Recognizing & Managing Communicable Diseases: Key Concepts, Background Information

This learning tool addresses how to recognize the signs and symptoms of illness in young children, respond to them, and effectively communicate with parents and health care providers about the illness. Designed for Head Start health managers, health staff, and other program staff, it allows them to quickly learn or review what their role is in dealing with a child who has a communicable disease. Questions for group discussion or individual reflection are included.

The following is an excerpt from Preventing and Managing Communicable Diseases.

Key Concepts
The Daily Health Check
Assessing the Ill Child
Caring for the Ill Child
Communicating with Health Providers
Questions for Discussion/Reflection


KEY CONCEPTS

Recognizing and managing communicable diseases involves a partnership among staff, families, and health professionals.

Head Start staff's role is to:

  • Work with health professionals to develop health policies, staff training, and information for parents.
  • Observe children for signs of illness.
  • Care for ill children until they can be sent home.
  • Document signs and symptoms, as well as actions taken.
  • Minimize the spread of illness to other children and staff.
  • Discuss with parents their ill child's condition, whether he is too sick to attend, the need for medical evaluation and treatment, and when to return.

Head Start staff's role is not to diagnose or prescribe treatment for illness - that's the health care provider's role; and not to provide total care for sick children - that's the parents' role.

Background Information

Head Start staff members are on the "front line" caring for children. You may recognize and respond to the first signs of illness in children. Dealing effectively with illness in children requires a partnership among staff, parents, children, and health care providers.

A. The Daily Health Check

The daily health check is a quick assessment of each child's health. It takes less than a minute. You gather information from what the parent and child tell you, and what you observe. You use all of your senses - listen, look, feel, and smell.

Do the health check each day:

  • When the child arrives at the program
  • Throughout the day

When you do the health check every day, you learn what is normal for each child, and you recognize unusual signs or symptoms indicating that the child might be ill.

When you recognize the early signs of illness, you can make the child more comfortable and alert the parents that the child might need medical evaluation and treatment. For example, you might observe that a child complains of sore throat and has a red body rash and fever. Documenting your observations, calling the parents to take the child home, and advising them to take the child to the doctor can lead to prompt diagnosis of strep throat and treatment for the child. This can prevent more severe illness for the child and the spread of the illness to others.

B. Assessing the Ill Child

  1. Interpreting the Health Check

    The health check tells you when a child might not be feeling "his normal self." These signs might indicate illness, fatigue, hunger, injury, or stress. Your assessment of the ill child involves careful observation, understanding of childhood illness, and familiarity with the child.

    Different children have different ways of showing you that they might be sick. For example, one child's "stomachache" might mean that she needs to have a bowel movement, but for another child that she's anxious or upset, and for another child that he's sick with the "stomach flu" and ready to vomit.

    Children can also show different signs at different ages:
    • It can be difficult to tell when infants are sick. You need to be alert to small signs such as fussiness, poor appetite, listlessness, or feeling warm.
    • When toddlers and young preschoolers are sick, they often have a general complaint, "I don't feel good." You need to ask them to tell you or show you where it hurts.
  2. Checking for Fever

    When a child complains of not feeling well and looks and acts sick, you may take the child's temperature to tell whether he has a fever. Fever is when the body's temperature rises higher than normal. Body temperature can rise in response to an illness, immunization, exercise, overdressing, or hot weather.

    Fever is not an illness in itself - it is a possible sign of illness. Consider fever along with all of the other signs and symptoms (i.e., how sick the child looks and acts) to determine how sick the child is.

C. Caring for the Ill Child

When a child is sick, staff must decide whether the child is too sick to stay in the program. Although it is not the role of the program to care for ill children, staff need to provide care until the parents arrive. You need to rely on clear health policies and your own judgment and experience.

  1. When a Child Is Too Sick to Attend

    A child is too sick to attend the program if (any of the following):
    • The child is too sick to participate comfortably in the program's activities.
    • The staff cannot adequately care for the needs of the sick child without compromising the care of other children.
    • The child might have a specified communicable disease that could spread to other children and staff.
  2. Developing a Care Plan

    When children are sick, they have greater emotional and physical needs. The basic care plan should follow the "4 C's":
    • Comfort the child
    • Care for the child's symptoms
    • Complete the Symptom Record
    • Call the parents

Comfort

Ill children may feel irritable, sad, lonely, frightened, angry, and bored. They often regress to a less mature level of behavior. Nurturing by a trusted caregiver in a familiar setting can reduce the stress of an illness:

  • Touch and sing to the child.
  • Frequently ask how she is feeling and acknowledge her feelings with understanding and concern.
  • Let her know who will pick her up and when.
  • Encourage the other children to draw a get-well picture, make her a snack, or choose a toy for her to play with.

Care

Isolation or "Get-Well" Area: The isolation or get-well area is a place to care for the sick child, slightly away from the main area of activity. The purpose is to isolate the germs so they don't spread to other children. Do not isolate the child. Maintain constant supervision of the sick child to observe her symptoms, care for her needs, and make her feel included.

Rest and Activities: When a child is sick, especially with a fever, he has a greater need for rest because his body is working to fight off the illness. Provide opportunity for quiet play, rest, and sleep.

Nutrition and Fluids: When a child has a fever, vomiting, or diarrhea, he has a greater need for nutrition and fluids to replace what is being lost. However, many children lose their appetite when they are sick. Frequently offer small amounts of liquids (e.g., water, juice, broth, gelatin) and light snacks (e.g., crackers, toast, noodles, tortillas, rice, bananas, applesauce).

Care for Fevers: When fever accompanies an illness, it actually helps the body fight off the disease. A fever is usually not harmful and does not need to be treated. To make the child feel more comfortable you may:

  • Undress the child to the point of comfort (i.e., light clothes and a sheet or blanket). Do not bundle the child to "sweat out" the fever.
  • Frequently offer clear liquids to drink.
  • Place a cool compress on the child's forehead.

Medications: Medications may be prescribed to treat an illness or relieve symptoms. But medications can also be dangerous if they are given when not needed, or if they are given in the wrong way, wrong amount, or at the wrong time. They can be dangerous even when given properly, for example, if the child has an allergic reaction.

Give medicines only in accordance with state licensing regulations and when prescribed by the child's health provider. Staff members should be trained in procedures to administer medications and document each time they give medicine to a child.

Emergency Care: Although severe illness is rare among children, staff must recognize and get immediate medical care (emergency medical system, 911) for the following:

  • Signs that the brain may not be functioning well - such as, listlessness, confusion, seizures, severe irritability, severe headache, unconsciousness.
  • Breathing problems - such as, rapid breathing, persistent coughing, wheezing, sucking-in around the ribs, choking, bluish/grayish lips or nails.
  • Severe loss of body fluids and circulation problems due to large blood loss, persistent vomiting or diarrhea, or dehydration - signaled by pale/ashen color, cold hands and feet.
  • Severe pain - such as, headache, abdominal pain, chest pain.

NOTE: Have emergency contact information and consent for emergency treatment signed by the parents on file for each child. Make sure the information is current.

Completing the Symptom Record

It is important to document the child's illness in order to share information with the parents. This helps parents know how their child is feeling and how they should care for him. If they take the child to the doctor, it will aid in the diagnosis and treatment.

Documentation is also important for the program's records. The records can be reviewed by a health consultant for improving the prevention and management of illnesses in the program. The records will also be available to the licensing agency, public health authority, or insurer in case of severe illnesses or complications.

Carefully document:

  • The signs and symptoms of illness that you observe.
  • How you responded to the symptoms.

Calling Parents

Staff and parents depend on each other for sharing concern and responsibility for the child and respecting each other's feelings and beliefs. Since a child's illness can add stress to the relationship between caregivers and parents, sensitive communication around illness is crucial.

Prepare in advance by developing clear, up-to-date health policies. Give parents a copy of the policies and discuss them during enrollment/orientation and parent-teacher meetings. Explain that, although the program takes many measures to reduce the spread of disease, it is inevitable that children get sick. Clarify the policy on when a child is too sick to attend and help parents plan who will care for the child when she is sick.

When a child is sick, always report the symptoms to the parents, either immediately or at the end of the day, depending upon the severity of the symptoms.

  • Express your concern about the child's health and comfort. For example, "I'm concerned that Emma hasn't wanted to eat or play and just doesn't seem herself."
  • Describe the child's symptoms and what you did. For example, "Joey vomited up his formula twice. He's been pulling at his left ear and has a fever of 101 under the arm. I cleaned him up, and he's asleep now." Do not be vague, for example, "Joey feels hot." Do not diagnose the illness, for example, "Joey has an ear infection so you need to pick him up and get him antibiotics."/li>
  • Try to be sensitive to the parents' situation. If the child needs to be sent home, tell the parents that you understand it might be difficult for them to make last-minute arrangements. Ask who will be able to pick up the child and when they will come. Try to be flexible - unless it is a medical emergency, immediate pick-up is not usually necessary. Reassure them that you will keep the child comfortable until they arrive.
  • Discuss the possible need for medical evaluation and treatment. When in doubt, suggest that the health provider check it out. Depending upon how sick the child looks and acts, you might state, "It's probably nothing serious, but if she's not getting better you might want to have her checked by her health provider," or "She looks pretty sick, and I really think that you should take her to the doctor right away."
  • Ask the parents to give you the health care provider's diagnosis and treatment recommendations. Emphasize that you are concerned about the child. Also, you may need to notify other parents and the health department of exposure to a communicable disease. Tell the parents when the child can return (e.g., when the symptoms resolve or 24 hours after starting antibiotics).

NOTE: When giving information to other parents or posting exposure notices, maintain confidentiality - do not report the name of the child.

D. Communicating with Health Providers

Periodically, health concerns arise that are beyond the knowledge of Head Start teachers, directors and health coordinators. Programs need to develop relationships with health professionals who can provide assistance. Keys to effective communication include:

  • Address questions to the appropriate health provider. For example, when your concerns address the health of a specific child, consult the child's health care provider (with the parents' permission). When the concerns are group health issues (e.g., health policies or infection control practices), contact your program's health consultant or the public health department.
  • State your concern briefly and clearly. Have all of the necessary facts (e.g., the Symptom Record) on hand.
  • Listen carefully and document the advice. If you don't understand something, clarify it immediately. If the advice is complicated, request written information. Summarize to confirm your understanding.

Questions for Discussion/Reflection

When a child becomes ill, it can be very stressful for the child, parent, and Head Start staff. Dealing effectively with illness requires cooperation among staff, families, and health professionals.

  • What is the greatest challenge for you in dealing with communicable diseases in the program?
  • What has your program done to encourage cooperation among staff, parents, and health professionals regarding communicable diseases?
  • What could your program do to manage illnesses more effectively?

Recognizing & Managing Communicable Diseases: Key Concepts, Background Information. Preventing and Managing Communicable Diseases. HHS/ACF/ACYF/HSB. 1996. English.

Last Reviewed: May 2009

Last Updated: October 24, 2016