Infection Control in Schools and Childcare Settings

Pediatrics is an area of medicine that is very cyclical – in the summer we see a lot of kids for well child checkups and sports physicals, while in the winter we see lots of respiratory infections like pneumonia, RSV, influenza, and the common cold. August and September it is back to school time, and we see a variety of very contagious infections like gastroenteritis (the “stomach bug”), strep throat, COVID, and other viral upper respiratory infections. 

Starting at a young age we teach children to share books, toys, playground equipment, and food. Unfortunately, one of the most common things they share are germs, and that doesn’t have be taught. In fact, we actively have to teach them NOT to share them. Because of this struggle, we see many contagious diseases spread quickly when kids get back into school and are once again in larger groups. 

General Sanitation Measures

Each environment where children are together will be slightly different, depending on if it is an infant daycare room, a middle school cafeteria, or a high school classroom. However, there are some general sanitation measures that can be used in all settings to help prevent the spread of infection. 

• Wipe down surfaces after hands-on activities. 

• Make sure toilets and sinks are clean and readily available. 

• Have hand sanitizer in multiple locations, particularly at entrances/exits for the cafeteria, gym, bathrooms, and individual classrooms. 

• Wipe down doorhandles frequently.

• Routinely clean community items such as toys, pens, silverware, books, and etc. Warm soapy water or other safe disinfectants can be used. 

• Fully clean the classroom environment at the end of every day. 

Good Personal Hygiene

In addition to cleaning and sanitation measures, teaching children good hygiene practices can also be helpful. Many of these are age-dependent, but it is amazing what even young children can accomplish with encouragement and repetition

• Sneeze and cough into a tissue or an elbow. Discourage placing hands over the face, as it is likely for children to immediately return to their actives. 

• Avoid sharing water bottles, utensils, and toothbrushes. In infant settings, be sure pacifiers and bottles are well labeled and not shared. 

• Wash hands or use hand sanitizer often. 

Another important infection control measure in all age groups involves separation of children who are sick. Parents should keep symptomatic children home. No student should return to daycare or school unless they have been fever-free for 24 hours. Some infections, such as strep throat, have recommendations for regarding treatment with antibiotics for a certain amount of time before returning to school. Check with your child’s doctor and school for recommendations if you have specific questions.

Daycare and Preschool

Infants and toddlers are the most likely age group to spread germs quickly amongst themselves, primarily because they frequently use their hands to rub their eyes and wipe at their noses. This age group is not capable of washing hands independently, and often the hand wiping the nose immediately goes back to playing with communal toys. Viruses in particular thrive in such an environment, and it can be difficult for the adults caring for these children to keep up with sanitation practices. 

Washing toys and cleaning off common surfaces frequently is particularly important in infant and preschool classroom settings. Many germs are spread through contact with contaminated surfaces in addition to direct contact with sick peers. 

Elementary School 

While elementary school children are more aware of germs than infants and toddlers, they are still very likely to spread infections quickly. They still tend to wipe noses on the backs of hands and put an entire mouth on a water fountain spout. There are still measures that can be helpful in managing the spread of infection in this age group, however, and teaching them the importance of these measures can go a long way. 

While school-wide sanitation measures are clearly important in elementary schools, one of the most effective ways of infection control is washing hands. This should be particularly emphasized before eating and after hands-on classroom activities. Post-pandemic elementary children will likely be very aware of the importance of hand-washing, but children this age are forgetful, impulsive creatures and will need frequent reminders. 

Remind this age group that they should not share water bottles or utensils at snack time and lunch. 

Middle School and High School

Middle and high school students are much more aware of the potential for spreading germs, and are much more reliable about infection control measures. However, given the crowded settings of most schools these populations are still at risk of quickly spreading infections, particularly respiratory illnesses. School sanitation measures as discussed above are still a vital part of infection control, but much of the burden for containing the spread of germs lies with the students themselves.  

I will say it again – WASH HANDS. This needs to be done frequently and often, particularly before eating or after hands-on activities. Take advantage of hand sanitizer stations or have a small container readily available in a back pack. 

Final thoughts

When there are large groups of individuals, the spread of highly contagious diseases can quickly occur. The younger the individual the more likely the spread of disease. We as caregivers and parents must help mitigate this as much as possible by instilling good personal hygiene, frequent hand washing practices in children of all ages. Keeping symptomatic children separate is also very important. 

Despite all of these measures, kids will still get sick. They have naive immune systems that must be challenged over the developmental years, and the only way they can develop immunity is through exposure (and vaccination, where applicable). The best you can do is to teach your child ways to stay healthy, make sure that the school environment is practicing good sanitation measures, and vaccinate against preventable disease. And when they do get sick…we’ll be ready to see you in the pediatric clinic.