Care of the Pediatric Patient with Childhood Communicable Diseases Elizabeth Allen RN, MSN

Learning Objectives Identify differences between the infant and child immune system and the adult Describe common childhood communicable diseases Choose the appropriate isolation precautions for common childhood communicable diseases Identify principles of negative pressure rooms Summarize aspects of HIV disease that are unique to the pediatric population

Infant Susceptibility to Infection Immune System Not Fully Developed Prenatal, perinatal, postnatal exposures to infection Especially with medical procedures, complications Maternal Antibodies Offer Limited Protection Diminishes with time Immunization Protection Incomplete

Children Susceptibility to Infection Developing Immune System Exposure to Infections from Others Close contact with adults, other children Poor Hygiene Habits Encourage hand washing After toileting, before eating Use disposable tissues Educate adult caregivers

Childhood Communicable Diseases Head Lice Also called Pediculus humanus capitis (peh-DICK-you-lus HUE-man-us CAP-ih-TUS), head lice are parasitic insects found on the heads of people. Having head lice is very common. Anyone who comes in close contact with someone who already has head lice, contaminated clothing, and other belongings. Preschool and elementary-age children, 3-10, and their families are infested most often. Girls get head lice more often than boys, women more than men. In the United States, African-Americans rarely get head lice.

Head Lice

Lice Treatment Pediculicide Shampoo Silicone gel Household cleaning Pyrethrum 1% Permethrin Once then 1 week later Silicone gel Household cleaning Nit removal Contact Isolation

Scabies 1st exposure may take 2-4 weeks for symptoms Itch, rash, sores, scaly Symptoms last a few weeks Treatment: Topical scabicide Antihistamine for itching Treat Close Contacts Contact Isolation! Spread by skin to skin contact Rash from hypersensitivity reaction to the mites, debris and feces. May take 2-4 weeks to occur post infestation Treat with topical scabicide, prevent secondary infection, antihistamine for itching Contact Isolation!! Scabies symptoms typically last 2-3 weeks

Childhood Communicable Diseases Impetigo (not Eczema) Streptococci Staphylococci Vesicle or pustule Honey colored crusts Treatment Topical antibiotic Amoxicillin Erythromycin Cover wounds as needed Contagious Good hand hygiene Wash skin, remove crusts, apply antibiotic ointment

Childhood Communicable Diseases Fifth’s Disease (Erythema Infectiosum) Parvovirus Symptoms Fever Headache Congestion “Slapped Cheek” rash Rash over torso, extremities Pain/swelling in joints Supportive Care Droplet Isolation Fetal Infection Symptoms appear over 3 stages: Stage 1 is mild illness for 2-3 days including fever, malaise, nausea, head and body aches. Then resolves for 1-7 days Stage 2: Fiery red rash over cheeks followed by a lacy rash over trunk and extremities- not on palms of hands or soles of feet. Stage 3: rash fades over 1-3 weeks Fetal Infection may result in fetal hydrops, anemia or spontaneous abortion

Childhood Communicable Diseases Varicella Chickenpox Shingles- rare in pediatrics Children who have never had chickenpox should get 2 doses of the chickenpox vaccine at these ages: 1st Dose: 12-15 months of age 2nd Dose: 4-6 years of age (may be given earlier, if at least 3 months after the 1st dose) People 13 years of age and older (who have never had chickenpox or received chickenpox vaccine) should get two doses at least 28 days apart. Dew Drops on a Rose

Childhood Communicable Diseases Varicella: Chickenpox Incubation 14-21 days Airborne transmission Airborne and Contact Isolation Negative Pressure Room Treatment Supportive Care Antihistamines for itching Monitor for signs of Reye Syndrome, Encephalitis, Secondary Skin Infection

Childhood Communicable Diseases Negative Pressure Isolation

Childhood Communicable Diseases Measles (Rubeola) Viral Illness Droplet and Airborne Transmission Airborne Isolation Incubation 8-12 days Contagious 4 days before to 4 days after rash appearance Increasing outbreaks in US Vaccination Supportive Care Increased risk for OM, encephalitis and pneumonia The younger the child, the greater risk for complications. Also immunocompromised

Childhood Communicable Diseases Mumps (Parotitis) Viral Illness Respiratory Transmission Droplet Precautions Increasing outbreaks in US Vaccination Supportive Care Children rarely very ill

Childhood Communicable Diseases Rubella (German or 3 day Measles) Viral Illness Droplet Spread Droplet Precautions Incubation 14-21 days Increasing outbreaks in US Birth defects if acquired by a pregnant woman Vaccination Supportive Care If pregnant woman infected during 1st trimester fetus may develop rubella syndrome- growth retardation, hepato-splenomegaly, purpuric skin lesions)

Childhood Communicable Diseases Atopic Dermatitis (Eczema) Affects up to 20% of pediatric population Non-infective Genetic predisposition, immune response Treatment Hydrate & Lubricate skin Reduce pruritis Minimize inflammatory changes Identify triggers Prevent infection Corticosteroid ointment Nursing Diagnoses?

Childhood Communicable Diseases Fungal Infections Ringworm (tinea capitis) Ringworm is a skin and scalp disease caused by several different kinds of fungi. Ringworm on the scalp usually makes a bald patch of scaly skin. People with ringworm on other parts of their skin can have a ring-shaped rash that is reddish and may be itchy. The rash can be dry and scaly or wet and crusty. Thrush, athlete’s foot, jock itch

Childhood Communicable Diseases Spread by contact with person, animal, object Fungal Treatment Medications: Thrush Nystatin suspension Clotrimazole Fluconazole Amphotericin B Ringworm Griseofulvin (give with fatty foods- finish prescription) Terbinafine Treat family, close contacts as needed Clean/dry

Childhood Communicable Diseases Conjunctivitis Several types Ophthalmia neonatorum (neonate) Bacterial conjunctivitis Staphylococcus aureus, haemophilus influenzae, streptococcus pneumoniae, moraxella catarrhails and escherichia coli. Viral Allergy Highly contagious Bacterial less common after age 5 years Can remain in school once treatment is started

Immune System Problems Human Immunodeficiency Virus (HIV) Infant testing (HIV+ mother) Early opportunistic infection indicates poor outlook Positive HIV: antiretroviral drugs Early symptoms non- specific Fever, FTT, thrush hepatosplenomegaly lymphadenopathy Infants born to HIV positive mothers are tested for HIV Majority of children in US with HIV became infected perinatally from their mother Testing recommended at 14-21 days, 1-2 months, 4-6 months. Any + result confirmed by retesting. HIV ruled out with 2 negative HIV tests at 6 months or older (London et al., 2014)

Immune System Problems Human Immunodeficiency Virus (HIV) Treatment Antiretroviral Therapy Treat Pregnant women after 14th week pregnancy Estimated 20% HIV + children develop AIDS in first year of life Most die by 4 years of age 80% treated as chronic disease with improving therapy May develop serious immune system disease in school age or adolescence