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Expert Q&A

	By Cathy Giessel, M.S., FNP-CS Nurse Practitioner

What are the most serious childhood illnesses I should worry about with my child who is in daycare?

Children in daycare are certainly at higher risk for contagious diseases than a child cared for in his own home. However, there is some evidence to suggest that the frequent colds children get while in childcare may offer some protection against asthma and allergies in the future. This theory is known as the Hygiene Hypothesis. Another benefit of more frequent colds in childcare during early life may be less colds on entry to kindergarten. Children who are exposed to second-hand smoke from tobacco are at greater risk for colds, bronchitis and asthma. Be sure others do not smoke around your child.

Communication with your childcare provider is a vital factor to your child's health when away from you. Your childcare provider should communicate with you daily about changes in your child's health that may be of importance. A childcare provider who will pick up the phone to let you know about fever or serious accidents is crucial. You should feel comfortable to drop by the childcare setting at any time to check on your child.

The most serious illness facing your child will be the one that results in the most significant injury and long-term detriment. And there is no general list that can be compiled because each person is vulnerable in different ways.

Frequent hand washing is the key to preventing many contagious diseases. A childcare provider that washes their hands after diapering children and wiping runny noses is your ally. There are numerous communicable diseases that are vaccine preventable. These diseases could be spread readily in a daycare setting. Most American children are vaccinated to prevent hepatitis B, measles, mumps, rubella, haemophilus influenza, diphtheria, tetanus, pertussis, polio, pneumococcal disease and chickenpox. With the increasing mobility of the world's population, it is still possible to be exposed to an unvaccinated child with one of these illnesses, so following the recommended vaccination schedules is important for a child in daycare settings. Influenza immunization is also recommended annually for children under 2 years of age and those with chronic diseases such as asthma, diabetes or heart disease.

Accidents are not an illness but certainly cause death and disability to countless children each year. Prevention relies on adult surveillance and intervention. Choking is a major hazard to toddlers who explore the world with their mouths. Toys that fit easily into a toilet paper tube are too small for your child to play with. Avoiding hard, bite-size foods can also help prevent choking. Examples of such foods are hot dogs cut into circles, nuts, popcorn and raw vegetables such as carrot sticks. Latex balloons are the No. 1 toy that results in fatal choking events in the United States. Developmentally appropriate accident prevention can be easily researched in many parenting references. In the childcare setting look for low student to teacher ratios. The less children the childcare provider has to watch, the more time they will have to closely observe your child during play. Soft surfaces in the playground area are important in preventing fractures from falls. And finally, seatbelts should be worn at all times when in motorized vehicles.

Obesity is not considered an illness but is at epidemic proportions in America. Prevention begins with the adults in the family setting an example of physical activity and healthy diet habits. Good nutrition goes a long way toward disease prevention.

Leukemia and other childhood cancers could be included in any list of the most serious childhood illnesses. There is no known prevention for these illnesses, but early detection can improve survival. So yearly physical examinations with your pediatric nurse practitioner or other healthcare provider are important to detect not only the worst-case scenario, but also more simple problems such as vision problems or developmental issues.

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