Child care centers and infectious disease since

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young children are often vulnerable targets for infectious disease due to their immature immune systems, grouping many infants and preschoolers together in day-care centers contributes to the spread of infectious disease. The problem is exacerbated by the fact that young children are not particularly concerned with good hygiene, and many day-care centers care for children who are not yet toilet trained.

Still, there are ways to lessen the risk. In fact, recent research indicates that after the first year, children in child care get sick at about half the rate as do those who are cared for at home. This is because youngsters in day care are exposed to germs sooner, and their immune systems learn to cope with the onslaught of exposure.

Many studies have shown that if the center staff understand the risks and are supervised and educated about infection control, there is much less infectious illness among the children in their care. simply by emphasizing hand washing, some centers have managed to cut diarrhea in half.

Before child-care facilities can be licensed, they must meet certain hygiene standards in a variety of areas, as set by local and state licensing authorities. Among other things, centers should clean all surfaces with a safe disinfectant. surfaces should be dried with paper towels after being sprayed. Adequate ventilation and sanitation are necessary. Chemical air fresheners should not be used, because many children are allergic to them.

Many infections in child-care centers are spread by fecal contamination. When diapers are changed, tiny amounts of feces on hands can be transferred to countertops, toys, and door handles, so that if one child is shedding an infection in the feces, it is not long before the infection spreads. some infectious viruses will appear in feces before diarrhea starts and will remain in feces for more than a week after symptoms disappear.

To prevent these problems, diapers should be checked every hour. Diaper-changing areas should not be located where food is prepared, stored, or served. The changing table should be cleaned after each use. soiled diapers should be thrown away in separate covered containers. staffers should wash hands before and after changing diapers. If a child has diarrhea, staff should wear disposable gloves before changing diapers.

Hands should be washed after using the toilet or handling diapers; after helping a child at the toilet; before preparing, handling, or serving food; before feeding an infant; before setting the table; after wiping or blowing noses; after touching blood, vomit, saliva, or eye secretions; after handling pets; and before and after eating.

Children can catch infectious diseases in a variety of ways. Airborne germs may transmit chicken pox, the common cold, fifth disease, influenza, meningitis, and tuberculosis. Germs can be transmitted by direct contact to cause cold sores, cytomegalovirus, head lice, scabies, and streptococcal infections. Germs can be spread via the fecal-oral route to cause diarrheal diseases or hepatitis a.

childhood cancers Cancer is the number-one disease killer of children—more than genetic problems, cystic fibrosis, and aids combined. About 8,600 children in the United States were diagnosed with cancer in 2001, and about 1,500 of them died from the disease that year. still, cancer is relatively rare in this age group, with only about one or two children developing the disease each year for every 10,000 children in the United States.

Since the 1980s, there has been an increase in the incidence of children diagnosed with all forms of invasive cancer; from 11.4 cases per 100,000 children in 1975 to 15.2 per 100,000 children in 1998. During this same time, however, death rates declined dramatically and survival increased for most childhood cancers. For example, the five-year survival rates for all childhood cancers combined increased from 55.7 percent in 1974 to 76, to 77.1 percent in 1992 to 1997. This improvement in survival rates is due to significant advances in treatment, resulting in cure or long-term remission for a substantial proportion of children with cancer.

over the last half of the 20th century, progress in childhood cancer diagnosis and treatment has transformed a once uniformly fatal disease into a group of malignancies that are now curable in most children. For example, leukemia survival rates have increased from just over 60 percent in the mid-1970s to near 80 percent in the mid-90s.

Causes

The causes of childhood cancers are largely unknown. A few conditions, such as down syndrome, genetic problems, and ionizing radiation exposures explain a small percentage of cases. Environmental causes of childhood cancer have long been suspected by many scientists but have been difficult to identify, partly because cancer in children is rare and partly because it is so difficult to identify past exposure levels in children. In addition, each of the distinctive types of childhood cancers develops differently, with a potentially wide variety of causes.

Scientists do know that children treated with chemotherapy and radiation therapy for certain forms of childhood and adolescent cancers, such as Hodgkin's disease, brain tumors, sarcomas, and others, may develop a second primary malignancy. They also know what does not cause childhood cancers: low levels of radiation exposure from radon are not significantly associated with childhood leukemias, nor is ultrasound use during pregnancy. Residential magnetic field exposure from power lines is not significantly associated with childhood leukemias, nor is on-the-job exposure of parents.

Although pesticides have been suspected to be involved in the development of certain forms of childhood cancer, results have been inconsistent and have not yet been validated by physical evidence of pesticides in the child's body or environment.

Several studies have found no link between maternal cigarette smoking before pregnancy and childhood cancers, but increased risks were related to the father's prenatal smoking habits in studies in the United Kingdom and China.

Little evidence has been found to link specific viruses or other infectious agents to the development of most types of childhood cancers, although scientists are exploring the role of exposure of very young children to some common infectious agents that may protect children from, or put them at risk for, certain leukemias.

Recent research has shown that children with AIDS have an increased risk of developing certain cancers, predominantly non-Hodgkin's lymphoma and Kaposi's sarcoma, and leiomyosarcoma (a type of muscle cancer).

Specific genetic syndromes, such as the Li-Fraumeni syndrome or neurofibromatosis, have been linked to an increased risk of specific childhood cancers.

The role of a mother's exposure to birth control pills, fertility drugs, and diethylstilbestrol (DES) is being studied in several ongoing trials.

Types of Childhood Cancers

Among the 12 major types of childhood cancers, leukemia and brain cancer account for more than half of the new cases.

Leukemia About a third of childhood cancers are leukemias (cancer of the bone marrow and tissues that make the blood cells). About 2,700 children younger than 15 years were diagnosed with leukemia in 2001. Leukemia triggers the production of too many abnormal white cells that invade the marrow and crowd out normal healthy blood cells, making the patient susceptible to anemia, infection, and bruising. The most common type of leukemia in children is acute lymphoblastic (ALL), which is highly treatable; today, about 70 percent of affected children are cured.

Brain cancer Tumors of the brain and spinal cord are the most common types of solid tumors in children. Some tumors are benign, and some children can be cured by surgery, but because of the difficulty in diagnosing and treating brain tumors, there has been less dramatic progress in treating them than other childhood malignancies. Today, 20 percent of all primary brain tumors occur in children younger than 15, with a peak in incidence between the ages of five and 10 years. Brain tumors are more common in boys than girls.

Bone cancers Cancer usually spreads to the bones from other sites, but some types originate in the skeleton. The most common bone cancer in children is osteogenic sarcoma. Bone cancer in children occurs most often during adolescent growth spurts; 85 percent of affected teenagers have tumors on their legs or arms, half of them around the knee. Ewing's sarcoma differs from osteosarcoma in that it affects the bone shaft, and tends to be found in bones other than the long bones of the arm and the leg, such as the ribs. Child deaths from bone cancer during 1950 to 1980 dropped by 50 percent.

Lymphomas This type of cancer begins in the lymph system, the body's circulatory network designed to filter out impurities. There are two general types of lymphomas: Hodgkin's disease and non-Hodgkin's lymphoma. Non-Hodgkin's lymphoma is more common in children; it can occur in the tonsils, thymus, bone, small intestine, spleen, or in lymph glands. The disease can spread to the central nervous system and the bone marrow. Today, treatments can cure many children, and promising treatments are being developed.

Neuroblastoma This type of tumor is found only in children and begins in the adrenal glands near the kidneys. Neuroblastoma usually appears in very young children.

Rhabdomyosarcoma The most common soft tissue sarcoma in children, this extremely malignant tumor originates in muscles, usually in the head and neck area (including the eyes), the genitourinary tract, or arms and legs. Although rhab-domyosarcoma tends to spread quickly, its symptoms are easy to spot compared to other forms of childhood cancer.

Wilms' tumor This rapidly developing tumor of the kidney most often appears in children between the ages of two and four. Wilms' tumor in children acts differently than does kidney cancer in adults. in children, the disease often spreads to the lungs; in the past, the death rate from this cancer was extremely high. However, treatment combining surgery, radiation therapy, and chemotherapy has been very effective in controlling the disease. As a result, cure rates for Wilms' tumor have improved.

Retinoblastoma This hereditary malignant eye tumor occurs in infants and young children, accounting for just 2 percent of childhood cancer. This disease is the first cancer for which researchers identified a tumor suppressor gene.

Other Other rare forms of childhood cancers include germ cell tumors, thyroid cancer, malignant melanoma (a type of skin cancer), testicular cancer, and primary cancers in the kidney, liver, and lung.

Child vs. Adult Cancers

When cancer strikes children and young people, it affects them differently than it does adults. For example, young patients often have a more advanced stage of cancer when first diagnosed. While only about 20 percent of adults with cancer have evidence that the disease has already spread when it is diagnosed, 80 percent of children's cancer has already invaded distant sites at diagnosis. While most adult cancers are linked to lifestyle factors such as smoking, diet, or exposure to cancer-causing agents, the causes of most childhood cancers are unknown.

Adult cancers primarily affect the lung, colon, breast, prostate and pancreas, while childhood cancers usually affect the white blood cells (leukemias), brain, bone, the lymphatic system, muscles, kidneys, and nervous system.

While most adult cancer patients are treated in their local community, cancers in children are rarely treated by family physicians or pediatricians. A child with cancer must be diagnosed precisely and treated by physicians and clinical and laboratory scientists who have special expertise in managing the care of children with cancer. Such teams are found only in major children's hospitals, university medical centers, and cancer centers.

child psychologist A mental-health professional with a Ph.D. who conducts scientific research and/or provides psychological services to infants, toddlers, children, and adolescents. Child psychology is focused on understanding, preventing, diagnosing and treating children's psychological, cognitive, emotional, developmental, behavioral, and family problems.

Child psychologists work in a variety of settings including private practice, hospitals, schools, and within the justice system. They do therapy, testing, evaluation, consultation, teaching, and research, depending on where they work and their specific job requirements.

Child psychologists must have a bachelor's degree in psychology or a related field, a master's degree (another two years) in psychology, and a doctorate in psychology, which may take up to five years after that, including internships and writing a dissertation. in most states a doctorate is required to practice independently as a child psychologist.

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