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

2. 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

3. 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

4. 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

5. 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.

6. Head Lice

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

8. 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

9. 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

10. 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

11. 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: 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

12. Childhood Communicable Diseases
Varicella: Chickenpox
Incubation 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

13. Childhood Communicable Diseases
Negative Pressure Isolation

14. 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

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

16. Childhood Communicable Diseases
Rubella (German or 3 day Measles)
Viral Illness
Droplet Spread
Droplet Precautions
Incubation 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)

17. 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?

18. 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

19. 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

20. 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

21. 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 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)

22. 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