Managing Common Illnesses to Support Healthy Learning Environments

Managing Common Illnesses to Support Healthy Learning Environments

Kimberly Clear-Sandor: Thanks, Melissa. Welcome, everybody. It's wonderful to have all of you here with us today in our child care health consultant quarterly webinar series. My name is Kimberly Clear - Sandor. I am a nurse, a family nurse practitioner, and one of the senior training and technical assistant associates with the National Center on Health, Behavioral Health and Safety, and have been working as a child care, health consultant for many years and working with all of you for them as well.

That's why I love seeing those names pop up in the chat. A lot of familiar ones. It's good, and I really appreciate that you all come back and join us to contribute and learn together. I'm excited every time now to be accompanied by my colleague, Mercedes. Mercedes, do you want to say hey?

Mercedes Gutierrez: Yeah. Hi, everyone. I'm happy to be back here again with you all. My name is Mercedes Gutierrez. I am also a senior training and technical assistance associate here with the National Center. I am a medical doctor and have my master's in public health and have been working in Head Start programs for over 10 years, and have been able to work as a child care health consultant for at least the past seven years.

Happy to be here with Kim and talk about some of the things we know about working in the field. We 're really excited about this training in particular because it's just fun. Can't wait to talk to you all.

Kim: Germs are fun.

Mercedes: Germs are fun.

Kim: Thank you, Mercedes. Today's webinar is Managing Common Illnesses, and to think about how we can support healthy environments in our early childhood programs. We know at the beginning of the school year, there's lots of little bugs out there that are coming together in classrooms, and children tend to get mild illnesses as they come together.

We hope today that we can go over some high touch points on things to consider and things you have in place and things to work with your front - line staff and your program leadership to think about managing all these infectious disease and really thinking about how we can best support the children in those learning environments. We are going to be talking about a lot of different illnesses today, and I do want folks to be on the lookout for another webinar later on, but earlier this fall, where we're talking some more about some of the common respiratory illnesses that we see. Next slide. Oh, you already have it up.

Mercedes: I did.

Kim: What is a child care health consultant? We love to start with this. Some of you may be new to working as a child care health consultant. Some of you may work with a child care health consultant. Some of you may want a child care health consultant.

We have a couple of different resources that are available online that can help you understand, what is a child care health consultant, and how can you use one? As a child care health consultant, I think that these are really nice to be able to work with a director of program to talk about your role and all the things that you could do as a consultant to support a program in their work.

We built these documents based off of best practices in the Caring for Our Children Online Standards Database. In general, we realize that there's 50 different flavors, and every state does it a little bit different, but the documents are really built off of that best practice. The way Caring for Our Children Online Standards Database defines a health consultant is as a health professional with education and experience in child and community health, who has specific training in early care and education.

Next slide. We developed a number of competencies for the child care health consultant to go along with what is a health consultant that further describes and really dives into, "What does the work of a health consultant look like and what can it encompass?" There are two documents, an at - a - glance and then one that is really a deeper dive. They're basically broken up into areas of general expertise as well as subject matter areas like infectious disease, nutrition, children with special health care needs, and things like that.

They really capture the amount of health, safety and wellness that health care consultants can bring to a program. What do you need to know? As a health consultant, I might use this to do a little inventory check. Where are my strengths? Where are some of the things I need to work on?

As we go through our webinars - you might find some of our past webinars on the Early Childhood Learning and Knowledge Center (ECLKC) website. They do align with the competencies and we do acknowledge them at the beginning of the program. It's a great professional development tool, and I just encourage you to take a look at them because they cover many of these different subject areas. Next slide.

No matter what you do as a health consultant or anybody working with a program and staff and families, it's important to remember that you bring your expertise around subject matter content, as well as your skills in general areas of expertise. How do you work with a program? How do you understand what's important to them? How do you create policies and procedures that work for them? 

You might create them, and then you might watch how they're working, and they might make them better over time. You might work with a program and think about, I might be working around managing infectious disease, but you know what? I think we need to do some health education or training. You're always combining both of those skills together, and I think that really is true. When we're talking about managing different common illnesses in the early childhood setting. Next slide. 

Our learning objectives for today are, by the end of the presentation, we will review signs and symptoms of illnesses that are commonly seen. We will talk about policies and procedure. We're going to explore some of those common childhood illnesses in a fun way. Get your fingers ready in the chat box, because we will be looking for your participation as we go along. Let's get started. 

Mercedes: Great. Let's start right off with a question for you all. As Kim said, please talk to us. Please speak to us in the chat box. 

We want to know why do young children get sick so often? What do you all think? Somebody wrote already. Not washing hands enough. Building immune system. 

What are you seeing, Kim? I'm trying to keep up. 

Kim: Close contact. Hand hygiene. No boundaries with each other. I love that. You know, not really. That sneeze right in the face kind of thing. Hands in the mouth. 

Mercedes: I couldn't keep up with the scrolling. 

Kim: Yeah. I really encourage folks to keep their eye on the chat, too. 

Mercedes: We love all the chat, and we love that you all write to us quickly. No worries. I know I'm saying I can't keep up, but I actually really appreciate it. 

I think you actually hit every single bullet point on my next slide. Basically, we know that children in early care and education settings are really in close contact with each other. They're also in close contact with staff members, and then adults from other households are contributing to that whole germ pool as well. 

They are at a very early stage of developing their immune system. They have not been exposed to many of the most common germs. Kim and I do another training where we talk about how many days out of the year kids are sick, and it's actually about 93 days out of the entire year that they have some sort of sick, illness - like symptom, which is crazy. 

Because usually, when we ask that question, we'll say, how many days of the year are kids sick? People say every day, because it feels like that, but they're at this stage of development where they're exploring their worlds by touching and then mouthing things, that exposes them to germs as well. Children also tend to put their hands in their mouth to soothe themselves. 

We're helping them really learn some of those healthy behaviors, like covering their cough or their sneeze, and learning how to hand - wash properly. They're not able to do any of these things on their own. They're really in that stage of where we're helping them. That also exposes them. 

Then finally, of course, they're not fully vaccinated. To some adults, it seems like they're sick the entire year, at least the majority of the year. It's all very normal for this age range because they're just in need of building up that immune system and in need of learning some of those healthy behaviors that help stop the spread of germs. I'm sorry. Did I skip, like, a million slides? Yes. OK. 

Kim: You're good. That was your list. 

Mercedes: Yes. Sorry. How are germs spread? There are four ways in which germs are spread, and especially important to acknowledge these in the early childhood education setting. We know that germs can be viruses, they can be bacteria, they can be fungi or even parasites. Some germs are good for our bodies, and then others make us very sick. 

They are spread through four modes of transmission. Direct contact I actually really love this picture on the left because it's realistic. Direct contact. This little baby is chewing on her toy, exploring this toy through her mouth. She's going to put it down. If we're not quick enough, someone else is going to pick it up. 

Having those policies I know Kim's going to talk a little bit later about policies we put in place to help reduce the spread through direct contact. The second picture shows a child coughing, sneezing. This is where we're helping them learn some of these healthy behaviors of covering their sneeze or covering their cough. It is possible to release germs in the air and have that airborne spread. 

Fecal - oral transmission is pretty common in our little ones. You know that there's opportunities during diaper changing where they can explore with their little hands. We, as adults, are responsible for helping them wash their hands after that to reduce the spread of fecal - oral. Of course, there's blood and other bodily fluids like saliva. Go ahead, Kim. I'm going to pass it to you. 

Kim: All the stuff that you guys noted in the chat the touching, the hugging, all that stuff contributes to how that is spread and how it's all picked up as we go. In the early childhood, in the classroom setting, what are we supposed to do? 

This is all very normal. We know all those behaviors are developmentally appropriate. We know germs are going to get spread around and we know little kids are going to get sick. It's really important that folks in the program understand their role is to really observe for those signs and symptoms of illness, and then, based on that, determine the next steps of what to do to support that child as well as the wellness of the program. 

The programs often have exclusion policies which are temporary exclusion policies, letting us know when children need to go home. You can go on to the next slide - I'd love to hear from you. In the early childhood setting, in the classrooms, what are some of the most common signs and symptoms that you see in children who are sick? What are those little hints that tell you that a child is experiencing illness? 

Mercedes: You had runny nose. I saw green mucus, fever, tired eyes, behavior change. 

Kim: I love the behavior, the fussiness, not acting like themselves. Sometimes, those are the ones that are so important, because as the early childhood staff knows those kids well, they pick up on those little signals. The fussiness, the change in behavior, runny nose, a little bit more tired today. Then some of that other stuff happens. The cough, the runny nose, the fever, and things like that. 

You're right. These are all the things we see. What makes me happy about this list is that nowhere in here did you say strep throat. It's what do we see. How can we tell that a child might not be feeling well? Next slide, please. 

Then, when the staff observed this in a child in their program, what are they supposed to do? What are they supposed to do to help care for the child and keep them comfortable? What do they need to document? What do they need to do to notify a family to pick them up or not? Do you need to notify others when a child is sick? 

As consultants working with programs, it's really important that you have the policies and procedures in place so that those on the front line that see these symptoms know what to do next. These are two resources. I do have Kim's favorite resources. They are both available online. They're online and they're free and you can use them at will. They're just super handy.

The Model Child Care Health Policies is a book that is kind of a fill - in - the - blank policy book. It's a great one to get you started or to do a double - check on your policies to see that you have everything you might want in there. 

We also have Caring for Our Children. It's an online standards database, so you can type in and then find national health and safety standards that are evidence - based, science - informed, research - based guidance. What I love most about the Caring for Our Children resource is that it's I always say it's right sized for early childhood. It's not just looking up what's hand, foot, and mouth disease and getting the information. It gives you guidance on, what does that look like in an early childhood program? 

What does that mean when you have a group of kids together, day after day? What are some of the things to think about? These resources will be on your resource list. Again, they're available online for free. They're based on best practices. They can be a really useful resource as a consultant, especially at the beginning of the year, when you're developing trainings and you're looking over policies and you maybe have a lot of new staff that you it's a great place to be able to look at and review those things. 

Next slide. As you're looking for that temporary inclusion/exclusion criteria to create, when a child presents with symptoms, you know what to do next, the best practice around the exclusion criteria recommends that these three statements are included in your temporary exclusion policy. The first is that the illness prevents a child from participating comfortably in activities. In other words, that kid just can't get through the day. 

Only the program's going to know about whether or not the child is comfortably participating in the day. A parent may make their best guess that they think they're going to be OK, they're feeling better, and maybe they're just not. 

The second one is a child needs care due to an illness that's greater than the staff members can provide without compromising the health and safety of other children. Again, you can see how this puts the responsibility on the program side to really make a determination if they have enough staff. Let's just say a child needs to be held all day. Can a teacher have a one - on - one with that child and still be in ratio and care for the other children there? A program is going to need to be able to make those decisions. 

The last one the child poses a risk of spreading harmful disease to others. I think after going through COVID, we all understand that one is there. It's important to know that if they're at risk for harmful disease, it's often because the program knows that there's been exposure to a harmful disease or something's running around in the community. 

Important to understand an exclusion is that it's not going to prevent all illnesses. We know that viruses can spread. People can be asymptomatic, have a virus, and you don't even know they have it. We also know that people can be very contagious before they have symptoms. 

Maybe in the 12 hours before they're getting, they're going to have that runny nose and a cough, those 12 hours may be part of the time they're most contagious. The exclusion criteria is for the kids' benefit and to try and minimize those contagious germs and the amount of germs in that environment. 

The next slide is something a very useful tool. It's in the Caring for Our Children online standards database, and it's called appendix A. I think it's because our teachers are working hard at identifying those signs and symptoms, it's a useful tool for them to figure out, does a child need to go home? 

In this case, you can see the signs and symptoms might be an ear ache. The child complains that their ear hurts or they're holding their ear. Then it tells you what might be causing it. It tells you what the complaints might be or seem. They have fever. They could have pain and irritability. Maybe they're just tugging at that ear. 

If you have a health consultant, it gives you advice whether or not you could call them. It tells you whether or not to notify a parent, whether or not they need to go home, and then when they can come back. It's also a great little tool to use if you need a training activity because it allows teachers to work with these situations and come up and increase their confidence in making decisions about, when do children need to go home? 

Mercedes: Yeah. I like that one, Kim, because it starts with a sign or symptom. That's all we know at that point. When the child is sick, that's all we know. I do want to segue into this question. 

There are times where you know a little bit more than the sign or symptom because the child has gone to the doctor or gotten a confirmed diagnosis from a medical provider. You tell us, what are some of the most common illnesses an actual diagnosis, tell me that you're seeing in programs? Flu, strep, upper respiratory infection, hand, foot and mouth, pinkeye, COVID, conjunctivitis. 

Kim: Scabies. 

Mercedes: Scabies. 

Kim: Upper respiratory. A lot of hand, foot and mouth. 

Mercedes: Lice. Yeah. Impetigo. 

Kim: Yeah. Chicken pox. 

Mercedes: I think you guys got them all. In addition to observing signs and symptoms during the day that might require exclusion, there are also times when a parent actually shares what the illness is and what the child has been diagnosed with, and that will then change how you look at your exclusion policy, because now, you have a confirmed diagnosis. 

I think my next slide just shows everything that you all have been talking about, everything that you listed in the chat. I think you got all of them. Yes, this is just a list of the most common illnesses seen in programs. They can be broken up into four different categories. 

You have your respiratory illnesses. You have enteric illnesses that really affect that GI or the bowel. That's the diarrhea, that's the vomiting that you're seeing. You have illnesses of the eye or the conjunctiva. Then you have some of those skin illnesses which could be caused by viruses, bacteria, parasites, fungi. Those are your ringworm, the rashes that are caused by hand, foot, and mouth. 

I want to take you back to what Kim has started us off with. I know that you might look at this and tell me an exact diagnosis, but I want you to think about the sign or the symptom here. What are you seeing here? What is the sign or symptom in these pictures? Red patches on leg, head, and ankle. Then you still gave me a diagnosis a fungal infection. Rash. Itchy, redness, rash. Ringworm. I think you guys got it. 

You would actually be surprised to know that only two of these pictures are actually ringworm. Just pop quiz. Which ones are ringworm, one, two, three, or four? What I do want you also to note is wait, I'm trying to see if I missed OK. One and four. Actually, it's two and four. I saw a couple two, and four. 

One is something called nummular eczema, and it actually always comes in these round patches. You'll have a kid in your program that gets sent home all the time, probably because you're thinking it's ringworm or something like that, and it's eczema, and that's just how their eczema presents. 

Two is ringworm. This is another common misconception, that ringworm is going to be just this one singular patch on the child's head, but it could manifest in several patchy areas. Three is atopic dermatitis. That's a little newborn foot. It's a very common rash that you'll see on newborns. Then four is definitely what we know and love to be ringworm, that raised circular rash with the central clearing. 

What I want you to take note is how this has manifested on the different skin tones. It's important to be aware of how it can manifest on different skin tones because a lot of our training, a lot of our books, will say this basic red, raised rash. On the darker skin tones, red does not always show, and it sometimes manifests as a darkness or even loss of color. It's important to note how things change on different skin tones. I'm just going to take you to the next slide. This is just some. 

Kim: Can I make a quick comment on someone in the chat? Someone said number two could definitely be something else. You're absolutely right. It could, because our job in the program is not to diagnose. Our job is to say, we're noticing something. I think it's just important to know that Mercedes is running through ringworm to look at how things look differently and what things could be. Not on us to know it, but there may be times when a parent comes and says that. 

Someone else mentioned that in Maine, they have a brown - tailed moth rash. Again, I never heard of that. I never heard of fire ants until I lived in Florida and somebody came in covered in what those were. Again, it's the exercise of writing down what it looks like in the chat was really intended to get us thinking about, how do we document what something looks like that we can share it with someone else that parents can go and tell someone or share what's going on so we can get a diagnosis back? 

When you get a diagnosis, you can look up the diagnosis and figure out what to do there. You have to know what's going on in your area too, because who would know about moth tail rashes? That local thing is always important. Mercedes, ringworm is not a worm, right? 

Mercedes: No, that's what we're. It is a fungal infection. It can affect the body, feet, or scalp. Many of you probably already knew that. This second category, observations, this is what Kim was getting at in the first place. This is what we want you to look up in the chart. OK, I have a, this child has a rash, a circular patch, dandruff or scaling. These are the observations. 

These are the signs and symptoms that you all might come across and that you need to understand or know and base your exclusion policies on. You're basing the exclusion policy on the signs and symptoms. Then afterwards, if you do have a confirmed diagnosis of ringworm, then you would know you would look on your exclusion chart and see if you should exclude or not. 

You might be surprised, and this might contradict some of your policies here, but we would say exclude at the end of the day. This isn't a medical emergency that you're sending the child home as soon as you figured out that they had ringworm. The child should be referred to their health care provider and start treatment before returning. 

Here's a fun poll that we're going to launch. Here's a scenario. During a daily health check, you notice a small, circular rash on a child's face as you're greeting them. The child was absent yesterday and you asked the parent or guardian how he's feeling today. 

They provide a note from the medical provider saying the lesion on his face is, in fact, ringworm, but he started treatment and he's able to return and is clear to return. Your poll's popping up for you now. What are you going to do next? Are you going to send the child home until that lesion is gone or are you going to let them stay in class? 

I don't think you guys can see it, but we see a bar going across of how many people are answering what. We have about a little over 50% of you guys answering, which is fine. 

Kim: There's a lot in the chat too, Mercedes. 

Mercedes: There's some in the chat. OK, no problem. I'm going to end the poll just to show you all. The results might should pop up for you. The majority of you said let the child stay in class. Yes, we would say that also. Let the child stay in class. 

What you could do to help prevent the spread is be extra diligent in taking steps to clean, sanitize, and disinfect areas that he may have touched prior to his absence. Thinking back, oh, he was really having spending a lot of time in this certain area of the classroom. 

Let me make sure I'm wiping down all of the toys, because I want to slow the spread of this ringworm. It is, again, not something that we're sending home sending a child home. We realize that when they miss school, they're missing out on a lot more than just it's just not worth it.

Again, ringworm is caused by a fungus called tinea. There are different names when it affects different parts of your body, but it is spread through direct skin - to - skin contact or indirect contact with an infected surface. This leads me to our next fun fact.

This is just for fun. In the chat, can you tell me, how long can the fungus that causes ringworm live on surfaces like tables, chairs, and bedding? You're thinking about all the tables in the classroom, some of the chairs that the child may have touched, even making sure we're washing down their cot and their bedding. How long do you think that ringworm could live on those surfaces? 

A couple of people said 48 hours. I see weeks, two - plus weeks, 7 to 10 days. I have no idea. No problem. The answer is coming. 10 days. One year. You guys are we're all in the range. 

The answer is actually 10 to 20 months. that's over a year. 10 to 20 months. That is why we emphasize much about having those routines, routine schedules of cleaning, sanitizing, and disinfecting. Then when you are aware of these illnesses, that's when you're being extra vigilant on those common, shared spaces. Let me turn it over to Kim. 

Kim: Here's another fun one. What do we see? Go on, right in the chat. 

Mercedes: People are saying pinkeye, but bring it back to, what sign or symptom do you see? What's the sign or symptom? 

Kim: There we go. 

Mercedes: Redness, irritated eyes, crusty eyes. OK. 

Kim: Crusty eyes. True. They're gooey, crusty, pink, puffy. The "pinkeye" I'm doing little air quotes over here is because the conjunctiva of people's eyes can turn red or pink light red but it can happen for a lot of different things. Each different cause can have its own treatment plan. 

Again, not our job in the program to diagnose what's happening or but it is important to be aware of it, because we may have noticed a child getting hit in the eye and then it becoming red, or maybe they had hand sanitizer on their hand and they touched their eye and now it's irritated in there, or they have bad allergies and they're red. 

The pinkeye, somebody said, isn't that a symptom? It is. The pinkness is part of the symptoms, but the pinkeye as a diagnosis usually refers to a bacterial or viral infection in the eye. They can also be allergic or an irritant of what it might be. 

Health care providers can sometimes diagnose what's going on with the eye just with a health history. They can do it, sometimes, through telehealth services. They usually look for any signs of a recent illness, like do they have a runny nose or a cough or anything else going on? We often hear the term conjunctivitis. That's because the conjunctiva, which is the white part, is all inflamed. 

There you go. We see it a lot. You all see it a lot. If it's from an allergy or an irritant, it's really not contagious. We do note that there could be from many different things. Knowing which one it is really isn't your responsibility. 

The next slide really pulls out, from the Caring for Our Children standard on how to approach this. When you see that redness in the eye, maybe the puffy eyelids and the crust, which are all very important things to notice, because the health care provider is going to want to know those things. You see what it could be caused by bacteria, virus allergy, or an irritant. 

Has anyone ever gotten sunscreen in their eye? That happens a lot, too. A kid touches, it's on their hand or they touch part of their face and they rub their eye. What are we seeing? That redness, the discharge, everything we saw in those pictures. Should they go home? 

The guidance is that they don't have to go home right away, but it should be reported to the family. Should look and see if there's anything else. Is there pain, does the child have a high fever or are they not acting right? If two or more of the kids have eyes that are discharging and stuff, you may want to reach out to a health care provider to get a diagnosis. Pain is a concern. You're definitely going to want to act on that. 

In your resource list, you do have links to the Caring for Our Children database and that chart that we showed you before that green chart that says these are the symptoms and then what to do. Both of those are linked as we go through this. Next slide. Yes, they can't see. Just yell out, Mercedes, if there's anything in the chat that I'm missing. 

Here's a fun fact. How often do people touch their face or eyes? What do you think? Throw it in the chat? Every day. We're talking about -  

Mercedes: 45 times. 1,000 times a day. 

Kim: I just think, throughout this session today, how many times have I touched my eyes? You're absolutely right. It's a lot. They did a study, and they said that people touch their face, on average, 23 times an hour. 23 times that they've gone from a surface to their eye, from their skin or their hair to their eye, from their nose or their mouth to their eyes. Nine of those times, they've come in direct contact with their eyes. 

Your eyes are another way that viruses and bacteria and germs can get into the body. Again, stressing the cleaning and sanitizing and handwashing, because those are all things that can lead to the eyes. Do we still have that conjunctivitis slide? 

Mercedes: Yeah, I skipped over it because it went out of order. Was there anything else you wanted to say about this one? 

Kim: It's cool. I mean, you might it's good. It's colorful. It's nice to look at. I just think, I just wanted you guys to have that, know it was out there. It really talks about the pinkeye when you look at the information from the American Academy of Pediatrics, is that they're really treating it as a symptom of the common cold. When you see those runny, puffy, goopy eyes, they're treating it like it's a common cold. They're not. 

Back in my day I'm getting old there was always, you have to treat pinkeye. Really, that's not the approach anymore. They're really talking about it as a viral that most of them are viral, like a common cold, and to just kind of let it run its course. It's spreading just around, just like a common cold would. Handwashing, cleaning surfaces, and being aware of all that hand eye - rubbing is going to be important. 

Mercedes: I'm going to cross over. Here's another one. What do you see here? Before you give me a diagnosis, which I'm sure you all know, what are the signs and symptoms that you see here? Bumps. Small red patches. Raised rash. Red bumps, red, itchy skin bumps, blisters, drooling, irritation, hives. Give me what's the diagnosis? Hand, foot, and mouth. Hand, foot, and mouth. I know. We can't trick you. I'm not trying to. I'm not trying to trick you. 

One thing I just want to make sure we all take note of here is there are three different skin tones on this screen, and there are three different presentations of this illness. You are all correct. This is hand, foot, and mouth, caused by coxsackievirus. You'll see, on the far left, they are red blisters or bumps around the mouth. Then you see in the middle, this child has actually lost skin color on his or her raised bumps. Then on the far right, you see patchy, darker - skinned patches affecting this child. 

You see the different presentations. Again, going back to how you originally answered the question, that is what we are looking for. That is what's going to help you build your exclusion policies. Another summary slide for you based off the CFOC standard. 

This is caused by coxsackievirus. What we're looking for are cold - like symptoms. I saw somebody noted the drooling. That child probably most likely has a fever too. The mouth sores. You can note that. Skin on rash skin rash on palms of the hands, soles of the feet, buttocks, legs, and arms. Sometimes, they just have no symptoms at all. 

This illness, it's not that serious, but it is very contagious. I'm sure you have all seen this. When one child gets it, it feels like the entire class now is out over the next week with hand, foot, and mouth. It spreads very quickly at schools and daycare centers. It's very common in children under five years old, but actually, anyone can get it. 

Exclusion does not reduce disease transmission, because children are shedding this virus before they're actually showing any of those symptoms. They're shedding this virus while they're picking up and mouthing all of those toys and putting them back down. They could be shedding it for a long time after in their stool as well. Important to note cleaning and sanitizing routines, but also important to think about what your policy is saying for hand, foot and mouth. 

Here's another fun one. What do you see here, without a diagnosis? Everybody lice, bugs, nits. I saw somebody put white something, but it went too fast. 

Kim: White flakes. 

Mercedes: Flakes, dandruff, white flakes, nits, dandruff or lice. Is it both? It's both. the picture on the right is actually dandruff and could very well be confused for nits. Why oh, it's the rolly thing on my mouse. I'm sorry, guys. 

The picture on the left is a picture of nits. That's actually a really pretty severe case, and I'm wondering if it's just AI - generated or something. Nits, they don't move the way dandruff does. That's a good way to it's a good observation that you could say. You're looking at a child's head. They have white flakes that are moving or falling out. 

Nits are actually attached to the strand of hair, and they have to be physically removed by that pinching or combing. Unlike dandruff, nits just don't flake out. They have that distinct kind of oval, oblong shape characterized by a pointed end and a round back. They are like little sects. As opposed to dandruff that's moving, it falls out. It doesn't have a distinct shape. Some dandruff are really big flakes and some are really small. 

I want to get into this next question, which is a true or false question, for you all that you could put into the chat. Lice can hop or fly from head - to - head. True or false? No, yes, true I have a lot of it seems like it's a lot of both. Maybe more false. For every five falses, I'm seeing a true. I'll tell you. 

It is false, lice crawl only. I guess, again, when we're thinking about that cleaning and sanitizing routine, the one area that I always think about is what is it, dramatic play? 

Kim: Hats. 

Mercedes: Hats or anything that they're putting on so it's not hopping from head - to - head. They're not sitting next to each other eating, and then one's hopping from one kid to the next. That's not going to happen. It could get passed through when they're sharing hats or sharing any of that dramatic play. 

Noting that, that actually takes us to our next slide. Lice is caused by a small parasitic insect. This picture, it makes me sad because it's probably a child that's suffering pretty bad to the point where they've scratched all of the scratched their head much that they now have open scabs. 

Because lice causes a very itchy scalp. You can see visible eggs called nits. Then the scratching if you don't treat this right away, the scratching could lead to a secondary infection. Really important to think about how it's spread. It's spread through direct head - to - head contact or sharing hats, headgear or clothing. Those are the things that you want to be diligent with when cleaning and sanitizing. 

Should a child be sent home for lice? Well, actually, the child should be sent home at the end of the day and excluded until treatment has begun. I'm just going to put it out there that we do not promote no - nit policies. They've really American Academy of Pediatrics has really advocated that they should be discontinued. A child missing school until they have no nits in their hair is just more detrimental than helpful. Think about your policies that you have around lice. 

Kim: There's always a lot of conversation around lice. That American Academy of Pediatrics standard has been around for a long time about the no - nit policy, and they can stay until the end of the day, and it just highlights, again, like you said, the dramatic play. People have talked about the helmets. Thinking about that cleaning and sanitizing schedules as part of your policies and procedures. Are those things included? Are we addressing them? 

Somebody else I just encourage you guys to just keep looking at the chat, because you all have fantastic little tips and tricks in there on doing checks for lice and looking that over. Just encourage you to look at that. This is one of my favorite questions. True or false, did people already start doing it? 

Mercedes: Yeah, they're answering. 

Kim: Children with green mucus always need antibiotics. Those green boogies, they just kind of thick and sit there, do they all need to go and get some antibiotics? What is going on here. I'm seeing a lot of no’s and falses in there, and I go ahead. Put that little "false" on the screen there, Mercedes. You are absolutely correct. I just love that you're all bought in on the green boogies do not mean you need to go home and get on antibiotics. 

We really want to be as much as we can, follow those exclusion policies based on best practices. A cold can go through a normal cycle of having really green, thick mucus, and then it can kind of be milky or clear, and it can get thick again. We're really thinking about, when does a cold go on too long and is the child getting sick again? Do they have a fever? Do they have other symptoms? 

Mercedes said in the beginning of the day, and you all agreed, these little kids get sick and then they get a little better, and then they're sick again, or they have a cough that lingers or a runny nose that lingers. Sometimes, kids' boogies are really green in the morning or when they get up from a nap and then they kind of clear up as the day goes on. 

We don't want to say you need to get on antibiotics before you come back just because someone has green mucus. It sounds like you're all on board with that. Sometimes, there's a little bit of a conversation and sharing with others. It might not be as familiar with that information. 

I think it's important that you're able to share with them about, why can mucus sometimes turn green? It's just sitting there in their upper airways and noses. That's just what happens when viruses in the body's immune system starts to break down and fight little bugs. Lots of green faces in the chat, too. Next slide. 

Respiratory illnesses. I'm just doing a little plug. We will be doing another webinar later this fall focused all on respiratory illnesses. This is a chart. It is from late 2023. There is some new information coming out that the new COVID variants do not have the sudden loss of taste or smell as much. I wouldn't totally bank on that. 

Respiratory viruses are out there flu, RSV, colds. We're all very familiar with that well before the pandemic. COVID-19 has definitely come into that array of symptoms. We're talking upper respiratory system. That's something that health professionals may say a lot, and other teachers or families may not be as familiar with those terms. 

Just be aware, we're talking about the nose, the mouth, the sinuses, the throat, all that congestion that can happen up there when they're just stuffy and runny. It still makes them irritable. It makes them not eat well. They can be coughing a lot and not sleeping well, and they can have fevers. 

How do you figure out what's going on? Remember the symptoms versus the diagnosis. Once you get that diagnosis from a health care provider, you can make different decisions. These charts are just kind of general guidance for you. 

When we talk about the lower respiratory symptoms, those are the things like a pneumonia. They're deep down in those lungs. They're less common than the upper respiratory symptoms, but they can sometimes be much more severe. Next slide. 

We do have some information sheets on the ECLKC, which is the Early Childhood Learning and Knowledge Center. It's our website where we put a lot of our materials. This is a great tool that you can use in your programs. You can use it to help your policies on, when someone is diagnosed with this, what do we need to do? It's a good one just to share with staff.

We know RSV has been increasing in frequency. We know it's been out there a lot more in the news and we're hearing that children have it. It has very similar symptoms to other respiratory illnesses. It's actually the most common respiratory infection in children under the age of two. 

But it's our little kids, our little ones under the age of one, even under age of two I worry the most about them because their little airways are tiny, they get swollen and full of mucus fast and then clog them up. These are really great resources for you to look at and think about how you can handle that if a child in your program is diagnosed. Next slide. 

Infectious disease. What can you do? I know Mercedes and I have really been touching on this as we've gone through today. We have our exclusion policy talking about, when can kids what symptoms send a kid home, what to do when a child has a specific diagnosis. How do we keep kids healthy on a regular basis? 

Handwashing. Do it often, do it the right way, always teach about it. Role modeling those healthy behaviors. When we can do it, when our teachers can do it, the children in your care are happy to copy those adults in their space. That role modeling it is important. Making sure that teachers really understand why those behaviors are important that they are incentivized to do them, to help the children learn them as well. 

We can't talk enough about cleaning, sanitizing, and disinfecting, as we talked about, whether it's lice and cleaning helmets or whether it's a sneeze that ends up landing on a table. We have to have a routine to clean this all the time. As Mercedes shared, you can spread the disease before you even have symptoms. It's important and after the symptoms seem to have resolved. 

Those disinfecting practices, cleaning, sanitizing and disinfecting on a regular basis, that's what keeps those germs at bay and at a minimum. Kids are still going to get exposed to things and still going to have many of those common illnesses. The idea is to try and keep them as few as possible. 

We have another fun true/false for you. This is one about a fever. A child with a fever is always contagious. What do we think? You got it. I think you guys kept your fingers right at the keypad you could 

Mercedes: They were ready. They were ready. They knew it was coming. 

Kim: They knew it was coming. It is false. A fever is an elevation in the normal body temperature. We really worry about our youngest kids under the age of two. If they have any sort of a fever above 100.4, it's dangerous. They have to be seen. Anything over 101 degrees is usually, in general, considered a fever. 

Does that mean they're contagious? No. It's another sign or symptom, just like a runny nose or a cough or something like that. Can fevers make kids feel miserable? Absolutely. Can it make them look miserable and scary? Absolutely. You definitely should work with the family to manage the fever, and especially when there's behavior changes, a child will need to go home. 

You can have a non - contagious fever from an ear infection, or from overheating, or from a urinary tract infection, you can have a fever. A cold is probably the most common reason a child has a fever, but it does not necessarily mean they are contagious. 

Next one. This is our down and dirty list of things that you can put in place that help reduce the spread of infectious disease. In the beginning of the year, you're making sure people are connected to health care providers and that they've had their well child visits and you know about any special conditions or needs the child has. 

We talked about our immunization policies. Those are our first line of defense. You want to have those according to your state regulations. If you're in a Head Start program, you follow the CDC schedule. 

Space and group size policy. I think people are much more aware after COVID that crowding isn't good. The closer we are together, the more we can spread. That's why we have ratios and we have square foot per child guidelines in child care licensing regulations. Be aware of what they are. Look at Caring for Our Children, those best practice policies, you can see, what is the real recommendation, because it does play a big role in that. 

How do we share our illness policies with families and staff? How do we do training? How do we manage a child when they are sick? Do we have a quiet space for them, a nice place for them to wait for their parent to pick up? What am I going to clean afterwards? Infectious disease prevention policy and the exclusion policy, which we've talked about. We call that our down and dirty list of things to have in place. 

Here's another hot one. Sanitizing solution is used after cleaning and needs to sit on a surface before wiping. Ding, ding, ding. I can't even see the chat there. It is true. Yes, you all know it. You have to clean before you sanitize. Look at the bottle to find out how long things have to sit on a surface in order to achieve sanitization. 

Read those labels. If you do nothing else, read those labels so that you're getting the cleaning, remove visible dirt, and then sanitize to get rid of the rest of the germs according to that bottle. We have a nice cleaning schedule for you. It's on the ECLKC. You can see it here. It has all the direct links you can really geek out on it and think about how that applies to the programs you're working with and the different areas that they have. Whew. Sorry, Mercedes. I left you with three minutes.

Mercedes: It's OK. We're just going to wrap this up for you all. We hope, today, that you have learned that it's more important to identify those signs and symptoms. It's really fun playing doctor, I know, but we don't want you to have that burden of trying to come up with a diagnosis. Know what the signs and symptoms are and make your exclusion policies based off those signs and symptoms. 

When you're creating that exclusion policy, remember that you should keep these three things in mind. Is the child too ill to participate in daily activities? If children, due to illness, require more care than the teacher can give, and if the child is at risk for spreading a harmful illness, that is when you want to take the time to exclude. Then, if we haven't said it enough, practice those daily methods of cleaning, sanitizing and disinfecting. 

We just like to leave you all with some resources for child care health consultants. This is on the ECLKC, "eclic" whatever you may call it, but is the whole compiled list of resources specifically for child care health consultants. We do have a MyPeers space where child care health consultants can talk to each other and share information. Please join MyPeers. It's, like, Facebook for early childhood education. It's a social platform.

I see we answered a lot of questions in the Q&A. If there's any more that we didn't get to answer, please write to health@ecetta.com. I'll pass it over to Melissa. 

Melissa Lin: Thank you, Kim and Mercedes, and thank you, everyone, for joining us today. I hope it was interesting and informative. Just a reminder to please fill out the evaluation. You have the link in a QR code. You'll also see it when you close out of the webinar today and, your feedback helps us improve future training and technical assistance offerings. If you have more questions, go to MyPeers or write to us at health@ecetta.info.

Mercedes: Oh, info, I'm sorry. I messed that up. 

Melissa: No worries. Next slide, please. Just to say an extra thank you, thank you for joining us. Please subscribe to our mailing list if you don't already. Next slide. Please also follow us on social media and hop over to MyPeers continue the conversation with colleagues across the country. Next slide, please.

Again, if you have any more questions after today's webinar, you can reach us at the email address health@ecetta.info. Also check out the ECLKC for today's resources and more. We thank you much, and a big thank you to Kim and Mercedes for presenting us this excellent information.