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.
Between 2008 and 2013, the Consumer Product Safety Commission (CPSC) received 1,300 reports of stroller and carriage injuries. These reports included 4 deaths. ASTM International* brings manufacturers and consumers together to develop standards. In 2013 ASTM updated the voluntary safety stroller and carriage standard. The new ASTM standard is ASTM F833-13b.
In March 2014, the CPSC approved a mandatory standard. The new federal standard incorporates by reference the ASTM voluntary standard. After September 10, 2015, nearly all strollers and carriages sold will have to meet the mandatory requirements.
The new standard governs full-size strollers that fold up. Also, it covers travel systems (including car seats), tandem, side-by-side, multi-occupant and jogging strollers. It adds to the ASTM standard requirements to prevent head entrapment and addresses the following hazards:
Many early education programs transport older infants, toddlers and young preschool age children in strollers. For risk reduction and liability protection, the best practice is to purchase strollers that meet the new standard as soon as they are available.
*ASTM International was formerly known as the American Society for Testing and Materials and is commonly called ASTM.