Children's Health Week 11-15

Emotional/psych abuse

-A pattern of behavior that impairs a child's emotional development or sense of self- worth -This may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance -Emotional abuse is often difficult to prove, and therefore, child protective services may not be able to intervene without evidence of harm or mental injury to the child -Emotional abuse is almost always present when other types of maltreatment are identified

Lester and Russell (2011)

-Active games -Pretend and sociodramatic play -Language play -Social play -Children's games w rules

Interventions

-Home visitation models (for younger children) -Trauma focused cognitive behavioral therapy (for preschool, school-age children, and adolescents) -Infant-parent psychotherapy -Group play training -Peer-mediated treatment -Family therapy -Parent training -Keeping children "in home" is most important for CPS, but is that the best for the child??

Assessments

-Responsibility of child protection services to carry out investigative interviews (if not "screened out) with children and family members when child maltreatment is suspected and reported -Assess exposure to child abuse and neglect and either substantiate it or not

Types of abuse

Physical, sexual, emotional/psych, substance abuse, abandonment, neglect

Fatal neglect

-A child's death is the most tragic consequence of neglect, and neglect causes or contributes to roughly two-thirds of all child maltreatment-related deaths -Victims of fatal neglect are more likely to be age 7 or younger -The most common reasons for fatal neglect are supervision neglect, chronic physical neglect, and medical neglect

Causes of childhood cancers

-90 to 95% of all cancers are not inherited from parents -Childhood cancers arise from non inherited mutations and changes in genes of growing cells -Rarely is there an increased risk of childhood cancer due to genetic condition (down syndrome) -Children who have had chemo or radiation for prior cancer may pose increased risk

Types of neglect

-Although state laws vary regarding the types of neglect included in definitions, summarized below are the most commonly recognized categories of neglect: -Physical neglect: Abandoning the child or refusing to accept custody; not providing for basic needs like nutrition, hygiene, or appropriate clothing -Medical neglect: Delaying or denying recommended health care for the child -Inadequate supervision: Leaving the child unsupervised (depending on length of time and child's age/maturity); not protecting the child from safety hazards, providing inadequate caregivers, or engaging in harmful behavior -Emotional neglect: Isolating the child; not providing affection or emotional support; exposing the child to domestic violence or substance abuse -Educational neglect: Failing to enroll the child in school or homeschool; ignoring special education needs; permitting chronic absenteeism from school

Consequences of neglect

-Although the initial impact may not be as obvious as physical or sexual abuse, the consequences of child neglect are just as serious -Research shows child neglect can have a negative impact in the following areas: -Health and physical development: malnourishment, impaired brain development, delays in growth or failure to thrive -Intellectual and cognitive development: poor academic performance, delayed or impaired language development -Intellectual and cognitive development poor academic performance, delayed or impaired language development -Emotional and psychological development deficiencies in self esteem, attachment, or trust -Social and behavioral development interpersonal relationship problems, aggression, conduct disorders

Substance abuse

-An element of the definition of child abuse or neglect in many States, circumstances that are considered abuse or neglect in some States include the following: -Prenatal exposure of a child to harm due to the mother's use of an illegal drug or other substance -Manufacture of methamphetamine in the presence of a child -Selling, distributing, or giving illegal drugs or alcohol to a child -Use of a controlled substance by a caregiver that impairs the caregiver's ability to adequately care for the child

What are chronic diseases

-An illness or medical condition lasts over long period of time or lifetime -Result of genetic or inherited conditions, environmental factors, or combo of both -Account for 7 out of 10 deaths (70%) among Americans each year (1.7 mil deaths) -75% of nation's health care spending is on people w chronic diseases

Causes and symptoms of asthma

-Asthma triggers: allergies and irritants, dryness/colds/flu, stress, food w high sodium to potassium ratio -Symptoms: tightening of chest, wheezing/coughing, sudden breathlessness, death (rare)

Developmental disorders

-Attention deficit/hyperactivity disorder (ADHD): trouble pay attention, control impulsive behaviors, overly active, can't be cured, successfully managed, some symptoms may improve as child ages -Causes and risks for ADHD are unknown, current research shows genetics play big role, scientists study other possible options like brain injury, environment exposure (lead), alc and tobacco use during pregnancy, premature delivery, low birth weight -Treatment for ADHD: w control of med and behavior therapy, no single treatment is answer for every child and good treatment plans will include close monitoring, follow ups, and any changes needed -Autism spectrum disorder: not respond to name by 12 months, not point at objects to show interest by 14 months, not play fake games by 18 months, avoid eye contact and like to be alone, trouble understanding other people feelings and talk ab own, delayed speak/lang, repeat words/phrases over, unrelated answers to questions, upset by minor changes, obsessive interests, flap hands/rock body/spin circles, unusual reactions to way things sound, smell, taste, look, feel -Treatment for autism: no cure, research shows early intervention treatment services greatly improve development, early intervention services help kids from birth-3 learn important skills, services can include therapy to help child talk, walk, and interact w others -More on autism: complex neurological and developmental disorders that affects how a person acts and interacts w others, communicates, and learns, affects structure/function of brain and nervous system, affects development and last thru persons life People w disorder have problems w: communication, interactions w other people (social skills), restricted interests and repetitive behaviors, scientists believe that both genes and the environment play role, fam studies provided evidence for genetic contribution

What is the overall burden of child injury

-Both fatal and nonfatal child injuries are costly in many ways -In addition to the profound burden of death and disability, injuries to children can also result in substantial economic costs including med care for the injuries child and lost productivity for his/her caregivers

Cystic fibrosis

-CF inherited disease that can damage many of the bodies organs. Disorders mostly common signs and symptoms include progressive damage to respiratory system and chronic digestive system problems. Features of disorder and their severity varies among affected individuals -No cure, used to be considered a fatal disease of childhood. Improved treatments and better ways to manage, many live well into adulthood -Common genetic disease w Caucasian population in US. The disease occurs in 1 in 2500 to 3500 white newborns. CF is less common in other ethnic groups, affecting about 1 in 17,000 African Americans and 1 in 31,000 Asian Americans -Treatment: preventing and controlling lung infections, loosening and removing mucus from lungs, preventing and treating intestinal blockage, providing adequate nutrition

Childhood cancers

-Cancer occurs when cells grow out of control, develop abnormal sizes and shapes, destroy neighboring cells, and spread to other organs and tissues -Cancer affects 14 out of every 100,000 children in US each year -Most common childhood cancers are leukemia, lymphoma, brain cancer, and bone cancer -Once diagnosed, seek treatment from docs specialized in pediatric oncology

Treatments and therapies of childhood cancers

-Chemo, radiation, immune based therapy, bone marrow transplants, new and developing therapies -Anti cancer drugs: stem cell transplantation, biological therapies, immunotherapies, and more

Leading causes of death

-Children aged 1-4 years: accidents, congenital malformations, deformations and chromosomal abnormalities, assault (homiocide) -Children aged 5-9 years: accidents, cancer, congenital malformations, deformations and chromosomal abnormalities -Children aged 10-14 years: accidents, intentional self harm (suicide), cancer

Measles alert in US

-Common symptoms: fever, runny nose, cough, rash (all over) -Small number may: develop pneumonia, brain swelling -Can cause pregnant women to deliver prematurely -Based on CDC stats: 2018 had 372 cases, 2019 had 1282 cases confirmed in 31 states even tho declared eliminated in 2000 -Greatest number of cases reposted in US since 1992 -Majority of cases were among people who were not vaccinated -More likely to spread and cause outbreaks in US communities where groups are unvaccinated -Last U.S. measles death in 2015 -Number of measles cases reported by year: 2010 was 63, 2011 was 220, 2012 was 55, 2013 was 187, 2014 was 667, 2015 was 188, 2016 was 86, 2017 was 120, 2018 was 375, 2019 was 1282 -US April 2019 states w highest cases: Washington, New York, Oregon, California, Texas, Michigan, etc.

What are infectious diseases

-Communicable diseases, contagious diseases, and transmissible disease -Caused by microorganisms such as protozoa, parasites, fungi, viruses, and bacteria that invade the body and lead to infection and damage to the body.

Malnutrution

-Condition develops when body is deprived of vitamins, minerals and other nutrients it needs to maintain healthy tissues and organ function -Occurs in people who are either under nourished or over nourished. Today is US more children suffer from this die to dietary imbalances rather than nutritional deficiencies -Poor nutrition leads to anemia, inadequate immune system function, and susceptibility to illness and intellectual development problems -Under nutrition occurs when not enough essential nutrients are consumed or when they are excreted more rapid than replaced -Over nutrition occurs in people who eat too much, eat the wrong things, don't exercise, take too many vitamins or dietary supplements -Risk of over nutrition is increased by being more than 20% overweight or consuming a diet high in fat and salt -Malnourished kids may be short for age, thin, bloated, and have weak immune systems, nutritional disorders can affect any system in body and senses of sight, taste, and smell. may also have anxiety, mood changes, other psychiatric symptoms -Other symptoms include pale thick dry skin, bruises, rashes, changes in skin pigmentation, thin hair, tight curls, pulls out easy, achy joints, bones soft/tender, gums bleed, tongue swollen/shrivel/crack, night blindness, increased sensitive to light

Other types of play

-Construction play (object play and tool use) -Toy play -Technology and play -Outdoor play -Playground activities

Effects of childhood cancers

-Early symptoms of cancer often mistaken for other infections and childhood illnesses -Cancer takes a child's strength, destroys organs and bones, weakens bodies defenses against other illnesses -Decreases quality of life in children -Long hospitalization and treatments -Long periods away from school -Separation anxiety -70% of all children w cancer can be cured

Prevention of chronic disease

-Ensure early and comprehensive prenatal nutrition and health care -Encourage healthy eating habits at early age -Physical activity into daily life when kids are young to prevent sedentary lifestyle associated w obesity -Enable early diagnosis of develop delays or mental illness to improve access to programs designed to help children -Regular med care for all kids increase chance that chronic disease diagnosed and treat early, lessening overall impact on child and fam

Fire/burns

-Every day, over 300 children ages 0 to 19 are treated in emergency rooms for burn-related injuries and two children die as a result of being burned. -Younger children are more likely to sustain injuries from scald burns that are caused by hot liquids or steam, while older children are more likely to sustain injuries from flame burns that are caused by direct contact with fire. -Prevention tips to prevent burns from fires, be alarmed, install and maintain smoke alarms in your home—on every floor and near all rooms family members sleep in. Test your smoke alarms once a month to make sure they are working properly. -Have escape plan, create and practice a family fire escape plan, and involve kids in the planning. Make sure everyone knows at least two ways out of every room and identify a central meeting place outside. -Cook w care, Use safe cooking practices, such as never leaving food unattended on the stove. Also, supervise or restrict children's use of stoves, ovens, or microwaves. -Check water heater temp, set your water heater's thermostat to 120 degrees Fahrenheit or lower. Infants who aren't walking yet can't get out of water that may be too hot, and maintaining a constant thermostat setting can help control the water temperature throughout your home—preventing it from getting too high.

Poisonings

-Every day, over 300 children in the United States ages 0 to 19 are treated in an emergency department, and two children die, as a result of being poisoned. It's not just chemicals in your home marked with clear warning labels that can be dangerous to children. -Everyday items in your home, such as household cleaners and medicines, can be poisonous to children as well. Active, curious children will often investigate—and sometimes try to eat or drink—anything that they can get into. -Prevention: lock them up, Keep medicines and toxic products, such cleaning solutions, in their original packaging where children can't see or get them. -Know the number. Put the nationwide poison control center phone number, 1-800-222-1222, on or near every telephone in your home and program it into your cell phone. -Call the poison control center if you think a child has been poisoned but they are awake and alert; they can be reached 24 hours a day, seven days a week. -Call 911 if you have a poison emergency and your child has collapsed or is not breathing. -Read the label, follow label directions and read all warnings when giving medicines to children. -Don't keep it if you don't need it. Safely dispose of unused, unneeded, or expired prescription drugs and over the counter drugs, vitamins, and supplements. To dispose of medicines, mix them with coffee grounds or kitty litter and throw them away. You can also turn them in at a local take-back program or during National Drug Take-Back events.

Measles global alert

-Extremely contagious: around 9 out of 10 people are not protected will become infected when exposed -Measles outbreak declared when number of cases reported in an area is higher than expected number of cases -Due to covid, about 41 countries had to put off their measles campaigns for 2020-21 result in risk of bigger outbreaks around the world -Measles outbreaks occurring every region of the world -Measles can enter US thru infected travelers entering or traveling thru to the US as well as thru infected US travelers returning from other countries

Falls

-Falls are the leading cause of non-fatal injuries for all children ages 0 to 19. Every day, approximately 8,000 children are treated in U.S. emergency rooms for fall-related injuries. This adds up to almost 2.8 million children each year. -Prevention: Play safely. Falls on the playground are a common cause of injury. Check to make sure that the surfaces under playground equipment are safe, soft, and well-maintained (such as wood chips or sand, not dirt or grass). -Make your home safer. Use home safety devices, such as guards on windows that are above ground level, stair gates, and guard rails. These devices can help keep a busy, active child from taking a dangerous tumble. -Keep sports safe. Make sure your child wears protective gear during sports and recreation. For example, when in-line skating, use wrist guards, knee and elbow pads, and a helmet. -Supervision is key. Supervise young children at all times around fall hazards, such as stairs and playground equipment, whether you're at home or out to play.

Keep your baby safe

-Falls: install stair gates, secure furniture to wall, don't use baby walkers use stationary play centers instead, never leave baby unattended on changing tables beds or other furniture. -Motor vehicles: never use front passenger seat, never use adult seat belt, use rear facing car seat until child outgrows the maximum weight and heigh limits of car seat around 2-3, have car seat checked by a child passenger safety technician -Fire/burns: never microwave baby bottle, test bathwater w wrist or elbow, install smoke alarms and carbon monoxide detectors, set water heater at 120 degrees or lower -Poisonings: use child resistant packages, learn poison control number (1-800-222-1222), lock up med household cleaners and poisonous items

Keep 5-9 year olds safe

-Falls: place furniture away from windows, use helmet and protective gear when biking, skating, riding, skateboarding or skiing, teach proper playground behavior and supervise actively -Motor vehicle: do safety check around car, use right type of car seat or booster seat until adult lap belt and shoulder belt fits correctly, never leave child alone in car -Fire/burns: talk to child ab fire safety have an escape plan, teach child not to play w matches and lighters, don't let child use microwave -Poisonings: lock up positions out of sight and reach, use child resistant packaging, keep products in original containers

Keep your 1-4 year olds safe

-Falls: use playground that are age appropriate, don't put toys or things that attract children on top of furniture, place furniture away from windows and secure to wall -Motor vehicle: use forward facing car seat in back seat of car, use appropriate child safe seat, never leave child alone in car -Fire/burns: make stove area a kid free zone, cook w pots and pans on back burners, place hot foods and liquids on center of table, lock up matches and lighters -Poisonings: lock up and keep poisons out of reach and sight, use child resistant packages, keep products in their original containers, don't call meds candy

Asthma

-Gasping or panting in greek -Inflammation and obstruction of airways to lungs making it hard for patient to breathe -Incidence of asthma has doubled in US over past 20 years -Among 20 mil children who live w chronic health conditions, asthma is one of the most severe -Not contagious -No known cures

Abandonment

-Generally a form of neglect, but can be separate in some states -In general, a child is considered to be abandoned when the parent's identity or whereabouts are unknown, the child has been left alone in circumstances where the child suffers serious harm, or the parent has failed to maintain contact with the child or provide reasonable support for a specified period of time. Some States have enacted laws—often called safe haven laws—that provide safe places for parents to relinquish newborn infants. Child Welfare Information Gateway produced a publication as part of its State Statute series that summarizes such State laws.

Diabetes

-Having diabetes (type 1 or 2) causes increased risk of heart and blood vessel disease, stroke, diabetes related complications at early age -Diabetes is disease which blood glucose levels are above normal. Most of food we eat is turned into glucose, sugar, for bodies yo use for energy. Pancreas makes hormone called insulin to help glucose get into cells of bodies. When you have this your body doesn't make enough insulin or can't use its own as well as it should. Causes sugar to build up in blood -Can cause serious health complications like heart disease, blindness, kidney failure, lower extremity amputations. 7th leading cause of death in US. -Symptoms: frequent urination, excessive thirst, unexplained weight loss, extreme hunger, sudden vision changes, tingling or numbness in hands/feet, feeling very tired, very dry skin, slow heal sores, more infections -Type 1 previously called insulin dependent diabetes mellitus (IDDM) or juvenile onset diabetes, may account for about 5% of all diagnosed diabetes. -Type 2 called non insulin dependent diabetes mellitus (NIDDM) or adult onset diabetes may account for about 90% to 95% all diagnosed cases -Treatment: healthy eating, physical activity, and insulin injections are basic therapies for type 1. Amount of insulin taken must be balanced food intake and daily activities. Blood glucose levels must be closely monitored thru frequent blood glucose testing. Healthy eating, physical activity, and blood glucose testing are basic therapies for type 2 diabetes. Many people w type 2 require oral med, insulin, or both to control blood glucose levels

Vaccinations

-HepB and HepA: hepatitis B and A -RV: rotavirus -Hib: haemophilus influenza type b -PCV: pneumococcal disease -IPV: polio (infantile paralysis) -MMr: measles, mumps, rubella -Varicella: chickenpox -Influenza: annual flu shot

Signs of physical abuse

-If a child: -Has unexplained burns, bites, bruises, broken bones, or black eyes -Has fading bruises or other marks noticeable after an absence from school -Seems frightened of the parents and protests or cries when it is time to go home -Shrinks at the approach of adults -Reports injury by a parent or another adult caregiver -Abuses animals or pets -If an adult: -Offers conflicting, unconvincing, or no explanation for the child's injury, or provides an explanation that is not consistent with the injury -Describes the child as "evil" or in some other very negative way -Uses harsh physical discipline with the child -Has a history of abuse as a child -Has a history of abusing animals or pets

Bacterial meningitis

-Severe, most recover but can cause serious complications like brain damage, hearing loss, learning disabilities. Infants are at higher risk, but any age at risk. germs that cause this can be contagious, some bacteria spread thru exchange of respiratory and throat secretions (kissing), most bacteria cause this are not as contagious as diseases like common cold or flu. -Signs and symptoms: sudden onset of fever, headache, stiff neck, nausea, vomit, sensitive to light, altered mental status -Treatment: antibiotics, and start them asap

Signs of sexual abuse

-If child: -Has difficulty walking or sitting -Suddenly refuses to change for gym or to participate in physical activities -Reports nightmares or bedwetting -Experiences a sudden change in appetite -Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior -Becomes pregnant or contracts a venereal disease, particularly if under age 14 -Runs away -Reports sexual abuse by a parent or another adult caregiver -Attaches very quickly to strangers or new adults in their environment -If adult: -Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex -Is secretive and isolated -Is jealous or controlling with family members

Signs of neglect

-If child: -Is frequently absent from school, begs or steals food or money, lacks needed medical or dental care, immunizations, or glasses, is consistently dirty and has severe body odor, lacks sufficient clothing for the weather, abuses alcohol or other drugs, states that there is no one at home to provide care -If adult: -Appears to be indifferent to the child, seems apathetic or depressed, behaves irrationally or in a bizarre manner, is abusing alcohol or other drugs

General signs of any maltreatment

-If child: -Is overly compliant, passive, or withdrawn -Comes to school or other activities early, stays late, and does not want to go home -Is reluctant to be around a particular person -Discloses maltreatment -If adult: -Denies the existence of—or blames the child for—the child's problems in school or at home -Asks teachers or other caregivers to use harsh physical discipline if the child misbehaves -Sees the child as entirely bad, worthless, or burdensome -Demands a level of physical or academic performance the child cannot achieve -Looks primarily to the child for care, attention, and satisfaction of the parent's emotional needs -Shows little concern for the child -If adult and child: -Rarely touch or look at each other -Consider their relationship entirely negative -State that they do not like each other

Signs of emotional abuse

-If child: -Shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression -Is either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example) -Is delayed in physical or emotional development -Has attempted suicide -Reports a lack of attachment to the parent -If adult: -Constantly blames, belittles, or berates the child -Is unconcerned about the child and refuses to consider offers of help for the child's problems -Overtly rejects the child

General signs of any abuse/neglect

-If child: -Shows sudden changes in behavior or school performance -Has not received help for physical or medical problems brought to the parents' attention -Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes -Is always watchful, as though preparing for something bad to happen -Lacks adult supervision

What are the financial costs of child injury

-In 2000 the US paid more than $87 bil in med and other costs, including work loss by fam members who cared for injured children -When the reduced quality of life injured children and their fam is added in, unintentional injuries cost more than $200 bil each year

Example

-In public health we define accidents and injuries as two different entities -Accidents imply that these situations are due to chance, unintentional injuries however characterize the event as predictable and preventable if the proper safety measures are in place, for example if a child falls off his bike and hits his head on the pavement, causing a traumatic brain injury, most people would say it was an accident -But in a realm injury prevention, this would be called an unintentional injury as it could have been prevented by a bicycle helmet, there is a subtle distinction between these two terms

Sexual abuse

-Includes activities by a parent or caregiver such as fondling a child's genitals, penetration, incest, rape, indecent exposure, and exploitation through prostitution or the production of pornographic materials -Sexual abuse is defined by CAPTA (Child Abuse Prevention and Treatment Act) as: "the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children."

Prevention

-Keep immunizations up to date for child and adult care givers -Wash hands often, during cold and flu seasons -Wash hands: after bathroom, before preparing/eating food, after changing diaper, after blowing nose/sneezing/coughing, after caring for a sick person, after playing w a pet -Be aware of what you eat and how you prepare it: keep hot foods hot and cold foods cold until eaten or cooked, be sure temp controls in fridge and freezers work, wash counters/cutting boards/utensils w soap and hot water when preparing meats, wash fruits/veggies, cook beef until can't see pink -Use antibiotics exactly as prescribed and complete in full -Report to the doc if conditions worsen -Stay alert to disease threats when traveling to undeveloped areas. Get recommended immunizations and use protective meds for travel -Plenty or rest when sick -Good hand washing and hygiene; proper disposal of soiled tissues; avoid sharing linens; proper disinfection of surfaces and toys; cough into elbow or clothing when tissues unavailable

Elkind (2007)

-Mastery play -Innovative play -Therapeutic play

Whopping cough

-What is it: bordetella pertussis bacteria, can cause violent and rapid coughing, over and over until air is gone from lungs and you are forced to inhale w a loud whooping sound. Extreme coughing can cause throwing up and tiredness -Incubation period: 5 to 21 days -How spread: contact w droplets form nose, eyes, mouth of infected -Most contagious: before cough onset (w onset of runny nose) continuing until child has been on antibiotics for 5 days. If untreated, infectious for 3 weeks after cough begins -Return to childcare center: after antibiotic treatment for 5 days -Prevent spread: immunizations, booster dose of Tdap for anyone over 11, cover cough/sneezes

Statistics and facts

-Nearly 3 in 4 children or 300 million children aged 2-4 years regularly suffer physical punishment and/or psychological violence at the hands of parents and caregivers (WHO, 2020) -One in 5 women and 1 in 13 men report having been sexually abused as a child aged 0-17 years (WHO, 2020) -120 million girls and young women under 20 years of age have suffered some form of forced sexual contact (WHO, 2020) -In the U.S., the annual rate of abuse and neglect is 12.10 per 1,000 children▪75% are 1st-time victims -Recurrence rate of substantiated abuse over 6 months is 6% -Younger children (birth-age 3) shows the highest victimization rate (16.1 per 1,000 children) -Neglect or physical and/or sexual abuse dramatically increases mortality for children under 1 year of age (Sabotta & Davis, 1992) -Vast majority of perpetrators are parents (with mothers slightly higher than fathers) -83.4% abuse is committed by a parent acting alone or with another person -Most common form is neglect (62.8%): falls, child found unresponsive, starvation, exposure to heat/cold, failure to safeguard

Neglect

-Neglect is by far the most common form of maltreatment -More than 538,000 children were neglected in 2010, accounting for about 78 percent of all unique victims of child maltreatment -In addition, neglect was either the sole cause or one of the contributors to over 68 percent of the 1,560 child maltreatment-related deaths in 2010. (U.S. Department of Health and Human Services, 2011) -Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation -An act or failure to act which presents an imminent risk of serious harm -Neglect is commonly defined in State law as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child's health, safety, and well-being are threatened with harm -Some states specifically mention types of neglect in their statutes, such as educational neglect, medical neglect, and abandonment; in addition, some States include exceptions for determining neglect, such as religious exemptions for medical neglect and financial considerations for physical neglect

Physical abuse

-Nonaccidental physical injury (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise harming a child, that is inflicted by a parent, caregiver, or other person who has responsibility for the child -Such injury is considered abuse regardless of whether the caregiver intended to hurt the child. Physical discipline, such as spanking or paddling, is not considered abuse as long as it is reasonable and causes no bodily injury to the child

Mechanism of injury, number of deaths, and costs

-Number of deaths estimated lifetime med and work loss costs for the five leading causes of fatal unintentional injury, both sexes, ages 0-19, US, 2005 -Motor vehicle (traffic), 6781 deaths, $56 mil total med cost, $8.2 bil total work loss cost -Drowning, 1120 deaths, $5.7 mil total med cost, $1.2 bil total work loss cost -Suffocation, 1047 deaths, $5.4 mil total med cost, $987 mil total work loss cost -Poisoning, 729 deaths, $3.4 mil total med cost, $924 mil total work loss cost -Fire/burn, 529 deaths, $7.1 mil total med cost, $547 mil total work loss cost -Total, 10,206 deaths, $77.6 mil total med cost, $11.9 bil total work loss cost

Routes of transmition

-Passed from one person to another thru direct or indirect contact -Other sources include contaminated food, body fluids, airborne microorganism, vector organisms (mosquitoes transmit malaria) inanimate objects (dollar bills, coins)

What is play

-Play encompasses the physical, intellectual, and socio emotional aspects of development at all levels -Play is an expression of children's subjective experience. Children have a different, or "other" way of seeing, feeling, and acting in the world, which comes alive in their play -When children play a game over and over, they develop a script of whats happens and when -This script is then used to organize and interpret new experiences and predict what might happen in similar situations -Adults can be the producer but not director of your child's drama -While we supply the time, space, tools, and companionship for play, children supply the imagination -Children are the scientists, engineers, and artists all combined -Children need time to daydream, imagine, and reflect upon their mental world

Influenza

-Prevent spread: fever or feeling feverish/chills, cough, sore throat, runny/stuffy nose, muscle or body aches, headaches, fatigue, vomiting, diarrhea, tho more common in children than adults -Incubation period: 1 to 3 days -How spread: highly contagious, contact w droplets from nose/eyes/mouth of infected person, virus may live on surfaces (toys, tissues, doorknobs, etc.) for several hours -Most contagious: variable, from day before until first 7 days of illness -Return tp childcare: after 24 hours w out fever and symptoms improving -Prevent spread: annual influenza vaccine recommended for children ages 6 months to 18 years as well as caregivers (especially <6 months), cover coughs/sneezes

Other unintentional injuries

-Report: Child dies every three weeks from falling TV -Guns... According to the CDC, the rate of firearm deaths among children under age 15 is almost 12 times higher in the United States than in 25 other industrialized countries combined. American children are 16 times more likely to be murdered with a gun, 11 times more likely to commit suicide with a gun, and nine times more likely to die in a firearm accident than children in these other countries -If you have kids in your house, and you keep firearms, keep the guns locked and unloaded, with the ammunition locked in a separate location. -Before your child goes to a friend's house, you should ask the friend's parent whether the family has firearms in the house, and how they are stored. This can be part of all the usual things you would discuss before a visit, like allergies, snacks, sunscreen, etc. -Keep the gun locked, keep the gun unloaded, store the ammunition locked, store the ammunition in a separate place from the gun

Consequences of low birth weight/premature

-Retinopathy of prematurity: eye disorder causing low vision/blindness, vision loss can be caused by damage to eye, eye incorrectly shaped, problem in brain. Babies born unable to see and vision loss can occur anytime during person life -Developmental delays: group of conditions due to impairment in physical, learning, language, or behavior areas, these being during developmental period, may impact day to day functioning, and usually last thru persons life -Cerebral palsy: group disorders affect persons ability to move and maintain balance and posture, CP most common motor disability in childhood, caused by abnormal brain development or damage develop brain affect persons ability to control their muscles -Chronic lung disease

Who is most vulnerable

-Some children at greater risk than others for injury, injury related death and disability are more likely to occur among males, children of lower socioeconomic status, those living in specific geographic regions, and in certain racial/ethnic groups, vulnerabilities in each category vary according to: -Gender: in every age group across all races and for every cause of unintentional injury, death rates are higher for males, male deaths rates are almost twice that of females, males ages 15-19 years have the highest rates of ED visits, hospitalizations, and deaths -Race/ethnicity: unintentional injury death rates are highest for american indians and alaskan natives, unintentional injury death rates are lowest for asians or pacific islanders, unintentional injury related death rates for whites and african americans are approximately the same (except for drowning) -Age: children less than 1 who die from injury are predominantly victims of unintended suffocation or accidental strangulation -Drowning is the main cause of injury deaths among children aged 1-4 -Most deaths of children 5-19 years are due to traffic injuries, as occupants, pedestrians, bicyclists, or motorcyclists -Socioeconomic status: children whose families have low socioeconomic status or who live in impoverished conditions and are poor have disproportionally higher rates of injury, a broad range of economic and social factors are associated w greater child injury including economics (lower household income), social factors (lower maternal age, increased number of persons in household, increased number of children in household under 16, lower maternal education, single parents), and community (multi fam dwelling, over crowding, and low income neighborhoods) -Geography: states w lowest injury rates are in the northeast, number of fire and burn deaths is highest in some southern states, number of traffic injuries highest in some southern states and in upper plains, lowest traffic injury rates in states in northeast region

Sports and rec

-Taking part in sports and recreation activities is an important part of a healthy, physically active lifestyle for kids. But injuries can, and do, occur. More than 2.6 million children 0-19 years old are treated in the emergency department each year for sports and recreation-related injuries. -Prevention tips, gear up, when children are active in sports and recreation, make sure they use the right protective gear for their activity, such as helmets, wrist guards, knee or elbow pads. -Use right stuff, be sure that sports protective equipment is in good condition and worn correctly all the time—for example, avoid missing or broken buckles or compressed or worn padding. Poorly fitting equipment may be uncomfortable and may not offer the best protection. -Be good model, communicate positive safety messages and serve as a model of safe behavior, including wearing a helmet and following the rules. -Practice makes perfect, have children learn and practice skills they need in their activity. For example, knowing how to tackle safely is important in preventing injuries in football and soccer. Have children practice proper form this can prevent injuries during baseball, softball, and many other activities. Also, be sure to safely and slowly increase activities to improve physical fitness; being in good condition can protect kids from injury. -Pay attention to temp, allow time for child athletes to gradually adjust to hot or humid environments to prevent heat-related injuries or illness. Parents and coaches should pay close attention to make sure that players are hydrated and appropriately dressed.

What are other costs

-The consequences of these fatal and nonfatal injuries to children carry a physical and emotional cost to the individual and our society -An injury affects more than just the injured child it affects many others involved in the child's life -With a fatal injury, fam, friends, coworkers, employers and other members of child's community feel the loss -With a nonfatal injury, fam members must often care for the injured child, which can cause stress, time away from work, and lost income -The community also feels the cost burden of child injuries, as does the state and the nation

What is the burden of fatal child injuries

-The number of children dying from unintentional injuries is staggering -An average of 12 children are injured every minute -About every 101 minute, a child is US dies from an unintentional injury, such as a vehicle crash, drowning, or fire related burns -Unintentional injuries are leading cause of death among children 1-19 years of age -They account for nearly 37 percent of all deaths to children after infancy

What is an unintentional injury

-The physical damage that results when a human body is suddenly subjected to energy in amounts that exceed the threshold of physiologic tolerance or else the result of a lack of one or more vital elements, like oxygen -Predictable and preventable when proper safety precautions are taken, they are not "accidents" -Accidents: implies that they are due to chance -Unintentional injuries: characterizes the event as predictable and preventable if safety measures are implemented -Does not cover injuries that result from harm being inflicted on purpose such as those sustained in a suicide attempt, by child maltreatment, or among children w special needs who may require a different set of injury prevention strategies -Most child injuries can be prevented -Parents and caregivers can play a life saving role in protecting children from injuries

Injury statistics

-Unintentional childhood injuries is a significant contributor to leading cause of death and disability among children ages 19 and younger -On average 12,175 children 0-19 died each year in the US from an unintentional injury -More than 9.2 mil are treated in emergency departments for nonfatal injuries -Injury treatment is leading cause of med spending for children -Estimated annual cost of unintentional child injuries in US nearly $11.5 bil

Perpetrators

-Vast majority of perpetrators are parents (with mothers slightly higher than fathers) -83.4% abuse is committed by a parent acting alone or with another person -Munchausen syndrome by proxy is the most common term used to describe a type of child abuse in which a caregiver exaggerates, fabricates, or induces symptoms of a medical condition in a child that lead to unnecessary and potentially harmful medical care -Other terms for this rare type of child abuse include: -Pediatric symptom falsification, factitious disorder by proxy, fabricated or induced illness by caregivers, child abuse in a medical setting, or simply medical child abuse

Motor vehicle

-We all want to keep our children safe and secure and help them live to their full potential, knowing how to prevent leading causes of child injury, like road traffic injuries, is a step toward this goal -Every hour nearly 150 children between ages 0-19 are treated in emergency departments for injuries sustained in motor vehicle crashes, more children 5-19 die from crash related injured than from any other type of injury -Prevention tips: one of the best protective measures is using seat belts, child safety seats, and booster seats are appropriate for your child's age and weight -Birth up to age 2: rear facing car seat, for the best possible protection, infants and children should be kept in a rear facing car seat, in the back seat buckled w seats harness, until they reach upper weight or heigh limits of their particular seat, check seats owners manual for weight and height limits -Age 2 up to at least age 5: forward facing car seat, when children outgrow their rear facing seats they should ride in forward facing, in the back seat bucked w seats harness, until reach upper weight or height limit of seat, check seat manual for weight and height limit -Age 5 up to at least 9: booster seat, once outgrows forward facing seat should ride in belt positioning booster seats, keep children in back seat for best possible protection -Once seat belts fit properly: children should use booster seats until adult seat belts fit proper, seat belts fit proper when the lap belt lays across the upper thighs (not stomach) and the shoulder belt fits across the chest (not neck), recommended height seat belt fit is 57 inches tall, for best protection keep children in back seat and use lap and shoulder belts -Back seat is safest: all children aged 12 under should ride in back seat, airbags can kill young children riding in front seat, never place a rear facing car seat in front seat or in front of an airbag, place children in middle of back seat when possible cause it is the safest spot in vehicle

Suffocation

-We all want to keep our children safe and secure and help them live to their full potential, knowing how to prevent the leading causes of child injury, suffocation, step toward goal -When a child is unable to breathe, suffocation, can be scary, infants are most at risk for suffocation while sleeping, toddlers are more likely to suffocate from choking on food and other objects, like small toys -Prevention tips: create a safe sleeping environment to prevent SIDS -Stay safe during meal and play time, cut or break age appropriate food into small bite size pieces, always suppressive infants or young children during mealtime. Encourage children to chew their food thoroughly and to swallow it before talking or laughing. Also, children should not eat while playing or running. Read the age recommendations and choking hazard labels on toy packaging to determine suitable toys for children. -Learn basic first aid and CPR. Knowing how to safely remove food and small objects from the airway and how to perform cardiopulmonary resuscitation (CPR) can save a child's life. Learn basic first aid and CPR and get recertified every 2 years.

Chickenpox

-What is it: a blister like rash, itching, tiredness, and fever. Can be serious especially in babies, adults, and people w weakened immune systems, spreads easy from infected people to others who have never had chickenpox or received vaccine. Spreads in air thru coughing or sneezing, can also be spread by touching or breathing in virus particles that come from chickenpox blisters -Incubation period: 10 to 21 days -How spread: airborne or direct contact w droplets from nose, mouth, or skin lesions of infected individuals or freshly contaminated objects -Most contagious: from 2 days before skin lesions develop until all lesions are crusted -Return to childcare: when all lesions have crusted -Prevent spread: immunizations, cover coughs and sneezes

Hepatitis A

-What is it: acute liver disease cause by hep A virus HAV, lasts from a few weeks to several months, does not lead to chronic infection -Incubation period: 2 to 7 weeks (usually 25 to 30 days) -How spread: eating contaminated food/water; close contact w infected individuals; contact w infected stool -Most contagious: from 2 weeks before illness until 1 week after jaundice has begun -Return to childcare: after 1 week from onset of jaundice -Prevent spread: immunizations, consider Hep A vaccine to caregivers, infected caregivers should not prepare meals for others

Scabies

-What is it: an infestation of skin by human itch mite, mite burrows into upper layer of skin where it lives and lays eggs. Most common symptoms are intense itching and pimple like skin rash -Incubation period: 4 to 6 weeks, 1 to 4 days after re exposure -How spread: skin contact w infested individual, contact w bedding or clothes of infected -Most contagious: from up to 8 weeks before skin rash appears until it has been treated w cream, during fever -Return to childcare: day after treatment begins -Prevent spread: all household should be treated to prevent re infestation, bedding and clothing worn next to skin during 4 days before the start of treatment should be washed in hot water, clothing cannot be washed should be removed and stored for many weeks

Head lice

-What is it: around 2 to 3 mm long, head lice infest the head and neck and attach their eggs to the base of the hair shaft, move by crawling, can't hop or fly -Incubation period: eggs (nits) hatch in 6 to 10 days -How spread: close contact w infested individuals and sharing combs, brushes, hats, bedding -Most contagious: when live insects on head -Return to childcare: after treatment, if crawling lice are gone. Remove nits, nits alone should not be reason for exclusion, read product info -Prevent spread: watched closely for 2 weeks for new head lice, close contacts need to be examined and treated for crawling lice. At home wash bedding, clothes in hot water or dry clean or seal in plastic bag for 10 days. Avoid sharing beds, combs, brushes -At school: avoid sharing headgear, hang coats separate, use individual pillow/sleep mat

Diphtheria

-What is it: bacteria invades the respiratory system, they produce a poison that can cause weakness/sore throat/fever/swollen glands in neck. Within 2-3 days a thick coating can build up in the throat or nose, making it hard to breathe/swallow. Thick gray coating called pseudomembrane and can build up over nasal tissues, tonsils, voice box, and throat. Formed from dead tissue caused by toxin that is produced by bacteria. Pseudomembrane sticks to tissue below and may get in the way of breathing. Toxin may be absorbed into the blood stream and may cause damage to the heart, kidneys, and nerves. -Incubation period: 2 to 7 days -How spread: contact w discharges from nose, eyes, mouth or skin lesions of infected individual -Most contagious: onset of sore throat to 4 days after treatment has begun -Return to childcare: after 2 negative cultures are obtained -Prevent spread: timely immunizations, booster dose of either Td or Tdap is recommended for anyone over 11 years of age, including adults

Tuberculosis (TB)

-What is it: bacteria usually attacks lungs, but TB bacteria can attack any part of the body such as kidney, spine, brain. Not treated properly can be fatal -Symptoms: bad cough lasts for 3 weeks or longer, pain in chest, coughing up blood or sputum, weakness or fatigue, weight loss, no appetite, chills, fever, sweating at night -Once a person is infected w TB bacteria the chance of developing is higher if: has HIV, has been recently infected w TB bacteria (in last 2 years), has other help problems like diabetes making it hard for the body to fight bacteria, abuses alc or dugs, not treated correctly for TB infection in past -Incubation period: many infected persons do not develop disease and have no symptoms. Risk of developing active disease is highest during first 1-2 years after infection -How spread: thru air from one person to another. TB bacteria are put into air when a person w TB disease of lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected -Most contagious: children w TB may be infectious to others when they have active disease of the lungs or throat -Return to childcare: only when health department or physician gives permission -Prevent spread: routine TB skin testing is not recommended for children, however, healthcare evaluations should assess risk of TB exposure and skin test if TB exposure is likely

MRSA

-What is it: bacterial cause of skin boils and abscesses -Incubation period: variable, occasionally initially mistaken as spider bites -How spread: direct skin contact w infected person, drainage or contaminated surfaces. Increased risk in crowded conditions -Most contagious: draining wounds are very contagious and should be covered at all times -Return to childcare: if wound drainage can be well contaminated under a dressing. Exclude high risk activities such as close contact team sports until healed -Prevent spread: cover skin lesions, avoid contact w wound drainage, proper disposal of dressings, do not share personal items, clean and disinfect athletic gear, wash and dry laundry on hot

Ringworm on body/scalp

-What is it: caused by fungus, dermatophyte infections can affect skin almost any area, scalp, legs, arms, feet, groin, nails. Itchy, redness, scaling, cracking of skin, ring shaped rash. Involves scalp or beard hair may fall out, nails become discolored, thick, crumble. More serious can lead to abscess or cellulitis. -Incubation period: unknown -How spread: direct skin contact w infected person/animal or to surfaces or objects contaminated w fungus -Most contagious: onset of lesions until treatment begins -Return to childcare: one treatment begins, on scalp requires meds -Prevent spread: avoid direct contact w infected, avoid sharing combs, brushes, hats, proper disinfections of surfaces and toys

Molluscum contagiosum

-What is it: common skin disease that shows up as small bumps w dimple in middle -Incubation period: usually 2 to 7 weeks, sometimes longer -How spread: direct skin contact w wound or contaminated surfaces -Most contagious: not very -Return to childcare: no restriction -Prevent spread: avoid contact sports, during outbreaks further restrict person to person contact

Polio

-What is it: crippling and potentially fatal infectious disease, no cure, safe and effective vaccines

Mononucleosis (mono)

-What is it: epstein barr virus, fever, sore throat, swollen lymph glands. Sometimes a swollen spleen or liver involved may develop. Heart problems or involvement of CNS occurs only rarely is almost never fatal -Incubation period: 4 to 7 weeks -How spread: kissing on mouth, sharing objects contaminated w saliva -Most contagious: variable, often prolonged -Return to childcare: no restriction unless child has fever, or uncomfortable, fatigued, or ill to participate in activities -Prevent spread: avoid kissing, sharing drinks/utensils

Fifth disease

-What is it: human parvovirus B 19, fever, runny nose, headache, red rash on face, second rash on chest, back, butt, arms, legs, may be itchy on soles of feet, may also have painful or swollen joints -Incubation period: 4 to 21 days -How spread: contact w droplets from nose, eyes, or mouth of infected person -Most contagious: only during week before rash develops -Return to childcare: no need to restrict one rash appears -Prevent spread: immunizations, cover cough and sneezes

Viral meningitis

-What is it: less severe and resolves w out specific treatment. Can affect anyone but infants younger than 1 month and compromised immune systems are higher risk. People around someone have chance of becoming infected w virus that made person sick but are not likely to develop meningitis as complication of illness. Enteroviruses most common cause, spread from person thru fecal contamination can occur when changing a diaper or using the toilet and not proper washing hands after. Enterovirus can also be spread thru respiratory secretions of infected person. -Sign snd symptoms: sudden onset of fever, headache, stiff neck, nausea, vomit, sensitivity to light, altered mental state -Treatment: no specific treatment, antibiotics not help, most recover on own in 7 to 10 days, hospital may be needed in more severe cases or w weak immune system

Giardia

-What is it: parasite that causes diarrhea, gas, greasy stools that tend to float, stomach or abdominal cramps, upset stomach or nausea, vomiting, dehydration -Incubation period: 1 to 4 weeks (usually 7 to 10 days) -How spread: contact w infected stool: consuming contaminated water or food, also found in soil -Most contagious: when have diarrhea -Return to childcare: when stools are formed or fewer than 5 stools per day

Pinkeye (conjuctivitis)

-What is it: pink/red eye, eyelid swelling, tearing/discharge, itchy/scratchy eyes, crusting eyelids or lashes occurs -Incubation period: variable, depending on cause, bacterial/viral/allergic -How spread: highly contagious, contact w secretions from eyes of an infected person or contaminated surfaces -Most contagious: depending on cause, up to 2 weeks -Return to childcare: recommendation of doc, bacterial conjunctivitis requires meds

Bronchiolitis, bronchitis, common cold, group ear infection, pneumonia, sinus infection, and most sore throat

-What is it: respiratory diseases caused by many different viruses and occasionally bacteria -How spread: contact w droplets from nose, eyes, or mouth of infected person; some viruses can live on surfaces (toys, tissues, doorknobs, etc.) for several hours -When is child most contagious: variable, often from the day before symptoms begin up to 5 days after onset -Return to childcare: No restriction unless child has fever or too uncomfortable, fatigued, or too ill to participate in activities -Prevent spread: good hand washing and hygiene, proper disposal of soiled tissues, avoid sharing linens, proper disinfection of surfaces and toys, cough into elbow or clothing when tissues available

Respiratory syncytial virus (RSV)

-What is it: respiratory virus that infects the lungs and breathing passages, most common cause of bronchiolitis and pneumonia in children under 1 -Incubation period: 2 to 8 days -How spread: highly contagious, contact w droplets from nose/eyes/mouth of infected person, virus may live on surfaces for several hours -Most contagious: variable, from day before until 3 to 8 days longer -Return to childcare: after 24 hours w out fever and child's symptoms are improving -Prevent spread: avoid sharing linens, toys

German measles

-What is it: rubella virus, fever, rash, birth defects if acquired when pregnant (deafness, cataracts, heart issues, cognitive developmental issues, and liver/spleen damage) -Incubation period: 14 to 23 days -How spread: contact w drops from nose, eyes, mouth of infected person; may be transmitted to fetus across placenta -Most contagious: from 5 days before until 7 days after rash appears -Return to childcare: 7 days after rash appears -Prevent spread: immunizations, child care providers should be rubella immune

Measles

-What is it: rubeola virus, fever, runny nose, cough, rash all over. One out of 10 w measles also gets ear infection and one out of 20 gets pneumonia. for every 1,000 children who get measles one or two will die. -Incubation period: 7 to 18 days -How spread: airborne or direct contact w droplets from nose, eyes, or mouth of infected person -Most contagious: from 4 days before rash begins until 4 days after start or rash -Return to childcare: at least 5 days after start of rash -Prevent spread: immunization, cover coughs and sneezes

Cold sore (herpes simplex virus)

-What is it: small painful blisters filled w fluid around lips or edge of mouth. Tingling or burning around mouth or nose, few days before appear, fever, sore throat, swollen lymph nodes in neck -Incubation period: 2 days to 2 weeks -How spread: direct contact w infected oral secretions or lesions (drooling, kissing, thumb sucking) -Most contagious: lesions are present -Return to childcare: after lesions are scabbed over and drooling controlled -Prevent spread: avoid kissing, sharing drinks, utensils

Pinworms

-What is it: small thin pin shaped worms that live in human colon and rectum (threadworms) -Incubation period: 2 to 8 weeks -How spread: pinworms lay microscopic eggs near rectum, causing itching. Infection spreads thru ingestion of pinworm eggs, after contamination of hands by scratching -Most contagious: eggs may survive up to 2 weeks after therapy and resolution of rectal itching, re infection is common -Return to childcare: no restriction, treatment should be given to reduce spread -Prevent spread: frequent good hand washing, particularly by infected child and any caregivers assisting w toileting; trim fingernails, prevent nail biting and fingers in mouth; proper disposal/cleaning of diapers, bedding, clothes, etc. proper disinfection of changing tables and toilet areas

Mumps

-What is it: starts w a few days of fever, headache, muscle aches, tiredness, and loss of appetite and is followed by swelling of salivary glands -Incubation period: 12 to 25 days (usually 16-18) -How spread: contact w droplets from nose, eyes, mouth of infected person -Most contagious: peak infectious time begins 2 days before swelling, but may range from 7 days before to 9 days after -Return to childcare: 9 days after parotid gland swelling begins -Prevent spread: immunizations

Hand foot and mouth disease

-What is it: starts w fever, poor appetite, vauge feeling of unwell, and sore throat. One or 2 days after fever, painful sores develop in mouth. Skin rash develops over 1-2 days, has flat or raised red spots w blisters, palms of hands and soles of feet, knees, elbows, butt, genital area. Dehydrated if not able to swallow liquids because of mouth sores. -Incubation period: 3 to 6 days -How spread: contact w fecal, oral, or respiratory secretions -Most contagious: several weeks after infection -Return to childcare: after 24 hours w out fever and child is behaving normal -Prevent spread: proper disinfection of changing tables, surfaces, and toys

Strep throat

-What is it: usually starts quick, severe pain when swallow, fever of 101 or higher, red swollen tonsils, white patches or pus, tiny red spots (petechiae) on soft/hard palate, headache, nausea, vomiting, swollen lymph nodes, body aches, rash -Incubation period: 1 to 5 days -How spread: contact w droplets from nose and mouth. Rarely outbreaks can be caused by contaminated food -Most contagious: from onset of symptoms until 24 hours after treatment -Return to childcare: after at least 24 hours of antibiotic treatment and no fever for 24 hours -Prevent spread: avoid kissing, sharking drinks/utensils, exclude infected adults from food handling

Roseola

-What is it: virus -Incubation period: about 10 days -How spread: respiratory droplets, often from healthy people -Return to childcare: no restriction unless child has fever or too ill -Prevent spread: proper disinfection of surfaces and toys

Bacterial gastroenteritis

-What is it: vomit, diarrhea, pathogenic e coli, salmonella, campylobacter, shigella, yersinia -Incubation period: varies w pathogen, from 6 hours to 7 days -How spread: contact w stool from infected individual/pets, contaminated food/bev (raw eggs and improper cooked meats) -Most contagious: diarrhea present, pathogenic e coli and shigella highly infectious in small doses -Return to childcare: no fever and stools are formed or fewer than 5 stools per day, pathogenic e coli and shigella require 2 negative stool cultures (exceptions may be rarely allowed by local health department for older children) -Prevent spread: proper cooking/handling of meats and raw eggs (reptiles not permitted in childcare centers, pet reptiles should be handled safely in other settings.)

Viral gastroenteritis

-What is it: vomiting, diarrhea, adenovirus, rotavirus, norovirus -Incubation period: varies w pathogen, usually 1 to 5 days -How spread: contact w stool, saliva, vomit from infected person directly from surfaces. Norovirus highly infectious, frequent cause of outbreak -Most contagious: from 2 days before until vomit and diarrhea improve -Return to childcare: no fever or vomit for 24 hours and fewer than 5 stools per day

Drowning

-When most of us are enjoying time at the pool or beach, injuries aren't the first thing on our minds. Yet, drownings are the leading cause of injury death for young children ages 1 to 4, and three children die every day as a result of drowning. -Prevention: learn life saving skills, everyone should know the basics of swimming (floating, moving through the water) and cardiopulmonary resuscitation (CPR). -Fence it off, install a four-sided isolation fence, with self-closing and self-latching gates, around backyard swimming pools. This can help keep children away from the area when they aren't supposed to be swimming. Pool fences should completely separate the house and play area from the pool. -Make life jackets a must, make sure kids wear life jackets in and around natural bodies of water, such as lakes or the ocean, even if they know how to swim. Life jackets can be used in and around pools for weaker swimmers too. -Be on lookout, when kids are in or near water (including bathtubs), closely supervise them at all times. Adults watching kids in or near water should avoid distracting activities like playing cards, reading books, talking on the phone, and using alcohol or drugs

General examples of chronic diseases

Heart disease, cancer, diabetes, stroke, obesity, respiratory disease, oral conditions are leading causes of death and disability in the US

Common cause of chronic disease

Lack of physical activity, poor nutrition, tobacco use, excessive alc consumption, prenatal exposure to tobacco smoke and alc

Initial reports

Indiana Child Abuse and Neglect Hotline: 1-800-800-5556

Overweight and obesity

Major public health problem, more children overweight, obese, or morbidly obese than ever before, many over weight children maintain obesity as adults, leads to obesity related complications like diabetes, heart disease, high blood pressure, high cholesterol, stroke, some cancers, arthritis, and sleep disordered breathing.

Respiratory diseases

Meningitis spread by contact w/ droplets spread by sneezing, coughing, talking, kissing, or singing

Gastrointestinal diseases

Through eating and drinking contaminated food and water

Unintentional injuries

Unintentional injuries in this action plan refer to the following causes or mechanisms of injury: motor vehicle, suffocation, drowning, poisoning, fire/burns, falls, sports and recreation

Child maltreatment

WHO (2020) defines child maltreatment as: -Child maltreatment is the abuse and neglect that occurs to children under 18 years of age -Includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation -Results in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power