Cold, wintery weather usually brings with it an increase in ill health, especially in communal environments such as schools and early years services where infections are most easily spread. What health problems are commonly associated with winter and what can early years managers do best to ensure the welfare of their children through the winter months? Martin Hodgson investigates.
Being prepared — contingency planning
Illnesses that commonly increase in incidence or severity in cold weather include:
coughs, colds and flu
gastrointestinal infections such as norovirus.
It is important that early years managers are prepared for winter health issues. In particular, managers should recognise that winter bugs and illness are likely to affect staff as well as children. Before cold weather hits, they should ensure that they are prepared to cope with possible staff shortages as well as sick children.
Coughs and colds
Sore throats and colds are perhaps the most common winter health issues. Typically caused by viral infections, the usual symptoms are a cough and a runny nose with the cough often getting worse at night. In addition, a child may have a raised temperature, a sore throat, headache, tiredness and poor appetite. Mucus building up behind the eardrums may cause dulled hearing or mild earache.
Symptoms are worse in the first 2–3 days and then usually ease. In many children, an irritating cough may linger for up to 2–4 weeks after other symptoms have gone.
Occasionally, coughs fail to clear and the result can be a more serious respiratory disease, such as a chest infection.
Flu is an acute respiratory illness associated with infection by an influenza virus. It can be a very dangerous disease for young children, especially those with other long-term conditions.
Influenza usually peaks between December and March. The flu virus is highly contagious and is easily passed on by breathing in the tiny droplets from the breath of infected people. Children are more likely to pass on the illness due to their relatively lower levels of personal hygiene.
The incubation period between infection and the appearance of symptoms is about two or three days. Symptoms include high temperature, fever, headache, sore throats, aches and pains and sometimes vomiting or a feeling of nausea. In most people, symptoms will last for a few days and then the patient will gradually improve. In children, it is common for the cough and tiredness to linger for one to two weeks after the fever has gone away.
In younger children, the pattern of influenza may be a typical influenza-like illness or look like other respiratory tract infections such as croup, bronchitis, or pneumonia.
Children infected with the flu should be kept at home, keep warm, rest and drink plenty of fluids.
The annual flu vaccine is being made routinely available on the NHS as a nasal spray to all young children over the age of two. The policy is currently being rolled out and for 2017/18 parents should check with their GP about eligibility. Children aged two and over with long-term health conditions are strongly advised to have the vaccine.
Children with asthma need to be especially careful in winter as cold air is a known trigger of asthma symptoms, such as wheezing and shortness of breath. Those children with severe asthma may find it best if they stay indoors on very cold, windy days.
Early years managers must make sure that children with asthma have suitable health arrangements and consent forms in place and that each child has a formal health plan agreed with their parents or guardians. This should specify any medication to be given, including any use of inhalers. It should also detail action to be taken in an emergency.
Noroviruses are the most common cause of gastroenteritis, affecting approximately a million people in the UK each year. The infection is often known as “winter vomiting disease” as there is always a peak of activity in winter.
Norovirus often causes outbreaks because it is easily spread from one person to another and the virus is able to survive in the environment for many days. Contact with contaminated surfaces or objects, particularly those contaminated with faeces or vomit, can spread the virus, as can consuming contaminated food or water. An outbreak will often affect both staff and children.
The symptoms of norovirus infection begin 12–48 hours after infection. They start with nausea followed by vomiting and watery diarrhoea. Some people may have a raised temperature, headaches and aching limbs. The symptoms will last for 12–60 hours and then subside.
Outbreaks can be difficult to control because of the easy transmission of the disease. The key form of defence is high standards of cleanliness and hygiene.
Preventing the spread of illness
Early years services are an ideal environment for the spread of infection and infectious diseases because of the relatively low state of immunity of children and the difficulties in encouraging them to maintain personal hygiene.
Cleanliness and good hygiene standards are essential to protect both children and staff. Keeping the premises clean and paying strict attention to effective infection control is the best way to prevent the spread of disease.
It is the responsibility of early years managers to ensure that the environment is visibly clean. Toilets and food serving areas should be high priority. There should be adequate hand washing facilities and staff should try to encourage children to observe basic personal hygiene skills, supervising them in washing their hands especially after using the toilet or before eating food. Washing facilities should include hot water, soap (preferably liquid soap) and paper towels rather than fabric towels which can harbour bugs.
Staff should be appropriately trained in infection control and supplied with plastic aprons and waterproof gloves to use when clearing up any spillage of blood or body fluids.
Children and adults should be encouraged to cover their mouths when sneezing or coughing and a ready supply of tissues should be made available to increase compliance in this area.
Enforcing ill-health policies
All early years services should have an ill-health policy. In the winter, it is particularly important that this is enforced.
In general, the policy should state that children who are unwell should be kept at home. Those with a temperature and other specific signs and symptoms, such as diarrhoea or vomiting, should be excluded until they are better, for 48 hours after illness in the case of diarrhoea or vomiting. The “48 hour rule” should be clearly communicated to parents and strictly adhered to.
Failure to implement such an exclusion policy will increase the risks of an illness spreading and affecting many more children.
Staff with diarrhoea or vomiting should also be sent home. They should not return to work until symptom free.
Common colds and coughs can be a difficult area where child exclusions are concerned. In such cases, common sense should be applied.
A child with a minor cough or runny nose who is otherwise feeling well and has no other symptoms will not normally require exclusion. However, exclusion is recommended in the case of:
severe cough, fever, sore throat, rash, vomiting, diarrhoea, earache, etc
excessive irritability or fatigue
a child being too ill to participate in activities.
In the case of an outbreak of diarrhoea or vomiting or any other infection or communicable disease, the early years manager should obtain expert advice from their local public health community infection control team. The service should co-operate carefully with the advice that the team provides.
During an outbreak, ill children should be excluded and environmental cleaning should be stepped up, especially in food serving areas and toilets. Staff should reinforce efforts to ensure good hand hygiene and toys should be cleaned and dried after use. Play with sand or plasticine/play dough should be suspended until the outbreak is over.
All staff should be fully trained to know exactly what to do during an outbreak. Suitable information should be provided to parents.
An updated version of Guidance on Infection Control in Schools and Other Childcare Settings was published by Public Health England in March 2017
Providers in Scotland should take note of Infection Prevention and Control in Childcare Settings (Day Care and Childminding Settings), published by Health Protection Scotland in September 2015