CHCCN301A: Ensure the health and
safety of children
Recognise and respond to signs of potential
illness
Contents
Report signs of potential illness
3
Early symptoms
3
Seek medical assistance as necessary according to policies and
procedures
Danger signs
Caring for sick children at the Centre
2
9
9
10
Inform the child’s parents as soon as possible
12
Separate child from other children as required and as
practicable
15
Prevent spread of infection
15
How to bring a temperature down
16
Exclusion guidelines for children and others suffering from an
infectious disease
16
Comfort and settle child
19
Identify, manage and monitor food allergies and medical food
conditions such as coeliac disease and diabetes
20
Food allergies
20
Coeliac disease
21
Diabetes mellitus
22
Summary
24
Additional resources
25
Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
Report signs of potential illness
Think of the last time you were ill. How did you know you were ill? What
symptoms did you have? Perhaps you just felt tired, listless or had a headache?
Perhaps you had more tangible symptoms such as a fever, aching joints, or
vomiting.
When children are ill they can often not tell you what is wrong. They are either
too young or find it difficult to explain their illness. The three-year-old may
complain of a hot tummy or a baby may just cry.
Activity 1
Quite often it is the physical signs such as vomiting, the dreaded diarrhoea or
simply a cough that alerts you to a potential sign of illness. An experienced
childcare worker, parent or carer will be able to tell when a child is ill from a
number of different ways. For example, you can tell if a child is ill just by observing
changes in their behaviour, their eating or drinking pattern, their skin colour, their
activity level, or their general temperament.
Activity 2
Early symptoms
It is important that you recognise early symptoms of illness so that infections in
the childcare centre are kept to a minimum. Before overt symptoms such as fever,
spots or vomiting appear a child may have been infectious for several days
previously. For example, in the case of chickenpox, a child is infectious days
before the first blister appears. As a childcare worker your role is not to diagnose
an illness but to recognise illness, to comfort and support the child and to
minimise the spread of possible infection to the other children in your care. Not
all illnesses children have are infectious but until they are diagnosed by a doctor
they need to be treated as such.
If you suspect a child is unwell from either change in their physical condition or
behaviour, it is then important to measure the child’s vital signs. Vital signs are:
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

temperature
heart rate (pulse)
breathing rate (respiration).
Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
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When a child is unwell and as his body fights the germs, his temperature, pulse
and breathing rate will rise. These give a baseline for gauging any change in the
child’s condition or alerting carers to the severity of the illness or disease.
Temperature
It is horrible to have a fever—you feel hot, cold, sore, cranky and tired. Children
feel the same way; their skin may feel hot and dry and their faces often have a
flushed appearance. They may not eat or drink and quite often they may vomit
with high fevers. If a child has an extremely high temperature their bodies will feel
hot to touch but their fingers and toes will often be cold and white. Touching a
child’s bare back is the best way to gauge their temperature, but the only way to
know is to take their temperature with a thermometer.
Measuring the temperature is important as a very small percentage of children
can have a seizure or fit if their temperature is high. This is called a febrile
convulsion. The brain becomes too hot and misfires causing generalised shaking
and rigidity of the body. It is frightening to watch but is normally over quickly with
no problems. So if you suspect a child is unwell and may have a temperature, it is
important to take his temperature accurately and act upon the results. If a child
has a convulsion he/she must be seen by a doctor.
What is normal?
The normal temperature for a child ranges from 36.4°C to 37.4°C. Any
temperature above 38°C is a fever; below that (37.5°–37.9°C) you must keep a
close watch with frequent reading of the temperature.
It is becoming easier and easier to take temperatures with the range of new
thermometers on the market. The old mercury thermometer is being replaced
with faster, self-reading, digital thermometers. They are still relatively expensive
and need to be replaced when batteries flatten, so it is wise to know how to take
a temperature the .old fashioned way.. All centres should carry mercury
thermometers even if there are digital ones in use.
Taking a temperature
The steps to taking an accurate temperature with a mercury thermometer are as
follows:
1. Wash your hands
2. Hold the thermometer and shake it until the mercury level records 36°C
or below. Do not hold the silver bulb end; this records the temperature.
3. Hold the child on your lap or sit beside them.
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Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
4. Reassure the child and explain what you are doing throughout the entire
procedure. Cooperation is helpful.
5. Place the thermometer under the child’s bare armpit. Make sure the silver
bulb is between the folds of the skin.
6. Keep the arm still to hold the thermometer in position for three minutes.
7. Measure three minutes with a watch for accuracy. More than this time is
fine, less gives you an inaccurate measurement.
8. Remove the thermometer gently and read the mercury level. Do not
touch the bulb with your fingers while reading.
9. Record the temperature; leave the child comfortable.
10. Wash the thermometer in cool disinfectant.
11. Wash your hands.
See if you can practise taking the temperature of a friend or family members.
Practise until you are confident.
Activity 3
Digital thermometers
Different digital thermometers work in a different ways, so read the instructions
prior to use. Most involve a switch on button until 888 or 000 is recorded. Follow
the procedure above; place the thermometer in the same position and wait for a
beeping sound and then read and record. Disinfect between use. You may also see
ear thermometers which are very fast and very accurate but, as yet, expensive.
Placed in the ear with a special membrane they will take a temperature in
seconds.
Heart rate or pulse
Your pulse is your heart beat.
1. Sit quietly. Place two fingers (not the thumb) of your right hand on the
inside of your left wrist, just under your watch band, towards your thumb.
Feel for your pulse. This is your radial pulse.
2. Place your fingers over your heart, left side of your chest, close to the left
nipple area. Feel your heart rate. This is your apex pulse.
3. Place your fingers on the side of your neck, just under your jaw. This is
your carotid pulse.
4. Using a watch with a second hand, find your radial pulse again and
measure how many times you feel the pulse beats in one full minute.
Write it down.
Your pulse when resting will probably range from 65.95 beats in a minute.
Children’s pulses are variable, depending on their age. At rest:
Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
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•
•
•
•
the 0–1-year-old’s pulse range is 90-120 beats per minute
a 2-year-old’s pulse range is 75-100
a 3–5-year-old’s pulse range is 70-90
a 5–10-year-old’s pulse range is 60-80.
These are only a rough guide as pulse is very variable and fluctuant. When a child
is ill the heart rate tends to be pretty fast, but it must remain strong and regular.
Irregular or weak heart rates signal the child is extremely ill.
Breathing rate or respiration
When a child seems unwell, it is also important to measure the breathing rate
(respiratory rate) and recognise breathing problems. Consider the situation
below.
Alice is two years old. She seems to have a bad cough. Her
breathing rate is rapid and she is very quiet today with no energy.
She is pale with pale lips. There is a funny whistling noise when she
breathes.
How sick do you think Alice is?
In fact, Alice needs to see a doctor in a hospital, very quickly.
There are a number of things which should have caused you to be worried about
Alice. Her colour, her activity level, the noise, speed and the nature of her
breathing are all indicators that Alice is having trouble breathing.
Activity 4
Breathing problems
When you exercise, the nature of your breathing changes. This is similar when you
have a breathing problem. Your nose will flare; you will raise your shoulders and
diaphragm to expand your lungs; the rate of your breathing increases and you will
hear the sound your breath makes. This is your body’s way of getting more air and
oxygen in. It is hard work to breathe like this, so often children with breathing
problems will be tired and listless.
There should no noise when you breathe normally, any noise such as a whistle,
wheeze or a grunting sound is a sign that breathing is difficult. The noise is caused
when the air passages are swollen or are narrower than they should be.
Coughing is the body’s way of clearing its air passages. Continuous or persistent
coughing should be seen by a doctor. Any change in the skin colour is also an
indicator of breathing trouble, grey or mottled skin, bluish tinge to the lips or nail
beds are signs the child requires immediate hospital attention.
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Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
Breathing should be quiet, effortless, regular and easy.
Measuring respirations
You count a child’s respiration or breathing rate as follows:
1. Sit the child down. There is no point counting a breathing rate if the child
is moving or crying.
1. 2 .Explain what you are doing and reassure them.
2. 3 .Place your hand on their chest or back and watch their chest rise.
3. 4 .Using your watch count how many breaths in, the child takes, in one
full minute.
4. Record the breaths per minute.
Count your own breathing rate as above and write it down.
Breathing rates
Your rate should be roughly anything between 10 and 20 times per minute.
Children’s normal breathing rates are dependent on their age.
•
•
•
babies have a faster rate: 30-38 times a minute
a toddler’s rate is slightly slower: 25-30 times a minute
preschoolers breathe usually between18-20 times a minute.
These rates are just a rough guide. Breathing increases with activity, stress,
excitement and fever. Both the rate and the nature of a child’s breathing will tell
you if they have a problem.
The most common childhood breathing diseases are asthma, bronchitis and
croup. These diseases narrow the air passages making breathing more difficult.
Any breathing problems need to be treated immediately as children can become
ill very quickly.
Activity 5: Symptoms of croup and bronchitis
The vital signs
Measuring the child’s vital signs and noticing any changes in his condition is
important to evaluate how well, or how ill, the child is. It will also give you an idea
if the child is responding to any treatment you have given and will let you know if
the child is becoming seriously ill.
The vital signs, temperature, heart rate and breathing rate are indicators of how
the child’s body is coping with the illness. These must be taken accurately and
recorded in the child’s personal file along with any other relevant information on
Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
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the child’s condition. An experienced childcare worker will be alerted by any
deviation from the normal and will know whether it is necessary to act upon the
findings.
Further symptoms
Spots
Spots can arise from a variety of causes, some are insignificant and some can be a
sign of grave illness. On small babies milia or milk spots occur in the first few
weeks after birth. Babies and young children tend to get heat rash, which are
small spots that arise when the skin gets warm, usually found around the neck,
thighs and waist. These spots will disappear quickly and are normal.
The spots that require further investigation and monitoring are those associated
with an unwell or feverish child. Any spots, that arise on the trunk and spread
over the body forming a rash, must be seen by medical staff. Blisters on the skin
are most commonly associated with chicken pox but can be caused by a number
of infectious diseases. These should also be reviewed by medical staff before a
child can return to care.
The spots or rash that many people worry about are those associated with a
specific type of meningitis. The purplish rash of meningitis is distinctive and must
be treated very quickly. Unfortunately, this rash is a late sign of the disease and
the child will be extremely unwell. Any unwell child with a fever, stiff or sore, head
or neck, must be seen by medical staff immediately to rule out this disease.
Diarrhoea and vomiting
It is fairly common for children in the course of their childhood, to have several
episodes of an illness that causes diarrhoea and vomiting. This is often termed
gastroenteritis (gastro) and is extremely infectious. There are many virus and
bacteria which can cause these symptoms and children can get very sick, some
requiring hospitalisation to aid their recovery.
A small child with gastroenteritis must be watched very carefully. With this illness,
they can lose too much fluid and become dehydrated. It is important to check that
they have a wet nappy every four to five hours and are given small, frequent
fluids. If there is any doubt, they should be assessed by a medical professional.
Remember all body fluids are highly infectious and great care must be taken when
dealing with these.
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Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
Seek medical assistance as
necessary according to policies and
procedures
Consider the situation below.
Sam is a one year old child who seems unwell. He is flushed and
listless. You take his vital signs. His temperature is 38.9°C, his pulse
is 120 and his breathing rate is 45. He also has a cough.
Sam’s condition is assessed from his vital signs which tell you he has
a fever, his heart is beating faster than normal and his breathing
rate is fast. He has a cough which may be due to an infection of his
airways. He is tired as his body is fighting the illness and he is
flushed due to his fever.
Sam is unwell but not critically. However, it must be remembered,
his condition may change. He should, of course, be taken home
immediately but while awaiting pick up by his carers he should be
watched closely. If his temperature should rise and his breathing
get difficult, very fast, very slow or irregular, the carers must seek
medical advice.
When children are ill their temperatures rise, their pulse rate is higher and their
breathing rate rises. Children look and act differently the sicker they become. If a
child is becoming really ill they become much less active, will refuse all food and
drinks and their breathing rate and colour will change. Children can get very sick
very quickly. But they can also get better equally quickly. It is important to know
what to look for and when to seek medical assistance when monitoring a sick
child.
Danger signs
The following signs should alert you to the need for medical assessment:
•
•
very rapid or irregular heart rate
temperature which remains above 39°c for several hours despite panadol
and other cooling measure
Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
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•
•
•
•
•
breathing difficulties, lots of effort, very fast breathing rate or noises
when breathing
grey or mottled skin colour or blue tinge to lips or nail beds
not passing urine for more than five hours
any change in responsiveness or conscious level
acute or sudden pain.
Any of the above signs will require medical care immediately. The director, or
whoever is in charge, must be informed if a child is unwell. They will often have
experience with ill children and will decide on the action to be taken.
If in any doubt about a child’s condition, quickly seek emergency, medical advice.
It is better to be overly careful than to be too late. For emergency advice ring the
nearest paediatric, casualty department. If you think that a child is extremely
unwell and you are worried by his condition, call an ambulance; it is better to be
cautious.
Listed by every phone in the childcare centre must be the telephone numbers of
the following:
•
•
•
•
ambulance
paediatric casualty
Poisons Information Centre
local GP.
When ringing the above emergency services it is best to have all the necessary
information by the telephone. This includes the child’s file, their present vital signs
and their past medical history.
When you catch a disease or have an infection your body needs to fight it off.
Your body will work hard to fight a nasty invader and this will mean you will often
get a fever and will need to sleep or rest much more. For example, if you have the
flu you feel hot and shivery, you want to spend the day at home in bed. Rest
allows the body time to recover. Sick children need lots of rest at home where
they are comfortable and looked after. It is, therefore, important the sick child
goes home with his parents or carer as soon as possible and does not return until
he is well.
Caring for sick children at the Centre
While a sick child is at the centre there are several steps you must take, both to
give the best possible care to that child and also to prevent infection from
spreading from the unwell child to you, other staff members and the other
children. These actions follow The Children’s Services Regulation 2004 guidelines.
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Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
1. Isolate. The sick child must be isolated to limit contact with others and
reduce the spread of disease. However, you must stay with the child at all
times, providing physical and emotional comfort.
2. Contact parents. Parents/carers should be informed as soon as the child
becomes unwell and the child should leave the centre into their care as
soon as possible.
3. Give emotional support. The ill child will feel miserable and will require
plenty of love and attention until he goes home.
4. Observe. The child care worker will have to monitor the child’s condition
by taking and recording his temperature, heart rate and breathing rate
(vital signs) and also by observing his condition.
5. If the child’s condition requires a doctor or hospital attention then it must
be done immediately even if the parents have not yet arrived.
Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
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Inform the child’s parents as soon as
possible
When informing parents of their sick child do not alarm them, the last thing you
wish to do is cause them to have an accident in their hurry to pick their unwell
child. The parents will need to be given some details of the child’s illness and why
you wish them to be taken home. An estimated time of pick up is helpful to the
staff and comforting to the child.
Most parents will be concerned and act immediately to return to the service to
collect their child. There may be occasion where a parent will not be as amenable
to collecting their child immediately. On such occasions parents will be reminded
of the exclusion policy of the service and that a child with a potentially infectious
disease must be taken home. The ill child who remains at the service has a higher
risk of infecting others. The ill child also needs, more than ever, the solace and
comfort of parents and the familiarity of the home environment.
If the child’s condition deteriorates while you await the arrival of the parents, you
must then seek medical advice or call an ambulance. The parents will then be
immediately informed of the changes and the course of action that has been
advised. Again it is important to be calm, careful and precise in your explanation
to the parents.
When the parents arrive the child can be handed over to their care. It is helpful
for the parents if the staff member can report on the child’s condition, let them
know when they last ate or drink, what symptoms they are displaying and when
they last had paracetamol.
You can record your actions and observations on an illness report , an example of
a completed illness report follows.
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Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
Illness report form for parent / doctor
Child Care Centre: Rainbow Cottage Child Care Centre
Date: 30/11/2009
Contact Person: Lillian Chu
Phone: 4989 76 00
Dear Parent/Doctor
Re: (Childs name) Sam Speziale
Date of birth: 20/10/2008
Child has: (Comments. including time observed, number of times, severity)
11:30 Coughing, flushed cheeks, listless. Temperature 38.9° C, Pulse 120,
Respirations 45. Called parents, removed jumper, administered Panadol
and settled with carer on lounge for cuddles and a book. Offered water –
took a few sips from sipper cup.
12:05 Temperature 38° C, Pulse 110, Respirations 45. Seems extra cuddly,
sipped water from sipper cup. Offered solids and bottle – both refused.
Coughing seemed to distress Sam. Nappy changed – a little wet.
12:30 Temperature 37.8° C, sipped water from sipper cup. Settled to sleep.
Restless – coughing in sleep.
1:30
Temperature 37.3° C, Woke Sam as grandmother had arrived to take Sam
home. Offered water from sipper cup. Nappy changed – a little wet and
soiled.
There has not been recent similar illness in other children in the centre.
Parent contacted by Lillian Chu at 11.30 am
Signed by carer: Lillian
Chu
Signed by director:
Signed by parent/guardian:
Copy provided to parent: YES
You will also need to advise the families in your service when any children have
contracted an infectious disease. This helps parents to be aware of symptoms that
may become evident in their child and also to take precautions to prevent further
infection.
Information must be provided that details the infectious disease, such as the
symptoms that may be evident, what to do if symptoms are observed and the
exclusion guidelines that may apply. Exclusion refers to the amount of time that
Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
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an individual with a particular infectious disease is infectious and how long they
must remain away from the service/ work/ school etc.
The notice following was developed by Lillian after Sam Specialez’s father rang the
service the next day to say that Sam had been diagnosed with Whooping Cough.
Note that the identity of Sam is kept confidential. This notice would be displayed
in prominent places, such as the front door to the service and on the door of the
room where the infectious disease was identified.
Families please be aware that there has been one case of
Whooping Cough
reported in the service.
Symptoms: Whooping cough is which and adults. It may start with a runny nose, sneezing
and then develop into coughing bouts. These coughing bouts can be very severe and
frightening. Young children are especially at risk of severe illness, which may result in
hospitalisation. Some have fits (convulsions) and some may develop inflammation of the
brain (encephalitis). Whooping cough is particularly serious in children under 2 years of
age and hospitalisation is usually necessary. Whooping cough is transmitted by direct
contact with droplets from the nose and throat of an infected person.
Treatment: Antibiotics may be given in the early stages to shorten the period of
contagiousness of a child with whooping cough. However, these do not lessen the severity
or duration of the illness.
Controlling the spread of infection: Whooping cough can be prevented by immunisation.
Fully immunised communities offer the best protection against whooping cough.
Erythromycin may be given to family and people in close contact with the disease. Adults
and teenagers are susceptible to the illness as well and may carry the bacteria while
exhibiting only mild symptoms. To control the spread of germs, children should be
encouraged to either: a) Cover their mouth and nose with a tissue when they sneeze or
cough, then dispose of the used tissue appropriately. Wash their hands with soap and
water, and dry thoroughly: or b) Cough or sneeze into their upper sleeve, or elbow, not
into their hands. Then wash their hands with soap and water, and dry thoroughly.
Exclusion Guidelines: Exclude for 21 days from the onset of coughing or until the person
has taken 5 days of an appropriate antibiotic.
If you suspect that your child may have Whooping Cough, please take your child
immediately to the doctor for a diagnosis. If a diagnosis of Whooping Cough in confirmed,
you must call the service and inform staff.
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Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
Separate child from other children as
required and as practicable
Prevent spread of infection
The child who is unwell will require immediate and absolute separation from the
other children at the service. At the beginning of the topic it was said that the
child is often infectious before the visible onset of symptoms, so the disease may
have been passed on already. However, it is important to minimise any further
spread and isolate the child as soon as symptoms are noticed. Separation can be
achieved by taking the child to another room or area and in some larger services
there may even be a sick bay. The child who is unwell will often just want to lie
down, sleep or be carried so they are usually easy to contain.
When a child is ill, particularly when he has a fever, there is a tendency for them
to vomit. In the case of an infectious disease all body fluids should be regarded as
highly infectious and normal precautions must be taken when dealing with any
spills or leaks.
Activity 6: Recap cleaning up a body fluid spill
If any clothes, either staff or child’s, are soiled by such fluids then they must be
soaked in hot soapy water and washed separately in a very hot wash and dried
either in a hot dryer or in the sun. One carer or staff member must remain with
the child to comfort and reassure them till they are taken home. The carer must
also monitor the child’s condition to make sure that it does not get worse. The
staff member who remains with the child must be careful not to catch or transmit
any infection from the ill child. On the child’s departure careful cleaning of the
carer’s hands and clothes will reduce cross contamination. Also the area the child
was isolated in must also be carefully cleaned and disinfected. All toys, books and
surfaces that the child has touched should be cleaned and disinfected to minimise
infection spread.
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© NSW DET 2010
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How to bring a temperature down
Consider this situation:
Helen is a 12-month-old with a high fever of 38.8°C. It is a hot day
and she is wearing lots of clothes.
What things should we could you do to reduce Helen’s
temperature? Too many clothes, hot weather, or lots of activity will
all make the body temperature rise but only a small amount. Any
temperature over 38°C is usually caused by an infection. When a
child is hot it is important to cool them down particularly if they are
prone to febrile convulsion.
When you have a temperature you feel shivery, this shivering action actually
increases your temperature. Anything you do to reduce the temperature should
not cause shivering and further discomfort.
•
•
Reduce the clothing but not completely, leave a light layer on. If you
remove the clothing the febrile child will tend to shiver.
Use a fan, but not directly on the skin; place the fan at a distance.
Give small, frequent, cool drinks to combat temperature and dehydration. Small
amounts will reduce the chances of the child vomiting. Ice chips or little pieces of
ice block are soothing for a child with a fever.
•
•
Give paracetamol (Panadol) only with parental consent and check the
temperature again in half an hour. Remember that paracetamol will mask
the signs of illness and the child will still need to be watched carefully
before he is taken home. There is some evidence that giving medications
to reduce the fever can slow the body’s immune response to infection. In
most instances we should not be worrying about treating the fever itself –
we should be focusing our attention of the way the child looks, behaves,
the level of alertness and whether there are any other symptoms such as
vomiting or cough.
Do not give a cool bath as this is extremely uncomfortable and dangerous,
but you can place tepid washers on the child’s neck and forehead to help
the child cool down more quickly.
Exclusion guidelines for children and
others suffering from an infectious
disease
In any workplace with a volume of persons, either staff or clients, diseases will
inevitably be spread by air, touch or body fluid contact. Those who are unwell
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Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
particularly at the onset of an illness should remain at home. For every disease
there is a written policy, an exclusion policy. This outlines the exclusion time (how
long you have to stay away) and return requirements (if you need a doctor’s
certificate) for most common infectious diseases. All staff and children must
adhere to that policy.
Those with infectious diseases must comply with the exclusion policy of the
service and remain at home until the disease is deemed non-infectious. Coming
back to work early when you are still ill, not only slows your recovery, but also
spreads infection to others. If children return before they have recovered they put
others at risk and may still feel tired and miserable. Time is needed to recover
particularly if the illness was severe.
Recommended minimum exclusion periods for infectious conditions for schools,
pre-schools and child care centres have been developed by the National Health
and Medical Research Council. These exclusion guidelines will support your
service‘s sick child and exclusion policies.
With some diseases you will also require a doctor’s certificate to confirm you are
non-infectious even if you have been off for the prescribed time. Returning
before the exclusion time is not allowed even with a doctor’s certificate.
Health authorities must be informed if a notifiable disease occurs in a service such
as, meningitis or measles. The health authority will then advise the exclusion or
isolation requirements. On occasion a service will be closed if a dangerous disease
arises.
Activity 7: Lucy
Lucy will need isolated immediately from the other children till she is taken home
by her parents/carers. One staff member will stay with her to both comfort and
monitor her illness. Her parents will be contacted immediately to take her away
from the centre, either home or to a medical service. Once Lucy has left, the staff
member who cared for her must wash her hands thoroughly and, where possible,
change clothes
These immediate preventative actions will help to minimise the spread of
infection but further action is required to prevent an outbreak of chickenpox in
the babies’ room.
Activity 8: Lucy continued
Lucy’s case study... continued
Because there is a case of chickenpox at the centre, it is wise to inform all staff
members, particularly those who are pregnant. It is also a good policy to place a
notice in every room for parents and staff to see. The notice should explain that
Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
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there has been a case of chickenpox, list the symptoms to be aware of and give
the length of time that infected children should remain away from the centre.
Early detection and awareness of the illness will minimise the cases at the centre.
It will also encourage parent to comply with the exclusion policies. It is important
that sick children remain away from a centre until they are completely well.
Excluding ill children prevents major disease outbreaks in childcare centres.
Disposing of soiled items and disinfecting contaminated areas also are paramount
to a healthy environment. All areas and items which may have been in contact
with the child, who has a potentially infectious illness, should be cleaned. This
includes toys, books, chairs, tables, surfaces, bed linen, and clothing. If you are
unsure of what the ill child may have been in contact with, such as in the case of
toys, it is wise to wash them all. Remember to wear gloves and wash your hands
well after dealing with any body fluids.
Lucy’s case study… continued
Sometimes children will return after an illness where they are non-infectious, but
are still feeling tired and drained from being unwell. In such a situation it is
prudent to advise the parents that the child would benefit from a little more quiet
time at home to fully recover. However, it is often difficult for parents to arrange
time off work to look after a sick child and they are keen for them to return as
soon as possible. The place for sick children is at home with their parents or
carers.
Activity 9: Lucy… continued
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Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
Comfort and settle child
Children who feel unwell will need plenty of reassurance and comfort. They will
often want to sleep or be held and are frequently miserable, cranky and restless.
The carer who remains with the child, separated from the rest of the service, must
be patient and it is helpful if they are well known to that particular child.
Familiarity will calm and comfort an ill child.
Activity 10
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Identify, manage and monitor food
allergies and medical food conditions
such as coeliac disease and diabetes
Some children in your care may have known allergies or medical food related
conditions. It is important that you are provided with information about signs and
symptoms to be aware of in order to best care for these child’s health needs.
This information will be gathered at enrolment and families will be encouraged to
update the information regularly.
Your service will have policies and procedures in place to guide your actions.
Food allergies
Although allergic reactions are common in young children, severe life threatening
reactions are uncommon and deaths are rare. Foods are the most common cause
of allergies in infants and young children. Food allergies may affect around 5% of
children under 3 years, while most children will outgrow their allergy, some will
not. Food allergies may become evident during the first 12 months when a child is
given a food for the first time.
Activity 11
Caring for a child with a food allergy will involve us being educated about the
child’s dietary needs and food allergens to avoid as well as being aware of the
signs and symptoms that may indicate a child is having a reaction.
The signs and symptoms of a mild to moderate reaction may include:
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swelling of the face, lips and eyes
rapid appearance of hives, itchy raised rash or welts on the skin
abdominal pain and vomiting.
The signs and symptoms of anaphylaxis (severe life threatening allergic
reaction)may include one or more of the following:
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difficulty breathing; noisy breathing
difficulty talking and/or hoarse voice
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© NSW DET 2010
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swelling/tightness of the throat
wheezing or persistent cough
paleness and floppiness (in young children)
collapse and/or unconsciousness.
Although most food reactions are mild or moderate, a minority of reactions will
require an emergency response. This will involve the administration of adrenalin
via an Epipen auto injector, notifying parents and calling for emergency services.
Coeliac disease
In people with coeliac disease, gluten (a protein in many cereal foods such as
wheat, rye, barley and possibly oats) causes damage to the lining of the small
intestine (bowel). This damage affects the digestion of foods and nutrients.
Nutrients are not absorbed properly, causing a range of health problems.
A proper diagnosis of coeliac disease must be made before starting a gluten free
diet. Starting the diet too early can make it harder to work out what is really
wrong. It is important to know for sure as the treatment needs to be lifelong to
prevent later health problems.
As long as people with coeliac disease do not eat foods containing gluten they are
quite normal and healthy.
Coeliac disease happens in about one out of every 3000 people in Australia. It can
be inherited, that is it can run in families.
Coeliac disease can start at any time after cereals containing gluten are given to a
baby, often between 9 months and 2 years. (Rice cereal does not contain gluten.)
It can also be found in older children or adults.
What are the signs of coeliac disease?
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slow growth or weight loss (failure to thrive)
diarrhoea (large, foul-smelling poos) or sometimes constipation
swollen abdomen
irritability, grizzling
anaemia.
In some people the symptoms may be mild enough that the coeliac disease is not
picked up until later childhood, or even until the person is an adult.
Once coeliac disease is diagnosed then the family will be encouraged to provide
you with detailed information about how to manage the child’s condition in the
service. This will usually involve the child avoiding certain foods, particularly
wheat, barley and rye products.
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Families will also provide you with details of the signs and symptoms to be aware
of that may indicate their child has consumed something that contains gluten.
These may be;
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stomach ache
nausea
diarrhoea.
For further information about coeliac disease see the additional resources section
at the end of this topic.
Diabetes mellitus
Diabetes (diabetes mellitus) is a condition where the body cannot use energy
from food. It is caused by having no insulin or not enough insulin.
Without insulin, glucose builds up in the bloodstream and overflows into the
urine. High glucose levels in the blood and the urine are the first signs of diabetes.
There are two main types of diabetes mellitus – type 1 and type 2.
Diabetes mellitus type 1 usually starts in childhood, adolescence or early adult life.
It is sometimes called juvenile-onset diabetes, or insulin-dependent diabetes
mellitus (IDDM)
Diabetes mellitus type 1 can be managed with balancing insulin injections (usually
needed 2 to 6 times each day), exercise and diet. However it cannot yet be cured.
How common is diabetes in children?
Diabetes mellitus type 1 occurs in about 1 in 1,000 children in Australia (in adults,
about 1 in 25 have diabetes mellitus type 2).
Diabetes mellitus type 1 usually begins between 5 and 12 years of age, although it
can occur in younger children.
The start of diabetes may not be noticed, especially in younger children.
The first signs of diabetes usually are:
•
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tiredness
increasing thirst
passing lots of urine (wee). Some children start to wet the bed again at
night.
weight loss
glucose in the urine (sometimes this is the only sign).
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Some children become quite ill before it is recognised that they have diabetes.
They may start vomiting and become drowsy, dehydrated, and possibly comatose.
In extreme cases, a child could die before the reason for their illness is worked
out. However, if a child who is very ill is taken to a doctor or hospital, it is easy to
diagnose diabetes with a simple test of their blood glucose level. Children usually
become better very quickly with emergency treatment—starting with lots of fluid
through a drip (intravenous infusion).
If you are caring for a child with diabetes in the service families will need to
provide you with information about their child’s diabetes management plan. This
plan will have been developed with their doctor and their diabetes team and will
provide guidance on food and medication requirements, signs and symptoms that
the child may be unwell and the procedure or action plan to follow in an
emergency.
The child who is having a ‘hypo’ (hypoglycaemia is when blood glucose levels get
too low) may:
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feel shaky, anxious and weak
sweat, look pale
cry, become irritable
be unable to concentrate and lack co-ordination
have slurred speech
feel hungry
complain of a headache.
If this happens you will refer to the child’s action plan and administer a sugary
food or drink snack (juice, honey or jelly beans. Notify the parents and call for
emergency help if necessary.
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© NSW DET 2010
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Summary
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Illness and infection are common occurrences in child care.
Each illness will have different signs and symptoms. While your role is not
to diagnose illness you will become skilled at recognising common
childhood illnesses.
The measurements of a child’s vital signs, that is, temperature,
respirations and pulse are useful baseline measurements for assessing nay
changes in a child’s health status.
A child’s heath condition may change quickly. Carers must know when to
seek medical advice.
Reporting illness must be done quickly and accurately.
Informing parents of a child’s illness must be done sensitively and calmly.
Some childhood diseases are notifiable, meaning they must be reported
to the health authorities.
Exclusion guidelines are in place to control the spread of infection in the
service.
Sick children need special attention and comfort from carers.
Some children may have known allergies or medical food related
conditions that require careful monitoring to prevent possible illness.
Certificate III in Children’s Services: CHCCN301A: Reader LO 9180
© NSW DET 2010
Additional resources
For more information about Coeliac disease: The Coeliac Society of Australia has
branches in every state, and provides a lot of information, support and help for
families coping with this disease. There is a video and a range of booklets
available. The website address is http://www.coeliac.org.au
For more information about diabetes: Diabetes Australia:
http://www.diabetesaustralia.com.au
National Diabetic Services Scheme (NDSS) is funded by the Australian
Commonwealth Government and administered in South Australia by DA-SA. It
provides an easy, low cost way for people with diabetes to buy essential diabetic
supplies. Lifetime registration is free. You need to fill in a registration form, get it
signed by your doctor and return it to DA-SA.
http://www.diabetessa.com.au/aspx/about_the_ndss.aspx
Juvenile Diabetes Research Foundation in Australia: A non-profit organisation
dedicated to finding a cure for diabetes and preventing its complications through
research. Telephone 1300 363 126 http://www.jdrf.org.au
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