THE ROLE OF THE FAMILY PHYSICIAN IN THE DAY-CARE SETTING

Injuries and infectious respiratory, gastrointestinal and dermatologic diseases are common in day care settings. Most day care injuries are contusions, abrasions and cuts involving the head and extremities. Imp act-absorbing surfaces under playground equipment, safety-proofing of ail play areas, increased staff supervision, and staff and parental ed ucation might reduce injuries by as much as 75 percent. Respiratory il lnesses are the most common day care infections. Chemoprophylaxis with rifampin is required for all close contacts of children infected with Haemophilus influenzae type B and Neisseria meningitidis. Diarrheal i llness may be caused by viral pathogens, bacterial agents such as Shig ella, Campylobacter or Salmonella, or parasitic infections caused by G iardia lamblia and Cryptosporidium. Strict hand-washing procedures, es pecially before food preparation and after toileting, may reduce diarr heal illness by 50 percent. Head lice (Pediculosis capitis) and scabie s are common dermatologic infections spread by direct contact and thro ugh clothing, bedding and hair brushes. Screening and treating affecte d children with permethrin preparations and thoroughly washing bedding and clothing are necessary to stop outbreaks. Use of universal precau tions for the handling of stool is essential to prevent the spread of both ordinary diarrheal illnesses and serious infections such as hepat itis A and B, human immunodeficiency virus and cytomegalovirus.