January 9, 2015

What to Do About Unvaccinated Kids in Day Care

A wave of disinformation in recent years has overwhelmed some otherwise thoughtful parents, prompting them to decline standard vaccinations for their children. But a recent study gives hope that wiser minds still prevail.

According to University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health, nearly 3 in 4 parents would remove their child from a day-care facility if other children there are unvaccinated. And more than 4 in 10 say kids who are “under-vaccinated” should be excluded from day care.

As explained in a news release from the university, all states require vaccines for children who attend day care, but the requirements might not include every recommended vaccine from birth to age 5. So some children still don’t receive all of those vaccines, which means day-care providers and parents must decide for themselves what to do about children in their child’s midst who aren’t up-to-date on all of their vaccines.

Some of the results from the national survey of parents with children as old as 5:

  • 74 percent agreed or strongly agreed that children’s immunization status should be reviewed every year to ensure they are up-to-date;

  • 74 percent would consider removing their child from a day-care facility where 1 in 4 kids weren’t up-to-date on vaccines;

  • percent that supported excluding children from a day-care facility who hadn’t gotten all vaccines: 41; percent that would allow a grace period for getting vaccinated: 28; percent that would insist on a doctor’s waiver for an unvaccinated child: 21; percent that would allow an unvaccinated child to attend a day-care facility: 10;

  • percent that say they should be informed of how many children at their day-care facility who aren’t up-to-date on vaccines: 66; percent who say the unvaccinated children should be named: 25.

Although the study “mirrors the national statistics that show approximately 25% of preschool children in the United States are not fully vaccinated,” according to Sarah J. Clark, associate director of the poll and a research scientist in the university’s department of pediatrics, the results “indicate that most parents want strong policies around making sure children in day care are up-to-date on vaccines. Checking vaccination records every year is beyond the scope of many state requirements, and may represent a significant change in practice at many day cares.”

Because the poll shows that parents want to know how many children lack vaccines, Clark believes that such information “might help parents understand the risk that their child could contract a vaccine-preventable disease — or transmit the disease to a vulnerable family member, such as a person with cancer.

“… Parents should feel empowered to ask about day-care vaccination policies, such as how the day-care handles the situation of children who are not up-to-date, and whether they check children’s vaccination status every year.”

To learn more about children’ vaccines, see our blogs here.

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June 6, 2014

Dangerous Flame Retardant Chemicals Are Everywhere

Parents of small children know that day care centers and preschools are notorious providers of germs the whole family can share, but what they might not be aware of is that they also pose a danger because their furnishings often are treated with flame retardants.

The chemicals in flame retardants, polybrominated diphenyl ethers (PBDEs) and tris phosphate compounds, have been linked to hormone disruption and lower IQs in children. According to a study published in the journal Chemosphere, they were found in 100% of the dust samples collected from 40 child care centers serving more than 1,760 children in Northern California.

As reported by the San Francisco Chronicle, the study was conducted by researchers from the University of California, Berkeley’s Center for Environmental Research and Children’s Health. They said that the results were representative of what's found in many homes and other environments because the chemicals have been widely used for decades in the polyurethane foam inside upholstered furniture.

In the early 1970s, California imposed requirements that upholstered furniture be manufactured with flame retardant chemicals. Those measures became standard elsewhere as well. But they were changed to enable flammability standards to be met without the use of the chemicals. As we noted earlier this week in our Patient Safety blog, “Burn Surgeon’s Testimony Tainted by Conflict of Interest,” chemical industry interests have tried to promote these dangerous substances using unsavory and misleading means.

Although PBDEs have been banned in California for almost a decade, they’re still found in older furniture and other products. And in many cases, their replacement was chlorinated tris, never mind that it had been removed from children's pajamas in 1977, according to The Chronicle, after it was found to mutate the DNA of people exposed to it. In California, it’s considered a carcinogen, or cancer-causing substance.

The Chemosphere study found levels of PBDEs in the child-care facilities to be somewhat lower than what previous studies found in residences. But the amounts of chlorinated tris were similar or higher than household levels found in other reports.

The authors said that the higher tris levels probably were found in the mats children use for napping, as well as in furniture. Of the facilities studied, 29 had upholstered furniture and 17 had napping mats made of foam.

To minimize your child’s exposure to these chemicals:

  • Choose natural fiber wall coverings instead of paint.

  • Use cleaning supplies without harsh chemicals.

  • Maintain a low level of dust.

  • Cover childrens' mats with cotton sheets.

And don’t despair: Despite the study's results, Asa Bradman, its lead author and an environmental health scientist, told The Chronicle, "People shouldn't panic and feel like child care is toxic for children."

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January 24, 2014

Sharing Is Good, Except for Germs

If there’s an echoing theme among parents with small children, it might be “Don’t put that in your mouth, you never know where it’s been.” As it turns out, according to a new study, bacteria are in a lot of places you don’t expect them to be, despite your best efforts.

As published in the journal Infection and Immunity and interpreted on AboutLawsuits.com, the study by researchers from the University of Buffalo suggests that cultures of certain bacteria can linger on cribs, toys, books and other children’s items long after scientists originally thought was possible, posing a potential risk of spreading common infections.

Researchers analyzed cultures, or biofilms, of Streptococcus pneumoniae and Streptococcus Pyogenes, and found that bacteria survived outside of the human body, the typical host necessary for growth, and they lasted for months as viable forms of infection.

S. Pyogenes is the culprit behind strep throat and skin infections. S. Pneumoniae attacks the respiratory tract, ears and other sites common among children and elderly people, and can cause death.

The researchers tested surfaces and items kids touch every day. There were high levels of both types of bacteria many hours after the surfaces had been cleaned; 4 in 5 stuffed toys tested positive for S. Pneumoniae and other surfaces yielded colonies of S. Pyogenes.

Because bacteria might survive in environments other than the human body, they have the potential to be continually infectious. The thinking used to be that their transmission required humans to breathe in infected bodily excretions from sneezing or blood exposure.

Rethinking cleaning procedures seems to be in order for day care facilities, schools, home nurseries and hospitals.

The best defense against this kind of bacterial exposure is what experts have preached forever: Wash hands often — yours and your kids — and use warm water and soap. Lather for at least 20 seconds.

Wash hands especially after touching particularly germy surfaces, such as toys, door handles, faucets, computer keyboards, touch screens and remote controls. Try not to touch your face after touching these surfaces.

Ask the people who look after your children — day care providers, baby sitters, teachers — what they do to prevent little ones from sharing the things they shouldn’t. Simply letting these folks know that you’re interested in hygiene can help them adhere to a healthful regimen.

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May 31, 2013

Feds Call for National Standards for Child Care Facilities

Earlier this month, the federal Department of Health and Human Services (HHS) announced stringent new health and safety standards for any child-care facility that receives government funding.

As reported in the Washington Post, reports of injuries and deaths in child-care facilities prompted the action. HHS officials said the new regulations also were developed because of emerging science on how critical the early years are for brain development and future success.

The regulations are meant to supersede individual state measures that critics claim are too lax and endanger children. As many as 1 in 5 children who receive the child-care subsidy, according to The Post, are in unlicensed and unregulated facilities that have no health and safety requirements.

The regulations will require workers in all subsidized child-care centers and homes to be trained in first-aid procedures, such as CPR, and safe sleeping practices. They demand quality-rating systems parents can access, and universal background and fingerprint checks of child-care workers. They also impose tough standards for monitoring and unannounced inspections to ensure compliance.

It has been 15 years since child-care rules were updated.

The regulations apply only to the 513,000 child-care centers and family homes that accept subsidies for the 1.6 million children who receive them through the federal Child Care and Development Fund, which expired in 2002. The HHS announcement, the paper said, was a surprise to Congressional representatives, including the bipartisan group of senators who have been negotiating a bill to reauthorize the child-care fund.

Nothing the feds do, it seems, can be devoid of politics. Sen. Barbara A. Mikulski (D-Md.) said that she appreciates the administration’s efforts, but that regulations are not enough. She wants Congress to reauthorize a child-care subsidy program “that not only addresses health and safety standards, but also improves the quality of our nation’s child-care programs.”

Rep. John Kline (R-Minn.) said, “The latest announcement by HHS is yet another effort to usurp Congress and move forward with the administration’s preferred policies.”

Many day-care centers in the U.S., The Post notes, are poorly run and often unsafe. And child care remains unaffordable for many people.

Current federal health and standards require only that:

  • subsidized providers prevent and control the spread of infectious diseases;

  • building and physical premises are safe;

  • providers have minimum health and safety training.

Beyond that, states pretty much impose whatever standards they wish. In South Dakota, for example, a family home child-care provider may care for as many as 12 children without a license or meeting any standards. In Virginia, that number is five. In Maryland and the District of Columbia, it’s one.

Many states, according to The Post, require only state, not federal, background checks of providers. That’s the standard in Virginia, where one infant died and only the commonwealth attorney’s investigation into the unlicensed family care provider’s home uncovered the fact that that the provider had several aliases and previous felony charges.

Some states exempt child-care centers run by religious organizations from meeting health and safety licensing standards. In Virginia, a 7-week-old boy was left for two hours in a small, overheated utility room with 14 other infants on a single foam pad while the caretaker ate lunch in another room. The baby died. Only one person at the facility, a janitor, had been trained to perform CPR.

Those child-care workers were charged with negligent homicide, but a judge dismissed the charges because of the center’s religious affiliation.

HHS officials said the proposed regulations couldn’t address all child-care ills; the $5 billion the government spends covers only about 18 in 100 low-income children who are eligible for the subsidy. But it’s a start.

If you want to know more about the sorry state of child care in America, link here to a recent investigative story in the New Republic. Some of its substantiated conclusions:

1. Most American day care centers are rated “fair” or “poor.”
2. Child-care workers are often poorly paid and minimally trained.
3. State regulators don’t have enough people to inspect facilities regularly — and often face pressure to keep appalling centers open anyway.
4. Child care remains extremely expensive for many families.
5. Governments in other countries spent a lot more on child care.

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