Since 1986, conference workshops, professional journal articles, manuals, national standards, and sample forms have described the risk to an unborn child if a pregnant mother is exposed to certain infections that commonly spread in groups of young children. Employers of female early education staff of child-bearing age should educate their staff members about this risk. They should urge them to discuss with their health care providers how to reduce their risk.
Cytomegalovirus (CMV) is one of the infections that pose a risk to an unborn child. CMV is a common infection among young children, usually without symptoms. Between 30% and 70% of children less than 3 years of age in child care excrete the virus in their urine, saliva and blood at any one time. Excretion of the virus may occur intermittently for years after the first infection. Women who work in child care may or may not be immune to the strains of CMV infecting children in their care. If a woman has her first CMV infection while pregnant, or has a CMV infection with a different strain than the one she had previously, her unborn child is more likely to be infected.
In utero (congenital) CMV infection occurs in only 1% of live births. However, CMV is the most common viral infection of babies before they are born and the most common cause of sensorineural hearing loss. About 10% of the CMV-infected babies have some symptoms or signs at birth. Those who do may have devastating multi-organ damage. These include poor growth, liver damage, brain damage, hearing loss, blindness, underdeveloped brains and developmental delay. About half of infants who have some symptoms of CMV at birth develop hearing loss from damaged nerves that are needed to carry sound sensations to the brain from the ear. About 15% of those who are infected but have no symptoms of CMV infection at birth develop this type of hearing loss as they grow older. In many children, the degree of hearing loss is progressive.
Nurses who conscientiously practice recommended hand hygiene don't get CMV infections from their CMV infected patients at a higher rate than other women. Teachers/caregivers of groups of young children could similarly reduce their risk by practicing hand hygiene after every contact with urine, saliva or blood. However, achieving this level of hand hygiene is challenging in group care. Teachers/caregivers have contact with more than one drooling child at a time, and frequently touch saliva coated toys or other surfaces. They change diapers or soiled underwear for children in their group multiple times a day.
At the least, women who teach groups of young children need to know how to reduce the risk if they might become or are pregnant. When properly informed, they can consider three options: 1) be very careful about practicing hand hygiene, 2) decide to provide care for preschool or older children instead of infants and toddlers when pregnancy is possible, or 3) choose to work in settings where they have less risk of contact with body secretions of young children.
Employers should explain CMV and other common occupational health risks verbally pre-employment. The information should be in an employee handbook given to each staff member, and discussed at a staff meeting at least once a year. It is best practice to use a Staff Health Assessment form that lists the common occupational risks. The list may prompt the health care provider who completes the form to assess and discuss these risks. Many health care professionals are unaware of the tasks performed by women whose work involves close contact with groups of young children. A list of these occupational risks is in Caring for Our Children, Managing Infectious Diseases in Child Care and Schools, and in Model Child Care Health Policies. Each of these publications has a sample Staff Health Assessment Form too.
Teach early education staff members about each of their occupational risks. Then have them sign a statement acknowledging the teaching received, that they understand and know how to reduce each risk, and that with this knowledge, they accept the risks.
The skin of infants and toddlers is more sensitive to ultraviolet radiation. Their skin absorbs chemicals more easily than the skin of adults and older children. Sun exposure can cause unhealthy changes in the skin at any age. Of the three types of ultraviolet radiation, UVA and UVB damage skin. Children should spend a lot of time outdoors. Protecting their skin from sun damage is very important.
No matter what type or tone of skin a person has, from infancy to old age, everyone should have protection from sun exposure. Sunscreen products and sun protective clothing help prevent sunburn, skin cancer and early skin aging throughout life. The best protection is wearing light weight, tightly-woven sun-protective hats and clothing outside. Wearing sun protective clothing should be combined with wearing sun screen after 6 months of age.
This module is temporarily removed for updating. 6/2018
Child care facilities located on sites that used harmful chemicals years ago could pose a health risk to children and pregnant women today. Young children and pregnant women are more vulnerable when exposed to chemicals. The Pennsylvania Department of Welfare and the Pennsylvania Department of Health are working together to ensure that new child care centers are located in healthy environments. The initiative is called Healthy and Green Child Care Siting. The PA Department of Health evaluates the history of a property and determines whether or not hazardous materials are present at a level that could harm the health of children and their caregivers. The activities address the following questions:
Identifying a potential problem does not mean the property isn’t safe. It means that additional investigation is warranted. If needed, the Department of Health will work with the environmental agencies to review how the property was used in the past and whether or not it poses a health risk.
This may include 1) a review of the chemicals used at the site; 2) how they were handled or stored; and 3) if they contaminated the property, whether or not they pose a health risk to children and their caregivers.
Sites or activities that raise concerns include:
Chemical exposures during child development may contribute to respiratory illnesses, cancer, neurodevelopmental disorders, obesity and birth defects. With over 3000 licensed child care centers in Pennsylvania, this program will help prevent harmful exposures to children and staff in child care centers. Providing a healthy environment for children is a goal we all share.
Contributed by Barbara Allerton, Epidemiology Research Associate, PA Department of Health