Prevention and management of common childhood diseases in day care institutions

The core answer to the prevention and control of common childhood diseases in day care institutions has never been the extreme goal of "zero disease", but the establishment of a flexible system of "stratified and graded pre-prevention + dynamic case management" - it is necessary to maintain the bottom line of prevention and control of statutory infectious diseases, but also to avoid the interference of excessive sterilization and blanket school closures on children's immunity and normal family life. Balancing the relationship between collective prevention and control standards and individual differences is the long-term plan that can be implemented.

Last week, I went to the district's public demonstration garden for quarterly supervision. Sister Zhang, a health doctor, held a thick absence registration book and complained. Just two weeks into autumn, there have been 21 cases of respiratory tract infection reported in the whole garden, and 3 positive cases of rotavirus. "We followed the frequency required by disease control to disinfect the area, conduct inspections in the morning, afternoon and evening, and track and report zero absences. I did everything I should do, but some children still got sick. Parents also complained that our children always complained that our children had dry throats because we disinfected too hard."

In fact, in the circle of child care and health care, there have always been two completely different practical ideas about the prevention and control of common diseases. One is the "zero tolerance" strict eradication school, which completely follows the standardized procedures for disease control. As long as there is a case of infectious disease, the children in the same class will be observed at home immediately, and public areas will be disinfected every two hours. Children are even prohibited from bringing their own toys and playing with sand and water and other game materials that can easily hide bacteria.； The other faction is the "natural immunity faction" that has emerged in recent years and is mostly promoted in private international kindergartens. It believes that common colds and low-grade fevers are necessary processes for children to build immunity. As long as they are not serious infectious diseases, they can enter the kindergarten normally. High-frequency disinfection is not even recommended for fear of destroying children's normal flora contact.

Both ideas are supported by real cases, and both have encountered pitfalls. I have seen kindergartens that implement strict disinfection to the extreme. The annual incidence of infectious diseases among children is indeed 12% lower than that of neighboring kindergartens. However, data tracked by the cooperative pediatric clinic shows that the incidence of allergic rhinitis and asthma among children in this kindergarten is 32% higher than that of neighboring kindergartens. Many children are more likely to get serious colds when they reach elementary school. ； I have also seen kindergartens that were completely liberalized. Last year, there was a private kindergarten that did not pay attention to the hand, foot and mouth warning issued by the disease control. In just one week, 47 children were infected. Finally, the National Health Commission reported it, and many parents were compensated for their medical expenses, and the principal was replaced directly.

Our team has conducted prevention and control pilots in 17 child care institutions for three years, and the most feasible path we have found is to first divide common diseases into three categories, without applying unified standards to all situations. The first category is notifiable infectious diseases such as hand, foot and mouth, norovirus, influenza, and measles. There is no room for negotiation. Disease control standards are followed completely. Once a case is discovered, closed-loop management is carried out immediately, and the isolation, disinfection, and school suspension procedures are all in place. The risk of serious illness of this type of disease is high, and there is no room for luck. The second category is common colds, mild herpetic angina, and viral gastroenteritis, which are contagious but have a very low risk of serious illness. We have implemented a "yellow card registration" system for the kindergarten. Parents can voluntarily choose whether to send the children to the kindergarten. As long as they sign an informed consent form, the kindergarten will arrange these children in separate activity areas. They will not share eating utensils. The health doctor will check the temperature twice a day. This will not delay the normal work of a dual-income family and will not cause widespread transmission. The third category is minor illnesses that are not contagious at all, such as allergic rhinitis, dysphagia, and minor trauma. They are directly classified as green cards. It is enough to participate in all activities normally. It is enough for the health care practitioner to pay more attention to the status. There is no need to persuade parents to take the child away if he feels a little uncomfortable.

Many people tend to overlook that prevention and control is not a unilateral matter of the kindergarten, and communication with parents is even more important than disinfection. Last month, a pilot kindergarten encountered an incident. A parent concealed his child's medical history of hand, foot and mouth, and secretly sent the child to him after being quarantined for 7 days. As a result, he infected three children in the same class, and the parents were in a fuss. Later, we made a plan for the kindergarten. We would hold a 15-minute online health meeting every month. Instead of reading boring disease control documents, we would just talk in plain language, such as, "This week, two children in our kindergarten got noro, please don't feed your children raw sashimi at home. "If the child has vomiting and diarrhea, he must stay at home for 48 hours before delivering the cold fruit, otherwise the whole class will have to suspend classes and everyone will be in trouble." If I put it so bluntly, parents would understand. Later, the underreporting rate of this kindergarten dropped by 80%.

I have been doing childcare care for almost 10 years. To be honest, there is really no perfect prevention and control plan. An old health care doctor who has been working for a lifetime told me that you should not always focus on the rigid standards in the documents and treat each child as your own. Then you will know when to be strict and when to be relaxed. Think about it, if your child just has a runny nose and is more energetic than anyone else, you will definitely not want to stay at home with him for a week without being able to go to work. ； But if a child in your class has hand, foot and mouth disease, you will definitely be the first to stand up and prevent him from coming to the kindergarten. The principle is the same.

Many kindergartens tend to go to two extremes now. Either they are afraid of taking responsibility and apply one-size-fits-all, suspending the whole class if there is any trouble, or they are afraid of parents' complaints and let them go completely without taking any risks. In fact, to put it bluntly, child care institutions are not sterile rooms. What we need to prevent are infectious diseases that can cause serious illness and spread on a large scale, not the small colds and coughs that children must experience as they grow up. Explaining the rules to parents thoroughly and leaving enough space for children to have normal contact with nature and bacteria is much more effective than disinfecting ten times a day.