The care of young children is an important news topic. Nearly 2.5 million children under the age of 12 live in the Netherlands, and most of them need childcare. Vrij Nederland recently published an article entitled ‘The drama of childcare’. Het Parool reports that half of childcare centres do not meet the requirements. The conclusion is that childcare centres in the Netherlands provide moderate to poor quality, while childcare is becoming more expensive.
- In 2012, 175,475 babies were born; 61% of those babies go to a nursery or childminder.
- There are approximately 540,000 children aged 1 to 4; more than 80% attend childcare. More than three-quarters of parents take their children there at 8 in the morning and collect them again at 6 in the evening.
- Although children are not required to attend school until the age of five, 98% start at the age of four.
Stress
Psychologist Marilse Eerkens concludes, on the basis of scientific research from around the world, that group childcare for young children rarely provides the right care. Not so long ago, young children grew up in a family with their mother and children of different ages, whereas they now spend the day with children of the same age. Toddlers between 2 and 4 years old have limited social skills; they can quickly become angry or take toys away from others.
It appears that spending time with a large number of children causes tension and the level of the stress hormone cortisol soon increases. High cortisol levels in children are directly correlated with negative emotions in the child and also with the behaviour of the staff. Children with a difficult temperament are more likely to experience friction and an increase in cortisol. Toddlers who stay at home or attend childcare centres that score highly for quality have lower cortisol levels.
Abdominal pain and young children
Children in childcare are ill more often than children who stay at home and are particularly likely to contract infectious diseases. Many children have abdominal pain. It is quickly assumed that this is caused by stress, whereas abdominal pain appears to be more often a sign of disease. Abnormalities were found in 88% of 220 Dutch children with abdominal pain who were examined. Of these, 33% were infected with an intestinal parasite, mainly Dientamoeba fragilis.
Dientamoeba fragilis
The subject of intestinal parasites deserves full attention because many children are infected and this almost always causes symptoms. By parasites, we do not mean worms that mainly cause anal itching, but the single-celled intestinal parasites Dientamoeba fragilis and Giardia lamblia. Infection with single-celled intestinal parasites is no longer a tropical disease, because frequent travel and immigration mean that more than a quarter of the Dutch population is affected.
Childcare centres in particular are a source of infection. Children are at increased risk because of the close contact in childcare and a lack of precautions. In Toronto, the stool of 900 children and 146 staff members was examined at 22 childcare centres. Parasites were absent at only 2 centres.
In April 2013, Dr Röser from Denmark reported that of more than 22,000 stool samples examined for parasites, 43% contained Dientamoeba fragilis. An important observation, he writes, is that the percentage was low in adults but rose to the astonishingly high figure of 71% in young children and parents with young children. Since a recent Dutch study confirms that 95.8% of children infected with Dientamoeba fragilis have gastrointestinal complaints, abdominal pain, loose stools or constipation, it is extremely important to pay attention to this.
How do you contract parasites?
By touching the toilet seat, the toilet flush button and the tap, another person’s stool can get onto your hands. This can also happen through direct hand-to-hand contact. Dr Stark found parasites on the hands of one third of infected children. Toddlers in nappies are a major source of infection.
Children touch one another and other people’s food, and they put toys and their fingers in their mouths. Hands that are not washed properly before preparing food pose a risk. Because children mainly play indoors, people do not always remember to set the table and wash the children’s hands before they eat anything. Bread or a snack of fruit or carrots is picked up with bare hands without washing them first. Door handles, tables and toys are also not disinfected sufficiently.
Guidelines
The GGD has drawn up guidelines for infectious diseases and does mention the intestinal parasite Giardia lamblia as a cause of diarrhoea, but information about Dientamoeba fragilis is lacking. Children only have to stay at home in cases of severe acute diarrhoea; with chronic gastrointestinal complaints and diarrhoea they are allowed to attend childcare. Infection with D.fragilis is not accompanied by severe diarrhoea. Children with diarrhoea, a changing bowel pattern or abdominal pain lasting longer than 2 weeks should have stool testing performed. If this does not happen and the cause is not found, it can take months or even years before it is discovered that the child is infected with D.fragilis. They are a source of infection for others, both children at the childcare centre and brothers, sisters and parents.
When an intestinal parasite is found in the stool, it is advisable to have all children and adults in the immediate environment tested; otherwise the child will be reinfected after treatment. It is important for parents of children who are infected and have symptoms to receive support and for handwashing guidelines to be followed properly so that reinfection can be prevented.
The website www.kinderopvang.tv focuses on this subject and contains practical information for parents and carers of children.
Sources
- 23 March 2013, Vrij Nederland, volume 74
- 24 April 2013, Röser D, Simonsen J, Nielsen HV, Stensvold CR, Mølbak K.Eur J Clin Microbiol Infect Dis. Dientamoeba fragilis in Denmark: epidemiological experience derived from four years of routine real-time PCR.
- Book Darmklachten, Saskia van As
