Expert Advice -- Diarrhea: Spreading at daycare

One of the children at our daycare center has been diagnosed with infectious colitis. His mother has informed us that this is very contagious. We need some information on this condition. I have searched and all I keep finding is ulcerative colitis. Are these two things the same? Please let me know more about this condition and what we can do to prevent the spread of it at our center.

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ABOUT THE EXPERT

Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Infectious colitis literally means inflammation of the large intestine. However, it is usually used to refer to an infection of the intestines caused by bacteria which most often produces bloody diarrhea. Viruses and other parasites can also cause infectious colitis, but the diarrhea involved in these illnesses is most often not bloody. No matter what is causing the diarrhea, daycare centers, parents at play-dates, and family members of the child with diarrhea get concerned with how to deal with the child without putting others at risk for getting the infection.

To understand recommendations for inclusion or exclusion of children with infectious colitis, it is important to realize just how this infection is transmitted. Bacteria which cause diarrhea are transmitted from what is called the fecal-oral route. Often, the infection is first acquired from inadequately cooked meat or poorly washed vegetables. However, these bacteria may also be shed in the stool of children who have little if any symptoms. If these children are not potty trained yet, the bacteria from their diaper can be easily spread around particularly in daycare settings.

Most cases of infectious colitis do not require antibiotics to cure. In fact, most of the time, the use of antibiotics can prolong the time these bacteria are excreted in the stool. Exceptions to this are when the child is under six months of age, very sick, or the bacteria responsible is one called Shigella.

Ultimately, the biggest question is when can the child return to daycare. Usually, the answer to that is when the child is no longer having significant diarrhea. However, in the case of Shigella or a specific E. coli called 0157:H7, it should also be after the child has had two stool cultures which are negative.

So, what is the best method of prevention? Simply, good hand-washing technique. In daycare centers, it means the caretakers must be very careful to wash hands and to clean the changing table surfaces. In addition, these workers must be aware of other things that are touched after changing a diaper but before hand washing such as the wipes box and the faucet handles of the sink. These should be cleaned regularly during the day.

Ulcerative colitis and infectious colitis are completely separate unrelated illnesses. The close contact of young children who by definition have poor voluntary hygiene allows for the easy spread of these bacteria, viruses, and parasites in a daycare setting. The most common causes of widespread diarrhea in daycare are:

Rotavirus
Giardia - A parasite most often picked up from streams and well water.
• Adenoviruses - These viruses most often cause runny nose and sore throat but cause diarrhea as well
• Shigella - A bacteria only found in human stool. So, if a child has it, a contact (family, playmate, etc.) of his probably has it too
E. coli 0157:H7 - This is the infamous bacteria found in poorly cooked hamburger or unwashed vegetables.
Cryptosporidium - A parasite is found in contaminated water and pets.

The single most important thing your staff can do to prevent spread of infectious colitis is wash hands thoroughly and often. Children with bloody diarrhea should be excluded from daycare, and I suggest you contact the mother to help coordinate when that child may return. Because while you don't want to expose the other children to the illness, you also don't want to exclude that child unnecessarily once the problem has passed.

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