IX Preface In the United States, more than two-thirds of children younger than 6 years, and almost all children older than 6 years, spend significant time in child care and school settings outside of the home. Exposure by being in a group of children increases the risk of infectious diseases. This fact has important personal, public health, economic, and social consequences. The intent of this book is to provide an easy-to-use reference for those who are responsible for the pre- vention and management of infectious diseases in child care and school settings—teachers/caregivers, pediatric clini- cians, public health professionals, and parents/legal guardians. This is the fifth edition of this book. New topics were added at the request of enthusiastic users. Review of scientific evidence since the previous editions led to a few changes as well. The text was cross-checked and updated to be con- sistent with 2 other publications: the American Academy of Pediatrics Red Book®: 2018–2021 Report of the Committee on Infectious Diseases, 31st Edition, and the American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education Caring for Our Children: National Health and Safety Performance Standards Guidelines for Early Care and Education Programs, 4th Edition. In this book, educators in group care settings and schools include directors, teachers/caregivers, and other education professionals. Educators will find that this book offers easy-to-read explanations for how infectious diseases spread, how to prepare for inevitable illness, and how to incorporate measures that limit any excess burden of illness associ- ated with group activities. The Signs and Symptoms Chart (Chapter 5) will help nonmedical professionals become aware of what might cause various signs and symptoms. The fact sheets (Chapter 6, Quick Reference Sheets) describe specific types of infectious diseases in common terms, with guidance about how they spread and what needs to be done by educators, children, and families when someone in the group has a disease. By using this book as a handy reference, educators can feel more confident in making decisions about inclusion and exclusion of ill children and in seeking advice from medical and public health professionals when necessary to reduce the burden of infectious dis- eases on other children and staff members. Child Care Health Consultants (licensed health professionals with education, experience, and training in child and community health and in health practices recommended for early education/child care programs) may find this book helpful in assisting programs and schools to create model policies and best practices for handling children with infec- tious diseases. Pediatricians and other health professionals will find this book helpful as a reference that facilitates communication with educators. Pediatric health professionals are the primary source of information for educators about the manage- ment of infectious diseases for individual children and the implications of these infections for groups of children and the adults who care for them. Pediatric health professionals can use the content of the book to identify exclusion and inclusion recommendations, supplement their communications with educators about infectious diseases of patients, and augment their instructions for the care of the child for parents and educators involved in the child’s care. They also can use the content of the book to identify the need for linking teachers/caregivers with public health authorities when necessary. Parents will benefit from the content of this book because it will provide a common means for communication among family members, pediatric health professionals, and educators that is based on the latest evidence and expert opinion about best practices. Additionally, parents and educators will benefit from the Quick Reference Sheets. These may be copied. For example, a health professional can give a copy to parents to share with educators, or educators can send copies home to parents. Use these sheets to describe a condition or infection affecting a child or the group of children to which a child is exposed. This book also addresses the controversial subject of exclusion and return-to-care criteria. Controversy exists because often, educators, pediatric clinicians, public health professionals, and parents disagree about which conditions require exclusion. For example, children with runny noses are often excluded from group care unnecessarily. Children and staff with diarrhea with frequent, loose bowel movements may be allowed to stay and pose a significant risk of spreading a gastrointestinal infection. Adding to the confusion, each state health department and licensing agency has unique and sometimes out-of-date rules or exclusion criteria for determining which symptoms, diseases, and con- ditions require exclusion from child care or school. The recommendations in this book are based on the best available scientific evidence as determined by American Academy of Pediatrics experts in infectious disease. Some of the practices suggested in this book can be followed without conflict with existing rules or regulations. Others will require changing obsolete rules and strongly held but mistaken beliefs. Susan S. Aronson, MD, FAAP Timothy R. Shope, MD, MPH, FAAP MIDCCS4-00-FM-i-xii.indd 9 6/10/19 1:28 PM
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