either the parents were afraid that their perfect attendance would be deducted or that no one would take care of their children, so they sent the children here without telling them that they had vomited or had a fever. If you really want to prevent diseases, you don’t need to make any pretense, just put every little thing on the head of the person: who will do the morning check-up, who will follow up on absent children, who will sign for disinfection, and if there is a problem, you can find the corresponding person, which is much more effective than buying a disinfection equipment worth 100,000 yuan.

Oh, by the way, I forgot to mention the easiest time to get into trouble: the half month of September every year when new students enter kindergarten is definitely the peak of the disease. Many kindergartens only focus on preparing children to adapt to kindergarten and calm their emotions, and forget to hold health information meetings for parents in advance to clearly explain the consequences of concealing the disease. Last year, there was a kindergarten where on the third day after the new students entered the kindergarten, a parent brought in a child with hand, foot and mouth rash, saying that he thought it was acne caused by a fire. In the end, the whole class was suspended for two weeks, which was not worth the loss.